Laeknabladid最新文献

Hidradenitis suppurativa is a chronic, debilitating disease due to recurrent infections, pain and foul smelling drainage. Presently, severe cases are treated with biologics. When surgery is needed it is usually extensive, requiring skin transplantation or flaps for closure. This case report presents a patient with severe disease on both buttocks, already treated with biologics. It was decided to attempt treatment with debridement and acellular fish skin to avoid extensive surgery. The treatment was successful, the patient is symptom-free on the right side 21 months after surgery and has minimal symptoms on the left side 7 months after surgery. He is contentwith the results.

Introduction: Ventricular assist devices are increasingly used as a treatment option for patients with advanced heart failure, however, there is a lack of information about the number of patients, indications, and outcomes of this patient population in Iceland.

Methods and materials: A retrospective study covering the period 01.01.2020 - 31.12.2024. The study population consisted of individuals who had received a ventricular assist device and had received treatment or follow-up care in Iceland either before or after implantation of the ventricular assist device. Clinical data were obtained from electronic medical records, and variables were collected before and after implantation.

Results: Between 2010 and 2024, six individuals received a ventricular assist device (VAD), all of whom were male. The age at implantation ranged from 17 to 66 years. Indications for VAD implantation were equally divided between bridge to transplantation (3/6) and bridge to candidacy (3/6). The underlying causes of heart failure were dilated cardiomyopathy (5/6) and ischemic cardiomyopathy (1/6). Four patients received a left ventricular assist device, while two received a biventricular assist device. Four patients subsequently underwent heart transplantation, one died while on VAD support, and one remained on VAD therapy at the end of the study period. The mean time from VAD implantation to heart transplantation was 249 days. Throughout the study period, there were a total of 1704 days on which at least one patient with a VAD was located in Iceland, corresponding to 31% of the study period. Four complications were documented in three patients: driveline infection, ventricular tachycardia, gastrointestinal bleeding and subarachnoid hemorrhage due to syncope.

Conclusions: Patients with VADs were effectively managed in Iceland, and the results imply that the use of VADs possibly represents a currently underutilized therapeutic option for advanced heart failure in Iceland.

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.

HIV can have various clinical manifestations and without treatment it can progress to AIDS and have severe complications. We have effective treatments against the infection and want to treat everyone with HIV before it progresses to AIDS. The premise for that is HIV testing. HIV infection should be on the differential when patients present with signs and symptoms not otherwise explained. We describe here two recent cases of AIDS in Icelandic women that did not have perceived risk factors resulting in a significant delay in HIV diagnosis leading to AIDS.

Meckel's diverticulum is a common congenital anomaly in embryonic development of the ileum. Meckel's diverticulum is most often asymptomatic, but complications can arise, such as gastrointestinal bleeding and diverticulitis. We present a case report of a 42-year-old man who was diagnosed with Meckel's diverticulitis with perforation and had a previous history of gastrointestinal bleeding.

Background: Cervical artery dissection is a common cause of ischemic stroke in young adults and middle-aged individuals. Due to advances in imaging techniques and increased knowledge, dissections are now diagnosed much more frequently than before. This study aimed to investigate the incidence of cervical artery dissection in Iceland from 2005 to 2023.

Methods: A retrospective study was conducted using medical records of individuals diagnosed with cervical artery dissection in Iceland between January 1, 2005, and December 31, 2023. The factors examined included gender, year of diagnosis, age at diagnosis, symptoms, risk factors, treatment, and prognosis. Data processing was performed using Excel® and Rstudio.

Results: The study sample consisted of 107 individuals, including 37 women and 70 men. The average incidence was 1.62 per 100,000 people per year. The incidence increased over the period, being 2.7 times higher in the latter half compared to the former. The average age of diagnosis was 50 years (range 18-101 years). The most common symptom was pain (72%), followed by sensory disturbances (67%), motor disturbances (49%), and Horner's syndrome (36%). Half of the patients experienced an ischemic stroke (51%). Five individuals (4.6%) had a recurrent dissection during the follow-up period. Dissections occurred in the internal carotid artery in 56% of cases and the vertebral artery in 44% of cases. All patients received antiplatelet and/or anticoagulant therapy. After 3-6 months, 77% had no or mild disability (0-2 on the modified Rankin scale).

Discussion: The incidence of cervical artery dissection in Iceland is consistent with findings from other studies. Diagnoses have increased in recent years, and the average incidence has risen. The majority of patients achieved good recovery, indicating effective diagnosis and treatment of cervical artery dissection in Iceland.