Now showing items 1-20 of 7336

    • Accidental poisoning, intentional self-harm and event of undetermined intent mortality over 20 years in Iceland: a population-based cohort study.

      Gunnarsdottir, Oddny Sigurborg; Rafnsson, Vilhjálmur; 1Office of Education, Research and Development, Landspitali-the National University Hospital of Iceland, Reykjavík, Iceland. 2Department of Preventive Medicine, Faculty of Medicine, University of Iceland, Reykjavík, Iceland vilraf@hi.is. (BMJ Publishing Group, 2020-05-20)
      Objectives: The aim was to study mortality due to suicide, accidental poisoning, event of undetermined intent and drug-related deaths through 20 years in Iceland. Design: A population-based register study. Participants: Individuals who died due to road traffic injury, suicide, accidental poisoning, event of undetermined intent and drug-related deaths in the population of Iceland during the years 1996-2015. Annual age-standardised rates were calculated, and the trend analysed by Pearson correlation and joinpoint regression. Setting: The population of Iceland framed the study material, and the data were obtained from nationwide registries for information on number of deaths and age-specific mean population in each year by gender. Results: The crude overall suicide rate during the last 10 years was 12.2 per 100 000 persons per year (95% CI 7.4 to 18.1), while the crude overall rate due to road traffic injuries was 4.6 per 100 000 persons per year (95% CI 2.0 to 8.3). Among men, suicide rates decreased, however not significantly (r(19)=-0.22, p=0.36), and for overdose by narcotics the rates increased significantly (r(19)=0.72, p<0.001) during the study period. Among women, the suicide rates increased, however not significantly (r(19)=0.35, p=0.13), for accidental poisoning, suicide and event of undetermined intent combined the rates increased significantly (r(19)=0.60, p=0.006); and the rates for overdose by sedative and overdose by narcotics both increased significantly r(19)=0.49, p=0.03, and r(19)=0.67, p=0.001, respectively. Conclusion: The suicide rates have not changed during 1996 to 2015; however, the rates for the combined accidental poisoning, suicide and event of undetermined intent increased significantly for women. The rise of the overdose rates for sedative among women and for narcotics among both genders are consistent with reports elsewhere. Keywords: epidemiology; public health; statistics & research methods; substance misuse; suicide & self-harm.
    • Þegar orkuna skortir – áhrif hlutfallslegs orkuskorts í íþróttum (RED-s) á heilsu og árangur

      Birna Varðardóttir; Sigríður Lára Guðmundsdóttir1; Anna Sigríður Ólafsdóttir; Deild heilsueflingar, íþrótta og tómstunda, menntavísindasviði Háskóla Íslands (Læknafélag Íslands, 2020-09)
      Mikilvægt er að íþróttafólk á öllum aldri tileinki sér mataræði sem styður sem best við heilsu og vellíðan, þjálffræðilega aðlögun, endurheimt og meiðslaforvarnir. Tiltæk orka vísar til þeirrar orku sem stendur eftir fyrir grunnstarfsemi líkamans þegar búið er að draga þá orku sem varið er við líkamlega þjálfun frá orkunni sem fæst úr fæðunni sem neytt er dag hvern. Hlutfallslegur orkuskortur í íþróttum (Relative Energy Deficiency in Sport, RED-s) stafar af viðvarandi skorti á tiltækri orku og hefur víðtæk áhrif á íþróttafólk, óháð kyni og getustigi. Áhrif RED-s geta meðal annars falið í sér skerðingu á efnaskiptahraða, hormónastarfsemi og tíðahring kvenna, beinheilsu, ónæmisvörnum, nýmyndun próteina og starfsemi hjarta- og æðakerfis. Slíkar truflanir á líkamsstarfsemi geta haft neikvæð áhrif á heilsu og íþróttaárangur til lengri og skemmri tíma. Þekkt er að RED-s getur átt sér mismunandi orsakir og birtingarmyndir. Samkvæmt erlendum rannsóknum er algengi breytilegt eftir íþróttagreinum og sérhæfingum innan þeirra en áhættan er talin hvað mest í úthaldsíþróttum, fagurfræðilegum íþróttum og þyngdarflokkaíþróttum. Greinin tekur saman þekkingu á áhrifum RED-s á heilsu og árangur, mikilvægi skimunar og snemmbærs inngrips. Þörf er á rannsóknum á RED-s meðal íslensks íþróttafólks sem gætu lagt grunninn að íslenskum ráðleggingum auk þess að efla forvarnir og meðferð
    • Snemmíhlutun í illvígri gláku með örígræði – minnsta ígræði sem grætt hefur verið í mannslíkamann - Tilfelli mánaðarins

