Interstitial lung abnormalities - current knowledge and future directions.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadEfforts to grasp the significance of radiologic changes similar to interstitial lung disease (ILD) in undiagnosed individuals have intensified in the recent decade. The term interstitial lung abnormalities (ILA) is an emerging definition of such changes, defined by visual examination of computed tomography scans. Substantial insights have been made in the origins and clinical consequences of these changes, as well as automated measures of early lung fibrosis, which will likely lead to increased recognition of early fibrotic lung changes among clinicians and researchers alike. Interstitial lung abnormalities have an estimated prevalence of 7-10% in elderly populations. They correlate with many ILD risk factors, both epidemiologic and genetic. Additionally, histopathological similarities with IPF exist in those with ILA. While no established blood biomarker of ILA exists, several have been suggested. Distinct imaging patterns indicating advanced fibrosis correlate with worse clinical outcomes. ILA are also linked with adverse clinical outcomes such as increased mortality and risk of lung cancer. Progression of ILA has been noted in a significant portion of those with ILA and is associated with many of the same features as ILD, including advanced fibrosis. Those with ILA progression are at risk of accelerated FVC decline and increased mortality. Radiologic changes resembling ILD have also been attained by automated measures. Such measures associate with some, but not all the same factors as ILA. ILA and similar radiologic changes are in many ways analogous to ILD and likely represent a precursor of ILD in some cases. While warranting an evaluation for ILD, they are associated with poor clinical outcomes beyond possible ILD development and thus are by themselves a significant finding. Among the present objectives of this field are the stratification of patients with regards to progression and the discovery of biomarkers with predictive value for clinical outcomes.Landspitali Scientific Fund University of Iceland Research Fund 2021 Eimskip University Fun

Technical Performance of Textile-Based Dry Forehead Electrodes Compared with Medical-Grade Overnight Home Sleep Recordings

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadThe current clinically used electroencephalography (EEG) sensors are not self-applicable. This complicates the recording of the brain's electrical activity in unattended home polysomnography (PSG). When EEG is not recorded, the sleep architecture cannot be accurately determined, which decreases the accuracy of home-based diagnosis of sleep disorders. The aim of this study was to compare the technical performance of FocusBand, an easily applicable textile electrode headband, to that of clinical EEG and electrooculography (EOG) electrodes. Overnight unattended recordings were conducted at participants' (n = 10) homes. Signals were recorded using a portable Nox A1 PSG device. The FocusBand's forehead EEG (Fp1-Fp2) signals contained features that are visible at both, the standard EEG (F4-M1) and EOG (E1-M2) signals. The FocusBand's EEG signal amplitudes were significantly lower compared to standard EEG (F4-M1; average difference 98%) and EOG (E1-M2; average difference 29%) signals during all sleep stages. Despite the amplitude difference, forehead EEG signals displayed typical EEG characteristics related to certain sleep stages. However, the frequency content of the FocusBand-based signals was more similar to that of the standard EOG signals than that of standard EEG signals. The majority of the artifacts seen in the FocusBand signals were related to a loosened headband. High differences in the frequency content of the compared signals were also found during wakefulness, suggesting susceptibility of the textile electrodes to electrode movement artifacts. This study demonstrates that the forehead biopotential signals recorded using an easily attachable textile electrode headband could be useful in home-based sleep recordings.European Union's Horizon 2020 Research and Innovation Programme NordForsk through the Business Finland NordForsk through Icelandic Center for Research Academy of Finland European Commission Research Committee of the Kuopio University Hospital Catchment Area for the State Research Funding Finnish Cultural Foundation Finnish Cultural Foundation-Kainuu Regional Fund Respiratory Foundation of Kuopio Region Research Foundation of the Pulmonary Diseases Finnish Anti-Tuberculosis Association Tampere Tuberculosis Foundatio

Comparison of treatment retention and response to secukinumab versus tumour necrosis factor inhibitors in psoriatic arthritis.

