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ADHD and bipolar disorder (BP) commonly coexist, and both share key symptoms, depending on affective state and emotional dysregulation. The overlap poses diagnostic challenges and may lead to underdiagnoses. Comorbid cases exhibit worsened symptom burden, increased psychiatric morbidity, admissions, and suicide attempts. Treating BP before ADHD is recommended. Stimulant use combined with mood stabilisers may be effective and relatively safe; however, this review finds that well-designed randomised controlled studies in the area is warranted., (Published under Open Access CC-BY-NC-BD 4.0. https://creativecommons.org/licenses/by-nc-nd/4.0/.)

Massive weight loss patients are often left with significant excess skin, which is associated with reduced quality of life and physical limitations due to the symptoms from the excess skin including pendulation, skin maceration, wounding, pain, and infection. The arm and thigh plasty are procedures that reduce the patient's physical symptoms and increase the quality of life by removing excess skin and shaping the remaining tissue. The aim of this review is to describe patient selection for the arm and thigh plasty, discuss indications, surgical principles, and common complications.

Testicular cancer is the most frequent solid tumour in young men and accounts for 1% of newly diagnosed malignant tumours. Tumours are divided into seminomas and non-seminomas. Approximately 50% of patients are cured by orchiectomy alone, while the other half in addition will need chemotherapy or radiotherapy for metastatic disease. Survival in patients treated for metastatic disease depends on prognostic criteria. Patients treated with systemic therapy have an increased risk of subsequent cancer and cardiovascular disease, as argued in this review.

Non-convulsive status epilepticus (NCSE) is a rare complication to electroconvulsive therapy (ECT). This case report presents a 28-year-old female with schizophrenia in clozapine treatment developing NCSE twice after two different series of ECT treatment. NCSE should be suspected in patients with impairment of consciousness after ECT and requires confirmation with electroencephalogram. Although NCSE is described after ECT, the diagnosis always necessitates thorough screening for other potential underlying causes.

This review investigates how point-of-care ultrasound (POCUS) allows individualised treatment based on the patient's clinical and physiological state. Serial examinations enable timely adjustments of interventions, potentially fewer side effects, and less need for x-ray examinations. One of the main barriers to POCUS is the lack of systematic training and quality control. The next step toward more widespread use of neonatal POCUS is systematic theoretical and practical training and implementing standardized examination protocols.

Patients with excess skin after massive weight loss often experience skin maceration, infection, wounding and reduced quality of life. Abdominoplasty is a surgical procedure that removes excess skin aiming to relieve physical inconveniences and improve quality of life. The abdominoplasty can be performed with different techniques using a horizontal, vertical and/or a circumferential procedure. The purpose of this review is to describe the indications for the different surgical approaches, the surgical principles and the complications following abdominoplasty in patients after massive weight loss.

Myocardial infarction with non-obstructive coronary arteries (MINOCA) is characterized by clinical evidence of myocardial infarction with normal or near-normal coronary arteries on angiography (less-than 50% stenosis). MINOCA is a group of heterogeneous diseases with different pathophysiologic mechanism which all can cause ischaemia. MINOCA is considered a "working diagnosis" after angiography until further evaluation regarding its underlying cause is made. The aim of this review is to assess the literature on clinical features, aetiology, diagnosis, treatment and prognosis of patients with MINOCA.

Diagnostic bias is when biased considerations along with inadequate individual thought patterns result in a misdiagnosis. It is a constant and challenging issue in all medical specialties. There is evidence that knowledge of diagnostic bias will enhance physicians' diagnostic abilities. This review finds that there are several effective strategies to reduce the risk of diagnostic bias. Cognitive models such as dual-process-theory and tools such as metacognition can help the clinician in their assessment of the patient.

Digital health technology is promising for improving mental healthcare by enabling continuous monitoring of behaviour by smartphones and wearables, new paradigms for testing in virtual reality, and analysis of big data through machine learning for prediction models. This might advance prevention efforts, and contribute to diagnostics and treatment; however, high quality studies of clinical effects and applicability are needed before implementation. In this review, we summarize the current status of the field relevant for a Danish mental healthcare setting, and comment on challenges.

