• Langtímahorfur sjúklinga með bráða kransæðastíflu

      Einar Logi Snorrason; Bergrós Kristín Jóhannesdóttir; Thor Aspelund; Vilmundur Guðnason; Karl Andersen; 1 Læknadeild Háskóla Íslands, 2 Haukeland Universitetssjukehus, Bergen, 3 Hjartavernd, 4 hjartadeild 14EG Landspítala (Læknafélag Íslands, Læknafélag Reykjavíkur, 2018-11)
      Inngangur: Hratt lækkandi dánartíðni vegna kransæðasjúkdóma á Íslandi helst í hendur við samsvarandi lækkandi nýgengi kransæðastíflu á undanförnum þremur áratugum. Markmið þessarrar rannsóknar var að bera saman langtímalifun einstaklinga með NSTEMI (Non-ST elevation myocardial infarction) og STEMI (ST elevation myocardial infarction) og kanna áhrif áhættuþátta á lifun. Efniviður og aðferðir: Rannsóknin náði til allra sjúklinga sem greindust með bráða kransæðastíflu á Landspítala árið 2006. Upplýsingar um áhættuþætti hjarta- og æðasjúkdóma og greiningar voru fengnar úr Sögukerfi spítalans. Sjúklingum var fylgt eftir fram til 1. janúar 2015. Endapunktur rannsóknarinnar var andlát af hvaða orsök sem er. Samsettur endapunktur var dauðsfall eða endurinnlögn vegna kransæðastíflu. Niðurstöður: Á árinu 2006 greindust 447 einstaklingar með bráða kransæðastíflu á Landspítala, þar af voru 280 með NSTEMI (I21.4) og 167 með STEMI (I21 - I21.9). Nýgengi NSTEMI árið 2006 var 91,3 á hverja 100.000 íbúa. Nýgengi STEMI árið 2006 var 55,9 á hverja 100.000 íbúa. Meðalaldur NSTEMI-sjúklinga var 73,0 ár. Konur með NSTEMI voru að meðaltali 8,4 árum eldri en karlar með NSTEMI (konur 78,3 ár og karlar 69,9 ár). Meðalaldur STEMI-sjúklinga var 65,3 ár. Konur með STEMI voru að meðaltali 7,3 árum eldri en karlar með STEMI (konur 70,4 ár og karlar 63 ár). Fimm ára lifun NSTEMI-sjúklinga var 51%, 42% meðal kvenna og 57% meðal karla. Fimm ára lifun STEMI sjúklinga var 77%, 68% meðal kvenna og 80% meðal karla (logrank: p<0,01). Eftir aldursleiðréttingu var marktækt verri langtímalifun eftir NSTEMI samanborið við STEMI. Ályktanir: Nýgengi NSTEMI var hærra en STEMI á Íslandi árið 2006. Konur höfðu verri langtímahorfur en karlar, sem skýrist af hærri meðal­aldri þeirra. Langtímalifun NSTEMI-sjúklinga var verri en lifun STEMI sjúklinga þrátt fyrir aldursleiðréttingu.
    • Aldarafmæli spænsku veikinnar og viðbrögð við skæðum farsóttum á 21. öld

      Magnús Gottfreðsson; Ritstjóri Læknablaðsins (Læknafélag Íslands, Læknafélag Reykjavíkur, 2018-10)
    • ÚR LÆKNABLAÐINU 1919: Inflúensan fyrrum og nú

      Þórður Thoroddsen (Læknafélag Íslands, Læknafélag Reykjavíkur, 2018-10)
    • Árangur kransæðahjáveituaðgerða hjá konum á Íslandi

