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Hirsla is an open access repository, designed as a place to store, index, preserve and redistribute in digital format scholarly work of Landspitali employees. (A/H1N1)

  • Performance of the EUCAST disc diffusion method and two MIC methods in detection of Enterobacteriaceae with reduced susceptibility to meropenem: the NordicAST CPE study. - ERRATUM

    Haldorsen, Bjørg; Giske, Christian G; Hansen, Dennis S; Orri Helgason, Kristjan; Kahlmeter, Gunnar; Löhr, Iren H; Matuschek, Erika; Österblad, Monica; Rantakokko-Jalava, Kaisu; Wang, Mikala; Småbrekke, Lars; Samuelsen, Ørjan; Sundsfjord, Arnfinn (Oxford University Press, 2018-10-01)
  • Performance of the EUCAST disc diffusion method and two MIC methods in detection of Enterobacteriaceae with reduced susceptibility to meropenem: the NordicAST CPE study.

    Haldorsen, Bjørg; Giske, Christian G; Hansen, Dennis S; Helgason, Kristjan Orri; Kahlmeter, Gunnar; Löhr, Iren H; Matuschek, Erika; Österblad, Monica; Rantakokko-Jalava, Kaisu; Wang, Mikala; Småbrekke, Lars; Samuelsen, Ørjan; Sundsfjord, Arnfinn; 1 Norwegian National Advisory Unit on Detection of Antimicrobial Resistance, Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway. 2 Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden. 3 Department of Clinical Microbiology, Herlev and Gentofte Hospital, Herlev, Denmark. 4 Department of Clinical Microbiology, Landspitali University Hospital, Reykjavik, Iceland. 5 EUCAST Development Laboratory, Växjö, Sweden. 6 Department of Medical Microbiology, Stavanger University Hospital, Stavanger, Norway. 7 Bacterial Infections Unit, National Institute for Health and Welfare, Turku, Finland. 8 Clinical Microbiology Laboratory, Turku University Hospital, Turku, Finland. 9 Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark. 10 Department of Pharmacy, Faculty of Health Sciences, UiT - the Arctic University of Norway, Tromsø, Norway. 11 Department of Medical Biology, Faculty of Health Sciences, UiT - the Arctic University of Norway, Tromsø, Norway. (Oxford University Press, 2018-10-01)
    To examine performance of EUCAST disc diffusion and supplementary MIC methods for detection of Enterobacteriaceae with reduced susceptibility to meropenem using EUCAST screening recommendations. Sixty-one Nordic laboratories delivered data on EUCAST disc diffusion (n = 61), semi-automated meropenem MIC (n = 23; VITEK2, n = 20 and Phoenix, n = 3) and gradient meropenem MIC (n = 58) methods. The strains (n = 27) included the major carbapenemase classes (A, n = 4; B, n = 9; D, n = 6) involved in the global spread of carbapenemase-producing Enterobacteriaceae (CPE) and non-CPE strains (n = 8) covering a range of broth microdilution (BMD) meropenem MICs. A triplicate Klebsiella variicola (meropenem MIC 0.5 mg/L) harbouring OXA-48 and Escherichia coli ATCC 25922 showed an overall good precision. Meropenem zone diameters below the EUCAST screening cut-off (<27 mm) were reported for strains with MIC ≥1 mg/L (n = 21), irrespective of resistance mechanism. For three strains (MIC = 0.5 mg/L) with OXA-48/-181, eight laboratories provided meropenem zone diameters above the screening cut-off. Very major errors (VMEs) were not observed. The overall distributions of major errors (MEs) and minor errors (mEs) were 9% and 36% (disc diffusion), 26% and 18% (VITEK2) and 7% and 20% (gradient MIC), respectively. Differences in ME and mE distributions between disc diffusion and MIC gradient tests compared with semi-automated methods were significant (P < 0.0001), using BMD MICs as a reference for categorization. The EUCAST disc diffusion method is a robust method to screen for CPE but isolates with meropenem MICs <1 mg/L pose challenges. The high ME rate in semi-automated methods might deter appropriate use of carbapenems in CPE infections with limited therapeutic options.
  • Spermatogonial quantity in human prepubertal testicular tissue collected for fertility preservation prior to potentially sterilizing therapy.

