• 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.
    • 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.
    • 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.
    • 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.
    • 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.
    • 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.
    • Cross-Country Validation of the Association Between Oral Health and General Health in Community-Dwelling Older Adults.

      de Almeida Mello, Johanna; Tran, Trung Dung; Krausch-Hofmann, Stefanie; Meehan, Brigette; van Hout, Hein; Turcotte, Luke; van der Roest, Henriette G; Garms-Homolová, Vjenka; Jónsson, Pálmi; Onder, Graziano; et al. (Elsevier Science, 2019-09)
      OBJECTIVE: Oral health is known to be associated with general health, but longitudinal relationships between oral health and general health indicators have not yet been fully explored in international research. SETTING AND PARTICIPANTS: The sample consisted of 3 longitudinal databases: a sample from Belgium from the Protocol 3 project (n = 8359), a combined sample from 6 European countries (n = 2501) from the IBenC study (Belgium, Finland, Iceland, Germany, Italy, and the Netherlands), and a sample from New Zealand (n = 15,012). All clients were 65 years or older and received long-term home care services. METHODS: Bayesian models were used to analyze the associations between 3 oral health indicators (chewing difficulty, nonintact teeth, and dry mouth) and 4 aspects of general health (activities of daily living functioning, cognition, depression, and health instability). In addition, the models explored the associations between current oral health and general health status and future oral health and general health status. RESULTS: Clients who had poorer oral health had a higher risk of suffering from poor general health. Especially chewing difficulty was associated with all general health indicators in all data sets (odds ratios > 1). Dry mouth and nonintact teeth showed significant associations with almost all general health indicators. Additionally, having poor oral health (respectively general health) was predictive of poor general health (respectively oral health) at future assessments (significant cross-lagged parameters). CONCLUSIONS/IMPLICATIONS: The results point out the need of the inclusion of oral health assessment and advice from dentists or oral health practitioners into the multidisciplinary conversation. In addition, identifying older people with oral health problems is essential in order to provide treatment and monitoring. Raising awareness for oral health is important, and policy makers should foster oral health promotion and care for older adults in order to keep them in good health.
    • Is There a Weekend Effect in Surgery for Type A Dissection?: Results From the Nordic Consortium for Acute Type A Aortic Dissection Database.

      Ahlsson, Anders; Wickbom, Anders; Geirsson, Arnar; Franco-Cereceda, Anders; Ahmad, Khalil; Gunn, Jarmo; Hansson, Emma C; Hjortdal, Vibeke; Jarvela, Kati; Jeppsson, Anders; et al. (Elsevier Science, 2019-09)
      BACKGROUND: Aortic dissection type A requires immediate surgery. In general surgery populations, patients operated on during weekends have higher mortality rates compared with patients whose operations occur on weekdays. The weekend effect in aortic dissection type A has not been studied in detail. METHODS: The Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD) registry includes data for 1,159 patients who underwent type A dissection surgery at 8 Nordic centers during 2005 to 2014. This study is based on data relating to surgery conducted during weekdays versus weekends and starting between 8:00 am and 8:00 pm ("daytime") versus from 8:00 pm to 8:00 am ("nighttime"), as well as time from symptoms, admittance, and diagnosis to surgery. The influence of timing of surgery on the 30-day mortality rate was assessed using logistic regression analysis. RESULTS: The 30-day mortality was 18% (204 of 1,159), with no difference in mortality between surgery performed on weekdays (17% [150 of 889]) and on weekends (20% [54 of 270], p = 0.45), or during nighttime (19% [87 of 467]) versus daytime (17% [117 of 680], p = 0.54). Time from symptoms to surgery (median 7.0 hours vs 6.5 hours, p = 0.31) did not differ between patients who survived and those who died at 30 days. Multivariable regression analysis of risk factors for 30-day mortality showed no weekend effect (odds ratio, 1.04; 95% confidence interval, 60.67 to 1.60; p = 0.875), but nighttime surgery was a risk factor (odds ratio, 2.43; 95% confidence interval, 1.29 to 4.56; p = 0.006). CONCLUSIONS: The 30-day mortality in surgical repair of aortic dissection type A was not significantly affected by timing of surgery during weekends versus weekdays. Nighttime surgery seems to predict increased 30-day mortality, after correction for other risk factors.
    • 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.
    • 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.
    • High expression of the vacuole membrane protein 1 (VMP1) is a potential marker of poor prognosis in HER2 positive breast cancer.

