Recent Submissions

  • Acute type-A aortic dissection - a review.

    Gudbjartsson, Tomas; Ahlsson, Anders; Geirsson, Arnar; Gunn, Jarmo; Hjortdal, Vibeke; Jeppsson, Anders; Mennander, Ari; Zindovic, Igor; Olsson, Christian; 1 Department of Cardiothoracic Surgery, Landspitali University Hospital, Faculty of Medicine, University of Iceland , Reykjavik , Iceland. 2 Department of Cardiothoracic Surgery, Karolinska University Hospital , Stockholm , Sweden. 3 Division of Cardiac Surgery, Yale School of Medicine , New Haven , CT , USA. 4 Department of Cardiothoracic Surgery, Turku University Hospital, University of Turku , Turku , Finland. 5 Department of Cardiothoracic Surgery, Aarhus University Hospital , Aarhus , Denmark. 6 Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Sweden and Department of Cardiothoracic Surgery, Sahlgrenska University Hospital , Gothenburg , Sweden. 7 Tampere University Heart Hospital and Tampere University , Tampere , Finland. 8 Lund University, Skåne University Hospital, Department of Clinical Sciences, Department of Cardiothoracic Surgery , Lund , Sweden. (Taylor & Francis, 2019-09-23)
    Objectives. Acute type-A aortic dissection (ATAAD) is still one of the most challenging diseases that cardiac surgeons encounter. Design. This review is based on the current literature and includes the results from the Nordic Consortium for Acute Type-A Aortic Dissection (NORCAAD) database. It covers different aspects of ATAAD and concentrates on the outcome of surgical repair. Results and conclusions. The diagnosis is occasionally delayed, and ATAAD is usually lethal if prompt repair is not performed. The dynamic nature of the disease, the variation in presentation and clinical course, and the urgency of treatment require significant attentiveness. Many surgical techniques and perfusion strategies of varying complexity have been described, ranging from simple interposition graft to total arch replacement with frozen elephant trunk and valve-sparing root reconstruction. Although more complex techniques may provide long-term benefit in selected patients, they require significant surgical expertise and experience. Short-term survival is first priority so an expedited operation that fits in with the surgeon's level of expertise is in most cases appropriate.
  • Associations between pretherapeutic body mass index, outcome, and cytogenetic abnormalities in pediatric acute myeloid leukemia.

    Løhmann, Ditte J A; Asdahl, Peter H; Abrahamsson, Jonas; Ha, Shau-Yin; Jónsson, Ólafur G; Kaspers, Gertjan J L; Koskenvuo, Minna; Lausen, Birgitte; De Moerloose, Barbara; Palle, Josefine; et al. (Wiley, 2019-09-18)
    BACKGROUND: Associations between body mass index (BMI), outcome, and leukemia-related factors in children with acute myeloid leukemia (AML) remain unclear. We investigated associations between pretherapeutic BMI, cytogenetic abnormalities, and outcome in a large multinational cohort of children with AML. METHODS: We included patients, age 2-17 years, diagnosed with de novo AML from the five Nordic countries (2004-2016), Hong Kong (2007-2016), the Netherlands and Belgium (2010-2016), and Canada and USA (1995-2012). BMI standard deviations score for age and sex was calculated and categorized according to the World Health Organization. Cumulative incidence functions, Kaplan-Meier estimator, Cox regression, and logistic regression were used to investigate associations. RESULTS: In total, 867 patients were included. The median age was 10 years (range 2-17 years). At diagnosis, 32 (4%) were underweight, 632 (73%) were healthy weight, 127 (15%) were overweight, and 76 (9%) were obese. There was no difference in relapse risk, treatment-related mortality or overall mortality across BMI groups. The frequency of t(8;21) and inv(16) increased with increasing BMI. For obese patients, the sex, age, and country adjusted odds ratio of having t(8;21) or inv(16) were 1.9 (95% confidence interval (CI) 1.1-3.4) and 2.8 (95% CI 1.3-5.8), respectively, compared to healthy weight patients. CONCLUSIONS: This study did not confirm previous reports of associations between overweight and increased treatment-related or overall mortality in children. Obesity was associated with a higher frequency of t(8;21) and inv(16). AML cytogenetics appear to differ by BMI status.
  • Blood pressure response to treatment of obese vs non-obese adults with sleep apnea.

    Kuna, Samuel T; Townsend, Raymond R; Keenan, Brendan T; Maislin, David; Gislason, Thorarinn; Benediktsdóttir, Bryndís; Gudmundsdóttir, Sigrun; Arnardóttir, Erna Sif; Sifferman, Andrea; Staley, Beth; et al. (Wiley, 2019-10)
    Many patients with obstructive sleep apnea (OSA), but not all, have a reduction in blood pressure (BP) with positive airway pressure (PAP) treatment. Our objective was to determine whether the BP response following PAP treatment is related to obesity. A total of 188 adults with OSA underwent 24-hour BP monitoring and 24-hour urinary norepinephrine collection at baseline. Obesity was assessed by waist circumference, body mass index, and abdominal visceral fat volume. Participants adherent to PAP treatment were reassessed after 4 months. Primary outcomes were 24-hour mean arterial pressure (MAP) and 24-hour urinary norepinephrine level. Obstructive sleep apnea participants had a significant reduction in 24-hour MAP following PAP treatment (-1.22 [95% CI: -2.38, -0.06] mm Hg; P = .039). No significant correlations were present with any of the 3 obesity measures for BP or urinary norepinephrine measures at baseline in all OSA participants or for changes in BP measures in participants adherent to PAP treatment. Changes in BP measures following treatment were not correlated with baseline or change in urinary norepinephrine. Similar results were obtained when BP or urinary norepinephrine measures were compared between participants dichotomized using the sex-specific median of each obesity measure. Greater reductions in urinary norepinephrine were correlated with higher waist circumference (rho = -0.21, P = .037), with a greater decrease from baseline in obese compared to non-obese participants (-6.26 [-8.82, -3.69] vs -2.14 [-4.63, 0.35] ng/mg creatinine; P = .027). The results indicate that the BP response to PAP treatment in adults with OSA is not related to obesity or urinary norepinephrine levels.
  • Moving from stigmatization toward competent interdisciplinary care of patients with functional neurological disorders: focus group interviews.

