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Biomedical subjects

B Myrvang

Publications and source records attributed to B Myrvang.

At least 19 recordsLinked to original sources
PubMed2001

Death rates and causes of death in cohorts of serum hepatitis patients followed up for more than 20 years.

A cohort of 214 drug addicts with serum hepatitis and a cohort of 193 hepatitis patients without drug addiction were examined in respect of death rates, causes of death and a number of risk factors for reduced survival. The death rate was significantly higher among the drug addicts than among non-addicts. The annual mortality rate was 1.5% in the drug addict group and 0.7% in the non-addict group. The highest relative risk of death was 860 for female drug addicts in age group 15-24 compared to females of the same age in the general population. The most prevalent cause of death in the drug addict group was drug overdose (53%), whereas in the other group 66% died from various somatic diseases. Hepatitis or complications of viral hepatitis played no role as cause of death among the drug addicts, and infections as a whole were also responsible for very few deaths. For male drug addicts, imprisonment before admission and leaving hospital without the doctors' permission were risk factors for early death.

Adolescent↗
PubMed2000

[Malaria in Norway--diagnosis, treatment and prevention].

The paper describes and discusses procedures and problems related to diagnostics, therapy and prophylaxis of malaria in Norway. A high degree of suspicion in physicians evaluating febrile travellers is of the utmost importance. The clinical symptoms and findings are initially rather unspecific, with fever and fever related symptoms. A definite diagnosis is made by the demonstration of malaria parasites in thin and thick blood smears, which is best performed by an infectious disease physician. Before treatment is started, it is important to determine whether the patient is infected with Plasmodium falciparum or with one of the more benign malaria species. If this is difficult microscopically, a test that detects P. falciparum antigen in blood may be useful in some cases. The therapy of benign malaria is still chloroquine plus primaquine; most patients with malaria falciparum can be routinely treated with mefloquine. Cases of complicated falciparum malaria, usually due to delayed diagnosis and start of treatment, require extensive and sophisticated treatment, usually including parenteral treatment with quinine. Prophylaxis consists of prevention of mosquito bites and chemoprophylaxis; the importance of avoiding bites should never be underestimated. A more widespread use of mefloquine among travellers to Africa is the most important change in chemoprophylaxis in recent years. Finally the article discusses possible improvements in diagnostic procedure, therapy and chemoprophylaxis.

Antimalarials↗
PubMed2000

[Falciparum malaria in Oslo and Akerhus].

BACKGROUND: Imported falciparum malaria in an increasingly frequent health problem in many areas in which it is not endemic. Complications are commonly seen, and reported case-fatality rates may exceed 3%. MATERIAL AND METHODS: The study is a medical chart-based retrospective study of all cases of falciparum malaria diagnosed in Oslo and Akershus counties, south-eastern Norway, 1988-1997. RESULTS: We identified 232 diagnosed cases; of these, records were available for 222 cases (95%). The incidence rate almost quadrupled during the study period. The two largest groups were immigrants visiting their country of origin (35%) and Norwegian tourists (29%). 95% of the cases were infected in Sub-Saharan Africa. There were no fatal cases, and only eight cases (3.6%) developed complicated falciparum malaria. In a statistical analysis, the following factors were found to be significantly associated with complicated disease: higher age, noncompliance to recommended chemoprophylaxis in assumed non-immune subjects, prolonged doctor's delay and prolonged diagnostic delay. INTERPRETATION: The study suggests that complications in imported falciparum malaria may largely be prevented by a high rate of chemoprophylaxis compliance in non-immune travellers and a high awareness of this possibility among physicians evaluating febrile travellers from endemic areas.

Adolescent↗
PubMed2000

[WHO's malaria program Roll Back Malaria].

Malaria is one of the main health problems in the world with 300-500 millions cases yearly and about one million deaths, mainly children in Sub-Saharan Africa. In the 1990s the malaria problem in Africa has increased, although we have methods to control the disease. In 1998 the new secretary general of WHO, Gro Harlem Brundtland, established the Roll Back Malaria programme, with the aim to markedly reduce malaria morbidity and mortality. Governments in malaria-affected countries have to take the lead in Roll Back Malaria. Their health systems must be improved and malaria control integrated into the general health system, and the methods available for prevention and treatment have to be intensified and improved. At the same time, Roll Back Malaria will encourage and promote malaria research which hopefully will result in new medicines, vaccines and other tools which will improve the chances of reducing malaria-related deaths and suffering. Roll Back Malaria is a cabinet project within the WHO, and the organisation has a key role as manager, co-ordinator and monitor of the project. However, it depends for resources on international support and commitment from other UN bodies, the World Bank, governments in the western world, pharmaceutical industry, philanthropists and other sources. At present an optimistic view prevails, and the preliminary aim, to halve the malaria mortality by the year 2010, seems realistic even with the control methods of today. However, if research efforts result in new and better tools to combat the disease, the task will definitely be easier.

