Ugeskrift for laeger最新文献

Autoimmune progesterone dermatitis (APD) is a rare, cyclic condition triggered by sensitisation to exogenous and/or endogenous progesterone. In this case report, we present a 44-year-old woman with presumed primary sensitisation from an intrauterine device, followed by cross-reactivity to endogenous progesterone. The patient experienced significant symptom relief following treatment with omalizumab. In conclusion, APD is diagnostically challenging due to its variable presentation, but treatment with omalizumab has shown promising results.

Transthyretin amyloidosis (ATTR-CM) is an infiltrative cardiomyopathy caused by the deposition of amyloid fibrils, leading to heart failure, arrhythmias, and increased mortality. ATTR-CM prevalence is rising. The first disease-modifying drugs have been approved and implemented in Denmark. Additional treatments slowing ATTR-CM progression are pending introduction into clinical practice. Treatments halting or even reversing progression are currently being investigated in clinical trials. The new therapies will significantly improve ATTR-CM-associated morbidity and mortality, as argued in this review.

Colorectal cancer (CRC) is considered to be a heterogeneous disease with different molecular subtypes based on the expression status of mismatch repair (MMR) e.g. It is well known that tumours with mismatch repair deficiency (dMMR) are associated with better prognosis, as well as a more effective response to immunotherapy. In this case report, a patient is diagnosed with three new dMMR tumors in the colon 3,5 years after successful treatment with immunotherapy for metastatic CRC. Until now, retreatment with immunotherapy has not been described in the literature, and this case report describes the advantages and disadvantages from this perspective.

Vaccination during pregnancy is an effective and safe way to protect both the pregnant individual and the child from serious infections as presented in this review. Influenza, COVID-19, and pertussis vaccines are routinely recommended and provide proven benefits for both mother and newborn. While inactivated and recombinant vaccines are safe to use, live-attenuated vaccines are contraindicated during pregnancy. Despite their importance, pregnant individuals are often excluded from clinical vaccine studies, highlighting the need for more research on maternal antibody transfer and optimal vaccination strategies in pregnancy.

Travel activity is high among Danes and pretravel advice is important to prevent infections. This review concludes that recommendations for vaccines are based on the incidence and consequences of travel-related infections. Further, advice should be individualised based on the destination, duration and type of travel, expected future travel, comorbidity, whether the traveler belongs to a risk group (elderly, pregnant women and children), and knowledge of any current outbreaks of infectious diseases. Recently, new vaccines against dengue fever and chikungunya fever have been marketed and several are under development.

This review presents vaccination as an effective measure in preventing hospitalisation and death in older adults. Older adults are at higher risk of severe infections due to several factors, including immunosenescence, multiple comorbidities and frailty. In Denmark, there is a free seasonal vaccination program against influenza and COVID-19 for individuals aged ≥ 65 years. Other relevant vaccines are available for this age group, including against pneumococcal disease, RSV and herpes zoster. Awareness of the benefits of vaccination in the elderly can help protect this vulnerable group from severe infections and their consequences.

The growing spread of myths and misinformation about vaccines has contributed to increased vaccine hesitancy and decreased vaccine acceptance worldwide. However, true contraindications and precautions to vaccination are rare. To ensure a high vaccine uptake, and thereby contributing to herd immunity and reducing illness, hospitalisation and mortality, it is essential to educate both healthcare professionals and the general population about the effectiveness and safety of vaccines as argued in this review. In Denmark, the use of electronic nudging has successfully contributed to increased vaccine uptake.

Protecting individuals undergoing immunosuppressive therapy through vaccination remains a clinical challenge due to the heterogeneity of underlying conditions and immunosuppressive treatments. These patients are at increased risk of severe infections, yet vaccination uptake remains suboptimal. Although vaccine responses may be reduced, this review finds vaccination to be generally safe, except for live attenuated vaccines, which should be avoided due to the risk of severe disease. A structured, multidisciplinary approach to vaccination may enhance uptake and improve protection in this vulnerable patient group.

Solid organ transplant (SOT) recipients receive maintenance immunosuppressive therapy and are at risk of infections and severe infection-related disease. Despite weaker immunological responses to vaccines in SOT recipients compared to controls, this review finds that vaccination has been associated with a lower risk of severe disease, and vaccination before transplantation is recommended in international and Danish guidelines. A national programme for vaccination of SOT candidates has been implemented in Denmark, and vaccination coverage is high for patients participating in the programme.