    Klinke, Marianne E; Hjartardóttir, Thórdís Edda; Hauksdóttir, Aldís; Jónsdóttir, Helga; Hjaltason, Haukur; Andrésdóttir, GuĐbjörg Thóra; 1 Faculty of Nursing, School of Health Sciences, University of Iceland , Reykjavik , Iceland. 2 The National University Hospital of Iceland , Reykjavik , Iceland. 3 Víðihlíð Nursing Home and Health Care Clinic , Grindavík , Iceland. 4 Faculty of Medicine, School of Health Sciences, University of Iceland , Reykjavik , Iceland. (Taylor & Francis, 2019-09-17)
    Purpose: To explore facilitating and inhibiting factors in the inpatient care of patients with functional neurological disorders as experienced by interdisciplinary teams of healthcare professionals. Method: Qualitative focus group interviews were conducted with 18 healthcare professionals of various professions. Data were analyzed using qualitative content analysis with inductive coding of data. Results: Two main categories were formulated: (a) Giving the diagnosis to patients - a moment of fragility and opportunities, and (b) Organization of care - ensuring the continuity and protecting patients' self-image. One overarching theme tied the two categories together: Establishing coherence in the inpatient trajectory - moving from stigmatization toward competent care. Coherence and steadiness in care was a prerequisite for transparency in goalsetting and for designating the responsibilities of individual healthcare professionals. Stigma and having clinical experience and knowledge of functional neurological disorders, as two counter-factors, influenced the extent to which this was achieved. Examples of facilitating factors for enhancing competent care were documentation of symptoms, effective ways of passing on clinical information, education, professional dialog, and organizational support. Discussion: To nurture competent care, guidelines, structured educational initiatives and other supportive actions should be promoted. We provide ideas for the next logical steps for clinical practice and research. IMPLICATIONS FOR REHABILITATION Close collaboration between interdisciplinary healthcare professionals plays an important role for reaching optimal results in the rehabilitation of inpatients with functional neurological disorder. There is currently limited knowledge regarding the facilitating and inhibiting features encountered by interdisciplinary healthcare professionals in the provision of care for patients with a functional neurological disorder. The findings show that a working environment that endorses a skillful culture of practice and which facilitates actions to reduce problems that hamper effective teamwork needs to be promoted. Solutions that help to solve many obstacles encountered by the team of healthcare professionals in the care provision of patients with functional neurological disorders include open dialog regarding symptoms, diagnosis and treatment, effective ways of documenting and reporting symptoms, and availability of guidelines and supporting educational material.
  • Prognostic impact of percutaneous coronary intervention in octogenarians with non-ST elevation myocardial infarction: A report from SWEDEHEART.

    Völz, Sebastian; Petursson, Petur; Angerås, Oskar; Odenstedt, Jacob; Ioanes, Dan; Haraldsson, Inger; Dworeck, Christian; Hirlekar, Geir; Redfors, Björn; Myredal, Anna; et al. (SAGE Publications, 2019-09-13)
    AIMS: Percutaneous coronary intervention (PCI) improves outcomes in non-ST elevation acute coronary syndromes (NSTE-ACSs). Octogenarians, however, were underrepresented in the pivotal trials. This study aimed to assess the effect of PCI in patients ≥80 years old. METHODS AND RESULTS: We used data from the SWEDEHEART registry for all hospital admissions at eight cardiac care centres within Västra Götaland County. Consecutive patients ≥80 years old admitted for NSTE-ACS between January 2000 and December 2011 were included. We performed instrumental variable analysis with propensity score. The primary endpoint was all-cause mortality at 30 days and one year after index hospitalization. During the study period 5200 patients fulfilled the inclusion criteria. In total, 586 (11.2%) patients underwent PCI, the remaining 4613 patients were treated conservatively. Total mortality at 30 days was 19.4% (1007 events) and 39.4% (1876 events) at one year. Thirty-day mortality was 20.7% in conservatively treated patients and 8.5% in the PCI group (adjusted odds ratio 0.34; 95% confidence interval 0.12-0.97, p = 0.044). One-year mortality was 42.1% in the conservatively treated group and 16.3% in the PCI group (adjusted odds ratio 0.97; 95% confidence interval 0.36-2.51, p = 0.847). CONCLUSIONS: PCI in octogenarians with NSTE-ACS was associated with a lower risk of mortality at 30 days. However, this survival benefit was not sustained during the entire study-period of one-year.
  • Predictors of quality of life for families of children and adolescents with severe physical illnesses who are receiving hospital-based care.