Merkel cell carcinoma is a neuroendocrine skin carcinoma caused by the Merkel cell virus and ultraviolet radiation. Approximately 25 Danish patients are diagnosed each year. Merkel cell carcinoma is often located on the sun-exposed areas of the skin and definitive diagnosis is made by the pathologist. Patients are treated at the department of plastic surgery and oncology with treatment modalities including surgery, radiotherapy, immunotherapy and chemotherapy as summarised in this review.

This is a case report of an adult female with omental infarction caused by internal herniation and omental torsion. The patient, who had no previous surgical record, presented with three days of pain in the right upper quadrant. Ultrasound evaluation showed no signs of cholecystitis, after which an abdominal computed tomography confirmed the diagnosis. The patient underwent laparoscopic omentectomy, with an uneventful recovery. This case highlights the importance of radiological and surgical awareness of this rare condition.

This review gives a summary of Danish preterm care, which has been defined by national adaptation of antenatal corticosteroids in the 1970ies and continuous positive airway pressure in the 1980ies. Today, preterm survival in Denmark is high, by international standards, but lower than in the neighbouring countries Sweden and Norway. The lack of a national neonatal quality database may offer an explanation to this. Starting in 2019, the Danish Newborn Quality Database reports complete population-based measures of newborn survival and health and may help improve standards of care in the future.

This review is about dysphagia, which is a collective term for all types of difficulty in swallowing. The causes behind are numerous, and the symptoms can be divided into oropharyngeal and oesophageal dysphagia. In the elderly population, the symptoms result in a thorough investigation, as it may be the first sign of underlying malignant disease. If malignant disease is not confirmed, the patient may be referred to the initial doctor. It is therefore important to know, that there is a large range of aetiologies and investigative possibilities of non-malignant dysphagia.

Tendinopathy is a condition of tendon overuse and is a very common cause of morbidity among recreational and competitive athletes. Chronic overload results in degenerative changes of the tendon, which becomes painful and swollen with impaired function. A reduction in the overloading activity is the mainstay of the treatment. A rehabilitating programme consisting of controlled loading of the affected tendon should follow this. Other modalities, which may facilitate treatment, are: injections with corticosteroid, platelet-rich plasma, and of high volume, as well as shock-wave therapy and surgery.

Spinal muscular atrophy (SMA) is an autosomal recessive disorder, which causes degeneration of peripheral nerves and muscles. It usually presents in childhood due to an insufficient level of survival motor neuron protein. This is a case series of three children, who had SMA type 1 or 2 and were treated with nusinersen from the age of five months, 16 months, and five years, respectively. At one-year follow-up, all children had improved motor function, but the child, who was treated from the age of five months, had more pronounced motor improvements than the other children. In conclusion, nusinersen seems to improve motor development in SMA, and an early treatment start is crucial.

Running is one of the most popular sports among the adult Danish population. Overuse injuries of the knee, such as runners knee, jumpers knee, patello-femoral pain syndrome and patello-femoral pre-arthrosis, are common and cause reduction of the health beneficial physical activity. Treatment should primarily focus on adjustment of training habits and physiotherapeutic guided rehabilitation. Other treatment options include changing landing pattern during running, corticosteroid injections, non-steroid anti-inflammatory drugs and ultimately surgery.

Patients with persistent cytopenia are frequently referred to the haematological departments , and a diagnosis of myelodysplastic syndrome is often suspected. After routine assessment including a broad range of blood tests, bone marrow biopsy, and cytogenetics, a definite diagnosis can still not be found for some patients, although they have symptomatic cytopenia. In these cases, next generation sequencing is a valuable supplement in identifying patients with early stages of myeloid cancer.

According to clinical lore the duration of untreated depression is associated with a poor treatment response. This is in accordance with the kindling hypothesis of depression. It is an important subject, since the duration of untreated depression is a potentially modifiable risk factor. Despite this, relatively few studies addressing the problem exist. While an association between the duration of untreated depression and treatment response generally is found, the uncontrolled and often retrospective nature of these studies makes it difficult to ascertain causality.

This article is based on a systematic literature search and meta-analyses of clinical data regarding effects of bisphosphonates (BP) and denosumab (DS) on preventing skeletal related events (SRE) in patients with bone metastases from solid tumours. Although there are pharmacological differences between the different types of BP no major differences were observed between BP in preventing SRE or in adverse events. Treatment with DS has in three randomised trials showed a greater effect than BP in preventing SRE. The optimal choice of bone-anti-resorptive agent should depend on the patient's general condition, renal function and treatment logistics.