      María Soffía Gottfreðsdóttir; Augndeild Landspítala læknadeild Háskóla Íslands (Læknafélag Íslands, 2020-09)
    • Samanburður á greiningu og meðferð ífarandi brjóstakrabbameina milli Íslands og Svíþjóðar

      Lilja Dögg Gísladóttir; Helgi Birgisson; Bjarni A. Agnarsson; Þorvaldur Jónsson; Laufey Tryggvadóttir; Ásgerður Sverrisdóttir; 1 Læknadeild Háskóla Íslands, 2 Landspítala, 3Krabbameinsskrá Krabbameinsfélags Íslands. (Læknafélag Íslands, 2020-09)
      TILGANGUR Rannsóknin var liður í innleiðingu gæðaskráningar brjóstakrabbameina á Íslandi og markmiðið að bera saman greiningu og meðferð ífarandi brjóstakrabbameina á Íslandi og í Svíþjóð. EFNIVIÐUR OG AÐFERÐIR Upplýsingar um alla einstaklinga sem greindust með ífarandi brjóstakrabbamein á Íslandi 2016-2017 fengust frá Krabbameinsskrá. Breytur úr sjúkraskrám voru skráðar í eyðublöð í Heilsugátt að fyrirmynd sænsku gæðaskráningarinnar og voru niðurstöður bornar saman við niðurstöður fyrir ífarandi brjóstakrabbamein af heimasíðu sænsku krabbameinsskrárinnar. Notað var tvíhliða kí-kvaðrat-próf til að bera saman hlutföll. NIÐURSTÖÐUR Á rannsóknartímabilinu greindust 486 ífarandi brjóstakrabbamein á Íslandi og 15.325 í Svíþjóð. Hlutfallslega færri 40-69 ára konur greindust við hópleit á Íslandi (46%) en í Svíþjóð (60%) (p<0,01). Á Íslandi voru haldnir heldur færri samráðsfundir fyrir fyrstu meðferð (92%) og eftir aðgerð (96%) miðað við Svíþjóð árið 2016 (98% og 99%) (p<0,05) en ekki var marktækur munur 2017. Varðeitlataka var gerð í 69% aðgerða á Íslandi en í 94% aðgerða í Svíþjóð (p<0,01). Ef æxlið var ≤30 mm var á Íslandi gerður fleygskurður í 48% tilvika en í 80% tilvika í Svíþjóð (p<0,01). Á Íslandi fengu 87% geislameðferð eftir fleygskurð en 94% í Svíþjóð (p<0,01). Ef eitlameinvörp greindust í brottnámsaðgerð þá fengu 49% geislameðferð eftir aðgerð á Íslandi en 83% í Svíþjóð (p<0,01). ÁLYKTANIR Marktækur munur er á ýmsum þáttum greiningar og meðferðar ífarandi brjóstakrabbameina milli Íslands og Svíþjóðar. Með gæðaskráningu brjóstakrabbameina á Íslandi er hægt að fylgjast með og setja markmið um ákveðna þætti greiningar og meðferðar í því skyni að veita sem flestum einstaklingum bestu meðferð.
    • Það sem ég tala um þegar ég tala um COVID-19

      Thor Aspelund; Miðstöð lýðheilsuvísindum, Háskóla Íslands, Hjartavernd (Læknafélag Íslands, 2020-09)
    • Hefur Nýja-Sjáland fundið réttu leiðina gegn COVID-19?

      Murdoch, David R; Rektor Otago-háskólans í Christchurch á Nýja-Sjálandi (Læknafélag Íslands, 2020-09)
    • No transmission of SARS-CoV-2 to 23 healthcare professionals involved in advanced life support of COVID-19 patient - association with low viral RNA in respiratory specimens.