      Helga Rún Garðarsdóttir; Linda Ósk Árnadóttir; Jónas A. Aðalsteinsson; Hera Jóhannesdóttir; Sólveig Helgadóttir; Þórdís Jóna Hrafnkelsdóttir; Arnar Geirsson; Tómas Guðbjartsson; Helga Rún Garðarsdóttir1 kandídat Linda Ósk Árnadóttir1 deildarlæknir Jónas A. Aðalsteinsson1 deildarlæknir Hera Jóhannesdóttir1 deildarlæknir Sólveig Helgadóttir4 læknir Þórdís Jóna Hrafnkelsdóttir2,3 læknir Arnar Geirsson5 læknir Tómas Guðbjartsson1,3 læknir 1Hjarta- og lungnaskurðdeild, 2hjartadeild Landspítala, 3 læknadeild Háskóla Íslands, 4svæfinga- og gjörgæsludeild Akademíska sjúkrahússins í Uppsölum, Svíþjóð, 5hjartaskurðdeild Yale New Haven spítala, Bandaríkjunum. (Læknafélag Íslands, 2018-07)
      Inngangur Markmið þessarar rannsóknar var að bera saman árangur kransæðahjáveituaðgerða hjá konum og körlum á Íslandi með áherslu á snemm- og síðkomna fylgikvilla, 30 daga dánartíðni og langtímalifun. Efniviður og aðferðir Afturskyggn rannsókn á öllum sjúklingum sem gengust undir kransæðahjáveituaðgerð á Íslandi á árunum 2001-2013. Upplýsingar fengust úr sjúkraskrám og Dánarmeinaskrá Embættis landlæknis. Fylgikvillum var skipt í snemm- og síðkomna fylgikvilla og heildarlifun reiknuð með aðferð Kaplan-Meier. Fjölþátta aðhvarfsgreining var notuð til að meta forspárþætti dauða innan 30 daga og Cox aðhvarfsgreining til að meta forspárþætti verri langtímalifunar. Meðaleftirfylgd var 6,8 ár. Niðurstöður Af 1755 sjúklingum voru 318 konur (18%). Meðalaldur þeirra var fjórum árum hærri en karla (69 ár á móti 65 árum, p<0,001), þær höfðu oftar sögu um háþrýsting (72% á móti 64%, p=0,009) og EuroSCOREst þeirra var hærra (6,1 á móti 4,3, p<0,001). Hlutfall annarra áhættuþátta eins og sykursýki var hins vegar sambærilegt, líkt og útbreiðsla kransæðasjúkdóms. Alls létust 12 konur (4%) og 30 karlar (2%) innan 30 daga frá aðgerð en munurinn var ekki marktækur (p=0,08). Tíðni snemmkominna fylgikvilla, bæði minniháttar (53% á móti 48% p=0,07) og alvarlegra (13% á móti 11%, p=0,2), var sambærileg. Fimm árum frá aðgerð var lifun kvenna 87% borin saman við 90% hjá körlum (p=0,09). Þá var tíðni síðkominna fylgikvilla sambærileg hjá konum og körlum 5 árum frá aðgerð (21% á móti 19%, p=0,3). Kvenkyn reyndist hvorki sjálfstæður forspárþáttur 30 daga dánartíðni (OR 0,99; 95%-ÖB: 0,97-1,01) né verri lifunar (HR 1,08; 95%-ÖB: 0,82-1,42). Ályktun Mun færri konur en karlar gangast undir kransæðahjáveituaðgerð á Íslandi og eru þær fjórum árum eldri þegar kemur að aðgerð. Árangur kransæðahjáveitu er góður hjá konum líkt og körlum, en 5 árum eftir aðgerð eru 87% kvenna á lífi.
    • Burðarmálsdauði á Íslandi 1988-2017

      Ragnhildur Hauksdóttir; Þórður Þórkelsson; Gestur Pálsson; Ragnheiður I Bjarnadóttir; Ragnhildur Hauksdóttir 1,4, Þórður Þórkelsson 1,2,3, Gestur Pálsson 1,2,3, Ragnheiður I. Bjarnadóttir 1,2,4 -1 Landspítali, 2 læknadeild Háskóla Íslands, 3 Barnaspítala Hringsins, 4 kvennadeild Landspítala. (Læknafélag Íslands, 2018-07)
      Inngangur Með burðarmálsdauða er átt við fæðingu andvana barns eða dauða þess á fyrstu 7 dögunum eftir fæðingu. Tíðni burðarmálsdauða á Íslandi hefur verið ein sú allra lægsta í heiminum undanfarin ár. Markmið rannsóknarinnar var að kanna hvernig tíðni og orsakir burðarmálsdauða hafa breyst á síðastliðnum 30 árum, einkum til að meta hvort hugsanlega sé hægt að lækka tíðnina enn frekar. Efniviður og aðferðir Gerð var afturskyggn rannsókn og var rannsóknartímabilið 1988-2017. Upplýsingar um þau börn sem dóu á burðarmálsskeiði voru fengnar úr Fæðingaskrá og þau flokkuð samkvæmt NBPDC-flokkunarkerfi, sem byggist á að skilgreina þá flokka burðarmálsdauða sem hugsanlega væri hægt að fyrirbyggja. Breyting á burðarmálsdauða var reiknuð út sem árleg prósentubreyting með Poisson-aðhvarfsgreiningu. Niðurstöður Tíðni burðarmálsdauða lækkaði að meðaltali um 3,3% (p<0,001) á ári á tímabilinu miðað við ≥28+0 vikna meðgöngu. Börnum sem létust vegna meðfæddra galla fækkaði um 4,8% (p=0,001) á ári. Andvana fæðingum vaxtarskertra einbura eftir ≥28+0 vikna meðgöngu fækkaði um 3,1% (p=0,029) á ári. Andvana fæðingum einbura eftir ≥28+0 vikna meðgöngu sem voru ekki vaxtarskertir fækkaði ekki marktækt. Ályktun Tíðni burðarmálsdauða hefur lækkað umtalsvert síðastliðin 30 ár. Dauðsföllum vegna meðfæddra galla fækkaði mikið vegna framfara í fósturgreiningu. Andvana fæðingum vaxtarskertra barna hefur fækkað og hefur árvökul mæðravernd skipt þar miklu máli. Erfiðast hefur reynst að fækka andvana fæddum einburum án áhættuþátta eins og vaxtarskerðingar. Mikilvægt að fræða konur um þýðingu minnkaðra hreyfinga fósturs á meðgöngu, hlusta á þær og rannsaka þegar ástæða þykir til.
    • Evrópufaraldur lifrarbólgu A á Íslandi árið 2017. Algengar breytingar í gallblöðru á myndgreiningu