    Stukenborg, J-B; Alves-Lopes, J P; Kurek, M; Albalushi, H; Reda, A; Keros, V; Töhönen, V; Bjarnason, R; Romerius, P; Sundin, M; Norén Nyström, U; Langenskiöld, C; Vogt, H; Henningsohn, L; Mitchell, R T; Söder, O; Petersen, C; Jahnukainen, K; 1 NORDFERTIL Research Lab Stockholm, Department of Women's and Children's Health, Karolinska Institutet and University Hospital, Stockholm, Sweden. 2 Pediatric Endocrinology Unit, Department of Women's and Children's Health, Karolinska Institutet and University Hospital, Stockholm, Sweden. 3 Sultan Qaboos University, College of Medicine and Health Sciences, Muscat, Oman. 4 Department of Development and Regeneration, Organ System Cluster, Group of Biomedical Sciences, KU Leuven, Herestraat 49, Leuven, Belgium. 5 Reproductive Medicine, Department of Obstetrics and Gynaecology, Karolinska University Hospital, Stockholm, Sweden. 6 Department of Medicine, Karolinska Institutet, Stockholm, Sweden. 7 Clinic and University, Children's Medical Center, Landspítali University Hospital, Reykjavik, Iceland. 8 Faculty of Medicine, University of Iceland, Reykjavik, Iceland. 9 Department of Paediatric Oncology and Haematology, Clinical Sciences, Lund University, Lund, Sweden. 10 Division of Paediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden. 11 Pediatric Blood Disorders, Immunodeficiency and Stem Cell Transplantation, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden. 12 Clinical Sciences, Paediatrics, Umeå University, Umeå, Sweden. 13 Department of Paediatric Oncology, The Queen Silvia Children's Hospital, Gothenburg, Sweden. 14 Department of Paediatrics, Faculty of Health Sciences, Linköping University, Linköping, Sweden. 15 Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden. 16 Division of Urology, Institution for Clinical Science Intervention and Technology, Karolinska Institutet, Huddinge, Stockholm, Sweden. 17 MRC Centre for Reproductive Health, The Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK. 18 The Edinburgh Royal Hospital for Sick Children, Edinburgh, UK. 19 Department of Women's and Children's Health, Paediatric Oncology Unit, Karolinska Institutet, Stockholm, Sweden. 20 University Hospital, Stockholm, Sweden. 21 Division of Haematology-Oncology and Stem Cell Transplantation, Children´s Hospital, University of Helsinki, Helsinki University Central Hospital, Helsinki, Finland. (Oxford University Press, 2018-09-01)
    Does chemotherapy exposure (with or without alkylating agents) or primary diagnosis affect spermatogonial quantity in human prepubertal testicular tissue? Spermatogonial quantity is significantly reduced in testes of prepubertal boys treated with alkylating agent therapies or with hydroxyurea for sickle cell disease. Cryopreservation of spermatogonial stem cells, followed by transplantation into the testis after treatment, is a proposed clinical option for fertility restoration in children. The key clinical consideration behind this approach is a sufficient quantity of healthy cryopreserved spermatogonia. However, since most boys with malignancies start therapy with agents that are not potentially sterilizing, they will have already received some chemotherapy before testicular tissue cryopreservation is considered. We examined histological sections of prepubertal testicular tissue to elucidate whether chemotherapy exposure or primary diagnosis affects spermatogonial quantity. Quantity of spermatogonia per transverse tubular cross-section (S/T) was assessed in relation to treatment characteristics and normative reference values in histological sections of paraffin embedded testicular tissue samples collected from 32 consecutive boy patients (aged 6.3 ± 3.8 [mean ± SD] years) between 2014 and 2017, as part of the NORDFERTIL study, and in 14 control samples (from boys aged 5.6 ± 5.0 [mean ± SD] years) from an internal biobank.
  • Læknisfræði framtíðar – Mun gervigreind og vélmenni leysa lækna af hólmi?

    Magnús Haraldsson (Læknafélag Íslands, Læknafélag Reykjavíkur, 2018-12)
  • Drep í fingrum í kjölfar ísetningar slagæðaleggja - sjúkratilfelli

    Atli Steinar Valgarðsson; Sigurbergur Kárason; Elín Laxdal; Kristín Huld Haraldsdóttir; 1 Skurðlækningadeild, 2 svæfinga- og gjörgæsludeild Landspítala, 3 læknadeild Háskóla Íslands. (Læknafélag Íslands, Læknafélag Reykjavíkur, 2018-12)
    Inngangur: Notkun slagæðaleggja er algeng hjá gjörgæslusjúklingum vegna þarfar fyrir rauntímaupplýsingar um blóðþrýsting og vökva­ástand sem notaðar eru til að stýra meðferð ásamt því að vera notaðir til blóðsýnatöku. Alvarlegir fylgikvillar eru afar sjaldgæfir, en varanlegur blóðþurrðarskaði kemur fyrir hjá færri en 0,1% sjúklinga. Tilfelli: Hér er sagt frá sjúklingi í sýklasóttarlosti á gjörgæsludeild sem gekkst undir aðgerð vegna rofs á skeifugörn. Á annarri viku komu fram einkenni blóðþurrðar í öllum fingrum vinstri handar. Sjúklingurinn var fjölveikur, hafði þurft háa skammta af æðavirkum lyfjum og þurfti endurtekið að skipta um slagæðaleggi í mismunandi slagæðum, meðal annars í sveifarslagæð og ölnarslagæð vinstri handar. Beitt var blóðþynnandi meðferð sem sjúklingurinn þoldi ekki vegna blæðinga frá meltingarvegi og því dregið úr henni. Átta vikum síðar hafði afmarkast drep í öllum fingrum vinstri handar og í kjölfarið var framkvæmd aðgerð þar sem hluti af fingrum II-V voru fjarlægðir en ekki þurfti að gera aðgerð á þumli. Orsök drepsins er talin vera margþætt, meðal annars undirliggjandi ástands sjúklings, blóðsegi eða blóðþurrð í kjölfar ísetningar slagæðaleggja. Ályktun: Hér er lýst vel þekktum en mjög sjaldgæfum fylgikvilla slagæðaleggsísetningar og lögð fram tillaga að meðferðarferli sjúklinga með einkenni um blóðþurrðardrep í fingrum.

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