Based on 19 studies (7,238 participants) a Cochrane review concludes that the addition of caffeine to an analgesic drug provides superior analgesia compared with the analgesic drug alone. The benefit is small, with a number needed to treat of approx. 16. The use of analgesics containing caffeine is associated with an increased risk of the development of physical dependence, overuse headache, and withdrawal symptoms upon abrupt discontinuation. Combination analgesics with caffeine should only be used temporarily and exclusively for the treatment of acute pain conditions.

In clinical trials a single dose of the N-methyl-D-aspartate (NMDA) receptor antagonist ketamine has shown a rapid antidepressant effect in patients with treatment-resistant depression and bipolar depression. The implications of glutaminergic mechanisms in depression and the rapid effect of a single dose of ketamine could open new pathways to understand the pathophysiology of depression and the development of novel rapid-acting antidepressant drugs.

Pulmonary interstitial emphysema (PIE) is a known complication of mechanical ventilation of preterm infants. PIE is associated with high mortality and treatment is controversial as both surgery and conservative treatment are possibilities. We present a case with a 15-month-old previously healthy child, hospitalized with severe respiratory distress. A computed tomography (CT) of the chest revealed localized PIE. He was successfully treated.

Clear cell adenocarcinoma generally develops in the kidney and the female genital organs. In 1964 the first case of primary clear cell adenocarcinoma of the colon was described. Since then less than 20 cases have been reported in the literature. We report a case of a 69-year-old man with a primary clear cell adenocarcinoma of the colon sigmoideum associated with adenoma and metastasis to two of 12 lymph nodes. Immunhistochemistry supported the diagnosis. The patient received adjuvant chemotherapy and 19 months following operation he was alive and had no signs of recurrences.

Over a five-year period a 67 year-old male had been experiencing recurring bouts of biliary obstruction with occasional superimposed cholangitis. Renewed endoscopic retrograde cholangiopancreatography revealed amorphous filling defects and excessive mucinous discharge from the papilla of Vater. Subsequent choledochoscopy demonstrated exophytic papillomatous lesions in the common and left hepatic bile duct. An extended left hemihepatectomy and resection of the common hepatic bile duct was performed. Histological examination revealed biliary papillomatosis - a rare lesion believed to be premalignant.

Introduction: It is a well-known phenomenon that there is a lack of information about patients' medicines at their admittance to hospital. By using data from the electronic medicine profile (PEM) the extra information is to be evaluated and compared to normal procedure for collecting medicine information., Material and Methods: This cross-section investigation involves patients admitted with acute hip fractures at Amager Hospital, Copenhagen. After registration of the patients' medication history extra information was extracted from PEM with the consent of the patient. Information from medication history, patient, general practitioner, and PEM was compared in order to reach an overall view of the patients' current medicine status., Results: Sixty-three patients participated; 58 gave consent. The average age was 80 years, and the patients used on average five medicaments each, totalling 323 out of which PEM stated the use of 99, which were not supplied by other sources. Out of 39 patients 2.5 lacked medicaments. 55% of these medicaments were estimated to be of significant clinical importance for further treatment. Two patients could have been exposed to a potential lethal occurrence had information from PEM not been applied. Every third drug that PEM added belonged to the Anatomical Therapeutic Chemical-systemets group N, which has the indication for the nervous system, including pain and depression., Conclusion: Information from PEM helps improve medication history. The possibility of wrong medication especially in the form of insufficient medication and interaction due to lack of information on the patients' current medicine is minimised through the use of PEM.

Viral meningitis is considered to be a benign illness with only mild symptoms. In contrast to viral encephalitis and bacterial meningitis, the prognosis is usually good. However, retrospective studies have demonstrated that patients suffering from viral meningitis may experience cognitive impairment following the acute course of infection. Larger controlled studies are needed to elucidate the potential neuropsychiatric adverse outcome of viral meningitis.

The prevalence of depression is increased in patients with chronic hepatitis C virus (HCV) infection. Several aetiological mechanisms are thought to be involved, e.g. premorbid psychiatric disease, genetic disposition to affective disorders, socio-economic factors, stigmatization and possibly HCV neuroinfection. Evidence to support that former intravenous drug abuse increases the risk of depression is lacking. It is particularly important to diagnose and treat depression in HCV patients as it constitutes a relative contraindication to antiviral treatment and may jeopardize therapeutic outcome.

