Now showing items 1-20 of 7148

    • Áhættuþættir og sjálfsumönnun einstaklinga með kransæðasjúkdóm

      Margrét Hrönn Svavarsdóttir; Kristín Guðný Sæmundsdóttir; Brynja Ingadóttir; 1) Hjúkrunarfræðideild Háskólans á Akureyri 2)Heilbrigðisvísindasviði Háskólans á Akureyri og Heilsugæslu höfuðborgarsvæðisins 3) Hjúkrunarfræðideild Háskóla Íslands og Landspítala (Félag íslenskra hjúkrunarfræðinga, 2020-03)
      Tilgangur: góð sjálfsumönnun getur dregið úr lífsstílstengdum áhættuþáttum og hægt á framgangi kransæðasjúkdóms. Tilgangur rann sóknarinnar var að kanna stöðu áhættuþátta meðal einstaklinga með kransæðasjúkdóm, sjálfsumönnun þeirra og trú á eigin getu. Aðferð: Þversniðsrannsókn þar sem þátttakendur voru einstaklingar sem lögðust inn á Landspítala eða Sjúkrahúsið á akureyri vegna kransæðasjúkdóms. gögnum um áhættuþætti, sjúkdómstengda þekkingu og bakgrunn var safnað við útskrift, með spurningalistum, mælingum og úr sjúkraskrá. Sjálfsumönnun var metin með „Self- Care of Coronary heart Disease inventory“ (SC-ChDi) mælitækinu sem metur viðhald heilbrigðis, stjórnun sjálfsumönnunar og trú á eigin getu til sjálfsumönnunar (stig 0–100 fyrir hvern þátt, fleiri stig gefa til kynna betri sjálfsumönnun). Við gagnaúrvinnslu var notuð lýsandi tölfræði og ályktunartölfræði. Niðurstöður: Þátttakendur í rannsókninni voru 445 (80% karlar), meðalaldur var 64,1 ár (sf 9,1). Tæplega helmingur hafði áður legið á sjúkrahúsi vegna kransæðasjúkdóms (45%) og 47% komu brátt á sjúkrahús. Tæplega helmingur þátttakenda var í ofþyngd, 42% með offitu, 20% með sykursýki og 18% reyktu. Einkenni kvíða höfðu 23% og einkenni þunglyndis 18% þátttakenda. Viðhald heilbrigðis mældist að meðaltali 61,6 (sf 15,4), stjórnun sjálfsumönnunar 53,5 (sf 18,5) og trú á eigin getu 52,3 (sf 22,9). Viðhald heilbrigðis mældist betra hjá konum, þeim sem bjuggu með öðrum, þeim sem höfðu áður lagst inn á sjúkrahús vegna kransæðasjúkdóms og þeim sem höfðu betri sjúkdómstengda þekkingu (r2 = 0,149, p < 0,01). Stjórnun sjálfs - umönnunar mældist betri hjá þeim sem höfðu áður lagst inn á sjúkra hús vegna kransæðasjúkdóms (r2 = 0,018, p < 0,01). Trú á eigin getu var meiri hjá þeim sem voru yngri, með minni einkenni þunglyndis og meiri sjúkdómstengda þekkingu (r2 = 0,086, p < 0,01). Ályktanir: Sjálfsumönnun kransæðasjúklinga er ábótavant og staða áhættuþátta alvarleg. Einstaklingshæfður stuðningur og fræðsla eftir útskrift gætu eflt sjálfsumönnun og trú á eigin getu og þannig stuðlað að betri stöðu áhættuþátta.
    • Streita, kulnun og bjargráð á meðal hjúkrunarfræðinga á bráðalegudeildum

