Central and extrapontine myelinolysis following correction of extreme hyponatremia. Case report and review of the literature

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenWe report a case of a 43-year-old woman who developed osmotic demyelination syndrome following correction of extreme hyponatremia that was considered to be of chronic nature. The serum sodium level was 91 mmol/L on admission to hospital. It was decided to correct the serum sodium slowly with the goal that the rate of correction would be no more than 12 mmol/l per 24 hours. This was achieved during the first two days of treatment but during the third day the rise in serum sodium was 13 mmol/l. On the 11th day of admission the patient had developed manifestations of pseudobulbar palsy and spastic quadriparesis. Magnetic resonance imaging study confirmed central and extrapontine myelonolysis. The patient received supportive therapy and eventually made full recovery. Current concepts in the pathophysiology of osmotic demyelination syndrome and the treatment of hyponatremia are reviewed. We recommend that the rate of correction of chronic hyponatremia should not exceed 8 mmol/l per 24 hours.Við greinum frá 43 ára gamalli konu sem fékk osmósuafmýlingarheilkenni (osmotic demyelination syndrome) í kjölfar leiðréttingar sérlega svæsinnar blóðnatríumlækkunar sem álitin var af langvinnum toga. Styrkur natríums í sermi var aðeins 91 mmól/l við komu á sjúkrahús. Stefnt var að hægfara leiðréttingu natríumlækkunarinnar og var markmiðið að hraði leiðréttingar yrði ekki meiri en 12 mmól/l á sólarhring. Það tókst fyrstu tvo daga meðferðar en á þriðja degi hækkaði natríumstyrkurinn um 13 mmól/l. Á 11. degi reyndist konan komin með merki um sýndarmænukylfulömun (pseudobulbar palsy) ásamt stjarfaferlömun (spastic quadriparesis) og staðfesti segulómmyndun miðbrúar- og utanbrúarafmýlingarskemmdir. Konan fékk almenna stuðningsmeðferð og náði smám saman fullum bata. Fjallað er um meinalífeðlisfræði osmósuafmýlingarheilkennis og meðferð blóðnatríumlækkunar. Við mælum með að hraði leiðréttingar langvinnrar blóðnatríumlækkunar sé ekki umfram 8 mmól/l á sólarhring