      Amirfallah, Arsalan; Arason, Adalgeir; Einarsson, Hjorleifur; Gudmundsdottir, Eydis Thorunn; Freysteinsdottir, Edda Sigridur; Olafsdottir, Kristrun Audur; Johannsson, Oskar Thor; Agnarsson, Bjarni Agnar; Barkardottir, Rosa Bjork; Reynisdottir, Inga; et al. (Public Library of Science, 2019-08-23)
      BACKGROUND: Fusion genes result from genomic structural changes, which can lead to alterations in gene expression that supports tumor development. The aim of the study was to use fusion genes as a tool to identify new breast cancer (BC) genes with a role in BC progression. METHODS: Fusion genes from breast tumors and BC cell lines were collected from publications. RNA-Seq data from tumors and cell lines were retrieved from databanks and analyzed for fusions with SOAPfuse or the analysis was purchased. Fusion genes identified in both tumors (n = 1724) and cell lines (n = 45) were confirmed by qRT-PCR and sequencing. Their individual genes were ranked by selection criteria that included correlation of their mRNA level with copy number. The expression of the top ranked gene was measured by qRT-PCR in normal tissue and in breast tumors from an exploratory cohort (n = 141) and a validation cohort (n = 277). Expression levels were correlated with clinical and pathological factors as well as the patients' survival. The results were followed up in BC cohorts from TCGA (n = 818) and METABRIC (n = 2509). RESULTS: Vacuole membrane protein 1 (VMP1) was the most promising candidate based on specific selection criteria. Its expression was higher in breast tumor tissue than normal tissue (p = 1x10-4), and its expression was significantly higher in HER2 positive than HER2 negative breast tumors in all four cohorts analyzed. High expression of VMP1 associated with breast cancer specific survival (BCSS) in cohort 1 (hazard ratio (HR) = 2.31, CI 1.27-4.18) and METABRIC (HR = 1.26, CI 1.02-1.57), and also after adjusting for HER2 expression in cohort 1 (HR = 2.03, CI 1.10-3.72). BCSS was not significant in cohort 2 or TCGA cohort, which may be due to differences in treatment regimens. CONCLUSIONS: The results suggest that high VMP1 expression is a potential marker of poor prognosis in HER2 positive BC. Further studies are needed to elucidate how VMP1 could affect pathways supportive of tumorigenesis.
    • 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.
    • 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.
    • 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.
    • Bone remodeling effect of a chitosan and calcium phosphate-based composite.

      Kjalarsdóttir, Lilja; Dýrfjörd, Arna; Dagbjartsson, Atli; Laxdal, Elín H; Örlygsson, Gissur; Gíslason, Jóhannes; Einarsson, Jón M; Ng, Chuen-How; Jónsson, Halldór; 1 Department of Orthopaedic Surgery, Landspítali University Hospital, Reykjavík, Iceland. 2 Faculty of Medicine, University of Iceland, Reykjavík, Iceland. 3 Genís hf., Siglufjördur, Iceland. 4 Department of Materials, Biotechnology and Energy, Innovation Center Iceland, Reykjavík, Iceland. 5 Department of Vascular Surgery, Landspítali University Hospital, Reykjavík, Iceland. (Oxford University Press, 2019-08-01)
      Chitosan is a biocompatible polymer that has been widely studied for tissue engineering purposes. The aim of this research was to assess bone regenerative properties of an injectable chitosan and calcium phosphate-based composite and identify optimal degree of deacetylation (%DDA) of the chitosan polymer. Drill holes were generated on the left side of a mandible in Sprague-Dawley rats, and the hole was either left empty or filled with the implant. The animals were sacrificed at several time points after surgery (7-22 days) and bone was investigated using micro-CT and histology. No significant new bone formation was observed in the implants themselves at any time points. However, substantial new bone formation was observed in the rat mandible further away from the drill hole. Morphological changes indicating bone formation were found in specimens explanted on Day 7 in animals that received implant. Similar bone formation pattern was seen in control animals with an empty drill hole at later time points but not to the same extent. A second experiment was performed to examine if the %DDA of the chitosan polymer influenced the bone remodeling response. The results suggest that chitosan polymers with %DDA between 50 and 70% enhance the natural bone remodeling mechanism.
    • 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.
    • Retinal metabolic and structural alterations in response to aflibercept treatment in neovascular age-related macular degeneration.