      Berglind Harpa Svavarsdóttir; Elísabet Hjörleifsdóttir; 1) Dagþjónustu aldraðra, Hlymsdölum, Egilsstöðum 2) Háskólanum á Akureyri (Félag íslenskra hjúkrunarfræðinga, 2020-03)
      Bakgrunnur: Streita og kulnun í starfi er algeng á meðal hjúkrunarfræðinga, sérstaklega í yngri aldurshópum. Afleiðingarnar geta leitt til heilsubrests ef ekki er brugðist við vandamálinu snemma. Tilgangur: Könnun á streitueinkennum meðal íslenskra hjúkrunarfræðinga mánuðinn áður en þeir svöruðu spurningalistum um persónu-, vinnu- og skjólstæðingstengd kulnunareinkenni og bjargráð við erfiðar aðstæður. Aðferð: Lýsandi þversniðsrannsókn með notkun mælitækjanna Perceived Stress Scale (PSS), Copenhagen Burnout inventory (CBi) og Ways of Coping (WOC). rannsóknin er hluti af stærri rannsókn á tveimur íslenskum sjúkrahúsum. Tölfræðileg úrvinnsla var framkvæmd á svörum frá 164 þátttakendum. Niðurstöður: Þátttakendur yngri en 40 ára sýndu marktækt meiri streitu en þeir sem voru 40 ára eða eldri (p = 0,001). Þátttakendur sem starfað höfðu 10 ár eða skemursýndu marktækt alvarlegri streitu en þátttakendur sem starfað höfðu lengur en 10 ár (p = 0,004). Þátttakendur yngri en 40 ára sýndu marktækt verri kulnunareinkenni en þeirsem eldri voru: persónutengd (p = 0,011), starfstengd (p = 0,018), skjólstæðingstengd (p = 0,017). Marktækur munur var á mati þátttakenda eftir sviðum á því hvort mönnun væri í góðu lagi á vinnustað, á skurðlækningasviði (60%), á lyflækningasviði (40%) (p < 0,001). Marktæk neikvæð fylgni kom fram á milli streitu, aldurs og starfsaldurs, og á milli kulnunarþátta og aldurs, starfsaldurs, menntunar og mönnunar. Marktæk neikvæð fylgni var á milli þess að flýja af hólmi og aldurs, starfsaldurs og þess að sækjast eftir og nýta sér félagslegan stuðning. Marktæk neikvæð fylgni var á milli þess að flýja í huganum og starfsaldurs. Ályktanir: Niðurstöðum ber að taka með varúð vegna lítils úrtaks. Þær gefa til kynna að yngri hjúkrunarfræðingar eigi frekar á hættu að finna fyrir streitu og kulnun. Mælitækin PSS og CBi henta í rannsóknir á streitu og kulnun hjá hjúkrunarfræðingum, en þörf er á frekari endurbótum á WOC-spurningalistanum.
    • Meðferðarmarkmið í aðdraganda andláts

      Þorgerður Ragnarsdóttir; Menntadeild LSH (Félag íslenskra hjúkrunarfræðinga, 2020-03)
    • Hiti hjá ónæmisbældum krabbameinssjúklingum — fyrstu viðbrögð

      Brynja Hauksdóttir; Halla Grétarsdóttir; Guðbjörg Guðmundsdóttir; Sérfræðingur í hjúkrun sjúklinga með krabbamein á dagdeild blóð- og krabbameinslækninga (11B), Landspítala. (Félag íslenskra hjúkrunarfræðinga, 2020-03)
    • Hjúkrun á geðdeildum — siðferðilegar mótsagnir þvingandi meðferðar og líkan um öruggar sjúkradeildir

      Eyrún Thorstensen; Helga Bragadóttir; 1) Landspítala 2) Hjúkrunarfræðideild, heilbrigðisvísindasviði, háskóla Íslands v/Hringbraut (Félag íslenskra hjúkrunarfræðinga, 2020-03)
    • Ashwagandha-induced liver injury: A case series from Iceland and the US Drug-Induced Liver Injury Network.

      Björnsson, Helgi K; Björnsson, Einar S; Avula, Bharathi; Khan, Ikhlas A; Jonasson, Jon G; Ghabril, Marwan; Hayashi, Paul H; Navarro, Victor; 1Landspitali University Hospital, Reykjavik, Iceland. 2National Center for Natural Products Research, School of Pharmacy, University of Mississippi, University, MS, USA. 3Indiana University School of Medicine, Indianapolis, IN, USA. 4University of North Carolina, Chapel Hill, NC, USA. 5Einstein Healthcare Network, Sidney Kimmel Medical College, Philadelphia, PA, USA. (Wiley, 2020-01-28)
      Background & aims: Ashwagandha (Withania somnifera) is widely used in Indian Ayurvedic medicine. Several dietary supplements containing ashwagandha are marketed in the US and Europe, but only one case of drug-induced liver injury (DILI) due to ashwagandha has been published. The aim of this case series was to describe the clinical phenotype of suspected ashwagandha-induced liver injury. Methods: Five cases of liver injury attributed to ashwagandha-containing supplements were identified; three were collected in Iceland during 2017-2018 and two from the Drug-Induced Liver Injury Network (DILIN) in 2016. Other causes for liver injury were excluded. Causality was assessed using the DILIN structured expert opinion causality approach. Results: Among the five patients, three were males; mean age was 43 years (range 21-62). All patients developed jaundice and symptoms such as nausea, lethargy, pruritus and abdominal discomfort after a latency of 2-12 weeks. Liver injury was cholestatic or mixed (R ratios 1.4-3.3). Pruritus and hyperbilirubinaemia were prolonged (5-20 weeks). No patient developed hepatic failure. Liver tests normalized within 1-5 months in four patients. One patient was lost to follow-up. One biopsy was performed, showing acute cholestatic hepatitis. Chemical analysis confirmed ashwagandha in available supplements; no other toxic compounds were identified. No patient was taking potentially hepatotoxic prescription medications, although four were consuming additional supplements, and in one case, rhodiola was a possible causative agent along with ashwagandha. Conclusions: These cases illustrate the hepatotoxic potential of ashwagandha. Liver injury is typically cholestatic or mixed with severe jaundice and pruritus, but self-limited with liver tests normalizing in 1-5 months.
    • Genome-wide meta-analysis identifies eight new susceptibility loci for cutaneous squamous cell carcinoma.