Advances in detection, evaluation and management of chronic kidney disease

Neðst á síðunni er að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenThe incidence of end-stage kidney failure has increased dramatically world-wide in recent decades. It is a disorder that carries high mortality and morbidity and its treatment is expensive. Increased emphasis has been placed on early detection in recent years in the hope that it may lead to preventive strategies. However, these efforts have been hampered by ambiguous disease definitions. Recent guidelines have defined chronic kidney disease (CKD) as glomerular filtration rate (GFR) less than 60 ml/min/1.73 m(2) and/or evidence of kidney damage by laboratory or imaging studies, of more than 3 months duration. Chronic kidney disease is divided into 5 stages based on renal function, where stage 1 is defined as normal GFR or above 90 ml/min/1.73 m(2), and stage 5 as GFR below 15 ml/min/1.73 m(2) which is consistent with end-stage kidney failure. The GFR can be measured directly but more conveniently it is calculated based on serum creatinine using formulas that have been shown to be fairly accurate. Epidemiological studies employing the new definition have shown that the prevalence of CKD is 5-10% in Western countries, leading to its recognition as a major public health problem. It has also been demonstrated that CKD is associated with increased cardiovascular risk. This year the Clinical Biochemistry Laboratory at Landspitali University Hospital will begin reporting the estimated GFR along with the serum creatinine values. It is important that Icelandic physicians learn to use the estimated GFR in their daily practice to make the diagnosis and staging of CKD more effective. Hopefully this will lead to earlier detection and institution of therapy that may retard the development of end-stage kidney failure and decrease the associated cardiovascular risk.Nýgengi nýrnabilunar á lokastigi hefur aukist jafnt og þétt um allan heim á undanförnum áratugum. Því hafa augu manna beinst að því að greina langvinnan nýrnasjúkdóm snemma svo draga megi úr áþján og kostnaði sem fylgir lokastigsnýrnabilun. Samkvæmt nýlegum leiðbeiningum er langvinnur nýrnasjúkdómur skilgreindur sem gaukulsíunarhraði (GSH) undir 60 ml/mín./1,73 m2 og/eða merki um skemmdir í nýrum samkvæmt þvag- eða myndgreiningarrannsóknum, í að minnsta kosti þrjá mánuði. Jafnframt er langvinnum nýrnasjúkdómi skipt í fimm stig eftir starfshæfni nýrna, frá stigi 1 sem er skilgreint sem eðlilegur GSH eða yfir 90 ml/mín./1,73 m2, og upp í stig 5, þegar GSH er kominn niður fyrir 15 ml/mín./1,73 m2 en það telst vera lokstigsnýrnabilun. Gaukulsíunarhraða er hægt að mæla beint en mun hentugra er að reikna hann út frá kreatíníni í sermi með því að nota jöfnur sem hafa reynst vera nokkuð áreiðanlegar. Hins vegar er kreatínín í sermi eitt sér frekar ónákvæmur mælikvarði á nýrnastarfsemi. Faraldsfræðilegar rannsóknir sem byggja á framangreindri skilgreiningu hafa sýnt að tíðni langvinns nýrnasjúkdóms er 5-10% á Vesturlöndum og er því víða farið að líta á hann sem lýðheilsuvandamál. Einnig hefur verið sýnt fram á að langvinnum nýrnasjúkdómi fylgir aukin hætta á hjarta- og æðasjúkdómum. Á þessu ári mun rannsóknastofa í klínískri lífefnafræði á Landspítala hefja þá nýbreytni að gefa upp reiknaðan GSH ásamt kreatíníngildum. Mikilvægt er að læknar kynni sér gildi reiknaðs GSH og nýti hann við dagleg störf. Þannig verður greining og meðferð sjúklinga með langvinnan nýrnasjúkdóm markvissari og verður vonandi hægt að koma í veg fyrir að sjúkdómurinn þróist yfir í lokastigsnýrnabilun auk þess að draga úr hættu á hjarta- og æðasjúkdómum

Gout – a treatable condition

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 FilesÞvagsýrugigt er liðbólgusjúkdómur sem í flestum tilfellum er læknanlegur en algengi hans á heimsvísu fer vaxandi. Án meðferðar getur sjúkdómurinn valdið varanlegum liðskemmdum en þrátt fyrir það benda rannsóknir til að vanmeðhöndlun sjúkdómsins sé mikil. Tengsl við lífsstílssjúkdóma á borð við efnaskiptavillu eru ótvíræð en sjúkdómurinn getur einnig verið fylgikvilli lífshættulegra sjúkdóma og meðferðar við þeim. Nú liggja fyrir nýlegar leiðbeiningar frá Bandaríkjunum og Evrópu varðandi greiningu og meðferð þvagsýrugigtar, bæði við bráðum liðbólgum sem og langtímameðferð. Aukin áhersla er lögð á meðferð til að fyrirbyggja sjúkdóminn, bæði með lífsstílsbreytingum og lyfjameðferð. Mikil áhersla er lögð á að fræða sjúklinga um sjúkdóminn og tilvist góðra meðferðarúrræða, hvernig skal bregðast við bráðri liðbólgu og mikilvægi þess að lækka styrk þvagsýru í blóði. Þegar sjúklingur greinist með þvagsýrugigt ætti að skima fyrir fylgisjúkdómum. Það er mikilvægt að setja meðferðarmarkmið þvagsýrulækkunar og fylgja þeim með eftirfylgd yfir langan tíma, því þannig er hægt að koma þvagsýrugigt í varanlegt sjúkdómshlé. -Gout is a disabling and common arthritis with increasing prevalence. Without treatment the disease can cause permanent joint damage. It is commonly associated with the metabolic syndrome but can also be related to a number of life-threatening diseases and their treatments. Gout is often misdiagnosed and its long-term management is suboptimal despite the availability of effective treatments. Recently The American College of Rheumatology (ACR) and European League against Rheumatism (EULAR) released common guidelines for the diagnosis of gout and EULAR updated their guidelines for management. There is increased emphasis on preventive treatment, both with lifestyle modifications and pharmacotherapy. It is important to educate patients about the disease and the existence of effective treatment options, how to manage an acutely inflamed joint and why it is important to lower serum urate. When a patient is diagnosed with gout he should be screened for associated comorbidities. It is important to treat-to-target and lower serum urate over a long period of time to induce permanent remission of gouty arthritis