    Svavarsdottir, Erla Kolbrun; Tryggvadottir, Gudny Bergthora; 1 Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland. 2 Landspitali University Hospital, University of Iceland, Reykjavik, Iceland. 3 University of Iceland, Reykjavik, Iceland. (Wiley, 2019-09)
    AIM: There is strong evidence regarding the impact of medical treatments on hospitalised children and their families after being diagnosed with a serious illness. Even though survival rates have increased for children and adolescents with illnesses such as cancer, kidney, liver and gastrointestinal diseases, lengthy medical procedures and symptom management may have an impact on the well-being and quality of life for families. Little is known, however, about promoting family quality of life in hospital-based paediatric settings. The main purpose of this study was to evaluate the predictors of quality of life (QOL) across physical health conditions among families of children and adolescents with cancer, kidney, liver and gastrointestinal diseases. Further, to evaluate the difference in perception on QOL among families of children with cancer compared to families of children with kidney, liver and gastrointestinal diseases. METHOD: The study design was cross-sectional. Thirty-eight families of children with cancer, kidney, liver or gastrointestinal diseases participated at a University Hospital. Data were collected using valid and reliable instruments to measure the study variables from March 2015 to May 2016. FINDINGS: The main result from the stepwise regression analysis indicated perceived family support and illness beliefs, significantly predicted quality of life of the family; approximately 41% of the variance in the families' perception of their quality of life was explained by the model. CONCLUSIONS: The findings emphasise the importance of supporting and maintaining quality of life for families of children with physical illnesses. RELEVANCE TO CLINICAL PRACTICE: Family level interventions within the healthcare system are needed for families of children with severe physical illnesses, since that can result in better outcomes for the child or adolescent and their family. Such an intervention would need to emphasise therapeutic conversations within a relational context, highlighting illness management, illness beliefs, and cognitive and emotional family support.
  • Ageing populations in the Nordic countries: Mortality and longevity from 1990 to 2014.

    Jørgensen, Terese Sara Høj; Fors, Stefan; Nilsson, Charlotte Juul; Enroth, Linda; Aaltonen, Mari; Sundberg, Louise; Brønnum-Hansen, Henrik; Strand, Bjørn Heine; Chang, Milan; Jylhä, Marja; et al. (SAGE Publications, 2019-08)
    Aims: Cross-country comparisons of mortality and longevity patterns of Nordic populations could contribute with novel insights into the compositional changes of these populations. We investigated three metrics of population ageing: the proportion of the population aged 75+ and 90+ years, the proportion of birth cohorts reaching 75 and 90 years, and life expectancy (LE) at age 75 and 90 years in Sweden, Norway, Iceland, Denmark and Finland, in the period 1990-2014. Methods: Demographic information was collected from national statistical databases and the Human Mortality Database. Results: All metrics on population ageing increased during the study period, but there were some cross-country variations. Finland experienced a notably steep increase in the proportion of 75+ and 90+ year olds compared to the other countries. Regarding the proportion reaching old ages, the Finnish lagged behind from the beginning, but females decreased this difference. The Danes were more similar to the other countries at the beginning, but did not experience the same increase over time. Gender-specific LE at age 75 and 90 years was similar overall in the five countries. Conclusions: Developments in cross-country variation suggest that survival until old age has become more similar for Finnish females and more different for Danish males and females compared with the other countries in recent decades. This provides perspectives on the potential to improve longevity in Denmark and Finland. Similarities in LE in old age suggest that expected mortality in old age has been more similar throughout the study period.
  • Diagnostic imaging trends in the emergency department: an extensive single-center experience.

    Juliusson, Gunnar; Thorvaldsdottir, Birna; Kristjansson, Jon Magnus; Hannesson, Petur; 1 Department of Radiology, Landspitali University Hospital, Reykjavik, Iceland. 2 Faculty of Medicine, University of Iceland, Reykjavik, Iceland. 3 Department of Emergency Medicine, Landspitali University Hospital, Reykjavik, Iceland. (SAGE Publications, 2019-07-31)
    BACKGROUND: Emergency Department imaging volume has increased significantly in North America and Asia. PURPOSE: To assess Emergency Department imaging trends in a European center. MATERIAL AND METHODS: The institutional radiological information system was queried for all computed tomography (CT), ultrasound (US), and magnetic resonance (MR) studies performed for the Emergency Department during 2002-2017. Descriptive statistics and linear regression analyses were used to assess overall study rates and temporal trends in overall and after-hours imaging after adjusting for patient visitations. RESULTS: CT use increased significantly from 38/1000 visits to 108/1000 at the end of the observation by 5.5 new exams per 1000 visits/year (P < 0.0001). US use increased gradually at a rate of 1.2/1000 per year during 2002-2008 with an accelerated annual increase of 6.4/1000 in 2009-2011 (P < 0.0001) raising US rates from 7/1000 to 28/1000 visits per year with stable rates from 2012 onwards. After on-site MR became available in 2004, its use increased from 0.3/1000 to 7/1000 at a rate of 1.9/1000 visits per year in 2005-2009 (P < 0.0001) and remained stable from 2010. While there was a significant increase in after-hours imaging, growth remained proportional to the overall trend in the use of CT, MR, and night-time CT with the exception of a slight decrease in after-hour US in favor of standard working hours (P < 0.0001). CONCLUSION: All modalities increased significantly in volume adjusted usage. US and MR rates have been stable since 2012 and 2010, respectively, after periods of increase while CT use continues to increase. Demand for after-hours imaging was mostly proportional to the overall trend.
  • Reliability and validity of the Japanese version of the ADL-focused Occupation-based Neurobehavioural Evaluation (A-ONE J): Applying Rasch analysis methods.