      Sif Ormarsdóttir; Páll Möller; Alma Óskarsdóttir; Pétur Hannesson; Arthur Löve; Haraldur Briem; 1 Landspítali, 2 læknadeild Háskóla Íslands, 3 Embætti landlæknis (Læknafélag Íslands, Læknafélag Reykjavíkur, 2018-06-05)
      Senda grein,Prenta greinEnglishFacebookTwitter Aim The incidence of hepatitis A (HAV) in Iceland is low with about one case per year in the last decades. Since 2016, there has been an ongoing outbreak of HAV in men who have sex with men (MSM). The aim of this study was to inves­tigate whether cases diagnosed in Iceland during 2017 had any link to the HAV outbreak in Europe. Methods All cases of HAV in Iceland during 2017 were reviewed retrospectively. Results Four of five cases diagnosed during 2017 were MSM and one was a female. Three cases presented the same week in the summer 2017. The age of the patients was between 25 and 39 years. All the male patients had had sex with men from Europe and/or had travelled to Europe prior to admission. All cases had typical signs and symptoms of HAV infection and in all cases recent infection was confirmed by positive serology and exclusion of other causes of acute hepatitis. Four of five patients had radiological signs of changes in the gallbladder with thickening of the wall and oedema and one underwent later an elective cholecystectomy. Conclusion The outbreak of HAV in MSM Europe reached Iceland in the summer 2017, emphasizing the importance of vaccination in this risk group as recommended by the Icelandic Health Authorities. The review of these cases indicate that changes such as thickening of the gallbladder wall without gallstones in patients with HAV are common. It is important to discrimi­nate patients with these changes associated with HAV from patients with acute acalculus cholecystitis.
    • Viðhorf íslenskra kvenna til erfðaráðgjafar og erfðaprófa á BRCA1 og BRCA2 stökkbreytingum

      Þórdís Jónsdóttir; Heiðdís Valdimarsdóttir; Laufey Tryggvadóttir; Sigrún Lund; Maríanna Þórðardóttir; Magnús Magnússon; Unnur Valdimarsdóttir; 1 Miðstöð í lýðheilsuvísindum, læknadeild Háskóla Íslands, 2 sálfræðideild Háskólans í Reykjavík, 3 Krabbameinsfélagi Íslands, 4 læknadeild Háskóla Íslands (Læknafélag Íslands, Læknafélag Reykjavíkur, 2018-06-05)
      Introduction The aim of this study was to explore the attitudes of Icelandic women towards existing genetic information, genetic counseling and genetic testing for BRCA mutations which dramatically increase risk for aggressive cancers. Materials and methods Women attending the cancer prevention clinic in Reykjavik, capital of Iceland, from October 12th until November 20th 2015 received an invitation to participate. Participation involved answering a short online questionnaire about background, family history of cancer as well as attitudes towards genetic counseling, BRCA testing and preventive use of such information. Descriptive statistics and chi-square tests were used to describe differences in attitudes towards those questions between subgroups of women. Results 1129 women (69% response rate) answered the questionnaire. Mean age was 47 years (span 21-76 years). Around half (47%) had heard fairly much about the mutations. Independent of family history of cancer, the majority of women were positive towards receiving genetic counseling (79%) and to undergo genetic testing (83%) for BRCA mutation with younger women being more interested than older women. On the other hand, only 4% of the women had already received genetic counseling and 7% undergone genetic testing. Women with family history of cancer were more knowledgeable about BRCA mutations (p<0.0001) and were less afraid of the consequence of being a mutation carrier (p<0.0001) compared to those with little or no family history. Regardless of family history, half (49%) worried that results from genetic testing could influence their health insurance. Almost all, or 97% of the women, were positive or very positive toward using existing genetic information obtained through scientific work, to inform affected indi­viduals of their mutation status. Conclusion Icelandic women are positive towards genetic counseling and testing for BRCA mutations although half of them worry that a positive result might affect their health insurance. Nevertheless, almost all women believe that existing genetic information should be used to inform carriers for preventive purposes.
    • Brátt kransæðaheilkenni hjá sjúklingum með eðlilegar eða nær eðlilegar kransæðar