The role of omega-3 polyunsaturated fatty acids in clinical medicine

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenIn recent years there has been a growing interest in the use of omega-3 polyunsaturated fatty acids as medical therapeutic agents, and a multitude of epidemiological and clinical studies have evaluated their role in health and disease. A drug containing high concentration of omega-3 polyunsaturated fatty acids has been approved for the treatment of hypertriglyceridemia and following myocardial infarction in some European countries. Furthermore, there is a growing body of evidence suggesting that these fatty acids may be of benefit in several other diseases. To date, the majority of research has focused on cardiovascular diseases including hypertension, atherosclerosis and the prevention of sudden cardiac death, where these fatty acids may be useful. In addition, several studies have suggested a beneficial effect in severe acute and chronic inflammatory diseases, particularly rheumatoid arthritis and immunoglobulin A nephropathy, although the results have not been consistent. Finally, the role of omega-3 polyunsaturated fatty acids in the structure and function of nervous tissue has prompted investigations on their effect on neurological development of premature and young infants and their use as therapeutic agents in psychiatric disorders. In this article we review the scientific evidence for the role of omega-3 polyunsaturated fatty acids in clinical medicine.Áhugi á notkun ómega-3 fjölómettaðra fitusýra í læknisfræðilegum tilgangi hefur glæðst mikið síðustu áratugi enda liggja nú fyrir fjölmargar rannsóknir á gagnsemi þeirra við meðferð ýmissa sjúkdóma. Yfirvöld lyfjamála í nokkrum löndum Evrópu hafa veitt lyfi sem inniheldur ómega-3 fjölómettaðar fitusýrur markaðsleyfi sem meðferð við hárri þéttni þríglýseríða í blóði og nýverið einnig sem hluta af meðferð eftir brátt hjartadrep. Þá hafa rannsóknir gefið vísbendingar um ávinning í mun fleiri sjúkdómum, sérstaklega hjarta- og æðasjúkdómum, og hafa meðal annars leitt í ljós að ómega-3 fjölómettaðar fitusýrur gætu nýst við meðferð háþrýstings, æðakölkunar og til að fyrirbyggja alvarlegar hjartsláttartruflanir og skyndidauða. Einnig hafa á undanförnum árum komið fram fjölmargar áhugaverðar rannsóknir á notkun þessara fitusýra í meðferð langvinnra bólgusjúkdóma, sérstaklega iktsýki og ónæmisglóbúlín A nýrnameins þar sem niðurstöður benda til marktæks ávinnings af slíkri meðferð en hafa ekki verið alveg samhljóða. Loks hafa rannsóknir á hlutverki ómega-3 fjölómettaðra fitusýra í miðtaugakerfi ýtt undir athuganir á gildi þeirra fyrir taugaþroska ungbarna og notkun við meðferð geðsjúkdóma en þær rannsóknir eru ekki eins langt á veg komnar. Í þessari grein er fjallað um gildi ómega-3 fjölómettaðra fitusýra í læknisfræði og helstu rannsóknir sem farið hafa fram á notkun þeirra við meðferð sjúkdóma

High-Temperature Geothermal Utilization in the Context of European Energy Policy—Implications and Limitations