      Sarin, Kavita Y; Lin, Yuan; Daneshjou, Roxana; Ziyatdinov, Andrey; Thorleifsson, Gudmar; Rubin, Adam; Pardo, Luba M; Wu, Wenting; Khavari, Paul A; Uitterlinden, Andre; et al. (Nature Publishing Group, 2020-02-10)
      Cutaneous squamous cell carcinoma (SCC) is one of the most common cancers in the United States. Previous genome-wide association studies (GWAS) have identified 14 single nucleotide polymorphisms (SNPs) associated with cutaneous SCC. Here, we report the largest cutaneous SCC meta-analysis to date, representing six international cohorts and totaling 19,149 SCC cases and 680,049 controls. We discover eight novel loci associated with SCC, confirm all previously associated loci, and perform fine mapping of causal variants. The novel SNPs occur within skin-specific regulatory elements and implicate loci involved in cancer development, immune regulation, and keratinocyte differentiation in SCC susceptibility.
    • HLA associations with infliximab-induced liver injury.

      Bruno, Christopher D; Fremd, Brandon; Church, Rachel J; Daly, Ann K; Aithal, Guruprasad P; Björnsson, Einar S; Larrey, Dominique; Watkins, Paul B; Chow, Christina R; 1Emerald Lake Safety, Newport Beach, CA, USA. 2Eshelman School of Pharmacy, University of North Carolina Institute for Drug Safety Sciences, Chapel Hill, NC, USA. 3Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK. 4National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK. 5Department of Internal Medicine, Landspitali University Hospital, Reykjavik, Iceland. 6Faculty of Medicine, University of Iceland, Reykjavik, Iceland. 7Liver Unit, CHU St Eloi Hospital, Montpellier, France. 8Emerald Lake Safety, Newport Beach, CA, USA. christina@elsafety.com. (Nature Publishing Group, 2020-02-06)
      Biomarkers that are able to identify patients at risk of drug-induced liver injury (DILI) after treatment with infliximab could be important in increasing the safety of infliximab use. We performed a genetic analysis to identify possible human leukocyte antigen (HLA) associations with DILI in European Caucasian users of infliximab in a retrospective study of 16 infliximab-DILI patients and 60 matched controls. In infliximab-associated liver injury, multiple potentially causal individual HLA associations were observed, as well as possible haplotypes. The strongest associated HLA allele was HLA-B*39:01 (P = 0.001; odds ratio [OR] 43.6; 95% confidence interval [CI] 2.8-infinity), which always appeared with another associated allele C*12:03 (P = 0.032; OR 6.1; 95% CI 0.9-47.4). Other associations were observed with HLAs DQB1*02:01 (P = 0.007; OR 5.7; 95% CI 1.4-24.8), DRB1*03:01 (P = 0.012; OR 4.9; 95% CI 1.2-20.5), and B*08:01 (P = 0.048; OR 3.4; 95% CI 0.9-13.2), which also appeared together whenever present in cases. Additional associations were found with HLA-DPB1*10:01 (P = 0.042; OR 20.9; 95% CI 0.7-infinity) and HLA-DRB1*04:04 (P = 0.042; OR 20.9; 95% CI 0.7-infinity). A strong association with HLA-B*39:01 was identified as a potentially causal risk factor for infliximab-induced DILI. Future work should aim to validate this finding and explore possible mechanisms through which the biologic interacts with this particular allele.
    • COPD: Should Diagnosis Match Physiology?

      Studnicka, Michael; Horner, Andreas; Sator, Lea; Buist, A Sonia; Lamprecht, Bernd; 1Department of Pulmonary Medicine, Paracelsus Medical University, Salzburg, Austria. 2Department of Pulmonology, Kepler University Hospital, Linz, Austria; Faculty of Medicine, Johannes-Kepler-University, Salzburg, Austria; Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Portland, OR. Electronic address: andreas.horner@kepleruniklinikum.at. 3Oregon Health & Science University, Linz, Austria. 4Department of Pulmonology, Kepler University Hospital, Linz, Austria; Faculty of Medicine, Johannes-Kepler-University, Salzburg, Austria. (Elsevier, 2020-02)
    • Long-term Outcome of Implantable Cardioverter/Defibrillator Lead Failure.