      Ingason, Arnar B; Jóhannesson, Jón M; Halldórsson, Jón T; Júlíusson, Unnsteinn I; Halldórsdóttir, Áslaug; Böðvarsson, Ásgeir; 1Husavik Hospital and Health Care Center, Husavik, Iceland. 2University of Iceland, Faculty of Medicine, Iceland. 3Department of Internal Medicine, Landspitali University Hospital, Iceland. 4Akureyri Primary Health Care Center, Akureyri, Iceland. (Taylor & Francis, 2020-08-21)
    • Characteristics of incidence hip fracture cases in older adults participating in the longitudinal AGES-Reykjavik study.

      Skuladottir, S S; Ramel, A; Hjaltadottir, I; Launer, L J; Cotch, M F; Siggeirsdottir, K; Gudnason, V; Sigurdsson, G; Steingrimsdottir, L; Halldorsson, T; et al. (Springer, 2020-08-18)
      Poor physical function and body composition my partly predict the risk of falls leading to fracture regardless of bone mineral density. Introduction: To examine the relationship between body composition, physical function, and other markers of health with hip fractures in older community-dwelling Icelandic adults. Methods: A prospective cohort of 4782 older adults from the AGES-Reykjavik study. Baseline recruitment took place between 2002 and 2006, and information on hip fractures occurring through 2012 was extracted from clinical records. Using multivariate regression analyses, baseline measures of bone health, physical function, and body composition were compared between those who later experienced hip fractures and to those who did not. Associations with the risk of fractures were quantified using Cox regression. Results: Mean age was 76.3 years at baseline. After adjustment for age, regression showed that male hip fracture cases compared with non-cases had (mean (95% confidence interval)) significantly lower thigh muscle cross-sectional area - 5.6 cm2 (- 10.2, - 1.1), poorer leg strength - 28 N (- 49, - 7), and decreased physical function as measured by longer timed up and go test 1.1 s (0.5, 1.7). After adjustment for age, female cases had, compared with non-cases, lower body mass index - 1.5 kg/m2 (- 2.1, - 0.9), less lean mass - 1.6 kg (- 2.5, - 0.8), thigh muscle cross-sectional area - 4.4 cm2 (- 6.5, - 2.3), and worse leg strength - 16 N (- 25, - 6). These differences largely persisted after further adjustment for bone mineral density (BMD), suggesting that body composition may contribute to the risk of fracture independent of bone health. When examining the association between these same factors and hip fractures using Cox regression, the same conclusions were reached. Conclusions: After accounting for age and BMD, older adults who later experienced a hip fracture had poorer baseline measures of physical function and/or body composition, which may at least partly contribute to the risk of falls leading to fracture. Keywords: Aging; Biomarkers; Body composition; Hip fracture; Physical function.
    • A gene expression-based single sample predictor of lung adenocarcinoma molecular subtype and prognosis.

      Liljedahl, Helena; Karlsson, Anna; Oskarsdottir, Gudrun N; Salomonsson, Annette; Brunnström, Hans; Erlingsdottir, Gigja; Jönsson, Mats; Isaksson, Sofi; Arbajian, Elsa; Ortiz-Villalón, Cristian; et al. (Wiley, 2020-08-03)
      Disease recurrence in surgically treated lung adenocarcinoma (AC) remains high. New approaches for risk stratification beyond tumor stage are needed. Gene expression-based AC subtypes such as the Cancer Genome Atlas Network (TCGA) terminal-respiratory unit (TRU), proximal-inflammatory (PI) and proximal-proliferative (PP) subtypes have been associated with prognosis, but show methodological limitations for robust clinical use. We aimed to derive a platform independent single sample predictor (SSP) for molecular subtype assignment and risk stratification that could function in a clinical setting. Two-class (TRU/nonTRU=SSP2) and three-class (TRU/PP/PI=SSP3) SSPs using the AIMS algorithm were trained in 1655 ACs (n = 9659 genes) from public repositories vs TCGA centroid subtypes. Validation and survival analysis were performed in 977 patients using overall survival (OS) and distant metastasis-free survival (DMFS) as endpoints. In the validation cohort, SSP2 and SSP3 showed accuracies of 0.85 and 0.81, respectively. SSPs captured relevant biology previously associated with the TCGA subtypes and were associated with prognosis. In survival analysis, OS and DMFS for cases discordantly classified between TCGA and SSP2 favored the SSP2 classification. In resected Stage I patients, SSP2 identified TRU-cases with better OS (hazard ratio [HR] = 0.30; 95% confidence interval [CI] = 0.18-0.49) and DMFS (TRU HR = 0.52; 95% CI = 0.33-0.83) independent of age, Stage IA/IB and gender. SSP2 was transformed into a NanoString nCounter assay and tested in 44 Stage I patients using RNA from formalin-fixed tissue, providing prognostic stratification (relapse-free interval, HR = 3.2; 95% CI = 1.2-8.8). In conclusion, gene expression-based SSPs can provide molecular subtype and independent prognostic information in early-stage lung ACs. SSPs may overcome critical limitations in the applicability of gene signatures in lung cancer. Keywords: gene expression; lung adenocarcinoma; molecular subtypes; prognosis; single sample predictor.
    • GWAS of thyroid stimulating hormone highlights pleiotropic effects and inverse association with thyroid cancer.