To access publisher's full text version of this article click on the hyperlink belowObjectives: To compare treatment retention and response to secukinumab vs adalimumab, including the other four TNF inhibitors (TNFi) as comparators, in PsA. Methods: All patients with PsA starting secukinumab or a TNFi in 2015-2018 were identified in the biologic registers of the Nordic countries. Data on comorbidities were linked from national registers. One-year treatment retention and hazard ratios (HRs) for treatment discontinuation were calculated. The proportion achieving a 6 month 28-joint Disease Activity Index for Psoriatic Arthritis (DAPSA28) remission was determined together with odds ratios (ORs) for remission (logistic regression). Both HRs and ORs were calculated with adalimumab as the reference and adjusted for baseline characteristics and concurrent comorbidities. All analyses were stratified by the line of biologic treatment (first, second, third+). Results: We identified 6143 patients contributing 8307 treatment courses (secukinumab, 1227; adalimumab, 1367). Secukinumab was rarely used as the first biologic, otherwise baseline characteristics were similar. No clinically significant differences in treatment retention or response rates were observed for secukinumab vs adalimumab. The adjusted HRs for discontinuation per the first, second and third line of treatment were 0.98 (95% CI 0.68, 1.41), 0.94 (0.70, 1.26) and 1.07 (0.84, 1.36), respectively. The ORs for DAPSA28 remission in the first, second and third line of treatment were 0.62 (95% CI 0.30, 1.28), 0.85 (0.41, 1.78) and 0.74 (0.36, 1.51), respectively. In the subset of patients previously failing a TNFi due to ineffectiveness, the results were similar. Conclusion: No significant differences in treatment retention or response were observed between secukinumab and adalimumab, regardless of the line of treatment. This suggests that even in patients who have failed a TNFi, choosing either another TNFi or secukinumab may be equally effective. Keywords: adalimumab; psoriatic arthritis; response; retention; secukinumab; treatment.NordForsk Foundation for Research in Rheumatology (FOREUM) Finska Lakaresallskapet Helsinki University Hospital Institutional gran

Liver Injury Following Tinospora Cordifolia Consumption: Drug-Induced AIH, or AIH?

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Creativity, leisure activities, social engagement and cognitive impairment: the AGES-Reykjavík study.

To access publisher's full text version of this article click on the hyperlink belowBackground: Participation in leisure activities and extensive social network have been associated with lower risk of cognitive impairment (CI) and dementia. Aims: We examined whether leisure activities (cognitive solitary, cognitive group, social, physical, or creative activities) and social involvement are associated with less incidence of CI or dementia. Methods: Analyses were performed from data of 2933 cognitively intact individuals at baseline included in the AGES-REYKJAVIK study. Odds ratios (OR) were calculated for incident CI and dementia in relation to cognitive individual, cognitive group, social, physical, and creative leisure activities as well as social networks. Models were adjusted for a number of known risk factors for cognitive decline. Results: In 5 years, 12% of the cohort were diagnosed with CI or dementia. All leisure activities were associated with reduced likelihood of cognitive decline in the raw model, but in adjusted models, cognitive solitary [OR 0.49 (Confidence Interval (CI) 0.38-0.64)], cognitive group [OR 0.50 (CI 0.30-0.82)], and creative activities [OR 0.53 (CI 0.35-0.83)] were significantly associated with less cognitive decline. Analyses examining creative leisure activities independently, controlling for all other activities, suggested individuals participating in creative activities exhibited less CI [OR 0.64 (CI 0.41-0.98)]. Among social networks variables, frequency of meeting with friends and relatives was associated with reduced likelihood of CI [OR 0.49 (CI 0.31-0.75)]. Discussion: Cognitive and creative leisure activities and frequent gatherings with friends and relatives are associated with reduced incidence of CI in this older cohort. Conclusion: Creative leisure activities might have special benefit for cognitive ability. Keywords: Cognitive impairment; Creativity; Dementia; Elderly; Leisure activities; Social relations.United States Department of Health & Human Services National Institutes of Health (NIH) - USA United States Department of Health & Human Services National Institutes of Health (NIH) - USA NIH National Institute on Aging (NIA) Althingi (the Icelandic Parliament

Dili is rare amongst patients without liver metastases receiving cancer treatment in Iceland: a population-based cohort study.