      Davidsson, Gustav Arnar; Jonsdottir, Gudlaug M; Oddsson, Hjortur; Lund, Sigrun H; Arnar, David O; 1Faculty of Medicine, University of Iceland, Reykjavik, Iceland. 2Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland. (American Medical Association, 2019-12-20)
      This study compares outcomes of a recalled implantable cardioverter/defibrillator lead with a control lead in individuals in Iceland.
    • ESHG PPPC Comments on postmortem use of genetic data for research purposes.

      Fellmann, Florence; Rial-Sebbag, Emmanuelle; Patch, Christine; Hentze, Sabine; Stefandottir, Vigdis; Mendes, Álvaro; van El, Carla G; Cornel, Martina C; Forzano, Francesca; 1The ColLaboratory, University of Lausanne, Lausanne, Switzerland. florence.fellmann@gmail.com. 2UMR 1027, Inserm, Université Paul Sabatier-Toulouse III, Toulouse Cedex, France. 3Genomics England, Queen Mary University of London, London, United Kingdom. 4Society and Ethics Research Group, Wellcome Genome Campus, Hinxton, United Kingdom. 5Human Genetics, Heidelberg, Germany. 6Department of Genetics and Molecular Medicine, Landspitali University Hospital, Reykjavik, Iceland. 7UnIGENe and CGPP-Centre for Predictive and Preventive Genetics, IBMC-Institute for Molecular and Cell Biology, i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal. 8Section Community Genetics, Department of Clinical Genetics and Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands. 9Clinical Genetics Department, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom. Francesca.Forzano@gstt.nhs.uk. (Nature Publishing Group, 2019-10-08)
    • Hemoglobin concentration and risk of arterial and venous thrombosis in 1.5 million Swedish and Danish blood donors.

      Hultcrantz, Malin; Modlitba, Anton; Vasan, Senthil K; Sjölander, Arvid; Rostgaard, Klaus; Landgren, Ola; Hjalgrim, Henrik; Ullum, Henrik; Erikstrup, Christian; Kristinsson, Sigurdur Y; et al. (Pergamon Press, 2019-12-20)
      Introduction: There are conflicting results whether elevated hematocrit is associated with an increased risk of thromboembolic events in individuals without polycythemia vera. To assess the risk of vascular events in relation to hemoglobin concentration, we conducted a large population-based cohort study based on Scandinavian health registers. Materials and methods: We included 1,538,019 Swedish and Danish blood donors between 1987 and 2012. Hazard ratios (HRs) of arterial and venous thrombosis were estimated using Cox regression. Additionally, we fitted person-stratified models where each donor was compared only to him-/herself. Results: The risk of myocardial infarction and ischemic stroke increased with higher hemoglobin concentration in both men and women. The HRs for myocardial infarction and ischemic stroke in men with hemoglobin concentration ≥ 17.5 g/dL were 3.52 (95% confidence interval [CI], 2.85-4.36) and 2.36 (95% CI, 1.63-3.43), respectively, compared to the reference group. The corresponding HRs for women with hemoglobin concentration ≥ 16.0 g/dL were 3.22 (2.12-4.89) and 2.35 (1.37-4.02) for myocardial infarction and ischemic stroke, respectively. The risk of venous thrombosis was highest in men with subnormal hemoglobin concentration (<13.0 g/dL), HR 1.69 (95% CI, 1.40-2.04). In the person-stratified model, the association between elevated hemoglobin concentration and risk of myocardial infarction was attenuated but remained significant. Conclusions: In this large cohort of Scandinavian blood donors, elevated hemoglobin concentration was associated with an increased risk of vascular events, primarily arterial events. Even though associations were weakened when each person served as their own control, a high hemoglobin concentration may serve as a cardiovascular risk marker.
    • The potential for organ donation in Iceland: A nationwide study of deaths in intensive care units.