Publisher's version (útgefin grein)The European Union (EU) has made climate change mitigation a high priority though a policy framework called "Clean Energy for all Europeans ". The concept of primary energy for energy resources plays a critical role in how different energy technologies appear in the context of this policy. This study shows how the calculation methodologies of primary energy content and primary energy factors pose a possible negative implication on the future development of geothermal energy when comparing against EU's key energy policy targets for 2030. Following the current definitions of primary energy, geothermal utilization becomes the most inefficient resource in terms of primary energy use, thus contradicting key targets of increased energy efficiency in buildings and in the overall energy use of member states. We use a case study of Hellisheidi, an existing geothermal power plant in Iceland, to demonstrate how the standard primary energy factor for geothermal in EU energy policy is highly overestimated for efficient geothermal power plants. Moreover, we combine life cycle assessment and the commonly utilized combined heat and power production allocation methods to extract the non-renewable primary energy factor for geothermal and show how it is only a minimal fraction of the total primary energy factor for geothermal. The findings of the study apply to other geothermal plants within the coverage of the European Union's energy policy, whether from high- or low-temperature geothermal resources. Geothermal has substantial potential to aid in achieving the key energy and climate targets. Still, with the current definition of the primary energy of geothermal resources, it may not reach the potential.This work is a part of the Primary Energy Efficiency (PEE) project that was funded by Nordic EnergyResearch, grant number 16X753.02, and co-financed by the National Energy Fund (Orkusjóður), grant number 12-2007, owned by the Government of Iceland. Also partially funded by the Landsvirkjun Energy Research fund,grant number FMV 04-2013.Peer Reviewe

Patient satisfaction with care and interaction with staff in the Acute Cardiac Unit at Landspitali - The National University Hospital of Iceland.

Efst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinnInngangur: Heilbrigðisþjónusta á Íslandi hefur þótt standa ágætlega í alþjóðlegum samanburði en reynsla sjúklinga af samskiptum við heilbrigðiskerfið hefur ekki mikið verið rannsökuð. Markmið þessarar rannsóknar var að kanna upplifun sjúklinga af þjónustu og samskiptum við heilbrigðisstarfsfólk á Hjartagátt Landspítala. Aðferðir: Spurningalisti byggður á Patient Satisfaction Questionnaire III var sendur til einstaklinga sem komu á Hjartagátt Landspítala frá 1. janúar til 29. febrúar 2012. Spurningalistinn var í formi fullyrðinga og gáfu þátttakendur til kynna hversu sammála eða ósammála þeir voru þeim á skala frá 1-5. Við greiningu gagna var notast við lýsandi tölfræði, Cronbach's alpha við greiningu á innra samræmi kvarðanna og þáttagreiningu. Hópar voru bornir saman með Wilcoxon-Mann-Whitney og Kruskal-Wallis prófum og fylgni metin með fylgnistuðlum Pearson og Spearman. Niðurstöður: Spurningalistinn var sendur til 485 einstaklinga og 275 (57%) svöruðu. Miðgildi (spönn) aldurs þeirra sem svöruðu var 62 (19-95) ár og 132 (48%) voru konur. Innra samræmi var hátt í öllum kvörðum spurningalistans nema einum. Meðaleinkunn úr öllum spurningalistanum var 6,8±1,0 (af 10). Alls voru 91% þeirra sem svöruðu ánægðir með framkomu lækna, 86% með framkomu hjúkrunarfræðinga og annars starfsfólks og 88% ánægðir með þá þjónustu sem þeir fengu. Hins vegar fannst 25% einstaklinga útskýringar á einkennum sínum ekki fullnægjandi og eftirfylgni ábótavant. Ályktanir: Almennt virðast skjólstæðingar Hjartagáttar ánægðir með þjónustuna sem þeir fá. Niðurstöður benda þó til að bæta megi þjónustu á sumum sviðum, einkum hvað varðar upplýsingagjöf við útskrift og eftirfylgni.Introduction: The Icelandic health care system ranks favourably in international comparison but patients' experience of interaction with the health service has not been well studied. The goal of this study was to examine the satisfaction of patients admitted to the Acute Cardiac Unit (ACU) at Landspitali - The National University Hospital of Iceland. Methods: A questionnaire based on the Patient Satisfaction Questionnaire III was mailed to patients admitted to the ACU between 1 January and 29 February 2012. Questions were presented as statements and participants asked to respond how strongly on a scale from 1 to 5 they agreed or disagreed with each statement. Data analysis was performed using descriptive statistics, Cronbach´s alpha for internal consistency of scales and principal components analysis, Wilcoxon-Mann-Whitney and Kruskal-Wallis tests for comparison of groups and Pearson and Spearman correlation coefficients for correlation between variables. Results: The questionnaire was mailed to 485 individuals of whom 275 (57%) responded. The median age of the participants was 62 (range, 19-95) years and 132 (48%) were women. Internal consistency of the scales was mostly high (Cronbach's alpha 0.62-0.91) and principal components analysis revealed one main factor. The mean score of the questionnaire was 6.8 ±1.0 and 91%, and 86% of the participants were pleased with their interaction with physicians and nurses, respectively. Similarly, 88% were pleased with the care they recieved but 25% felt they received insufficient explanations of their symptoms or that follow-up care was lacking. Conclusion: Patients of the ACU generally appear to be satisfied with their care. However, our results suggest that improvement is needed in several areas, including information provided at discharge and follow-up care. Key words: Health service, acute cardiac unit, heart disease, quality of care, PSQ-III questionnaire, survey