      Zhou, Wei; Brumpton, Ben; Kabil, Omer; Gudmundsson, Julius; Thorleifsson, Gudmar; Weinstock, Josh; Zawistowski, Matthew; Nielsen, Jonas B; Chaker, Layal; Medici, Marco; et al. (Nature Publishing Group, 2020-08-07)
      Thyroid stimulating hormone (TSH) is critical for normal development and metabolism. To better understand the genetic contribution to TSH levels, we conduct a GWAS meta-analysis at 22.4 million genetic markers in up to 119,715 individuals and identify 74 genome-wide significant loci for TSH, of which 28 are previously unreported. Functional experiments show that the thyroglobulin protein-altering variants P118L and G67S impact thyroglobulin secretion. Phenome-wide association analysis in the UK Biobank demonstrates the pleiotropic effects of TSH-associated variants and a polygenic score for higher TSH levels is associated with a reduced risk of thyroid cancer in the UK Biobank and three other independent studies. Two-sample Mendelian randomization using TSH index variants as instrumental variables suggests a protective effect of higher TSH levels (indicating lower thyroid function) on risk of thyroid cancer and goiter. Our findings highlight the pleiotropic effects of TSH-associated variants on thyroid function and growth of malignant and benign thyroid tumors.
    • Association of glial and neuronal degeneration markers with Alzheimer's disease cerebrospinal fluid profile and cognitive functions.