      Palsson, Thordur P; Sigvaldason, Kristinn; Kristjansdottir, Thora E; Thorkelsson, Thordur; Blondal, Asbjorn T; Karason, Sigurbergur; Palsson, Runolfur; 1Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland. 2Division of Anesthesia and Intensive Care Medicine, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland. 3Division of Neonatal Intensive Care, Children's Medical Center, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland. 4Division of Anesthesia and Intensive Care, Akureyri Hospital, Akureyri, Iceland. 5Internal Medicine Services, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland. (Wiley, 2020-01-17)
      Background: The deceased organ donation rate in Iceland has been low compared with other Western countries. The aim of this study was to explore the potential for organ donation after brain death in Iceland. Methods: Observational cohort study of patients with catastrophic brain injury who died in intensive care units (ICUs) at hospitals in Iceland in 2003-2016. Medical records were retrospectively reviewed to identify potential donors (PDs), using the WHO Critical Pathway for Deceased Donation. Trends in annual incidence of PDs, conversion to actual donors, and family refusals were assessed. Results: Among 1537 patients who died in the ICU, 125 (8.1%) were identified as PDs. Of 103 PDs who were declared brain dead, consent for organ donation was pursued in 84 cases and granted in 63. Fifty-six became actual donors. The annual donation rate averaged 13 per million population (pmp), but rose abruptly in the final 2 years to 36 and 27 pmp, respectively. This was paralleled by an increase in annual incidence of PDs from an average of 28 pmp to 54 and 42 pmp, respectively. The donor conversion rate increased during the study period (P = .026). Twenty-three PDs (18%) were not pursued without an apparent reason. Conclusions: The donation rate increased markedly in the last 2 years of the study period after remaining low for more than a decade. This change can largely be explained by a high incidence of PDs and a low family refusal rate. Missed donation opportunities suggest a potential to maintain a high donation rate in the future.
    • Asparaginase-Associated Pancreatitis in Acute Lymphoblastic Leukemia: Results From the NOPHO ALL2008 Treatment of Patients 1-45 Years of Age.

      Rank, Cecilie U; Wolthers, Benjamin O; Grell, Kathrine; Albertsen, Birgitte K; Frandsen, Thomas L; Overgaard, Ulrik M; Toft, Nina; Nielsen, Ove J; Wehner, Peder S; Harila-Saari, Arja; et al. (American Society of Clinical Oncology, 2019-11-26)
      Purpose: Asparaginase-associated pancreatitis (AAP) is common in patients with acute lymphoblastic leukemia (ALL), but risk differences across age groups both in relation to first-time AAP and after asparaginase re-exposure have not been explored. Patients and methods: We prospectively registered AAP (n = 168) during treatment of 2,448 consecutive ALL patients aged 1.0-45.9 years diagnosed from July 2008 to October 2018 and treated according to the Nordic Society of Pediatric Hematology and Oncology (NOPHO) ALL2008 protocol. Results: Compared with patients aged 1.0-9.9 years, adjusted AAP hazard ratios (HRa) were associated with higher age with almost identical HRa (1.6; 95% CI, 1.1 to 2.3; P = .02) for adolescents (10.0-17.9 years) and adults (18.0-45.9 years). The day 280 cumulative incidences of AAP were 7.0% for children (1.0-9.9 years: 95% CI, 5.4 to 8.6), 10.1% for adolescents (10.0 to 17.9 years: 95% CI, 7.0 to 13.3), and 11.0% for adults (18.0-45.9 years: 95% CI, 7.1 to 14.9; P = .03). Adolescents had increased odds of both acute (odds ratio [OR], 5.2; 95% CI, 2.1 to 13.2; P = .0005) and persisting complications (OR, 6.7; 95% CI, 2.4 to 18.4; P = .0002) compared with children (1.0-9.9 years), whereas adults had increased odds of only persisting complications (OR, 4.1; 95% CI, 1.4 to 11.8; P = .01). Fifteen of 34 asparaginase-rechallenged patients developed a second AAP. Asparaginase was truncated in 17/21 patients with AAP who subsequently developed leukemic relapse, but neither AAP nor the asparaginase truncation was associated with increased risk of relapse. Conclusion: Older children and adults had similar AAP risk, whereas morbidity was most pronounced among adolescents. Asparaginase re-exposure should be considered only for patients with an anticipated high risk of leukemic relapse, because multiple studies strongly indicate that reduction of asparaginase treatment intensity increases the risk of relapse
    • Indirect Calorimetry Overestimates Oxygen Consumption in Young Children: Caution is Advised Using Direct Fick Method as a Reference Method in Cardiac Output Comparison Studies.