Adult↗
PubMed2000

Erythromelalgia in a patient with AIDS.

Erythromelalgia is a clinical syndrome characterized by burning pain in the extremities together with erythema and increased skin temperature. Typically, the patients experience relief from cold, and aggravation from warmth. Symptoms are hypothesized to be caused by arteriovenous shunting and reduced nutritive skin capillary perfusion with corresponding tissue hypoxia. Erythromelalgia is most often primary, but may be secondary to a wide variety of diseases. We report erythromelalgia in a patient with acquired immune deficiency syndrome (AIDS). At peak pain intensity he actively cooled hands and feet for more than 12 h/day. Many doctors handling human immunodeficiency virus/AIDS patients are unfamiliar with erythromelalgia, and the condition can easily be overlooked, especially the more common milder cases.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Association between apolipoprotein E genotypes and cancer risk in patients with acquired immunodeficiency syndrome.

The apolipoprotein E (apoE) genotype was determined in 197 deceased acquired immunodeficiency syndrome (AIDS) patients treated at Ullevaal Hospital in Oslo, Norway. A full autopsy had been performed on all. Cancer had developed in 71 individuals, mainly lymphomas (46) and Kaposi's sarcomas (18). The apoE genotype distribution was consistent with Hardy-Weinberg equilibrium, and allele frequencies were in the typical Scandinavian range (6.9% apoE2; 75.6% apoE3; and 17.5% apoE4). Cancer cases had a significantly higher frequency of apoE4 alleles than noncancer cases (24.6% and 13.5%, respectively) and a lower frequency of apoE2 alleles (3.5% versus 8.7%). Background factors, such as survival from AIDS diagnosis, could not explain these differences. Our study thus indicates that apoE genotype affects the development of cancers among AIDS patients.

Acquired Immunodeficiency Syndrome↗
PubMed1999

[Neurosyphilis--still a relevant differential diagnosis].

Syphilis, in all stages, is almost eradicated in Norway. Since 1993, only six to 17 patients have been registered per year. However, syphilis rates are increasing in some of Norway's neighbouring countries, e.g. Russia and the Baltic countries. Physicians must be aware of the disease. We report three patients admitted to an emergency psychiatric ward in Oslo, diagnosed with neurosyphilis during 1994-97. Doctor's delay in diagnosing was respectively seven and fifteen months for two of these patients. The diagnosis is difficult, for many reasons: The disease is rare; it can mimic several other diseases; incidental partial treatment with antibiotics given for other disorders may complicate the clinical picture; it may be difficult to obtain a reliable history; and new clinical pictures ("formes frustes") may occur. The traditional syphilis screening is not recommendable, but physicians' awareness and a low threshold for requiring syphilis serology tests is important in order to get an early diagnosis of one of the few curable psychiatric disorders.

Adult↗
PubMed1999

[Empirical antibiotic treatment of patients with acute myelogenous leukemia].

All febrile episodes (a total of 276) which occurred in 85 patients with acute myelogenous leukaemia treated in four Norwegian centres during the period 1990-1994 were studied retrospectively in order to assess the efficacy of antibiotic treatment. 72% of these episodes were initially treated with benzyl penicillin and aminoglycoside (standard treatment), while alternative empirical treatment was given in the remaining cases. The treatment was successful in 94% of the febrile episodes initially treated with standard treatment and in 96% of the episodes which received alternative antibiotics. For both types of treatment, a change to second line antibiotic regimen was made for various reasons in a majority of cases. The combination benzyl penicillin and aminoglycoside seems to be a safe empirical treatment for febrile neutropenia in patients with acute myelogenous leukaemia in our treatment centres, provided that the treatment is modified in patients with unsatisfactory clinical response.

Adolescent↗
PubMed1999

Treatment with interferon-alpha2a alone or interferon-alpha2a plus ribavirin in patients with chronic hepatitis C previously treated with interferon-alpha2a. CONSTRUCT Group.