One of us? Negotiating multiple legal identities across the Viking diaspora

Migrations from mainland Scandinavia during the Viking age resulted in the establishment of colonies across the North Atlantic. Evidence of sustained sociocultural contact between these colonies has encouraged scholars to recognise the Viking world as a diaspora. Medieval Iceland, by way of its poets, writers, and learned men, was the locus of the memorialisation of this diaspora. Laws provide historians with a way in which to understand the creation of identity in a past society and the criteria that formed the basis of these identities. In the Viking world, where separate identities were emerging while still being connected through the diaspora, the manner in which identity was constructed and negotiated is of special interest. This paper uses Grágás, the medieval Icelandic law code, along with laws from other parts of the diaspora and Icelandic sagas to unpick how Viking diasporans negotiated identity, where they ‘belonged’, and where they were excluded

Development of a prognostic model of COVID-19 severity : a population-based cohort study in Iceland

© 2022. The Author(s).BACKGROUND: The severity of SARS-CoV-2 infection varies from asymptomatic state to severe respiratory failure and the clinical course is difficult to predict. The aim of the study was to develop a prognostic model to predict the severity of COVID-19 in unvaccinated adults at the time of diagnosis. METHODS: All SARS-CoV-2-positive adults in Iceland were prospectively enrolled into a telehealth service at diagnosis. A multivariable proportional-odds logistic regression model was derived from information obtained during the enrollment interview of those diagnosed between February 27 and December 31, 2020 who met the inclusion criteria. Outcomes were defined on an ordinal scale: (1) no need for escalation of care during follow-up; (2) need for urgent care visit; (3) hospitalization; and (4) admission to intensive care unit (ICU) or death. Missing data were multiply imputed using chained equations and the model was internally validated using bootstrapping techniques. Decision curve analysis was performed. RESULTS: The prognostic model was derived from 4756 SARS-CoV-2-positive persons. In total, 375 (7.9%) only required urgent care visits, 188 (4.0%) were hospitalized and 50 (1.1%) were either admitted to ICU or died due to complications of COVID-19. The model included age, sex, body mass index (BMI), current smoking, underlying conditions, and symptoms and clinical severity score at enrollment. On internal validation, the optimism-corrected Nagelkerke's R2 was 23.4% (95%CI, 22.7-24.2), the C-statistic was 0.793 (95%CI, 0.789-0.797) and the calibration slope was 0.97 (95%CI, 0.96-0.98). Outcome-specific indices were for urgent care visit or worse (calibration intercept -0.04 [95%CI, -0.06 to -0.02], Emax 0.014 [95%CI, 0.008-0.020]), hospitalization or worse (calibration intercept -0.06 [95%CI, -0.12 to -0.03], Emax 0.018 [95%CI, 0.010-0.027]), and ICU admission or death (calibration intercept -0.10 [95%CI, -0.15 to -0.04] and Emax 0.027 [95%CI, 0.013-0.041]). CONCLUSION: Our prognostic model can accurately predict the later need for urgent outpatient evaluation, hospitalization, and ICU admission and death among unvaccinated SARS-CoV-2-positive adults in the general population at the time of diagnosis, using information obtained by telephone interview.Peer reviewe