    Higashi, Yasuhiro; Takabatake, Shinichi; Matsubara, Asako; Nishikawa, Koji; Shigeta, Hiroto; Árnadóttir, Guðrún; 1 Kansai Rehabilitation Hospital, Japan. 2 Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, Japan. 3 Hiroshima City Rehabilitation Hospital, Japan. 4 Ishikawa Prefectural Takamatsu Hospital, Japan. 5 Kita-Osaka Police Hospital, Japan. 6 The National University Hospital, Iceland. 7 University of Iceland, Iceland. (SAGE Publications, 2019-06)
    The rating scale structure might be improved by collapsing two categories twice (from five categories to three categories). Unidimensionality of the items was obtained for 20 items. Targeting was acceptable, and separation reliability for item calibrations was high and acceptable for people.Conclusion/limitations: This study provides important information regarding the possibilities for revising the ordinal A-ONE J FI Scale, converting it into a unidimensional scale. Further study with increased and more diverse sample is needed.
  • PAP treatment in patients with OSA does not induce long-term nasal obstruction.

    Värendh, Maria; Andersson, Morgan; Björnsdóttir, Erla; Arnardóttir, Erna S; Gislason, Thorarinn; Pack, Allan I; Hrubos-Strøm, Harald; Johannisson, Arne; Juliusson, Sigurdur; 1 Department of Otorhinolaryngology, Head and Neck Surgery, Skåne University Hospital, Lund, Sweden. 2 Faculty of Medicine, Lund University, Lund, Sweden. 3 Sleep Department, Landspitali - The National University Hospital of Iceland, Reykjavík, Iceland. 4 Faculty of Medicine, University of Iceland, Reykjavik, Iceland. 5 Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania. 6 Department of Otorhinolaryngology, Akershus University Hospital, Lørenskog, Norway. 7 Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden. 8 Department of Otolaryngology, Head and Neck Surgery, Landspitali - The National University Hospital of Iceland, Reykjavík, Iceland. (Wiley, 2019-10)
    We hypothesized that positive airway pressure treatment would induce nasal obstruction and decrease nasal cavity due to mucosal swelling. We further hypothesized that subjective and objective nasal obstruction at baseline would negatively affect positive airway pressure adherence. A total of 728 patients with sleep apnea were investigated in the Icelandic Sleep Apnea Cohort at baseline and 2 years after starting positive airway pressure. Patients underwent home sleep apnea testing at baseline. Questionnaires were answered and acoustic rhinometry was completed at baseline and follow-up. The proportion of patients reporting subjective nocturnal nasal obstruction was reduced (baseline: 35% versus follow-up: 24%; p < 0.001). Small interior nasal dimensions increased (p < 0.001) independent of adherence to treatment. Small nasal volume at baseline was a determinant for becoming a non-user of positive airway pressure treatment (odds ratio 2.22, confidence interval 95% 1.35-3.67, p = 0.002). Subjective nasal obstruction decreased 2 years after initiating positive airway treatment in sleep apnea, and objectively small nasal dimensions increased. Small nasal volume at baseline was a negative predictor for positive airway pressure treatment adherence. Maybe most importantly, positive airway pressure treatment did not cause long-term objective or subjective nasal obstruction.
  • MRSA outbreak in a tertiary neonatal intensive care unit in Iceland.

    Kristinsdottir, Iris; Haraldsson, Asgeir; Thorkelsson, Thordur; Haraldsson, Gunnsteinn; Kristinsson, Karl G; Larsen, Jesper; Larsen, Anders Rhod; Thors, Valtyr; 1 Faculty of Medicine, University of Iceland , Reykjavík , Iceland. 2 Children's Hospital Iceland, Landspitali University Hospital , Reykjavík , Iceland. 3 Department of Clinical Microbiology, Landspitali University Hospital , Reykjavík , Iceland. 4 Department of Bacteria, Parasites and Fungi, Statens Serum Institute , Copenhagen , Denmark. (Taylor & Francis, 2019-09-11)
    Introduction: Preventing the spread of methicillin-resistant Staphylococcus aureus (MRSA) and understanding the pathophysiology and transmission is essential. This study describes an MRSA outbreak in a neonatal intensive care unit in Reykjavik, Iceland at a time where no screening procedures were active. Materials and methods: After isolating MRSA in the neonatal intensive care unit in 2015, neonates, staff members and parents of positive patients were screened and environmental samples collected. The study period was from 14 April 2015 until 31 August 2015. Antimicrobial susceptibility testing, spa-typing and whole genome sequencing were done on MRSA isolates. Results: During the study period, 96/143 admitted patients were screened for colonization. Non-screened infants had short admissions not including screening days. MRSA was isolated from nine infants and seven parents. All tested staff members were negative. Eight infants and six parents carried MRSA ST30-IVc with spa-type t253 and one infant and its parent carried MRSA CC9-IVa (spa-type t4845) while most environmental samples were MRSA CC9-IVa (spa-type t4845). Whole genome sequencing revealed close relatedness between all ST30-IVc and CC9-IVa isolates, respectively. All colonized infants received decolonization treatment, but 3/9 were still positive when last sampled. Discussion: The main outbreak source was a single MRSA ST30-IVc (spa-type t253), isolated for the first time in Iceland. A new CC9-IVa (spa-type t4845) was also identified, most abundant on environmental surfaces but only in one patient. The reason for the differences in the epidemiology of the two strains is not clear. The study highlights a need for screening procedures in high-risk settings and guidelines for neonatal decolonization.
  • Clinical practice guideline on prevention of rhabdomyolysis induced acute kidney injury: Endorsement by the Scandinavian Society of Anaesthesiology and Intensive Care Medicine.