      Sævar Vignisson; Ingibjörg Guðmundsdóttir; Þórarinn Guðnason; Ragnar Daníelsen; Maríanna Garðarsdóttir; Karl Andersen; 1 Læknadeild Háskóla Íslands, 2 hjartadeild, 3 röntgendeild Landspítala. (Læknafélag Íslands, Læknafélag Reykjavíkur, 2018-05-03)
      Senda grein,Prenta greinEnglishFacebookTwitter Introduction: The classical pathophysiological process underlying acute coronary syndromes has been considered to be plaque rup­ture followed by platelet activation and aggregation and subsequent thrombus formation leading to myocardial ischemia and infarction. A substantial number of patients with acute coronary syndromes appear to have normal or near normal (<50% stenosis) coronary arteries on angiography. Recently, this clinical entity has been coined MINOCA (Myocardial Infarction with Non-Obstructive Coronary Arteries). The purpose of this paper is to describe the proportion of MINOCA among ACS patients in Iceland. Material and methods: We performed a retrospective analysis of all admissions for acute coronary syndromes at Landspitali University Hospital, the single coronary catheterization facility in Iceland, during a five year period between 2012 and 2016. All patients admitted for STEMI or NSTEMI that turned out to have normal or near normal coronary arteries were consecutively included in the study. For each patient the diagnosis was re-evaluated according to further assessments using a diagnostic algorithm specially constructed for this study. Results: During the five year study period 1708 patients were studied with coronary angiography during first hospitalization for STEMI or NSTEMI. Among these, 225 (13.2%) had normal or non-obstructive coronary arteries with less than 50% luminal narrowing. The final diagnosis of these patients were plaque erosion / rupture in 72 indi­viduals (32%), myocarditis in 33 (14.7%), takotsubo cardiomyopathy in 28 (12.4%), type II myocardial infarction in 30 (13.3%), vasospastic angina in 31 (13.8%) and other or undetermined cause in 31 (13.8%) patients. Conclusion: The proportion of MINOCA in Iceland is 13.2% of patients admitted for acute coronary syndromes. Plaque erosion / rupture was considered a likely cause in one third of patients with other causes beeing evenly distributed with approximately half that frequency. Identification of the underlying cause of MINOCA would become more accurate with a consistent use of cardiac magnetic resonance imaging in these patients as it provided a definitive diagnosis in all of those ­studied.
    • Skimun fyrir berklum meðal gigtarsjúklinga sem hófu meðferð með TNFa-hemlum á Íslandi 1999-2014

      Þórir Björgúlfsson; Gerður Gröndal; Þorsteinn Blöndal; Björn Guðbjörnsson; 1 Gigtarlækningar Landspítala, 2 göngudeild sóttvarna, Heilsugæslu höfuðborgarsvæðisins, 3 læknadeild Háskóla Íslands, 4 rannsóknastofu í gigtarsjúkdómum (Læknafélag Íslands, Læknafélag Reykjavíkur, 2018-05-03)
      Introduction: Treatment with TNFα inhibitors (TNFαi) greatly increases the risk of reactivation of tuberculosis in rheumatic patients. Therefore, it is recommended to screen patients for tuberculosis before initiating TNFαi treatment. Iceland has a low prevalence of tuberculosis and BCG vaccination is not routine praxis. The purpose of this study was to review the results from TB-screening in routine praxis and to analyze whether changes in the screening process are to be recommended. Material and methods: All patients with RA, PsA and AS who were registered in ICEBIO (1999-2014) due to TNFαi treatment were included. Data collection consisted of age, sex, start date of TNFαi treatment and results from a tuberculin skin test (TST) and chest x-ray. The data were then crosschecked with the Berkill registry, a nationwide database for TB. Results: 756 individuals (58% female, mean-age of 54 years) were included. TST was negative in 614 cases (81%), 41 positive (5.4%), 9 false positives (1.2%) and 92 were missing (12%). 119 patients were registered in Berkill whereof 72 had a history of positive TST and 55 had been vaccinated, while 14 patients had been diagnosed with tuberculo­sis (where of 7 had negative TST on screening). Three patients were diagnosed with tuberculosis after the TNFi treatment. Conclusion: These results illustrate the importance of tuberculosis screening before initiating TNFαi treatment. Improvement in registration of TST results is necessary and whether interferon gamma release assays (IGRA) should be added to the screening process remains to be discussed.
    • ADHD meðal barna og unglinga: samsláttur við aðrar raskanir

      Urður Njarðvík; Sálfræðideild Háskóla Íslands (Sálfræðingafélag Íslands, 2018-04-18)
      Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common reasons for referrals in child mental health services. Comorbidity with other disorders is so frequent that children are more commonly diagnosed with an additional disorder than ADHD alone. The purpose of this article is to provide a review of research on the prevalence of various comorbid disorders among children and adolescents with ADHD. The most common psychiatric and neurodevelopmental disorders are discussed, their prevalence examined and studies compared in terms of research methods. Icelandic studies are included whenever possible. The most prevalent comorbid disorders were oppositional defiance disorder and anxiety disorders (up to 40%). Mood disorders were also prevalent (up to 20%) while autism spectrum disorders and tic disorders were reported at a lower rate. Icelandic studies are sparse but available data suggests a high frequency of comorbidity, especially with anxiety disorders and depression. As additional diagnoses negatively impact the progress of children with ADHD, it is essential that professionals working with this group of children regularly screen for these disorders and closely monitor the course of symptoms. Keywords: ADHD, comorbidity, children, psychopathology, epidemiology.
    • Þvagsýrugigt - læknanleg liðbólga