      Teitsdottir, Unnur D; Jonsdottir, Maria K; Lund, Sigrun H; Darreh-Shori, Taher; Snaedal, Jon; Petersen, Petur H; 1Faculty of Medicine, Department of Anatomy, Biomedical Center, University of Iceland, Reykjavik, Iceland. udt1@hi.is. 2Department of Psychology, Reykjavik University, Reykjavik, Iceland. 3Department of Psychiatry, Landspitali - National University Hospital, Reykjavik, Iceland. 4deCODE genetics/Amgen, Inc., Reykjavik, Iceland. 5Division of Clinical Geriatrics, Center for Alzheimer Research, NVS Department, Karolinska Institutet, Huddinge, Sweden. 6Memory clinic, Department of Geriatric Medicine, Landspitali - National University Hospital, Reykjavik, Iceland. 7Faculty of Medicine, Department of Anatomy, Biomedical Center, University of Iceland, Reykjavik, Iceland. (BioMed Central, 2020-08-04)
      Background: Neuroinflammation has gained increasing attention as a potential contributing factor in the onset and progression of Alzheimer's disease (AD). The objective of this study was to examine the association of selected cerebrospinal fluid (CSF) inflammatory and neuronal degeneration markers with signature CSF AD profile and cognitive functions among subjects at the symptomatic pre- and early dementia stages. Methods: In this cross-sectional study, 52 subjects were selected from an Icelandic memory clinic cohort. Subjects were classified as having AD (n = 28, age = 70, 39% female, Mini-Mental State Examination [MMSE] = 27) or non-AD (n = 24, age = 67, 33% female, MMSE = 28) profile based on the ratio between CSF total-tau (T-tau) and amyloid-β1-42 (Aβ42) values (cut-off point chosen as 0.52). Novel CSF biomarkers included neurofilament light (NFL), YKL-40, S100 calcium-binding protein B (S100B) and glial fibrillary acidic protein (GFAP), measured with enzyme-linked immunosorbent assays (ELISAs). Subjects underwent neuropsychological assessment for evaluation of different cognitive domains, including verbal episodic memory, non-verbal episodic memory, language, processing speed, and executive functions. Results: Accuracy coefficient for distinguishing between the two CSF profiles was calculated for each CSF marker and test. Novel CSF markers performed poorly (area under curve [AUC] coefficients ranging from 0.61 to 0.64) compared to tests reflecting verbal episodic memory, which all performed fair (AUC > 70). LASSO regression with a stability approach was applied for the selection of CSF markers and demographic variables predicting performance on each cognitive domain, both among all subjects and only those with a CSF AD profile. Relationships between CSF markers and cognitive domains, where the CSF marker reached stability selection criteria of > 75%, were visualized with scatter plots. Before calculations of corresponding Pearson's correlations coefficients, composite scores for cognitive domains were adjusted for age and education. GFAP correlated with executive functions (r = - 0.37, p = 0.01) overall, while GFAP correlated with processing speed (r = - 0.68, p < 0.001) and NFL with verbal episodic memory (r = - 0.43, p = 0.02) among subjects with a CSF AD profile. Conclusions: The novel CSF markers NFL and GFAP show potential as markers for cognitive decline among individuals with core AD pathology at the symptomatic pre- and early stages of dementia. Keywords: AD biomarker profile; Alzheimer’s disease; Cerebrospinal fluid; Cognitive domains; Glial fibrillary acidic protein; Neurofilament light; S100 calcium-binding protein B; YKL-40.
    • The Impact of Family Strengths Oriented Therapeutic Conversations on Parents of Children with a New Chronic Illness Diagnosis.

      Svavarsdottir, Erla Kolbrun; Kamban, Solrun W; Konradsdottir, Elísabet; Sigurdardottir, Anna Olafia; 1University of Iceland, Reykjavik, Iceland. 2Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland. (Sage Publications, 2020-07-29)
      A growing number of families with children are dealing with a new diagnosis of chronic illnesses or health problems that are demanding. Nurses are in a prime position to provide support and empowerment to these families. The aim of the study was to evaluate the benefits of two sessions of a Family Strengths Oriented Therapeutic Conversation (FAM-SOTC) intervention, offered by advanced practice nurses (APNs) to mothers (N = 31) of children and adolescents in Iceland with newly diagnosed chronic illnesses/disorders. Families of children with Juvenile Idiopathic Arthritis (JIA), epilepsy, Type 1 diabetes (T1DM), or with sleep disturbance with attention-deficit/hyperactivity disorder (ADHD), reported significantly higher family support, greater conviction about their illness beliefs, increased quality of life, and greater satisfaction with health care services after receiving two sessions of the FAM-SOTC intervention (Time 2) compared to before the intervention (Time 1). The findings emphasize the importance of the APN's role and family nursing expertise in supporting families of children with a new diagnosis of chronic illnesses or disorders who are in active treatment.
    • Zonulin-Dependent Intestinal Permeability in Children Diagnosed with Mental Disorders: A Systematic Review and Meta-Analysis.

