Pediatric autoimmune encephalitis in Denmark during 2011–17:A nationwide multicenter population-based cohort study

Background: The incidence of pediatric autoimmune encephalitis (AIE) is unknown. Our aim was to assess the incidence of pediatric AIE in Denmark 2011–17. Methods: In a nationwide population-based setting, we retrieved data on all children tested for AIE before age 18 years. We reviewed medical records in a) children with AIE antibodies (n = 18) to assess whether children fulfilled the AIE consensus criteria, b) children tested negative for AIE antibodies who were registered with an AIE diagnostic code to estimate the incidence of “antibody negative but probable AIE”, and c) a reference cohort (n = 596) to determine the positive predictive value of International Classification of Diseases (ICD) codes used for anti-NMDAR encephalitis. Results: 375 children were tested for AIE 2011–17 (median age 11.1 years; 54% girls); 18 children (5%) had AIE antibodies (percentage tested positive): CSF GAD 65 -IgG (3.1%), plasma NMDAR-IgG (2.8%), CSF NMDAR-IgG (1.8%), plasma GAD 65 -IgG (1.0%), and plasma CASPR2-IgG (0.4%). Five children fulfilled the criteria for probably/definite anti-NMDAR encephalitis (incidence: 0.07/100,000 person-years; 95% CI = 0.03–0.17), and 4 children with anti-GAD 65 associated AIE (incidence = 0.055/100,000 person-years, 95% CI = 0.021–0.15). The incidence of “antibody negative but probable AIE” was 0.055/100,000 person-years (95% CI = 0.021–0.15). The positive predictive value of ICD diagnostic codes used for anti-NMDAR encephalitis was 8%. Conclusions: We diagnosed only children with anti-NMDAR, anti-GAD 65 , and “antibody negative but probable AIE”. Before examining AIE antibodies, clinical presentation, paraclinical studies (CSF, EEG, and MRI), and incidence of pediatric AIEs should be considered. Updating the ICD to include AIE codes is warranted. </p

Longitudinal Analysis of Quality of Life, Clinical, Radiographic, Echocardiographic, and Laboratory Variables in Dogs with Myxomatous Mitral Valve Disease Receiving Pimobendan or Benazepril: The QUEST Study

Peer reviewe

Gamma-hydroxybutyrate and cocaine intoxication in a Danish child

GHB intoxication must be considered in children with coma and a suspicion of drug intoxication. Furthermore, mixed intoxication with several substances and the possibility of unpredictable symptom profiles should be anticipated to ensure optimal symptomatic treatment of patients

Characteristics of Danish children registered with and pharmacologically treated for hypertension

INTRODUCTION: A previous study found that 0.04% of Danish children were registered with hypertension, among whom 54% were treated pharmacologically. Our study describes pharmacologically treated cases at the onset of antihypertensive therapy, noting whether the evaluation of target-organ damage could be improved. METHODS: Our review of the medical records of children under 16 years living in Central and Eastern Denmark from April 2014 to May 2015 found that 119 children were registered with an International Classification of Diseases, tenth edition diagnosis of hypertension and treated with antihypertensive medicine. RESULTS: The cohort consisted of 61% boys and 39% girls (p = 0.01). The majority of patients (80%) had secondary hypertension. Renal aetiology was found in 52%. Echocardiography, retinal examination and examination for proteinuria were undertaken in 77%, 74% and 100%, respectively. Both echocardiography and retinal examination were undertaken in 61% of patients with renal aetiology. Among the remaining patients, 95% and 89% underwent these examinations, respectively (p &lt; 0.001 and p &lt; 0.001). Abnormal echocardiography, abnormal retinal examination and proteinuria were found in 39%, 16% and 66%, respectively, of patients with renal aetiology and in 30%, 24% and 35% of the remaining patients (p = 0.3, p = 0.4 and p &lt; 0.001). CONCLUSIONS: Examination for target-organ damage was performed less often in patients with hypertension of renal aetiology than in the remaining patients. Examination for target-organ damage is recommended in all hypertensive children to determine whether treatment is indicated to reduce long-term morbidity. FUNDING: The study received funding from the Novo Nordisk Foundation, grant number NNF15OC0015702 and from Amager-Hvidovre Hospital Foundation. TRIAL REGISTRATION: not relevant