      Guðrún Jóhannsdóttir; Ólafur Pálsson; Helgi Jónsson,; Björn Guðbjörnsson; 1 Sérnámslæknir á lyflækningasviði Landspítalia, 2 gigtardeild, 3 rannsóknarstofu í gigtarsjúkdómum, Landspítala, 4 læknadeild Háskóla Íslands. (Læknafélag Íslands, Læknafélag Reykjavíkur, 2018-04-04)
      Gout is a disabling and common arthritis with increasing prevalence. Without treatment the disease can cause permanent joint damage. It is commonly associated with the metabolic syndrome but can also be related to a number of life-threatening diseases and their treatments. Gout is often misdiagnosed and its long-term management is suboptimal despite the availability of effective treatments. Recently The American College of Rheumatology (ACR) and European League against Rheumatism (EULAR) released common guidelines for the diagnosis of gout and EULAR updated their guidelines for management. There is increased emphasis on preventive treatment, both with lifestyle modifications and pharmacotherapy. It is important to educate patients about the disease and the existence of effective treatment options, how to manage an acutely inflamed joint and why it is important to lower serum urate. When a patient is diagnosed with gout he should be screened for associated comorbidities. It is important to treat-to-target and lower serum urate over a long period of time to induce permanent remission of gouty arthritis.
    • Sykursýki er áskorun: Tíu ára eftirfylgd einstaklinga með sykursýki

      Hafdís Guðlaugsdóttir; Árún Sigurðardóttir; 1 Heilbrigðisstofnun Suðurnesja, 2 Landspítala, 3heilbrigðisvísindasviði Háskólans á Akureyri, 4 Sjúkrahúsinu á Akureyri (Læknafélag Íslands, Læknafélag Reykjavíkur, 2018-04-04)
      Inngangur: Sykursýki er langvinnur sjúkdómur með alvarlega og kostnaðarsama fylgikvilla. Það er því mikilvægt að bregðast við fjölgun tilfella af sykursýki með góðu og skipulögðu eftirliti. Tilgangur rannsóknarinnar var að rannsaka afturskyggnt árangur eftirfylgni í 10 ár á svipgerð líkamlegra mæligilda, hjá hópi fólks með sykursýki tegund eitt og tvö sem hefur verið í eftirliti á sérhæfðri sykursýkismóttöku á heilsugæslustöð og bera saman við alþjóðastaðla. Efniviður og aðferðir: Afturskyggn ferlirannsókn yfir 10 ár, þar sem upplýsingar voru fengnar úr rafrænni sjúkraskrá og gagnagrunni sykursýkismóttöku Heilbrigðisstofnunar Suðurnesja árin 2005, 2010 og 2015. Ein mæling var notuð hvert ár fyrir hvern þátttakenda (n=113). Þýðið voru þeir sem skráðir voru í móttökuna í upphafi árs 2005. Mæligildi hópsins voru metin og borin saman við alþjóðastaðla og mæting í eftirlit greint. Niðurstöður: Meðal HbA1c-gildið var 7,22% árið 2005 en hækkaði marktækt í 7,56% árið 2015 (P=0,040). Hlébilsþrýstingur lækkaði marktækt til 2015. Flestir náðu alþjóðamarkmiðum í HbA1c-gildi 2005 (51,3%), HDL árið 2010 (43,8%), LDL árið 2015 (41,9%), þríglýseríði 2010 (79,8%), líkamsþyngdarstuðli (LÞS) 2015 (44,2%), slagbilsþrýstingi árið 2010 (63,4%) og hlébilsþrýstingi 2015 (74,2%). Marktæk tengsl voru milli einkenna frá taugakerfi og hærra HbA1c-gildis. Líkamsþyngdarstuðull var um 32 kg/m² öll árin. Skráning á fylgikvillum sykursýkinnar batnaði við upptöku sykursýkiseyðublaðs í skráningarkerfinu Sögu árið 2015. Ályktanir: Lækka þarf meðal HbA1c-gildið til að minnka líkur á fylgikvillum og skoða leiðir til að ná blóðfitu- og blóðþrýstingsgildum nær alþjóðastöðlum. Gera þarf átak til að bæta skráningu. - Introduction: Diabetes is a chronic disease often with serious and costly complications. Therefore well organised diabetes care is needed. The purpose was to research outcome of treatment on biological parameters in people with type one and two diabetes in one primary care over ten years and compare with international guidelines. Material and methods: Retrospective cohort study, information was gathered from medical records at Sudurnes Health Center, in the years 2005, 2010 and 2015. The sample was persons listed in diabetes unit in beginning of 2005. One measurement for every participant each of the three years was used (n=113). Biological parameters were analysed and compared to international guidelines and attendance to clinic examined. Results: HbA1c level was 7.22% in 2005 but increased significantly to 7.56% in 2015. Diastolic blood pressure decreased significantly to 2015. Most achieved international guidelines in HbA1c goals in 2005 (51%), HDL in 2010 (43.8%), LDL in 2015 (41.9%) TG, in 2010 (79.8%), BMI in 2015 (44.2%), systolic blood pressure in 2010 (63.4%) and diastolic blood pressure in 2015 (74.2%). BMI was around 32 kg/m² in all three years. In 2015, association was found between neuropathic symptoms and higher HbA1c level. Documentation regarding diabetes complications became much better in 2015 when a new form for electronic documentation was launched. Conclusion: Tighter blood glucose control is needed to lessen risk of complications, as well as to reduce lipid and blood pressure closer to international guidelines. Improving documentation is important.
    • Samanburður á styrk grindarbotnsvöðva hjá keppnisíþróttakonum og óþjálfuðum konum