      Sigurdsson, Theodor S; Lindberg, Lars; 1Department of Pediatric Anesthesia and Intensive Care, Children's Hospital, Skåne University Hospital, Lund, Sweden. theodors@landspitali.is. 2Department of Anesthesia and Intensive Care, Landspítalinn University Hospital, Reykjavík, Iceland. theodors@landspitali.is. 3Department of Pediatric Anesthesia and Intensive Care, Children's Hospital, Skåne University Hospital, Lund, Sweden. (Springer, 2019-11-18)
      Direct Fick method is considered a standard reference method for estimation of cardiac output. It relies on indirect calorimetry to measure oxygen consumption. This is important as only a minor measurement error in oxygen consumption can result in false estimation of cardiac output. A number of studies have shown that indirect calorimetry overestimates oxygen consumption in adults. The aim of this prospective single center observational method comparison study was to compare the determination of oxygen consumption by indirect calorimetry and reverse Fick method in pediatric patients. Forty-two children mean age 352 days (range 30 to 1303 days) and mean weight 7.1 kg (range 2.7-13.6 kg) undergoing corrective cardiac surgery were included in the study. The mean (standard deviation) oxygen consumption by reverse Fick method was 43.5 (16.2) ml/min and by indirect calorimetry 49.9 (18.8) ml/min (p < 0.001). Indirect calorimetry overestimated the reverse Fick oxygen consumption by 14.7%. Bias between methods was 6.5 (11.3) ml/min, limits of agreement (LOA) - 15.7 and 28.7 ml/min and percentage error of 47.7%. A significant bias and large percentage error indicates that the methods are not interchangeable. Indirect calorimetry and the direct Fick method should be used with caution as a reference method in cardiac output comparison studies in young children.
    • Characteristics and treatment regimens across ERS SHARP severe asthma registries.

      van Bragt, Job J M H; Adcock, Ian M; Bel, Elisabeth H D; Braunstahl, Gert-Jan; Ten Brinke, Anneke; Busby, John; Canonica, Giorgio W; Cao, Hui; Chung, Kian Fan; Csoma, Zsuzsanna; et al. (European Respiratory Society, 2020-01-09)
      Little is known about the characteristics and treatments of patients with severe asthma across Europe, but both are likely to vary. This is the first study in the European Respiratory Society Severe Heterogeneous Asthma Research collaboration, Patient-centred (SHARP) Clinical Research Collaboration and it is designed to explore these variations. Therefore, we aimed to compare characteristics of patients in European severe asthma registries and treatments before starting biologicals.This was a cross-sectional retrospective analysis of aggregated data from 11 national severe asthma registries that joined SHARP with established patient databases.Analysis of data from 3236 patients showed many differences in characteristics and lifestyle factors. Current smokers ranged from 0% (Poland and Sweden) to 9.5% (Belgium), mean body mass index ranged from 26.2 (Italy) to 30.6 kg·m-2 (the UK) and the largest difference in mean pre-bronchodilator forced expiratory volume in 1 s % predicted was 20.9% (the Netherlands versus Hungary). Before starting biologicals patients were treated differently between countries: mean inhaled corticosteroid dose ranged from 700 to 1335 µg·day-1 between those from Slovenia versus Poland when starting anti-interleukin (IL)-5 antibody and from 772 to 1344 µg·day-1 in those starting anti-IgE (Slovenia versus Spain). Maintenance oral corticosteroid use ranged from 21.0% (Belgium) to 63.0% (Sweden) and from 9.1% (Denmark) to 56.1% (the UK) in patients starting anti-IL-5 and anti-IgE, respectively.The severe asthmatic population in Europe is heterogeneous and differs in both clinical characteristics and treatment, often appearing not to comply with the current European Respiratory Society/American Thoracic Society guidelines definition of severe asthma. Treatment regimens before starting biologicals were different from inclusion criteria in clinical trials and varied between countries.
    • Multi-sensory training and wrist fractures: a randomized, controlled trial.

      Baldursdottir, Bergthora; Whitney, Susan L; Ramel, Alfons; Jonsson, Palmi V; Mogensen, Brynjolfur; Petersen, Hannes; Kristinsdottir, Ella K; 1Faculty of Medicine, University of Iceland, Reykjavik, Iceland. bergbald@landspitali.is. 2The Icelandic Gerontological Research Institute, Landspitali University Hospital, Reykjavik, Iceland. bergbald@landspitali.is. 3Department of Physical Therapy, Landspitali University Hospital, Tungata 26, 101, Reykjavik, Iceland. bergbald@landspitali.is. 4Department of Physical Therapy, University of Pittsburgh, Pittsburgh, USA. 5The Icelandic Gerontological Research Institute, Landspitali University Hospital, Reykjavik, Iceland. 6Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland. 7Faculty of Medicine, University of Iceland, Reykjavik, Iceland. 8Akureyri Hospital, Akureyri, Iceland. (Editrice Kurtis, 2019-02-11)
      Background: Asymmetric vestibular function, decreased plantar sensation, postural control and functional ability have been associated with fall-related wrist fractures. Objective: To investigate whether multi-sensory training (MST) improves postural control, vestibular function, foot sensation and functional ability among people with fall-related wrist fractures compared to wrist stabilization training (WT). Methods: This was an assessor-blinded, randomized controlled trial. Ninety-eight participants, age 50-75 years, were randomized to MST or WT. Pre- and post-training measurements: Head Shake Test (HST), Video-Head Impulse Test (vHIT), Semmes-Weinstein Monofilaments (SWF), Biothesiometer (BT), Sensory Organization Test (SOT), 10-m Walk Test (10MWT), Five Times Sit to Stand Test (FTSTS), Activities-Specific Balance Confidence (ABC) and Dizziness Handicap Inventory Scales (DHI). The training period was 12 weeks, with six supervised sessions by a physical therapist and daily home exercises for both groups. Results: There were significant endpoint differences in SOT (p = 0.01) between the two groups, in favor of the MST group, but no changes were seen in other outcome variables. Subgroup analysis with participants below normal baseline SOT composite scores indicated that the MST was more effective in improving 10MWT fast (p = 0.04), FTSTS (p = 0.04), SWF (p = 0.04) and SOT scores (p = 0.04) than the WT. Conclusions: MST improves postural control among people with a fall-related wrist fracture. The results further suggest that the program is more effective for those with SOT balance scores below age-related norms.
    • Soluble urokinase plasminogen activator receptor (suPAR) levels predict damage accrual in patients with recent-onset systemic lupus erythematosus.