Characteristics of Danish children registered with and pharmacologically treated for hypertension

INTRODUCTION: A previous study found that 0.04% of Danish children were registered with hypertension, among whom 54% were treated pharmacologically. Our study describes pharmacologically treated cases at the onset of antihypertensive therapy, noting whether the evaluation of target-organ damage could be improved. METHODS: Our review of the medical records of children under 16 years living in Central and Eastern Denmark from April 2014 to May 2015 found that 119 children were registered with an International Classification of Diseases, tenth edition diagnosis of hypertension and treated with antihypertensive medicine. RESULTS: The cohort consisted of 61% boys and 39% girls (p = 0.01). The majority of patients (80%) had secondary hypertension. Renal aetiology was found in 52%. Echocardiography, retinal examination and examination for proteinuria were undertaken in 77%, 74% and 100%, respectively. Both echocardiography and retinal examination were undertaken in 61% of patients with renal aetiology. Among the remaining patients, 95% and 89% underwent these examinations, respectively (p &lt; 0.001 and p &lt; 0.001). Abnormal echocardiography, abnormal retinal examination and proteinuria were found in 39%, 16% and 66%, respectively, of patients with renal aetiology and in 30%, 24% and 35% of the remaining patients (p = 0.3, p = 0.4 and p &lt; 0.001). CONCLUSIONS: Examination for target-organ damage was performed less often in patients with hypertension of renal aetiology than in the remaining patients. Examination for target-organ damage is recommended in all hypertensive children to determine whether treatment is indicated to reduce long-term morbidity. FUNDING: The study received funding from the Novo Nordisk Foundation, grant number NNF15OC0015702 and from Amager-Hvidovre Hospital Foundation. TRIAL REGISTRATION: not relevant

Characteristics of Danish children registered with and pharmacologically treated for hypertension

INTRODUCTION: A previous study found that 0.04% of Danish children were registered with hypertension, among whom 54% were treated pharmacologically. Our study describes pharmacologically treated cases at the onset of antihypertensive therapy, noting whether the evaluation of target-organ damage could be improved. METHODS: Our review of the medical records of children under 16 years living in Central and Eastern Denmark from April 2014 to May 2015 found that 119 children were registered with an International Classification of Diseases, tenth edition diagnosis of hypertension and treated with antihypertensive medicine. RESULTS: The cohort consisted of 61% boys and 39% girls (p = 0.01). The majority of patients (80%) had secondary hypertension. Renal aetiology was found in 52%. Echocardiography, retinal examination and examination for proteinuria were undertaken in 77%, 74% and 100%, respectively. Both echocardiography and retinal examination were undertaken in 61% of patients with renal aetiology. Among the remaining patients, 95% and 89% underwent these examinations, respectively (p &lt; 0.001 and p &lt; 0.001). Abnormal echocardiography, abnormal retinal examination and proteinuria were found in 39%, 16% and 66%, respectively, of patients with renal aetiology and in 30%, 24% and 35% of the remaining patients (p = 0.3, p = 0.4 and p &lt; 0.001). CONCLUSIONS: Examination for target-organ damage was performed less often in patients with hypertension of renal aetiology than in the remaining patients. Examination for target-organ damage is recommended in all hypertensive children to determine whether treatment is indicated to reduce long-term morbidity. FUNDING: The study received funding from the Novo Nordisk Foundation, grant number NNF15OC0015702 and from Amager-Hvidovre Hospital Foundation. TRIAL REGISTRATION: not relevant

The obesity paradox in chronic disease: facts and numbers

Body size, particularly large, is a matter of concern among the lay public. Whether this is justified depends upon the state of health and should be judged individually. For patients with established chronic disease, there is sufficient evidence to support the benefits of large body size, i.e., the obesity paradox. This uniform finding is shared over a variety of cardiovascular, pulmonary, and renal diseases and is counterintuitive to the current concepts on ideal body weight. The scientific community has to increase the awareness about differences for optimal body size in health and disease. Simultaneously, clinicians have to be aware about body weight dynamics implications and should interpret the changes in the context of an underlying disease in order to implement the best available management