Laeknabladid最新文献

Background: Advances in acute stroke care including specialized stroke units, intraveneous thrombolysis and mechanical thrombectomy for ischemic stroke, and prompt blood pressure reduction in intracerebral hemorrhage, have significantly reduced its devasting consequences. This study investigates acute stroke care quality at Landspitali University Hospital in Iceland (LUH).

Method: Retrospective, cross-sectional study describing the cohort of stroke patients seeking emergency treatment at LUH in 2022, comparing the quality of provided treatment to benchmarks set in neighbouring countries.

Results: Among 337 adult ischemic strokes and 71 intracerebral hemorrhages, the mean age was 70,7 (SD: 14,4); 72,6% arrived to LUH within six hours of onset. Baseline NIHSS was documented in 29,8% and 24,3% received a CT scan within15 minutes. Revascularisation therapy was given to 17,8% of ischemic strokes. Median door-to-needle and door-to-puncture times were 31 and 93 minutes with thrombolysis and thrombectomy, respectively; 69% of thrombectomies achieved a good reperfusion grade (mTICI 2b-3). In cases of intracerebral hemorrhage, 57,9% had documented systolic blood pressure targets, with 36,0% aiming for <160 mmHg and 17,2% for <140 mmHg. Anticoagulation was associated with 19,7% of these hemorrhages, of which 66,7% received reversal treatment. In all, 67,0% of ischemic stroke cases and 57,7% of intracerebral hemorrhages were admitted to a Neurology department, with a median admission time of 7,82 hours. Additionally, 19,6% of ischemic stroke cases were referred to a TIA/stroke outpatient clinic.

Conclusion: The hospital met benchmarks in thrombectomy rates and nearly in door-to-needle time in thrombolysis. There is room for improvement in other areas. The results can be used to support further enhancement of acute stroke treatment in Iceland and as a basis for policy development.

Objective: To investigate the epidemiology, severity, treatment, and prognosis of patients with C. difficile infections (CDI) diagnosed at Landspítali University Hospital from 2017-2022.

Materials and methods: The study population consisted of adult patients at Landspítali with double-positive (PCR + ELISA) diagnostic tests. If the same patient had two or more positive samples within a 28-day period, they were considered to reflect the same infection, and the latter samples were excluded.

Results: Overall, 358 CDI were identified in 301 patients. The majority of cases were diagnosed in women (59.5%). The incidence of healthcare-associated CDI was 3.23 infections/10.000 in-hospital days (range 2.65 - 3.26). Incidence of community-associated CDI was 0.57 infections/10.000 inhabitants of the Reykjavik metropolitan area. Incidence was positively correlated with increasing age and remained similar throughout the study period. The recurrence rate during the study period was 15.3% with a mean follow-up period of 1.6 person-years. At least 85.5% of patients had taken antibiotics within a month before diagnosis, most commonly from the penicillin class (57.8%), followed by cephalosporins (51.5%). More than half (54.7%) of patients had taken proton pump inhibitors preceding diagnosis. Metronidazole was the most common initial treatment (63.0%). Of these, 29.4% of cases required further treatment within 28 days of treatment start. Fecal microbiota transplantation was performed in 13 cases. The 30-day all-cause mortality rate was 7.3%.

Conclusions: The incidence of CDI at Landspítali has remained stable and comparable to what has been reported in Europe during the same period. Most patients had one or more risk factors present. Most received antibiotics as treatment, most commonly metronidazole. The results of this study indicate that incidence and clinical presentation of CDI in Iceland are stable, whilst novel treatment options look promising.

