Comorbid disease burden among MS patients 1968–2012: A Swedish register–based cohort study

Background: People with multiple sclerosis (pwMS) have increased comorbid disease (CMD) risk. Most previous studies have not considered overall CMD burden. Objective: To describe lifetime CMD burden among pwMS. Methods: PwMS identified using Swedish registers between 1968 and 2012 ( n = 25,476) were matched by sex, age, and county of residence with general-population comparators ( n = 251,170). Prevalence, prevalence ratios (PRs), survival functions, and hazard ratios by MS status, age, and time period compared seven CMD: autoimmune, cardiovascular, depression, diabetes, respiratory, renal, and seizures. Results: The magnitude of the PRs for each CMD and age group decreased across time, with higher PRs in earlier time periods. Before 1990, younger age groups had higher PRs, and after 1990, older age groups had higher PRs. Male pwMS had higher burden compared with females. Overall, renal, respiratory, and seizures had the highest PRs. Before 2001, 50% of pwMS received a first/additional CMD diagnosis 20 years prior to people without MS, which reduced to 4 years after 2001. PwMS had four times higher rates of first/additional diagnoses in earlier time periods, which reduced to less than two times higher in recent time periods compared to people without MS. Conclusion: Swedish pwMS have increased CMD burden compared with the general population, but this has reduced over time.

Evaluation of sevoflurane and isoflurane as maintenance agent in buffaloes after glycopyrrolate-xylazine-butorphanol-propofol anaesthesia

The study was aimed to compare the efficacy and safety of isoflurane and sevoflurane as maintenance agent in a balanced anaesthetic combination for buffaloes undergoing diaphragmatic herniorrhaphy. Twelve clinical cases of diaphragmatic hernia in female buffaloes were randomly selected and assigned to two groups (PS and PI) of six animals each. After premedication with glycopyrrolate, xylazine and butorphanol, induction was done with propofol. For maintenance, either sevoflurane (PS) or isoflurane (PI) was used with oxygen through a partial rebreathing system. Clinical, physiological, behavioral, haematological and biochemical parameters were recorded at different intervals. No significant differences were observed in maintenance scores, degree of muscle relaxation as well as haematological and blood biochemical parameters between the groups. The heart and respiratory rates were observed to be less depressed in PS than in PI. The recovery and standing with ataxia in PS was significantly earlier than the PI. Both isoflurane and sevoflurane were found to be safe and effective maintenance anaesthetic agents for buffaloes undergoing diaphragmatic herniorrhaphy; however, the sevoflurane was assessed to be slightly better as maintenance agent because of faster recovery and lesser cardiovascular depression than isoflurane.

Effect And Predictive Value Of Routine Preoperative Laboratory Testing For Endoscopic Retrograde Cholangiopancreatography

Background and Aims: Several studies and guidelines are questioning routine preoperative laboratory tests in surgical and endoscopic procedures. Their effect in endoscopic retrograde cholangiopancreatography is not currently known. This study was carried out to evaluate the risk of adverse effects in endoscopic retrograde cholangiopancreatography and their association with preoperative lab tests. Materials and Methods: A single-center, prospective observational study on all 956 patients undergoing 1196 endoscopic retrograde cholangiopancreatographies in the Endoscopy Unit of Helsinki University Central Hospital from 1 March 2012 to 28 February 2013. Routine preoperative laboratory test results (basic blood count, creatinine, potassium, sodium, international normalized ratio/thromboplastin time, and amylase), health status, medication, and demographic information of all patients were analyzed in relation to adverse effects related to endoscopic retrograde cholangiopancreatography and procedural sedation. Results: Multivariate analysis showed post–endoscopic retrograde cholangiopancreatography pancreatitis (43 cases, 3.6%) to have no association with abnormal routine preoperative laboratory tests. Respiratory depression caused by sedation (128 cases, 11%) was not associated with abnormal routine preoperative laboratory tests, and anemia was found to be a slightly protecting factor. Cardiovascular depression caused by sedation was associated with thrombocytopenia (odds ratio = 1.87, p = 0.025) and, in male patients, hyponatremia (odds ratio = 3.66, p < 0.001). Incidence of other adverse effects was too low for statistical analysis. Conclusion: Routine universal preoperative lab testing was not found to be successful in predicting adverse effects in endoscopic retrograde cholangiopancreatography procedures. Laboratory testing should be done focusing on each patient’s individual needs.