Impaired cognitive function is commonly seen in patients with hepatitis C-virus (HCV). This might be due to a toxic effect of the virus itself or to neuroinflammatory processes with a direct damaging cerebral effect. The symptoms appear in the pre-cirrhotic stage and impair the patient's level of functioning. Therefore, doctors in contact with HCV patients should be up to date on the existing knowledge in the field to be able to inform patients about their cognitive deficits and take them into consideration. It is unknown if the cognitive deficits decline when the virus is eradicated.

Neuromyelitis optica (NMO) is a rare inflammatory disorder characterised by optic neuritis and transverse myelitis. We report a severe pediatric case presenting with impaired vision, tetraparesis, bladder retention and lower extremity pain. Magnetic resonance imaging demonstrated longitudinally extensive lesions of the spinal chord and atypical lesions in both cerebral hemispheres. Cerebrospinal fluid was pleocytotic. Symptoms responded well to intravenous immunoglobulin G and high-dose methyl prednisolone therapy.

Background: Early prevention of COPD and immediate consultation about tobacco cessation is a major issue in respiratory medicine., Aim: To evaluate if a community-based walk-in lung function service, either in a clinic or a shopping mall, could result in early detection of COPD. Early detection would facilitate prevention., Materials and Methods: In an area with 1.5 mill inhabitants, a walk-in lung function service opened in 2005/06 once a month for 3 hours at a clinic and on two full days in a mall. The staff consisted of two respiratory nurses and one chest physician. The nurses informed all participants about their lung function level and all received a preventive talk about tobacco consumption. Those with signs of COPD spoke with the doctor immediately., Results: A total of 1169 subjects, 59% women, with a mean (SD) age of 60 years (15), visited the walk-in services, 602 (52%) of whom visited the walk-in service at the clinic. Among the participants, 826 (71%) were smokers (n=452) or former smokers (n=374). The mean tobacco consumption was 32 (18) packs a year. We found that more current smokers visited the walk-in service at the clinic (45% versus 33%), whereas more ex-smokers visited the lung function service at the mall (38% versus 25%) (p < 0.01). The mean tobacco consumption was 32 (18) packs a year, with a difference between those visiting the mall and the clinic (32 (20) versus 23 (16), p<0.05). Among smokers, 54% had normal lung function, 15% had signs of airway obstruction, whereas 31% had developed moderate to severe COPD., Conclusion: Despite free medical access, more that one thirds had signs of airway obstruction. As all were informed about tobacco cessation, a walk-in service in a clinic and not a supermarket is most cost effective.

Introduction: The incidence of new HIV diagnoses in Denmark has remained stable since 1991, but it has increased among the subgroup of homosexual men in recent years. This may reflect an actual increase in newly infected, e.g. as a result of increased risk behaviour, or it may reflect increased HIV testing. To clarify the causes of this increase we describe and analyse the development of HIV infection in Denmark in the period 1995-2005 with special emphasis on the route of transmission, immunological status at the time of diagnosis and the prevalence of patients at risk of transmitting HIV., Materials and Methods: Observational study based on the Danish HIV Cohort Study, which includes all adults seen at Danish HIV clinics since 1995., Results: From 2000 to 2004 the number of newly-infected homosexual men increased (from 69 to 123), particularly in persons under 30 years (from 5 to 42). The median CD4 cell count at the time of diagnosis increased in this group (median 19.1 cells/microL per year [95% CI: 3.7-11.3]), while it remained stable among heterosexually infected. The number of newly-diagnosed homosexually infected under 30 years with a CD4 cell count over 400 cells/microL increased from 0 in 2000 to 23 in 2004. The prevalence of patients with high viral load (and thus potentially at risk of transmitting HIV) decreased in all risk groups., Conclusion: Newly-diagnosed homosexual men present at an earlier stage of disease progression and with a better preserved immune system today than 5-10 years ago, presumably due to a combination of frequent HIV testing and increased risk behaviour among young homosexuals in particular. Increased preventive measures targeting known risk groups are necessary to prevent further spread.