      Jakobsen, Ditte B; Torp, Thomas L; Stefansson, Einar; Peto, Tunde; Grauslund, Jakob; 1 Department of Ophthalmology, Odense University Hospital, Odense, Denmark. 2 Department of Clinical Research, University of Southern Denmark, Odense, Denmark. 3 University of Iceland, Reykjavik, Iceland. 4 Landspitali University Hospital, Reykjavik, Iceland. 5 Centre for Public Health, Queen's University Belfast, Belfast, UK. (Wiley, 2019-08)
      PURPOSE: Non-invasive retinal markers of disease activity could pave the way for individualized treatment in neovascular age-related macular degeneration (nAMD). We aimed to evaluate if retinal vascular oxygen saturation and calibres could predict the initial treatment response after a loading phase of intravitreal aflibercept in nAMD. METHOD: A total of 149 eyes were included (nAMD, n = 76; dry AMD, n = 30; normal eyes n = 43). Of these, 57 treatment-naïve eyes with nAMD received three monthly injections with 2.0 mg aflibercept and were subsequently stratified according to functional and structural response according to development in best-corrected visual acuity and macular retinal thickness. The retinal vascular oxygen saturation and calibres were measured prior to treatment and 1 month after the third injection. RESULTS: Patients with nAMD and dry AMD had higher retinal arteriolar oxygen saturation as compared to normal eyes (94.3% versus 95.2% versus 92.6%, p = 0.04). Thirty-nine (68.4%) and 12 (21.1%) eyes with nAMD were functional and structural responders. After the loading phase, structural nonresponders developed a higher retinal arteriolar (95.3% versus 93.3%, p = 0.03) and venular (64.7% versus 59.4%, p = 0.02) oxygen saturation, and responders developed a lower retinal arteriolar calibre (118.0 versus 114.3 μm, p < 0.01). In a multiple logistic regression model, increasing retinal venular oxygen saturation associated with a negative structural treatment outcome (odds ratio 1.17 for each 1% increment after the loading phase, 95% confidence interval 1.01-1.36, p = 0.03). CONCLUSION: Changes in the retinal venular oxygen saturation associate independently with initial treatment response in nAMD, but functional and structural retinal measurements prior to treatment could not predict the treatment response.
    • Venovenous extracorporeal membrane oxygenation treatment in a low-volume and geographically isolated cardiothoracic centre.

      Ingvarsdottir, Inga L; Vidarsdottir, Halla; Valsson, Felix; Simonardottir, Liney; Sigurdsson, Martin I; Myrdal, Gunnar; Geirsson, Arnar; Gudbjartsson, Tomas; 1 Department of Anaesthesiology and Intensive Care, Landspitali University Hospital, Reykjavik, Iceland. 2 Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland. 3 Faculty of Medicine, University of Iceland, Reykjavik, Iceland. (Wiley, 2019-08)
      BACKGROUND: Extracorporeal membrane oxygenation (ECMO) treatment is generally offered in large tertiary cardiothoracic referral centres. Here we present the indications and outcome of venovenous-ECMO (VV-ECMO) treatment in a low-volume, geographically isolated single-centre in Iceland, a country of 350 000 inhabitants. Our hypothesis was that patient survival in such a centre can be similar to that at high-volume centres. METHODS: A retrospective study that included all patients treated with VV-ECMO in Iceland from 1991-2016 (n = 17). Information on demographics, indications and in-hospital survival was collected from patient charts and APACHE II and Murray scores were calculated. Information on long-term survival was collected from a centralized registry. RESULTS: Seventeen patients were treated with VV-ECMO (nine males, median age 33 years, range 14-74), the indication for 16 patients was severe acute respiratory distress syndrome, most often following pneumonia (n = 6), H1N1-infection (n = 3) or drowning (n = 2). Median APACHE-II and Murray-scores were 20 and 3.5, respectively, and median duration of VV-ECMO treatment was 9 days (range 2-40 days). In total 11 patients (64,7%) survived the treatment, with 10 patients (58,8%) surviving hospital discharge, all of who were still alive at long-term follow-up, with a median follow-up time of 9 years (August 15th, 2017). CONCLUSION: Venovenous-ECMO service can be provided in a low-volume and geographically isolated centre, like Iceland, with short- and long-term outcomes comparable to larger centres.