BACKGROUND: Preliminary results from combination therapy with interferon-alpha and ribavirin (IFN/Rib) in patients with chronic hepatitis C have been promising, with up to 50% sustained hepatitis C virus (HCV) RNA response. The aim of this study was to investigate whether a sustained HCV RNA response could be obtained with combination therapy in patients who were non-responders or relapsers after IFN treatment. METHODS: In a multicenter study we randomized 53 HCV RNA-positive patients into 2 treatment groups. They all had biopsy-confirmed chronic hepatitis C, and all were recruited from a previous IFN study: 26 were previous non-responders and 27 responders with relapse. Group A received interferon-alpha2a, 4.5 MIU thrice weekly for 6 months, and group B received ribavirin, 1000-1200 mg/day, in combination with the same dose of interferon-alpha2a for 6 months. Median Knodell index was 5.0 in both groups. Genotype 1 was found in 24 (45%), type 2 in 3 (6%), and type 3 in 26 (49%). RESULTS: Sustained clearance of HCV viremia 6 months after interferon-alpha2a treatment stop was obtained in 12 of 53 patients (23%): 6 of 27 in the IFN group (22%) and 6 of 26 (23%) in the IFN/Rib group (NS). Nine of 27 (33%) former responders with relapse, compared with 3 of 26 (12%) non-responders, obtained a sustained HCV RNA response (P = 0.054). In previous relapse patients sustained loss of viremia was more frequent in genotype 3 (50%) than in genotype 1 (11%) patients (P = 0.022). CONCLUSIONS: In a group of previous IFN-alpha2a-treated chronic HCV patients we obtained a similar sustained clearance of viremia when retreated either with IFN-alpha2a alone or with a combination of IFN-alpha2a and ribavirin for 6 months. Previous relapse patients with HCV genotype 3 obtained sustained loss of viremia significantly more often (50%) than type-patients (11%). Previous IFN responders with relapse responded better than previous non-responders.

Adult↗
PubMed1999

Low frequency of complications in imported falciparum malaria: a review of 222 cases in south-eastern Norway.

We performed a retrospective study of 222 cases of falciparum malaria diagnosed in Oslo and Akerhus counties, Norway, from January 1988 to December 1997. Except for 12 cases, all had acquired the disease in sub-Saharan Africa. Sixty-four (28.8%) cases occurred in assumed non-immune individuals; of these, 41 (64.1%) were compliant to recommended antimalarial chemoprophylaxis. The mean time lag from first symptom to diagnosis (total diagnosis delay) was 4.6 d (median 3 d, range 0-30 d) and the mean time from presentation to diagnosis (doctor's delay) was 1.3 d (median 0 d, range 0-25 d). There were no fatal cases, and only 8 (3.6%) had a complicated course. The following factors were significantly associated with development of complicated disease: higher age, non-immunity combined with chemoprophylaxis non-compliance, prolonged doctor's delay and prolonged total diagnosis delay (p < or = 0.05). Our data suggest that complicated disease in imported falciparum malaria may largely be prevented by high chemoprophylaxis compliance rates in non-immune travellers and a high index of suspicion in physicians evaluating febrile travellers.

Adolescent↗
PubMed1999

African tick-bite fever imported into Norway: presentation of 8 cases.

We report on 8 Norwegian travellers to Southern Africa with African tick-bite fever (ATBF), a recently described spotted fever group rickettsiosis. All patients had acute flu-like symptoms and developed I or multiple inoculation eschars. The patients were treated with either doxycycline or ciprofloxacin, and all recovered. The diagnosis of ATBF was confirmed by the detection of specific IgM antibodies to Rickettsia africae by microimmunofluoroscence in convalescent-phase serum samples.

Antibodies, Bacterial↗
PubMed1998

[Cytomegalovirus as the cause of toxic dilatation of the colon].

Toxic dilatation of the colon is sometimes a complication which occurs during exacerbations of inflammatory bowel disease. It often requires immediate surgical intervention. We describe here a male patient with known ulcerative colitis who was investigated for fever of unknown cause, diarrhoea, and general illness. Upon admission he had only modest symptoms of colitis and received no immunosuppressive treatment. The condition worsened considerably, and subsequent colonoscopy demonstrated widespread lesions compatible with viral disease, but not with ulcerative colitis. Antiviral treatment for cytomegalovirus was started immediately, but progression of the condition with toxic dilatation called for a rapid colectomy. Histological examination showed widespread lesions compatible with cytomegalovirus infection. This clinical picture is rarely seen in immunocompetent patients.