To access publisher's full text version of this article click on the hyperlink belowBackground: There is limited information on the frequency of idiosyncratic drug-liver injury (DILI) among cancer patients. The aim of the study was to evaluate the frequency of DILI due to cancer treatment in a population-based setting. Material and methods: All patients diagnosed with genitourinary cancer, breast cancer or metastatic malignant melanoma in 2007-2018 were matched with a database containing laboratory results for all major hospitals in Iceland. Medical chart review was performed for cases with ALT/AST ≥5× upper limit of normal (ULN), ALP ≥2× ULN or bilirubin ≥2× ULN. Patients with liver-, and/or bone metastases and isolated elevations of ALP and patients with other etiologies of liver enzyme elevations were excluded. Cases with a RUCAM score of probable or highly probable were included. Results: Among 4956 patients, 840 patients had liver enzyme elevations. Overall, nine (0.2%) cases of DILI were identified, seven women (78%), median age 59 years (IQR 52-66). Four patients had kidney cancer, four breast cancer and one metastatic prostate cancer. In eight cases, a single agent was implicated: Pazopanib (n = 3), axitinib, docetaxel, gemcitabine, letrozole and paclitaxel. In all cases, the treatment was interrupted or discontinued due to the liver injury. No patient developed jaundice or liver failure and no death was linked to DILI. Time to normalization of liver enzymes was 17 days (IQR 25-120). Conclusion: DILI was found to be rare and no cases of severe liver injury occurred. However, approximately 90% of patients switched to another treatment which might have affected prognosis. Keywords: DILI; RUCAM; hepatotoxicity; liver enzymes; malignancy.Landspitali University Hospita

Low dose rabbit antithymocyte globulin is non-inferior to higher dose in low-risk pediatric kidney transplant recipients.

To access publisher's full text version of this article click on the hyperlink belowBackground: Currently, there is no consensus among pediatric kidney transplant centers regarding the use and regimen for immunosuppressive induction therapy. Methods: In this single center, retrospective cohort study, pediatric kidney transplant recipients transplanted between 1 May 2013 and 1 May 2018 with rabbit antithymocyte globulin (rATG) induction were included. We stratified patients based on immunological risk, with high risk defined as those with repeat transplant, preformed donor specific antibody, current panel-reactive antibodies > 20%, 0 antigen match and/or African-American heritage. Outcome of interest was the incidence of biopsy proven acute rejection by 1 year. Results: A total of 166 patients met inclusion criteria. Age of patients was 12 years (11 mo-21 y), (median, range), 21.5% received a living donor transplant and 50.6% were female. Low-immunologic-risk patients were divided into 2 groups, those who received the lower cumulative rATG dose of ≤ 3.5 mg/kg (n = 52) versus the higher cumulative dose of > 3.5 mg/kg (n = 47). The median total dose in the lower dose group was 3.1 (IQR 0.3) and 4.4 (IQR 0.8) in the higher dose group, P < 0.001. Rejection rate did not differ significantly between the 2 treatment groups (7/52 vs. 6/47). None in the lower dose group developed BK nephropathy versus 3 in the higher dose group. Graft loss due to BK nephropathy occurred in 1 patient in the higher dose group. Graft loss in the whole cohort at 12 months was a rare event (n = 1) with 99.5% graft survival and 100% patient survival. Conclusions: Reduced rATG dosing (≤ 3.5 mg/kg) when compared to higher dosing (> 3.5 mg/kg) is safe and effective in low-risk pediatric kidney transplant recipients without increasing risk of rejection. A higher resolution version of the Graphical abstract is available as Supplementary information. Keywords: Acute allograft rejection; Immunosuppression; Induction therapy; Thymoglobulin; Transplantation.Tashia and John Morgridge Endowed Postdoctoral Fellow of the Stanford Maternal and Child Health Research Institut

Effectiveness of Nursing Interventions for Patients With Cancer and their Family Members: A Systematic Review.