      Enocsson, Helena; Wirestam, Lina; Dahle, Charlotte; Padyukov, Leonid; Jönsen, Andreas; Urowitz, Murray B; Gladman, Dafna D; Romero-Diaz, Juanita; Bae, Sang-Cheol; Fortin, Paul R; et al. (Academic Press, 2019-10-17)
      Objective: The soluble urokinase plasminogen activator receptor (suPAR) has potential as a prognosis and severity biomarker in several inflammatory and infectious diseases. In a previous cross-sectional study, suPAR levels were shown to reflect damage accrual in cases of systemic lupus erythematosus (SLE). Herein, we evaluated suPAR as a predictor of future organ damage in recent-onset SLE. Methods: Included were 344 patients from the Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort who met the 1997 American College of Rheumatology classification criteria with 5-years of follow-up data available. Baseline sera from patients and age- and sex-matched controls were assayed for suPAR. Organ damage was assessed annually using the SLICC/ACR damage index (SDI). Results: The levels of suPAR were higher in patients who accrued damage, particularly those with SDI≥2 at 5 years (N = 32, 46.8% increase, p = 0.004), as compared to patients without damage. Logistic regression analysis revealed a significant impact of suPAR on SDI outcome (SDI≥2; OR = 1.14; 95% CI 1.03-1.26), also after adjustment for confounding factors. In an optimized logistic regression to predict damage, suPAR persisted as a predictor, together with baseline disease activity (SLEDAI-2K), age, and non-Caucasian ethnicity (model AUC = 0.77). Dissecting SDI into organ systems revealed higher suPAR levels in patients who developed musculoskeletal damage (SDI≥1; p = 0.007). Conclusion: Prognostic biomarkers identify patients who are at risk of acquiring early damage and therefore need careful observation and targeted treatment strategies. Overall, suPAR constitutes an interesting biomarker for patient stratification and for identifying SLE patients who are at risk of acquiring organ damage during the first 5 years of disease.
    • Comparative Treatment Outcomes for Patients With Idiopathic Subglottic Stenosis.

      Gelbard, Alexander; Anderson, Catherine; Berry, Lynne D; Amin, Milan R; Benninger, Michael S; Blumin, Joel H; Bock, Jonathan M; Bryson, Paul C; Castellanos, Paul F; Chen, Sheau-Chiann; et al. (American Medical Association, 2019-10-31)
      Importance: Surgical treatment comparisons in rare diseases are difficult secondary to the geographic distribution of patients. Fortunately, emerging technologies offer promise to reduce these barriers for research. Objective: To prospectively compare the outcomes of the 3 most common surgical approaches for idiopathic subglottic stenosis (iSGS), a rare airway disease. Design, setting, and participants: In this international, prospective, 3-year multicenter cohort study, 810 patients with untreated, newly diagnosed, or previously treated iSGS were enrolled after undergoing a surgical procedure (endoscopic dilation [ED], endoscopic resection with adjuvant medical therapy [ERMT], or cricotracheal resection [CTR]). Patients were recruited from clinician practices in the North American Airway Collaborative and an online iSGS community on Facebook. Main outcomes and measures: The primary end point was days from initial surgical procedure to recurrent surgical procedure. Secondary end points included quality of life using the Clinical COPD (chronic obstructive pulmonary disease) Questionnaire (CCQ), Voice Handicap Index-10 (VHI-10), Eating Assessment Test-10 (EAT-10), the 12-Item Short-Form Version 2 (SF-12v2), and postoperative complications. Results: Of 810 patients in this cohort, 798 (98.5%) were female and 787 (97.2%) were white, with a median age of 50 years (interquartile range, 43-58 years). Index surgical procedures were ED (n = 603; 74.4%), ERMT (n = 121; 14.9%), and CTR (n = 86; 10.6%). Overall, 185 patients (22.8%) had a recurrent surgical procedure during the 3-year study, but recurrence differed by modality (CTR, 1 patient [1.2%]; ERMT, 15 [12.4%]; and ED, 169 [28.0%]). Weighted, propensity score-matched, Cox proportional hazards regression models showed ED was inferior to ERMT (hazard ratio [HR], 3.16; 95% CI, 1.8-5.5). Among successfully treated patients without recurrence, those treated with CTR had the best CCQ (0.75 points) and SF-12v2 (54 points) scores and worst VHI-10 score (13 points) 360 days after enrollment as well as the greatest perioperative risk. Conclusions and relevance: In this cohort study of 810 patients with iSGS, endoscopic dilation, the most popular surgical approach for iSGS, was associated with a higher recurrence rate compared with other procedures. Cricotracheal resection offered the most durable results but showed the greatest perioperative risk and the worst long-term voice outcomes. Endoscopic resection with medical therapy was associated with better disease control compared with ED and had minimal association with vocal function. These results may be used to inform individual patient treatment decision-making.
    • Association of Genetically Predicted Lipid Levels With the Extent of Coronary Atherosclerosis in Icelandic Adults.