    Chew, Michelle S; Rehn, Marius; Olkkola, Klaus T; Örn Sverrisson, Kristinn; Yli-Hankala, Arvi; Møller, Morten Hylander (Wiley, 2019-08-22)
    The Scandinavian Society of Anaesthesiology and Intensive Care Medicine Clinical Practice Committee endorses the recent DASAIM/DSIT guideline for prevention of rhabdomyolysis-induced acute kidney injury. However, we emphasize the low quality of evidence with only weak recommendations for all interventions, highlighting that further research is very likely to have an important impact on the confidence in the estimate of effect and is likely to change the estimates.
  • Diagnostic imaging in adult 
non-cystic fibrosis bronchiectasis.

    Juliusson, Gunnar; Gudmundsson, Gunnar; 1 Dept of Radiology, Landspitali University Hospital, Reykjavik, Iceland. 2 Dept of Respiratory Medicine, Landspitali University Hospital, Reykjavik, Iceland. 3 Faculty of Medicine, University of Iceland, Reykjavik, Iceland. (European Respiratory Society, 2019-09)
    Radiology plays a key role in the diagnosis of bronchiectasis, defined as permanent dilatation of the bronchial lumen. Volumetric thin-section multidetector computed tomography is an excellent noninvasive modality to evaluate bronchiectasis. Bronchiectasis is categorised by morphological appearance. Cylindrical bronchiectasis has a smooth tubular configuration and is the most common form. Varicose bronchiectasis has irregular contours with alternating dilating and contracting lumen. Cystic bronchiectasis is the most severe form and exhibits saccular dilatation of bronchi. Bronchial dilatation is the hallmark of bronchiectasis and is evaluated in relation to the accompanying pulmonary artery. A broncho-arterial ratio exceeding 1:1 should be considered abnormal. Normal bronchi are narrower in diameter the further they are from the lung hila. Lack of normal bronchial tapering over 2 cm in length, distal from an airway bifurcation, is the most sensitive sign of bronchiectasis. Findings commonly associated with bronchiectasis include bronchial wall thickening, mucus plugging and tree-in-bud opacities. Bronchiectasis results from a myriad of conditions, with post-infectious bronchiectasis being the most common. Imaging can sometimes discern the cause of bronchiectasis. However, in most cases it is nonspecific or only suggestive of aetiology. While morphological types are nonspecific, the distribution of abnormality offers clues to aetiology. KEY POINTS: Bronchiectasis is a chronic progressive condition with significant disease burden and frequent exacerbations, for which the diagnosis relies on cross-sectional imaging.The major imaging findings include bronchial dilatation, bronchial contour abnormalities and visualisation of the normally invisible peripheral airways.Bronchiectasis is the end result of various conditions, including immunodeficiencies, mucociliary disorders and infections. Imaging is often nonspecific with regard to aetiology but can be suggestive.Distribution of abnormality in the lung offers helpful clues for establishing aetiology. EDUCATIONAL AIMS: To review the cross-sectional imaging appearance of bronchiectasis and the common associated findings.To get a sense of how radiology can aid in establishing the aetiology of bronchiectasis.
  • Increased incidence of autoimmune hepatitis is associated with wider use of biological drugs.

    Valgeirsson, Kjartan B; Hreinsson, Jóhann P; Björnsson, Einar S; 1 Department of Internal Medicine, National University Hospital of Iceland, Reykjavik, Iceland. 2 Faculty of Medicine, University of Iceland, Reykjavik, Iceland. (Wiley, 2019-08-22)
    BACKGROUND & AIMS: Population-based studies on the epidemiology of autoimmune hepatitis (AIH) are scarce. Drug-induced AIH (DIAIH) is increasingly recognized in association with immunomodulatory therapy. We aimed to determine the incidence, prevalence and natural history of AIH in a population-based setting. METHODS: We collected data of new diagnosis of AIH in Iceland from 2006 to 2015. Cases were identified through search of diagnostic codes and text search for AIH within electronical medical records of all hospitals in Iceland and through records of smooth muscle antibodies (SMA) test results by the only laboratory in the country analyzing SMA. Patients were included in the final analysis if they received the clinical diagnosis of AIH or were started on immunosuppressive therapy. RESULTS: The mean annual incidence of AIH in Iceland was 2.2 cases per 100 000 inhabitants. Point prevalence on 31 December 2015 was 27/100 000. The median age at diagnosis was 56 years and 86% of patients were of female gender. DIAIH was suspected in 13 of 71 patients (18%) of which eight cases were related to infliximab. Immunosuppressive treatment was started in all but two patients. At the end of follow-up (median 4.8 years) 66 of 71 (93%) patients were alive. CONCLUSION: The incidence and prevalence rates of AIH in Iceland are the highest reported so far in a population-based setting. Higher incidence can partly be explained by the increasing use of biological drugs. Immunosuppressive therapy was very effective in achieving remission and prognosis was favorable.
  • A significant proportion of patients with choledocholithiasis have markedly elevated alanine aminotransferase.