      Ingunn Lúðvíksdóttir; Hildur Harðardóttir; Þorgerður Sigurðardóttir; Guðmundur Úlfarsson; 1 CrossFit Sport, Sporthúsinu, 2 læknadeild Háskóla Íslands, 3 kvennadeild Landspítala, 4 Táp sjúkraþjálfun, 5 umhverfis- og byggingarverkfræðideild Háskóla Íslands. (Læknafélag Íslands, Læknafélag Reykjavíkur, 2018-03-05)
      Introduction: Exercise can stress the pelvic floor muscles. Numerous women experience urinary incontinence while exercising or competing in sports. This study investigated pelvic floor muscle strength, urinary incontinence, and knowledge in contracting pelvic floor muscles among female athletes and untrained women. Materials and methods: This was a prospective case-control study measuring pelvic floor muscle strength using vaginal pressure meas­urement. Participants answered questions regarding general health, urinary incontinence, and knowledge on pelvic floor muscles. Partici­pants were healthy nulliparous women aged 18-30 years, athletes and untrained women. The athletes had competed in their sport for at least three years; including handball, soccer, gymnastics, badminton, BootCamp and CrossFit. Results: The women were comparable in age and height. The athletes (n=18) had a body mass index (BMI) of 22.8 kg/m² vs. 25 kg/m² for the untrained (n=16); p<0.05. The athletes trained on average 11.4 hours/week while the untrained women participated in some activity on average for 1.3 hours/week; p<0.05. Mean pelvic floor strength was 45±2 hPa in the athletes vs. 43±4 hPa in the untrained; p=0.36 for whether the athletes were stronger. Of the athletes, 61.1% experienced urinary incontinence (n=11) compared with 12.5% of the untrained women (n=2); p<0.05. Incontinence usually occurred during high intensity exercise. The athletes were more knowledgeable about the pelvic floor muscles; p<0.05. Conclusion: There was not a significant difference in the strength of pelvic floor muscles of athletes and untrained women. This suggests that pelvic floor muscles are not strengthened during general training but require specific exercises. This holds especially for football, handball and sports with high physical intensity. Coaches need to pay special attention to training and strengthening women's pelvic floor muscles to reduce the occurrence of urinary incontinence.
    • Lifrarbólga A á Íslandi

      Hallfríður Kristinsdóttir; Arthur Löve; Einar Stefán Björnsson; 1 Læknadeild Háskóla Íslands, 2 veirufræðideild, 3 meltingardeild Landspítala (Læknafélag Íslands, Læknafélag Reykjavíkur, 2018-03-05)
      Senda grein,Prenta greinEnglishFacebookTwitter Introduction: Hepatitis A virus (HAV) epidemics occurred repeatedly in Iceland in the early 20th century, but since then few cases have been reported and no epidemics since 1952. The latest Icelandic studies on HAV from around 1990 showed low incidence of infection and de­- creasing prevalence of antibodies. The objective of this study was to determine the incidence, clinical presentation and origin of HAV, abroad or in Iceland. Material and methods: A retrospective search was undertaken on all patients with positive anti-HAV IgM during the 11 years period of 2006-2016 in the virological database of the National University Hospital of Iceland. Clinical data was collected from medical records on symptoms at diagnosis, blood test results and possible route of transmission. Results: A total of 12 individuals were diagnosed with acute hepatitis A during the period and 6691 HAV total andibody tests and 1984 HAV IgM antibody tests were performed. Nine (75%) had been abroad within 7 weeks from initial symptoms. The most common symptoms were jaundice (83%), fever (67%) and nausea and/or vomiting (58%). 50% were admitted to a hospital. 42% had elevated INR/PT. Everyone sur­vived without complications. Conclusion: Annually, approximately one case of acute hepatitis A was diagnosed in Iceland during the study period but a very high number of antibody tests were performed. The majority of cases occurred among individuals who had recently been abroad. If patients have jaundice, fever and nausea, testing for HAV infection should be undertaken. HAV is not endemic in Iceland.
    • Ótilgreindir brjóstverkir og tengsl við viðvarandi verkjaupplifun og vanlíðan