To access publisher's full text version of this article click on the hyperlink belowCancer diagnosis poses enormous physical and psychosocial challenges for both the affected person and their families. This systematic review identifies the characteristics and effectiveness of nursing interventions offered to adult patients with cancer and their families. Five databases were searched, and 19 studies published from 2009 to 2020 were included. Interventions were categorized as follows: (a) interventions with supporting and cognitive components (n = 3), (b) interventions that included skills training for the caregiver (n = 3), (c) interventions to enhance care through managing symptoms (n = 8), (d) interventions focusing on the dyad or family-patient relationship (n = 4), and (e) interventions targeted to the patient's condition (n = 1). The results of this review offer an overview from which to carry out new studies and are useful for providing future directions within family nursing practice, taking into account the impact that the family has on the disease and the consequences the condition may bring to the whole family

The Progress of Pain and Painkillers

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Advances in lung cancer diagnosis and treatment - a review

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadLungnakrabbamein er annað algengasta krabbameinið á Íslandi hjá konum og þriðja hjá körlum. Þótt hægt hafi á nýgengi sjúkdómsins á undanförnum árum dregur ekkert krabbamein fleiri Íslendinga til dauða. Einkenni lungnakrabbameins geta verið staðbundin en eru oftar almenns eðlis og á það stóran þátt í hversu margir sjúklingar greinast með útbreiddan sjúkdóm. Á síðustu árum hafa orðið miklar framfarir í greiningu og meðferð lungnakrabbameins. Tilkoma jáeindaskanna og berkjuómspeglunar hafa bætt stigun sjúkdómsins og gert meðferð markvissari. Lungnaskurðaðgerðir með brjóstholssjá hafa stytt legutíma og fækkað fylgikvillum, auk þess sem nýjungar í geislameðferð nýtast betur sjúklingum sem ekki er treyst í skurðaðgerð. Mestar nýjungar hafa þó orðið í lyfjameðferð útbreidds lungnakrabbameins. Þar hafa öflug líftæknilyf komið til sögunnar sem gera kleift að klæðskerasauma meðferðina út frá mælingum á stökkbreytingum og lífmörkum í æxlunum. Loks hafa nýlegar skimunarrannsóknir með lágskammta tölvusneiðmyndum sýnt marktæka lækkun á dánartíðni. Hér eru helstu nýjungar í greiningu og meðferð lungnakrabbameins reifaðar með hliðsjón af þeim framförum sem orðið hafa og er sérstaklega vísað til íslenskra rannsókna.Lung cancer is the second and third most common cancer in Iceland for females and males, respectively. Although the incidence is declining, lung cancer still has the highest mortality of all cancers in Iceland. Symptoms of lung cancer can be specific and localized to the lungs, but more commonly they are unspecific and result in significant diagnostic delay. Therefore, majority of lung cancer patients are diagnosed with non-localized disease. In recent years, major developments have been made in the diagnosis and treatment of lung cancer. Positive emission scanning (PET) and both transbroncial (EBUS) or transesophageal ultrasound (EUS) biopsy techniques have resulted in improved mediastinal staging of the disease and minimal invasive video-assisted thoracic surgery (VATS) has lowered postoperative complications and shortened hospital stay. Technical developments in radiotherapy have benefitted those patients who are not candidates for curative surgery. Finally, and most importantly, recent advances in targeted chemotherapeutics and development of immunomodulating agents have made individual tailoring of treatment possible. Recent screening-trials with low-dose computed tomography show promising results in lowering mortality. This evidence-based review focuses on the most important developments in the diagnosis and treatment of lung cancer, and includes Icelandic studies in the field