      Asbjornsdottir, Birna; Snorradottir, Heiddis; Andresdottir, Edda; Fasano, Alessio; Lauth, Bertrand; Gudmundsson, Larus S; Gottfredsson, Magnus; Halldorsson, Thorhallur Ingi; Birgisdottir, Bryndis Eva; 1Unit for Nutrition Research, Faculty of Food and Nutritional Sciences, University of Iceland, 101 Reykjavik, Iceland. 2Faculty of Medicine, School of Health Sciences, University of Iceland, 101 Reykjavik, Iceland. 3Children's and Adolescents Psychiatric Unit, Landspitali University Hospital, 101 Reykjavik, Iceland. 4Division of Pediatric Gastroenterology and Nutrition, Harvard Medical School, MassGeneral Hospital for Children, Boston, MA 02114, USA. 5Faculty of Pharmaceutical Sciences, School of Health Sciences, University of Iceland, 101 Reykjavik, Iceland. 6Department of Scientific Affairs, Landspitali University Hospital, 101 Reykjavik, Iceland. (MDPI Publishing, 2020-07-03)
      Worldwide, up to 20% of children and adolescents experience mental disorders, which are the leading cause of disability in young people. Research shows that serum zonulin levels are associated with increased intestinal permeability (IP), affecting neural, hormonal, and immunological pathways. This systematic review and meta-analysis aimed to summarize evidence from observational studies on IP in children diagnosed with mental disorders. The review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic search of the Cochrane Library, PsycINFO, PubMed, and the Web of Science identified 833 records. Only non-intervention (i.e., observational) studies in children (<18 years) diagnosed with mental disorders, including a relevant marker of intestinal permeability, were included. Five studies were selected, with the risk of bias assessed according to the Newcastle-Ottawa scale (NOS). Four articles were identified as strong and one as moderate, representing altogether 402 participants providing evidence on IP in children diagnosed with attention deficit and hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and obsessive-compulsive disorder (OCD). In ADHD, elevated serum zonulin levels were associated with impaired social functioning compared to controls. Children with ASD may be predisposed to impair intestinal barrier function, which may contribute to their symptoms and clinical outcome compared to controls. Children with ASD, who experience gastro-intestinal (GI) symptoms, seem to have an imbalance in their immune response. However, in children with OCD, serum zonulin levels were not significantly different compared to controls, but serum claudin-5, a transmembrane tight-junction protein, was significantly higher. A meta-analysis of mean zonulin plasma levels of patients and control groups revealed a significant difference between groups (p = 0.001), including the four studies evaluating the full spectrum of the zonulin peptide family. Therefore, further studies are required to better understand the complex role of barrier function, i.e., intestinal and blood-brain barrier, and of inflammation, to the pathophysiology in mental and neurodevelopmental disorders. This review was PROSPERO preregistered, (162208).
    • Assessing cardiovascular risks from a mid-thigh CT image: a tree-based machine learning approach using radiodensitometric distributions.

      Ricciardi, Carlo; Edmunds, Kyle J; Recenti, Marco; Sigurdsson, Sigurdur; Gudnason, Vilmundur; Carraro, Ugo; Gargiulo, Paolo; 1Institute for Biomedical and Neural Engineering, Reykjavík University, Reykjavík, Iceland. 2Department of Advanced Biomedical Sciences, University Hospital of Naples 'Federico II', Naples, Italy. 3Icelandic Heart Association, (Hjartavernd), Kópavogur, Iceland. 4Faculty of Medicine, University of Iceland, Reykjavík, Iceland. 5CIR-Myo, Department of Biomedical Sciences, University of, Padova, Italy. 6A&C M-C Foundation for Translational Myology, Padova, Italy. 7Institute for Biomedical and Neural Engineering, Reykjavík University, Reykjavík, Iceland. paologar@landspitali.is. 8Department of Science, Landspítali, Reykjavík, Iceland. paologar@landspitali.is. (Nature Publishing Group, 2020-02-18)
      The nonlinear trimodal regression analysis (NTRA) method based on radiodensitometric CT distributions was recently developed and assessed for the quantification of lower extremity function and nutritional parameters in aging subjects. However, the use of the NTRA method for building predictive models of cardiovascular health was not explored; in this regard, the present study reports the use of NTRA parameters for classifying elderly subjects with coronary heart disease (CHD), cardiovascular disease (CVD), and chronic heart failure (CHF) using multivariate logistic regression and three tree-based machine learning (ML) algorithms. Results from each model were assembled as a typology of four classification metrics: total classification score, classification by tissue type, tissue-based feature importance, and classification by age. The predictive utility of this method was modelled using CHF incidence data. ML models employing the random forests algorithm yielded the highest classification performance for all analyses, and overall classification scores for all three conditions were excellent: CHD (AUCROC: 0.936); CVD (AUCROC: 0.914); CHF (AUCROC: 0.994). Longitudinal assessment for modelling the prediction of CHF incidence was likewise robust (AUCROC: 0.993). The present work introduces a substantial step forward in the construction of non-invasive, standardizable tools for associating adipose, loose connective, and lean tissue changes with cardiovascular health outcomes in elderly individuals.
    • Disease duration, age at diagnosis and organ damage are important factors for cardiovascular disease in SLE.