      Erla Svansdóttir; Sesselja Hreggviðsdóttir; Björg Sigurðardóttir; Elísabet Benedikz; Karl Andersen; Hróbjartur Darri Karlsson; 1 Gæða- og sýkingavarnadeild Landspítala, 2 sálfræðideild Háskóla Íslands, 3 Hjartagátt Landspítala, 4 læknadeild Háskóla Íslands, 5 læknadeild Háskóla Otago, Dunedin, Nýja Sjálandi, 6 hjartadeild, SDHB Dunedin, Nýja Sjálandi. (Læknafélag Íslands, Læknafélag Reykjavíkur, 2018-02-05)
      Introduction: An estimated 50-75% of visits to cardiac emergency departments are due to chest pain which is non-cardiac in nature (non-cardiac chest pain (NCCP). This study evaluates the prevalence of NCCP in the emergency departments at Landspitali, and assesses its association with continued chest-pain post discharge, mental well-­being and the information-provision provided to NCCP patients during hospitalization. Material and methods: Participants were 390 patients (18-65 years) presenting with chest pain to the cardiac emergency or the general emergency department at Landspitali from October 2015-May 2016. Measurements included questionnaires assessing somatic symptoms, mental well-being and quality of life, and questions regarding continued chest-pain and information-provision during hospitalization. Results: In total 72% of participants (282) were considered having NCCP while 24% (92) had cardiac disease. NCCP patients experienced a similar burden of somatic and depressive symptoms, but slightly more anxiety and mental distress than cardiac patients. Equal proportions (60%) of NCCP and cardiac patients reported having experienced chestpain post discharge. Continued chest-pain was, however, associated with greater anxiety (β=0.18, p<0.001) and depression (β=0.18, p<0.003) among NCCP patients. Thirty percent of NCCP patients lacked instructions of how to respond to continued chest-pain and only 40% received information regarding other possible causes of chest pain. Conclusion: NCCP was prevalent among patients presenting to emergency departments at Landspitali. The majority of NCCP patients experienced continued chest-pain after discharge, and such pain experience was associated with mental distress. A third of NCCP patients lacked information about possible causes for the pain and advice about coping with symptoms.
    • Hreyfing og svefn reykvískra ungmenna

      Vaka Rögnvaldsdóttir,; Berglind M. Valdimarsdóttir; Brychta, Robert J.; Soffía M Hrafnkelsdóttir; Sigurbjörn Á. Arngrímsson; Erlingur Jóhannsson; Chen, Kong Y.; Sigríður L. Guðmundsdóttir; 1 Rannsóknastofu í íþrótta- og heilsufræði, menntavísindasviði Háskóla Íslands, 2 NIH, Heilbrigðisstofnun Bandaríkjanna, 3 deild Íþrótta og hreyfingar, Háskóli hagnýtra vísinda í Vestur-Noregi, Bergen (Læknafélag Íslands, Læknafélag Reykjavíkur, 2018-02-05)
      Introduction: Physical activity and sleep are major determinants of overall health. According to international recommendations, adolescents should engage in moderate to vigorous physical activity for at least 60 min each day and sleep eight to ten hours each night. The association between physical activity and sleep in adolescents is not well known. The aim of the study was to estimate a) the proportion of Icelandic adolescents that achieves recommended physical activity and sleep, b) if there is an association between physical activity and sleep patterns, and c) sex differences in physical activity and sleep. Material and methods: A total of 411 adolescents from the 10th grade in six schools in Reykjavik were invited to participate in a cross-sectional study in the spring of 2015. Valid data was obtained from 106 boys and 160 girls. Objective and subjective measures of physical activity and sleep were made by wrist-worn accelerometers and a questionnaire. Results: Almost half of the participants fulfilled the physical activity recommendations according to the questionnaire. Although 51.1% reported usually getting enough sleep, only 22.9% achieved the recommended sleep length according to objective assessment. No associations were observed between sleep and subjective physical activity. Girls had higher accelerometer-measured physical activity than boys on non-school days (p<0.01), but weekly averages were not different between sexes. Girls and boys did not differ in subjective or objective measures of sleep. Conclusion: The behavior of Icelandic adolescents does not reflect recommended amount of sleep and physical activity. Only 22.9% obtained the recommended sleep length and just 11.3% fulfilled recommendations of both sleep and physical activity.
    • Severe cholestatic hepatitis due to large vessel vasculitis: report of two cases

      Xu, Jason; Björnsson, Einar S.; Sundaram, Vinay; [ 1 ] Cedars Sinai Med Ctr, Dept Med, Los Angeles, CA 90048 USA Show more [ 2 ] Natl Univ Hosp Iceland, Dept Gastroenterol & Hepatol, Reykjavik, Iceland Show more [ 3 ] Univ Iceland, Fac Med, Reykjavik, Iceland Show more [ 4 ] Cedars Sinai Med Ctr, Div Gastroenterol & Hepatol, Los Angeles, CA 90048 USA Show more [ 5 ] Cedars Sinai Med Ctr, Comprehens Transplant Ctr, Los Angeles, CA 90048 USA (Oxford University Press, 2018-02)
      Giant cell arteritis (GCA) is a vasculitis of medium and large sized vessels that occurs most often in people > 50 years of age with associated symptoms of fever, weight loss, headache and jaw claudication. Polymyalgia rheumatica (PMR), which is characterized by aching and stiffness in the shoulders, hip girdle, neck and torso, is intimately associated with GCA, and evidence suggests that GCA and PMR are two phases of the same disease. The occurrence of liver enzyme abnormalities in either of these conditions is rare. Furthermore, as these conditions occur most commonly in the elderly population who may be subject to polypharmacy, patients with elevated aminotransferases due to underlying GCA/PMR may mistakenly have their abnormal liver function tests attributed to drug-induced liver injury. Given the potential complications of these diseases if left untreated, including ischemic stroke and blindness, early recognition and treatment are critical. We report two patients who developed severe cholestatic liver enzyme elevation, which had been initially attributed to drug toxicity, but was ultimately caused by large vessel vasculitis, specifically GCA and PMR.
    • Segabrottnám við brátt blóðþurrðarslag er mesta framför í læknisfræði í áraraðir