Introduction: A woman in her mid-seventies with a history of chronic atrial fibrillation (AF), coronary artery disease, polymyalgia rheumatica, and type 2 diabetes was found in a semi-comatose state in her home. In the emergency room, she presented with left arm weakness and aphasia. Magnetic resonance imaging of the brain revealed multiple acute infarcts attributed to cardiac emboli, although transthoracic echocardiography (TTE) did not detect cardiac thrombi. Following extensive rehabilitation, she was readmitted with chest pain and dyspnea, which were thought to be related to a bradycardia-induced heart failure. She received a pacemaker, but her clinical state did not improve. Therefore, cardioversion of her AF was planned; however, prior to the procedure, transesophageal echocardiography (TEE) revealed a mass in the aortic root. The mass, which was attached to the non-coronary aortic valve cusp, was surgically removed via open-heart surgery, and the valve was repaired to prevent aortic insufficiency. The patient fared well postoperatively. Histological analysis confirmed papillary fibroelastoma, which is the third most common benign heart tumor after myxoma and lipoma. This case, which is the first documented report of a papillary fibroelastoma of the aortic valve in Iceland, demonstrates the importance of considering cardiac tumors in patients with embolic stroke.

Introduction: Type 1 diabetes is characterized by destruction of the insulin-producing beta cells causing hyperglycemia. Insulin treatment targeting euglycemia mitigates complications. This study aims to assess glycemic control in Icelandic children with diabetes over the past 14 years and examine the impact of a semi-automatic insulin pump.

Methods: The study included Icelandic pediatric patients with type 1 diabetes from the past 14 years. Data on HbA1c, date of diagnosis, co-occurring diagnoses, sex, age, number of ketoacidosis diagnoses, and the introduction of a semi-automatic insulin pump were gathered from medical records.

Results: The average of means HbA1c peaked in 2012 at 70,4±11,3 mmol/mol and had its nadir in 2022 at 59,5±11,2 mmol/mol. The proportion of children with HbA1c over 70 mmol/mol was highest in 2011 (51.8%) and lowest in 2022 (10.2%). Females had higher HbA1c levels, the difference decreased by the end of the study period. Mean HbA1c decreased by 6.4 mmol/mol 18 months after introduction of a semi-automatic insulin pump. There was no significant change in mean HbA1c when 18 months prior and post introduction were compared. No change in incidence was observed over the period. Between 2018-2023, 11.2% had hypothyroidism, 2.2% had celiac disease, and 29 cases of ketoacidosis were diagnosed.

Discussion: Significant progress has been made in treating Icelandic children with type 1 diabetes in recent years. There was no increase in incidence, contrary to other studies. The impact of the semi-automatic insulin pump was less pronounced than in other studies, possibly due to a longer follow-up period.

Introduction: Neuroendocrine tumors are rare tumors, originating from the neuroendocrine system. They originate most commonly in the lungs and gastrointestinal organs. These tumors differ according to their origin and maturity. Neuroendocrine tumors can be hormonally active or inactive.

Method: This is a retrospective study of patients that had surgery for a neuroendocrine tumor in the upper gastrointestinal organs, in the period 2010-2020. Tumor origin was registered, as well as operations and factors related to the operations, complications, and survival rate. Patients who underwent surgery for a primary tumor in the upper gastrointestinal tract, or liver metastasis were included. Data was gathered from medical charts from Landspitali University Hospital, and analyzed with descriptive and survival statistics with the help of the softwares Microsoft Excel and GraphPad Prism. Appropriate permits were gathered.

Results: In total, 31 patients, was operated for neuroendocrine tumors in the upper gastrointestinal tract but tumor resection was only done on 29 patients. Those 29 patients made the study sample. 34% of the patients had complications that required intervention or intensive care treatment. No patient died within 30 days of the operation. Total survival of the patients was 88% and disease specific survival was 95%.

Conclusion: Few patients are operated on for a neuroendocrine tumor in the upper gastrointestinal tract each year. The surgeries were successful, and survival is comparable to other studies.

Introduction: Ischemic stroke is a common disease that can stem from multiple different causes, some of which are uncommon. A 43 year old woman with a history of systemic lupus erythematosus and antiphospholipid syndrome visited the emergency department due to dysarthria and was diagnosed with ischemic stroke. Transesophageal echocardiogram showed a mass on the mitral valve. After further workup, she was diagnosed with Libman-Sacks endocarditis, which is caused by endothelium damage along with hypercoagulability, and can form due to systemic lupus erythematosus or antiphospholipid syndrome. Libman-Sacks endocarditis is a nonbacterial thrombotic endocarditis and thromboembolism is rare. It is treated with anticoagulation. It is also important to treat the underlying cause of the endocarditis.