      Björnsson, Eythór; Thorleifsson, Guðmar; Helgadóttir, Anna; Guðnason, Thórarinn; Guðbjartsson, Tómas; Andersen, Karl; Grétarsdóttir, Sólveig; Ólafsson, Ísleifur; Tragante, Vinicius; Ólafsson, Ólafur Hreiðar; et al. (American Medical Association, 2019-11-20)
      Importance: Genetic studies have evaluated the influence of blood lipid levels on the risk of coronary artery disease (CAD), but less is known about how they are associated with the extent of coronary atherosclerosis. Objective: To estimate the contributions of genetically predicted blood lipid levels on the extent of coronary atherosclerosis. Design, setting, and participants: This genetic study included Icelandic adults who had undergone coronary angiography or assessment of coronary artery calcium using cardiac computed tomography. The study incorporates data collected from January 1987 to December 2017 in Iceland in the Swedish Coronary Angiography and Angioplasty Registry and 2 registries of individuals who had undergone percutaneous coronary interventions and coronary artery bypass grafting. For each participant, genetic scores were calculated for levels of non-high-density lipoprotein cholesterol (non-HDL-C), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides, based on reported effect sizes of 345 independent, lipid-associated variants. The genetic scores' predictive ability for lipid levels was assessed in more than 87 000 Icelandic adults. A mendelian randomization approach was used to estimate the contribution of each lipid trait. Exposures: Genetic scores for levels of non-HDL-C, LDL-C, HDL-C, and triglycerides. Main outcomes and measures: The extent of angiographic CAD and coronary artery calcium quantity. Results: A total of 12 460 adults (mean [SD] age, 65.1 [10.7] years; 8383 men [67.3%]) underwent coronary angiography, and 4837 had coronary artery calcium assessed by computed tomography. A genetically predicted increase in non-HDL-C levels by 1 SD (38 mg/dL [to convert to millimoles per liter, multiply by 0.0259]) was associated with greater odds of obstructive CAD (odds ratio [OR], 1.83 [95% CI, 1.63-2.07]; P = 2.8 × 10-23). Among patients with obstructive CAD, there were significant associations with multivessel disease (OR, 1.26 [95% CI, 1.11-1.44]; P = 4.1 × 10-4) and 3-vessel disease (OR, 1.47 [95% CI, 1.26-1.72]; P = 9.2 × 10-7). There were also significant associations with the presence of coronary artery calcium (OR, 2.04 [95% CI, 1.70-2.44]; P = 5.3 × 10-15) and loge-transformed coronary artery calcium (effect, 0.70 [95% CI, 0.53-0.87]; P = 1.0 × 10-15). Genetically predicted levels of non-HDL-C remained associated with obstructive CAD and coronary artery calcium extent even after accounting for the association with LDL-C. Genetically predicted levels of HDL-C and triglycerides were associated individually with the extent of coronary atherosclerosis, but not after accounting for the association with non-HDL cholesterol. Conclusions and relevance: In this study, genetically predicted levels of non-HDL-C were associated with the extent of coronary atherosclerosis as estimated by 2 different methods. The association was stronger than for genetically predicted levels of LDL-C. These findings further support the notion that non-HDL-C may be a better marker of the overall burden of atherogenic lipoproteins than LDL-C.