      Albert Páll Sigurðsson; Taugadeild Landspítala Fossvogi (Læknafélag Íslands, Læknafélag Reykjavíkur, 2018-01-04)
      This article discusses endovascular thrombectomy in acute ischemic stroke. This treatment is vascular medicine's most significant leap in years. This treatment is complicated, and various technical aspects are discussed. Close cooperation is required between different specialties since patient selection for treatment is complex. Interventionists need close collaboration with stroke neurologists. Government needs to be involved as this treatment mandates structural changes which will incur more manpower and financial resources. Telemedicine is also discussed as it has been shown to be advantageous for augmenting thrombolytic administration for acute ischemic stroke. Due to technical advances, it has been easier to provide such service, but hurdles need to be resolved so it can be fully implemented. It is likely that telemedi­cine will also play a role in thrombectomy. This article proposes how thrombectomy could be delivered in Iceland. It will prove difficult to provide such complex treatment in a scattered population of 343.000 people where expertise is limited to one or two sites. It is important to remember, that coronary intervention was a formidable challenge at one time, but it was accomplished. Can we learn from that experience?
    • Verkferlar í tengslum við fæðuofnæmi og fæðuóþol í leikskólum Reykjavíkurborgar

      Aðalheiður Rán Þrastardóttir; Fríða Rún Þórðardóttir; Jóhanna Torfadóttir; 1 Miðstöð í lýðheilsuvísindum Háskóla Íslands, 2 Landspítala, 3 Háskóla Íslands. (Læknafélag Íslands, Læknafélag Reykjavíkur, 2018-01-04)
      Introduction: The aim of the study was to explore prevalence of food allergies and intolerances among children in preschools in Reykjavik, Iceland. Also, to investigate how well preschools maintain a safe environment for children with food allergies. Materials and methods: In 2014, a questionnaire designed specifically for this study, was sent to 65 preschools. Forty-nine participated (75%) representing a total of 4225 children. Prevalence of food allergy and intolerance was determined based on medical certificates from physi­cians delivered to the preschools. Descriptive statistics were used to assess whether there were protocols related to food allergy, and if there was a difference between schools based on staff‘s education and number of children. Results: The prevalence of documented food allergies/intolerances in children aged 2-6 years was 5%, 1% had severe allergy and 1% had multiple food allergies. Lactose intolerance was most frequent (2%), then milk allergy (2%) and egg allergy (1%). Only 41% preschools had a protocol that was activated if food with an allergen was accidentally given. Moreover, only 55% of preschools with children with severe ­allergy reported all of their staff to have knowledge of symptoms related to anaphylaxis and only 64% were trained to respond to an anaphylactic shock. The education of preschool principals, kitchen employees and number of children in preschool were not related to having an active protocol at site. Conclusion: Prevalence of food allergy and intolerance was 5% in preschools in Reykjavik. Strategy for an active protocol related to food allergy was lacking in 59% of pre-schools.
    • Áhrif slökunarmeðferðar á einkenni sjúklinga með krabbamein

      Þóra Jenný Gunnarsdóttir; Lilja Jónasdóttir; Nanna Friðriksdóttir; 1) Hjúkrunarfræðideild Háskóla Íslands 2) Landspítala 3) Landspítala og hjúkrunarfræðideild Háskóla Íslands (Félag íslenskra hjúkrunarfræðinga, 2018)
      Relaxation therapy has been offered at the oncology and haematology outpatient clinic at Landspítali, the national university hospital in Reykjavík, Iceland, for more than a decade. Many patients are satisfied with the therapy, but little is known about other outcomes. The purpose of this study was to assess changes in nine common symptoms among cancer patients who received relaxation therapy. Patients who receive relaxation therapy have since 2007 been asked to complete the Edmonton Symptom Assessment Scale (ESAS) before and after each therapy session. ESAS includes nine symptoms with severity scored on a 0-10 numeric rating scale. Higher scores indicate more severity. A retrospective chart review was completed on charts from patients who received relaxation therapy from January 2007 until August 2008. Data from 251 cancer patients was analyzed and symptom ratings were compared before and after the relaxation therapy. The results showed significant decrease in symptom prevalence, mean number of symptoms, and symptom severity. The prevalence of patients with worst feeling of well-being decreased from 92% to 59%, tiredness from 87% to 65%, anxiety from 78% to 54% and shortness of breath from 60% to 40%. The mean number (SD) of symptoms decreased from 6.2 (2.2) to 4.8 (2.8) (p<0.001). The symptom severity decreased significantly for all symptoms with the largest difference between the severity means (SD) for symptoms of well-being which improved from 3.8 (1.9) to 1.8 (2.1) (p< 0.001). Tiredness decreased from 3.9 (2.2) to 1.9 (1.9) (p< 0.001) and anxiety from 3.5 (2.1) to 1.5 (1.6) (p<0.001). In conclusion, these results indicate that this individualized relaxation therapy is effective, at least in the short term, to reduce both symptom prevalence and severity of symptoms common in cancer patients. The integration of relaxation therapies should be enhanced within the hospital settings among cancer patients. Key words: Relaxation therapy, integrative medicine, symptoms, cancer, ESAS.