Colectomy↗
PubMed1998

[Imported fever].

Fevers without distinguishing symptoms in persons who have visited tropical or subtropical areas is an increasing health problem in most western countries. The condition may be caused by several different microbes, but among cases diagnosed in Norway five infections dominate: falciparum malaria, vivax malaria, typhoid fever, paratyphoid fever, and dengue fever. In this article the authors give an overview of current microbes, and present diagnostic guidelines on how to handle cases of imported fevers in Norway. Primary measures should be taken against immediate life-threatening diseases, e.g. typhoid fever and falciparum malaria.

Fever↗
PubMed1998

The effect of treatment with alpha-interferon on hepatitis G/GBV-C viraemia. The CONSTRUCT Group.

BACKGROUND: Hepatitis G virus (HGV) or GBV-C is frequently detected in patients co-infected with hepatitis C virus (HCV). This study investigated host and virologic factors influencing the response to HGV/GBV-C to alpha-interferon treatment. METHODS: HGV/GBV-C was detected and quantified by nested polymerase chain reaction. The influence of variables such as liver biopsy appearance, liver function abnormalities, and response of HCV to interferon treatment was monitored. RESULTS: Fourteen of the 25 HGV/GBV-C-infected patients treated with interferon (3-6 MIU three times a week for 6 months) became non-viraemic during treatment, although all relapsed after treatment withdrawal at 6 months, with no net change in virus load between 0 and 12 months. CONCLUSIONS: Predictive factors for clearance of HGV/GBV-C viraemia by interferon were pre-treatment severity of liver disease (median Knodell score of 4, compared with 7 for non-responders; P = 0.030) and alanine aminotransferase levels (median, 114, 182 for non-responders; P = 0.039). Clearance was associated with the treatment response of HCV. Nine of 13 who cleared HGV/GBV-C also cleared HCV, compared with 3 of 11 HGV/GBV-C non-responders; P = 0.05). The shared susceptibility of HGV/GBV-C and HCV to interferon treatment suggests a link between the mechanism of clearance of the two viruses.

Adult↗
PubMed1998

Herpes simplex virus type 2 DNA detected in cerebrospinal fluid of 9 patients with Mollaret's meningitis.

We present clinical and virological data on 9 patients, 7 women and 2 men aged 31-56 years, with recurrent aseptic meningitis (Mollaret's meningitis). Polymerase chain reaction detected Herpes simplex virus type 2 DNA in cerebrospinal fluid samples from all patients collected during their latest attacks of meningitis. Six patients had no history of genital herpes. Only 1 patient was offered prophylactic antiviral treatment during the study period (45 months).

Adult↗
PubMed1998

[Imported fever. A diagnostic challenge].

Fevers without distinguishing symptoms in persons who have visited tropical or subtropical areas is an increasing health problem in most western countries. The condition may be caused by several different microbes, but among cases diagnosed in Norway five infections dominate: falciparum malaria, vivax malaria, typhoid fever, paratyphoid fever and dengue fever. Primary measures should be taken against immediate life-threatening diseases e.g. typhoid fever and falciparum malaria.

Africa↗
PubMed1997

[Serous meningitis associated with primary genital herpes infection].

Aseptic meningitis is not an uncommon complication to primary genital herpes infection caused by herpes simplex virus type 2 (HSV-2). Compared with other types of viral meningitis, HSV-2-meningitis is associated with a significant rate of neurological complications in the acute stage. In addition, some patients will suffer from recurrent aseptic meningitis (Mollaret's meningitis) later. We describe six patients, five women and one man, age 26-35 years, with aseptic meningitis caused by HSV-2. All the patients showed serological evidence of primary herpes infection (negative HSV-IgG and/or positive HSV-IgM in serum samples). Polymerase chain reaction detected HSV-2 in cerebrospinal fluid in all five of five cases, while virus cultures were positive in two of the six cases. Only three patients showed clinical signs of simultaneous genital herpes infection. One patient, a 28-year-old female, developed transient autonomic nervous system dysfunction with urinary retention, constipation, and neuralgic pain in the buttocks, perineum and lower limbs. 13 months later she was hospitalised for a genital herpes infection with headache, parestesia and fever, but spinal fluid examination showed no abnormality.

Adult↗