Lakartidningen最新文献

Combined lifestyle management is the foundation of all obesity treatment. Through person-centered dialogue, patients are supported in designing an individualized plan. The plan may include guidance on energy-reduced healthy eating, increased physical activity, stress management strategies or improved sleep. Treatment can be delivered in-person or online, either individually or in groups. Regular evaluation is a key component of treatment, and an empathetic approach is essential for the treatment alliance.

Metabolic and bariatric surgery aims to achieve long-term weight loss with improvement of obesity-related diseases and quality of life, without negatively affecting daily life. Despite limited food intake, an individual who has undergone this type of surgery should in principle be able to eat any food and not suffer from gastrointestinal problems or nutritional deficiencies. In cases of advanced obesity (BMI ≥35 kg/m2), we believe that bariatric surgery is the first-line treatment for individuals from 18 years of age. The type of procedure should be chosen in consultation with the patient, and gastric bypass has been recommended for individuals with type 2 diabetes or a BMI ≥35 kg/m2 for many years in Sweden. Individuals who have undergone metabolic and bariatric surgery need daily nutritional supplements and should be monitored throughout their lives. Long-term results are good with lasting weight loss and improvement in obesity-related diseases and physical quality of life. Recurrent weight gain and other issues should be managed in multidisciplinary teams. Swedish metabolic and bariatric surgery is generally well developed and of high quality.

Costs related to overweight and obesity, including costs of health care and productivity losses of production, correspond to 2 % of Sweden's Gross Domestic Product (GDP) and is projected to reach 2.4 % of GDP by 2060. In middle income countries, obesity costs to society increase even faster, projected to reach 4-5 % of GDP by 2060. However, the total cost of obesity is not just financial, but also social and environmental. Addressing obesity successfully requires action at both individual and societal levels, and across several sectors. Treatment at the individual level needs to be combined with general preventive actions. International examples of such actions include Health Holland, the Commissioner for the Wellbeing of Future Generations in Wales, and VicHealth in Australia. With inspiration from these initiatives, the organization A healthier Sweden aims to facilitate turning knowledge into practice for systems change for better health.

Superior vena cava (SVC) syndrome is caused by obstruction of blood flow in the SVC resulting in swelling of the face, neck and upper extremities. Dyspnea and hoarseness are common. Distension of the veins in the neck and chest wall can be seen. The diagnosis is made by contrast-enhanced CT. The most common cause is malignancy. However, iatrogenic causes have increased due to an increasing number of central venous catheters and implantable cardiac devices. SVC syndrome is a rare but important differential diagnosis to angioedema. This case report presents a man with iatrogenic SVC syndrome who was misdiagnosed multiple times. To avoid misdiagnosis, increased knowledge of SVC syndrome, a readiness to reconsider the diagnosis and a thorough physical examination are important.

Most patients can discontinue antidepressants without severe problems, while some experience significant withdrawal symptoms such as anxiety, dizziness, and sensory disturbances. These symptoms, which often occur in the final stages of tapering, should not automatically be interpreted as a relapse of the underlying condition. Healthcare professionals must adopt a reassuring yet non-minimizing approach, providing clear, balanced information to normalize the process and reduce nocebo effects. Personalized tapering strategies, including gradual dose reductions based on hyperbolic curves or the so-called 10 procent rule, can ease the transition. More evidence-based examples of successful tapering methods are needed to support patients effectively through this challenging phase.

Human and planetary health are interconnected. The UN's Sustainable Development Goals aim for a healthy, peaceful world, but climate change - accelerated by human activity - is a major threat. Rising temperatures, water scarcity, pollution, and biodiversity loss contribute to worsening health crises. The healthcare sector itself is a major polluter, responsible for >5% of global CO₂ emissions. Chronic kidney disease (CKD) is increasingly linked to climate change, with extreme heat, air pollution, and water contamination exacerbating risks. Dialysis has a heavy environmental footprint, consuming vast amounts of water, energy, and plastic. Suggestions for development of a sustainable care system for kidney diseases are presented. To achieve sustainable nephrology, green dialysis and plant-based diets, are crucial. Reducing reliance on animal agriculture and ultraprocessed foods benefits both human and planetary health. Urgent action is needed to reform healthcare towards sustainability and align with the »One Health« approach, emphasizing the interdependence of human, animal, and environmental health.

Metabolic acid-base disturbances often result from several independent processes. These processes are difficult to tease out using traditional bicarbonate-centred approaches. According to standard base excess partitioning, standard base excess is the sum of the acid-base effects of changes in the concentration of sodium, chloride, lactate, albumin and an unspecified entity termed »Other Ions«. Since the first five of these entities are routinely analysed, »Other Ions« can be calculated at the bedside. In this article, five short case vignettes are used to illustrate how standard base excess partitioning provides a more complete understanding of the patient's acid-base disturbance, and how it may allow for more physiologically appropriate therapy.

High-sensitive cardiac troponins are essential biomarkers in the diagnostics of myocardial infarction. However, analytical interference such as macrotroponin, where troponin forms stable complexes with endogenous antibodies, can lead to persistently elevated levels without actual myocardial injury. The first case report presents a young woman with recurrent chest pain and prolonged troponin I elevation over several years, which ultimately could be attributed to macrotroponin I. The second case report describes a young man presenting with intermittent chest pain and stable troponin I elevation. Following extensive investigations, the elevation was ultimately attributed to macrotroponin. These cases highlight the clinical importance of recognizing this diagnostic pitfall, especially when elevated troponin level lacks correlation with symptoms, ECG or imaging findings. In case of suspected macrotroponin, contact your local laboratory for further investigation.