    Björnsson, Helgi K; Björnsson, Einar S; 1 Division of Gastroenterology and Hepatology, Department of Internal Medicine, The National University Hospital of Iceland , Reykjavik , Iceland. 2 Faculty of Medicine, University of Iceland , Reykjavik , Iceland. (Taylor & Francis, 2019-09-03)
    Objective: To determine the frequency and nature of liver enzyme elevations among patients presenting with choledocholithiasis (CDL). Methods: A prospective study identified all patients with serum level of alanine aminotransferase (ALT) ≥500 U/L (normal levels: <70 U/L in men, <45 U/L in women) over 1 year. Additionally, other patients with CDL were identified during the same period retrospectively by diagnostic codes and ERCP procedures, providing data on all CDL patients. Symptoms, liver tests, history of cholecystectomy, and radiological imaging were analyzed. Patients with radiologically confirmed CDL or a clinical diagnosis of CDL were included. Results: During the study period, 110 patients had CDL, 60% women, mean age 65 years. Overall 86/110 (78%) had confirmed CDL on imaging and 24/110 (22%) clinically diagnosed. Overall 26% had undergone cholecystectomy, median bile duct diameter 10.0 mm, median maximal liver tests: ALT 436, ALP 226, bilirubin 60 μmol/L (<25). Overall 9/110 (8%) had ALT ≥1000, 43/110 (39%) ALT levels between 500 and 1000 IU/L and 58/110 (53%) had ALT <500 IU/L. Patients with ALT ≥1000 had smaller bile duct diameter of 7 versus 10 mm (p < .001) but similar proportions of cholecystectomies. In the multivariate analysis age, maximal AST and maximal bilirubin were independent predictors of ALT >500. Maximal AST and bile duct diameter were independent predictors of ALT >1000. Conclusions: Approximately 8% of patients with CDL had markedly elevated ALT. These patients had smaller bile duct diameter. Pronounced ALT elevation is a part of the clinical spectrum of CDL.
  • Hyperuricemia is associated with intermittent hand joint pain in a cross sectional study of elderly females: The AGES-Reykjavik Study.

    Jonsson, Helgi; Aspelund, Thor; Eiriksdottir, Gudny; Harris, Tamara B; Launer, Lenore J; Gudnason, Vilmundur; 1 Landspitalinn University Hospital, Reykjavík, Iceland. 2 University of Iceland, Reykjavik, Iceland. 3 Icelandic Heart Association, Kopavogur, Iceland. 4 National Institute on Aging, Bethesda, MD, United States of America. (Public Library of Science, 2019-08)
    BACKGROUND: The debate whether "asymptomatic hyperuricemia" should be treated is still ongoing. The objective of this cross-sectional study was to analyze whether hyperuricema in the elderly is associated with joint pain. METHODS AND FINDINGS: Participants in the population-based AGES-Reykjavik Study (males 2195, females 2975, mean age 76(6)) answered standardized questions about joint pain. In addition they recorded intermittent hand joint pain by marking a diagram of the hand. In males, no association was found between hyperuricemia and pain. Females however, showed a positive association between hyperuricemia and joint pain at many sites. After adjustment for age, BMI and hand osteoarthritis however, only intermittent hand joint pain (OR 1.30(1.07-1.58), p = 0.008) and intermittent pain in ≥10 hand joints (OR 1.75(1.32-2.31), p<0.001) remained significant. The best model for describing the relationship between serum uric acid levels (SUA) and intermittent hand joint pain in ≥10 joints was non-linear with a cut-off at 372 μmol/L. The attributable surplus number of symptomatic females with SUA ≥372 μmol/L was approximately 2.0% of the study population for those reporting pain in ≥10 hand joints. Next after having severe hand osteoarthritis, SUA ≥372 was an independent predictive factor of intermittent pain in ≥10 hand joints. Intermittent hand joint pain was also an independent risk factor for worse general health description. CONCLUSION: Results from this population based study indicate that hyperuricemia in elderly females may be a rather frequent cause of intermittent hand joint pain, often in many joints. The most likely explanation relates to low-grade urate crystal induced inflammation. Our data do not allow for assessment of the severity of symptoms or whether they merit specific treatment, but intermittent hand joint pain was an independent predictor of worse general health. These findings may be an important contribution to the debate on whether hyperuricemia should be treated.
  • Can a Simple Dietary Screening in Early Pregnancy Identify Dietary Habits Associated with Gestational Diabetes?