      Nived, Ola; Ingvarsson, Ragnar Freyr; Jöud, Anna; Linge, Petrus; Tydén, Helena; Jönsen, Andreas; Bengtsson, Anders A; 1Department of Rheumatology, Institution for Clinical Sciences, Lund, Sweden ola.nived@med.lu.se. 2Department of Rheumatology, Institution for Clinical Sciences, Lund, Sweden. 3Landspitali University Hospital, Reykjavik, Iceland. 4Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden. (BMJ, 2020-06)
      Objective: To report the incidence rate ratios (IRR) of acute myocardial infarctions (AMI) and cerebrovascular events (CVE) in incident SLE cases from a defined population. To study the risk factors for cardiovascular events in all patients with SLE at our unit. Methods: Patients with SLE diagnosed from 1981 to 2006 were followed through to 2016. IRRs of AMI and CVE were calculated. The AMI and CVE incidence patterns for patients with SLE were studied in relation to hypertension, smoking, renal dysfunction, anticardiolipin (aCL) antibodies at diagnosis, disease duration and organ damage before an event. Results: 262 patients with SLE were included in the study; of these 175 were from the defined population. Overall, 37 AMI and 44 CVE were recorded. An increased IRR of 3 for AMI was found (p<0.001). Smoking, hypertension and reduced renal function were risk factors for AMI. An increased IRR of 3.3 for ischaemic CVE was found for women (p<0.001). Hypertension and aCL were risk factors for CVE. Organ damage before events was increased. Conclusions: Cardiovascular events are increased in SLE and are associated with hypertension, smoking and increased damage rate. Keywords: cardiovascular diseases; epidemiology; lupus erythematosus, systemic.
    • Berkjuskúlk – yfirlit

      Gunnar Guðmundsson; Gunnar Júlíusson; 1 Lungnadeild Landspítala, 2 læknadeild Háskóla Íslands, 3 röntgendeild Karólínska Háskólasjúkrahúsins í Stokkhólmi, Svíþjóð. (Læknafélag Íslands, 2020-07)
      Berkjuskúlk er sjúkdómur þar sem berkjur verða óeðlilega víðar og um er að ræða viðvarandi ástand. Þetta getur verið staðbundið eða dreift um bæði lungu. Sjúkdómurinn kemur á öllum aldri og veldur hósta með uppgangi og endurteknum sýkingum. Tíðni er hærri hjá konum og vex með aldri. Hann einkennist af endurteknum tímabilum þar sem einkenni versna mikið og gerist það oftast vegna sýkinga. Berkjuskúlk getur verið af óþekktum orsökum en getur tengst fjöldamörgum sjúkdómum bæði í lungum og utan þeirra. Sem dæmi um slíka sjúkdóma eru astmi, langvinn lungnateppa og liðagigt auk þess sem brestir í ónæmiskerfi tengjast berkjuskúlki. Þannig er sjúkdómsmynd ólík milli einstaklinga. Greining fæst með tölvusneiðmynd af lungum til viðbótar við klínísk einkenni. Uppvinnsla til að greina aðra sjúkdóma sem hafa tengsl við berkjuskúlk er mikilvæg. Í því sambandi er sögutaka, líkamsskoðun og frekari rannsóknir mikilvægar. Sjúklingar með berkjuskúlk hafa skert heilsutengd lífsgæði og styttar lífslíkur. Meðferð er fólgin í meðferð undirliggjandi sjúkdóma, sýklalyfjum og loftvegahreinsun. Lungnaendurhæfing og reglulegt eftirlit eru einnig mikilvæg. Í þessari grein verður gefið yfirlit um berkjuskúlk sem nýtist mörgum læknum í daglegu starfi því sjúkdómurinn sést víða, bæði hjá heimilislæknum, á sjúkrahúsum og utan sjúkrahúsa.
    • Trefjabólgusepi í smágirni - Sjúkratilfelli

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