Laeknabladid最新文献

A case is reported of a man in his 70s that presented to the emergency department due to difficulty swallowing after a fall. He was found to have a large retropharyngeal hematoma, which led to complete airway obstruction about an hour after the injury. As oral endotracheal intubation was impossible due to the bleeding, an emergency cricothyrotomy was performed in an ambulance by an emergency medicine trainee. The patient was then transferred to Landspitali for further treatment, but was discharged home in good health 19 days later. Retropharyngeal bleeding following trauma is rare. A pre-hospital cricothyrotomy has not previously been reported for this injury.

Trigeminal neuralgia is the most common cause of facial pain in individuals over 50 years old and can have a profoundly negative impact on quality of life. Epidemiological studies have measured the annual incidence of trigeminal neuralgia at around 4-5 cases per 100,000 inhabitants per year. In Iceland, this would amount to about 16-20 new cases annually. The incidence increases steadily with age, peaking between 50 and 70 years. The pain is sudden and often compared to an electric shock. The attacks usually occur in the second or third branches of the trigeminal nerve. The pain is often triggered by sensory stimulation. Chewing, brushing teeth, speaking, or exposure to cold wind on the face, can all trigger an attack. The most common cause of trigeminal neuralgia is believed to be pressure from a nearby blood vessel on the nerve at its origin in the brainstem. Other underlying causes include multiple sclerosis (MS), tumors and in some cases, no cause is found. Treatment for trigeminal neuralgia involves medication with drugs such as carbamazepine, oxcarbazepine, gabapentin, or various types of surgical procedures. This article will review the epidemiology, pathogenesis, clinical symptoms, diagnosis and treatment of trigeminal neuralgia.

Background and aims: Migraine is a neurological disorder that is characterized by severe headaches and temporary motor and sensory disturbances. Migraine triggers are internal or external factors that can increase the likelihood of a migraine attack. Some individuals with migraine associate their attacks with the consumption of certain types of food, but no have been conducted in Iceland. The aim of the study was to estimate the proportion of individuals with migraine in Iceland who associate their symptoms with consuming certain types of food.

Methods: An electronic questionnaire was submitted to two groups (≥18 years old), members of the Icelandic Facebook group 'Migreni' (n=395 and to patients being treated by a neurologist (n=108), with the question if they thought certain foods could trigger migraine attacks. A total of 503 opened the survey (19.6% in the Facebook group and 65% managed by a neurologist). Response options were never/rarely, sometimes, often, or always. Other questions included types of migraine, medication use and background.

Results: Out of 466 participants, 354 individuals (76%) claimed that food often or always triggered their migraine. The proportion was higher in the Facebook group than in the neurologist group (78% vs. 66%, p=0.007). Red wine and skipping meals (hunger) were the most common food-related triggers, reported as triggers often or always by >50%. Other common food triggers included white wine, liquorice, and smoked meat; they were reported as triggers by 20-50% of participants.

Conclusion: Food seems to be a common migraine trigger, and the main food-related triggers were similar to those reported in other studies. However, previous studies have not shown liquorice as a common food trigger for migraines, and smoked meat was found to be a more common trigger than seen in other studies.

SGLT2 inhibitors increase renal excretion of sodium and glucose by blocking the SGLT2 transporters in the proximal tubule. Not only do they lower blood sugars levels but also have positive effects on blood pressure and weight. They lead to more efficient energy metabolism in the heart and kidneys, increase the production of red blood cells and decrease fibrosis and inflammation in the heart and the kidneys. Large double blind randomized trials have shown both cardiac and renal protective effects. Patient with heart failure, both with reduced and preserved ejection fraction have shown to benefit from treatment with SGLT2 inhibitors. They have lower risk of death due to cardiovascular causes and decreased risk of hospitalization because of heart failure compared to patient treated with placebo both with and without diabetes type 2. SGLT2 inhibitors are shown to decrease risk of chronic kidney disease stage 5 and dialysis, death due of cardiovascular events and doubling of serum creatinine in patients with chronic kidney disease both with and without diabetes type 2. They are now recommended for treatment of heart failure and chronic kidney disease with the highest evidence grade. SGLT2 inhibitors do not increase risk of hypoglycemia or acute kidney injury but do have a serious uncommon adverse effect that are normoglycemic ketoacidosis and Fournier's gangrene that physicians need to be alert to.

Eosinophilic esophagitis (EoE) is a common cause of swallowing difficulties in both children and adults. The incidence of EoE has been increasing over the past decades, which cannot be solely attributed to improved diagnostic techniques. EoE is more common in adults than in children. The diagnosis is confirmed by a biopsy from the esophageal mucosa showing a significant infiltration of eosinophils. Many patients respond to treatment with proton pump inhibitors, but those with severe EoE may require dietary modifications, topical steroids, and/or dilation of esophageal strictures. This review covers the incidence, risk factors, natural course, diagnosis, and treatment options for EoE, both within the Icelandic healthcare system andi n a broader context.