    Hrolfsdottir, Laufey; Gunnarsdottir, Ingibjorg; Birgisdottir, Bryndis Eva; Hreidarsdottir, Ingibjorg Th; Smarason, Alexander Kr; Hardardottir, Hildur; Halldorsson, Thorhallur I; 1 Unit for Nutrition Research, Landspitali University Hospital and Faculty of Food Science and Nutrition, University of Iceland, Eiríksgata 29 101 Reykjavik, Iceland. laufeyh@sak.is. 2 Institution of Health Science Research, University of Akureyri and Akureyri Hospital, Eyrarlandsvegi, 600 Akureyri, Iceland. laufeyh@sak.is. 3 Unit for Nutrition Research, Landspitali University Hospital and Faculty of Food Science and Nutrition, University of Iceland, Eiríksgata 29 101 Reykjavik, Iceland. 4 Department of Obstetrics and Gynecology, Landspitali University Hospital, Hringbraut, 101 Reykjavík, Iceland. 5 Institution of Health Science Research, University of Akureyri and Akureyri Hospital, Eyrarlandsvegi, 600 Akureyri, Iceland. 6 Faculty of Medicine, University of Iceland, Vatnsmýrarvegi 16, 101 Reykjavík, Iceland. 7 Centre for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen, Denmark. (MDPI Publishing, 2019-08-11)
    Gestational diabetes mellitus (GDM) is predominantly a lifestyle disease, with diet being an important modifiable risk factor. A major obstacle for the prevention in clinical practice is the complexity of assessing diet. In a cohort of 1651 Icelandic women, this study examined whether a short 40-item dietary screening questionnaire administered in the 1st trimester could identify dietary habits associated with GDM. The dietary variables were aggregated into predefined binary factors reflecting inadequate or optimal intake and stepwise backward elimination was used to identify a reduced set of factors that best predicted GDM. Those binary factors were then aggregated into a risk score (range: 0-7), that was mostly characterised by frequent consumption of soft drinks, sweets, cookies, ice creams and processed meat. The women with poor dietary habits (score ≥ 5, n = 302), had a higher risk of GDM (RR = 1.38; 95%CI = 3, 85) compared with women with a more optimal diet (score ≤ 2, n = 407). In parallel, a pilot (n = 100) intervention was conducted among overweight and obese women examining the effect of internet-based personalized feedback on diet quality. Simple feedback was given in accordance with the answers provided in the screening questionnaire in 1st trimester. At the endpoint, the improvements in diet quality were observed by, as an example, soft drink consumption being reduced by ~1 L/week on average in the intervention group compared to the controls. Our results suggest that a simple dietary screening tool administered in the 1st trimester could identify dietary habits associated with GMD. This tool should be easy to use in a clinical setting, and with simple individualized feedback, improvements in diet may be achieved.
  • Polygenic Risk: Predicting Depression Outcomes in Clinical and Epidemiological Cohorts of Youths.

    Halldorsdottir, Thorhildur; Piechaczek, Charlotte; Soares de Matos, Ana Paula; Czamara, Darina; Pehl, Verena; Wagenbuechler, Petra; Feldmann, Lisa; Quickenstedt-Reinhardt, Peggy; Allgaier, Antje-Kathrin; Freisleder, Franz Joseph; et al. (American Psychiatric Association, 2019-08-01)
    OBJECTIVE: Identifying risk factors for major depression and depressive symptoms in youths could have important implications for prevention efforts. This study examined the association of polygenic risk scores (PRSs) for a broad depression phenotype derived from a large-scale genome-wide association study (GWAS) in adults, and its interaction with childhood abuse, with clinically relevant depression outcomes in clinical and epidemiological youth cohorts. METHODS: The clinical cohort comprised 279 youths with major depression (mean age=14.76 years [SD=2.00], 68% female) and 187 healthy control subjects (mean age=14.67 years [SD=2.45], 63% female). The first epidemiological cohort included 1,450 youths (mean age=13.99 years [SD=0.92], 63% female). Of those, 694 who were not clinically depressed at baseline underwent follow-ups at 6, 12, and 24 months. The replication epidemiological cohort comprised children assessed at ages 8 (N=184; 49.2% female) and 11 (N=317; 46.7% female) years. All cohorts were genome-wide genotyped and completed measures for major depression, depressive symptoms, and/or childhood abuse. Summary statistics from the largest GWAS to date on depression were used to calculate the depression PRS. RESULTS: In the clinical cohort, the depression PRS predicted case-control status (odds ratio=1.560, 95% CI=1.230-1.980), depression severity (β=0.177, SE=0.069), and age at onset (β=-0.375, SE=0.160). In the first epidemiological cohort, the depression PRS predicted baseline depressive symptoms (β=0.557, SE=0.200) and prospectively predicted onset of moderate to severe depressive symptoms (hazard ratio=1.202, 95% CI=1.045-1.383). The associations with depressive symptoms were replicated in the second epidemiological cohort. Evidence was found for an additive, but not an interactive, effect of the depression PRS and childhood abuse on depression outcomes. CONCLUSIONS: Depression PRSs derived from adults generalize to depression outcomes in youths and may serve as an early indicator of clinically significant levels of depression.
  • Association Between Preoperative Opioid and Benzodiazepine Prescription Patterns and Mortality After Noncardiac Surgery.

