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An elderly, right-handed, male patient presented to the emergency department at a middle sized hospital with a few hours' history of mild confusion and a difficulty expressing himself verbally. Past medical history consisted of hypertension and cured hairy cell leukemia. CT scan of the brain showed a 5 cm infarction in the left occipital lobe, and a corresponding P2 occlusion was seen. The patient was admitted to the stroke unit. While at the stroke unit, a detailed neurologic exam by a neurologist was performed. It was revealed that the patient could not read at all, but he could write perfectly with preserved spelling and handwriting. A diagnosis of "alexia without agraphia" was made. An MRI of the brain was performed, and infarctions well corresponding with prior case reports on the diagnosis were seen.

Methemoglobinemia is a condition characterized by tissue hypoxia and normal oxygen partial pressure in the blood. The methemoglobin is created through the oxidation of the hemoglobin molecule in erythrocytes, changing Fe2+ to its ferric state Fe3+, causing it to lose its oxygen-carrying capacity. The condition can be drug-induced, caused by congenital enzyme deficiency or triggered through disease processes such as sepsis. In this case report, we describe an 80-year-old woman who developed severe methemoglobinemia in connection with a fatal pneumococcal sepsis.

Duplication of the vermiform appendix is a very rare anomaly that should be considered and suspected in patients who have previously undergone an appendectomy and present with low right quadrant abdominal pain, alongside other differential diagnoses such as stump appendicitis and cecal diverticulitis. In previously known cases, appendix duplications have been missed on computed tomography and ultrasound examinations, illustrating the difficulty with diagnosis. Sometimes, duplication of the appendix is associated with other teratological phenomena in the gastrointestinal tract and the genitourinary system, which is why previous medical history or records from pediatrics can be of clinical value. A missed diagnosis can lead to increased morbidity and mortality.

Intestinal ultrasound (IUS), which is performed as transabdominal ultrasound, is a method of assessing inflammatory bowel disease (IBD) that has gained worldwide recognition in recent years. It is widely adopted by gastroenterologists in large parts of Europe and North America, and its implementation continues to spread to new countries. IUS is non-invasive, complication-free, does not entail radiation, is cost-effective, does not have contraindications and is appreciated by patients. It does not require any patient preparation and can be used as a point-of-care examination. Energy and material consumption are minimal. IUS is included in the ECCO-ESGAR (European Crohn's and Colitis Organisation; European Society of Gastrointestinal and Abdominal Radiology) guidelines for diagnostic assessment of IBD and holds similar diagnostic sensitivity and specificity as other modalities such as MR and CT enterography. Recent research suggests that IUS can be used to evaluate early treatment response in acute severe colitis and to predict long-term response to therapy in IBD patients. The ability of IUS to assess transmural healing has led to the proposal of using IUS as an endpoint in clinical trials. Intestinal ultrasound has the potential to become a standard cross-sectional imaging modality for monitoring IBD patients and is currently underused in Sweden.

For Swedish patients with diabetes or recent myocardial infarction, there is good information about treatment through national quality registers. However, for the much larger patient group with essential hypertension, corresponding information is lacking. QregPV, a quality register in the Västra Götaland region, provides insight into 15 years of treatment of 250,000 patients in primary care with essential hypertension or coronary artery disease. Despite increasingly better treatment over 15 years, the register shows large unexplained practice differences with significant potential for reduced secondary morbidity and healthcare costs. These data from QregPV raise important questions about the implementation of guideline recommendations in real practice.

The updated Swedish guidelines for anaphylaxis, published by the Swedish Association for Allergology (SFFA) in the autumn of 2024, provide evidence-based recommendations for acute care. The guidelines highlight the importance of rapid intervention and clear diagnostic standards to ensure patient safety. Immediate intramuscular administration of adrenaline is the only evidence-based intervention in the acute phase and should occur without delay or consideration of severity grading. Routine use of corticosteroids is no longer recommended, and severity grading is replaced by NIAID/FAAN criteria. Antihistamines are reserved for post-stabilization. Documentation, observation, and control of serum tryptase levels are essential for continued care, diagnostic accuracy, and long-term management.

Co-occurring diagnoses of autism spectrum disorder (ASD) and borderline personality disorder (BPD) have received growing attention in recent years. In a register-based study of ASD and BPD diagnoses established among individuals aged 18-40 in the Stockholm region, we examined cases where both diagnoses were present. The number of individuals diagnosed with co-occurring ASD and BPD increased markedly between 2012 and 2022. This group demonstrated significantly higher risk (odds ratio) of other psychiatric diagnoses and inpatient care compared to individuals with only ASD, only BPD, or a clinical comparison group. Notably, there was a twenty-fold increased risk of suicide attempts and severe self-harm. These findings underscore the need for targeted treatment interventions for this vulnerable population.

A growing number of pharmacological and device-based therapies are available to improve well-being and prognosis for patients with heart failure. The increasing complexity of the treatment algorithm also makes implementation of optimal therapy challenging for the healthcare system and the physician. Recent years have seen increasing implementation of heart failure therapies in Sweden, but there is still meaningful room for improvement. Key factors to enable continued progress include knowledge dissemination and clinical decision-support systems that might include alerts and/or »nudging« in the electronic health record system, increased resources to improve the access to heart failure nurses and specialist cardiology care, heart failure registries, and digital/registry-based screening for missed diagnoses or treatment of heart failure.