    Sigurdsson, Martin I; Helgadottir, Solveig; Long, Thorir E; Helgason, Dadi; Waldron, Nathan H; Palsson, Runolfur; Indridason, Olafur S; Gudmundsdottir, Ingibjorg J; Gudbjartsson, Tomas; Sigurdsson, Gisli H; et al. (American Medical Association, 2019-06-19)
    IMPORTANCE: The number of patients prescribed long-term opioids and benzodiazepines and complications from their long-term use have increased. Information regarding the perioperative outcomes of patients prescribed these medications before surgery is limited. OBJECTIVE: To determine whether patients prescribed opioids and/or benzodiazepines within 6 months preoperatively would have greater short- and long-term mortality and increased opioid consumption postoperatively. DESIGN, SETTING, AND PARTICIPANTS: This retrospective, single-center, population-based cohort study included all patients 18 years or older, undergoing noncardiac surgical procedures at a national hospital in Iceland from December 12, 2005, to December 31, 2015, with follow-up through May 20, 2016. A propensity score-matched control cohort was generated using individuals from the group that received prescriptions for neither medication class within 6 months preoperatively. Data analysis was performed from April 10, 2018, to March 9, 2019. EXPOSURES: Patients who filled prescriptions for opioids only, benzodiazepines only, both opioids and benzodiazepines, or neither medication within 6 months preoperatively. MAIN OUTCOMES AND MEASURES: Long-term survival compared with propensity score-matched controls. Secondary outcomes were 30-day survival and persistent postoperative opioid consumption, defined as a prescription filled more than 3 months postoperatively. RESULTS: Among 41 170 noncardiac surgical cases in 27 787 individuals (16 004 women [57.6%]; mean [SD] age, 56.3 [18.8] years), a preoperative prescription for opioids only was filled for 7460 cases (17.7%), benzodiazepines only for 3121 (7.4%), and both for 2633 (6.2%). Patients who filled preoperative prescriptions for either medication class had a greater comorbidity burden compared with patients receiving neither medication class (Elixhauser comorbidity index >0 for 16% of patients filling prescriptions for opioids only, 22% for benzodiazepines only, and 21% for both medications compared with 14% for patients filling neither). There was no difference in 30-day (opioids only: 1.3% vs 1.0%; P = .23; benzodiazepines only: 1.9% vs 1.5%; P = .32) or long-term (opioids only: hazard ratio [HR], 1.12 [95% CI, 1.01-1.24]; P = .03; benzodiazepines only: HR, 1.11 [95% CI, 0.98-1.26]; P = .11) survival among the patients receiving opioids or benzodiazepines only compared with controls. However, patients prescribed both opioids and benzodiazepines had greater 30-day mortality (3.2% vs 1.8%; P = .004) and a greater hazard of long-term mortality (HR, 1.41; 95% CI, 1.22-1.64; P < .001). The rate of persistent postoperative opioid consumption was higher for patients filling prescriptions for opioids only (43%), benzodiazepines only (23%), or both (66%) compared with patients filling neither (12%) (P < .001 for all). CONCLUSIONS AND RELEVANCE: The findings suggest that opioid and benzodiazepine prescription fills in the 6 months before surgery are associated with increased short-and long-term mortality and an increased rate of persistent postoperative opioid consumption. These patients should be considered for early referral to preoperative clinic and medication optimization to improve surgical outcomes.
  • The risk of developing a mismatch repair deficient colorectal cancer after undergoing cholecystectomy.

    Halldorsson, Matthias Orn; Hauptmann, Michael; Snaebjornsson, Petur; Haraldsdóttir, Kristín Huld; Aspelund, Thor; Gudmundsson, Elias Freyr; Gudnason, Vilmundur; Jonasson, Jon Gunnlaugur; Haraldsdottir, Sigurdis; a Faculty of Medicine , University of Iceland , Reykjavík , Iceland. 2 b Department of Epidemiology and Biostatistics , The Netherlands Cancer Institute , Amsterdam , The Netherlands. 3 c Department of Pathology , The Netherlands Cancer Institute , Amsterdam , The Netherlands. 4 d Landspitali University Hospital Iceland , Reykjavík , Iceland. 5 e University of Iceland , Reykjavík , Iceland. 6 f Icelandic Heart Association , Kópavogur , Iceland. 7 g Department of Pathology , Landspitali-University Hospital , Iceland. 8 h Department of Internal Medicine , Stanford University , Stanford , CA , USA. (Taylor & Francis, 2018-08)
    OBJECTIVES: Mismatch repair deficient (dMMR) colorectal cancer (CRC) is caused by inactivation of the MMR DNA repair system, most commonly via epigenetic inactivation of the MLH1 gene, and these tumors occur most frequently in the right colon. The objective was to determine whether cholecystectomy (CCY) increases the risk of a dMMR CRC by comparing CCY incidence in patients with dMMR CRC and proficient MMR (pMMR) CRC to unaffected controls. MATERIALS AND METHODS: All patients diagnosed with CRC in Iceland from 2000 to 2009 (n = 1171) were included. They had previously been screened for dMMR by immunohistochemistry (n = 129 were dMMR). Unaffected age- and sex-matched controls (n = 17,460) were obtained from large Icelandic cohort studies. Subjects were cross-referenced with all pathology databases in Iceland to establish who had undergone CCY. Odds ratios were calculated using unconditional logistic regression. RESULTS: Eighteen (13.7%) dMMR CRC cases and 90 (8.7%) pMMR CRC cases had undergone CCY compared to 1532 (8.8%) controls. CCY-related odds ratios (OR) were 1.06 (95% CI 0.90-1.26, p = .577) for all CRC, 1.16 (95% CI 0.66-2.05 p = .602) for dMMR CRCand 1.04 (95% CI 0.83-1.29, p = .744) for pMMR CRC. Furthermore, OR for dMMR CRC was 0.51 (95% CI 0.16-1.67, p = .266), 2.04 (95% CI 0.92-4.50, p = .080) and 1.08 (95% CI 0.40-2.89, p = .875) <10 years, 10-20 years and >20 years after a CCY, respectively. CONCLUSIONS: There was no evidence of increased risk of developing dMMR CRC after CCY although a borderline significantly increased 2-fold risk was observed 10-20 years after CCY. Larger studies are warranted to examine this further.

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