Framtíð sjúkrahúsþjónustu á Stór-Reykjavíkursvæðinu : Verður nýi meðferðarkjarninn skammgóður vermir?

Peer reviewe

Landspitali–The National University Hospital on the Edg

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 Downloa

Respiratory function and CT abnormalities among survivors of COVID-19 pneumonia : a nationwide follow-up study

Publisher Copyright: © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.INTRODUCTION: Considering the pulmonary burden caused by acute COVID-19, questions remain of respiratory consequences after recovery. The aim of the study was to describe respiratory function of COVID-19 pneumonia survivors at mid-term follow-up (median 68 days) and assess whether impairments were predicted by acute illness severity or residual CT abnormalities. METHODS: Residents of Iceland that had COVID-19 and oxygen saturation ≤94% from 28 February 2020 to 30 April 2021 were offered a clinical follow-up visit with an interview, a 6 min walk test (6MWT), spirometry with gas exchange measurement and chest CT. The results of these examinations were described, grouped by the level of care during acute illness. The associations of disease severity and CT abnormalities at follow-up with subjective dyspnoea, 6MWT results and lung function test results were estimated with regression analyses. RESULTS: Of 190 eligible patients, 164 (86%) participated in the study. Of those, 32 had never been admitted to hospital, 103 were admitted to hospital without intensive care and 29 had required intensive care. At a follow-up, need for intensive care during acute illness was associated with shorter walking distance on 6MWT, lower oxygen saturation and lower DLCO. Imaging abnormalities at follow-up were observed for most participants (74%) and the magnitude of these changes was associated with decrements in 6MWT distance, oxygen saturation, forced vital capacity and DLCO. CONCLUSIONS: The findings show that impaired exercise capacity and lung physiology at follow-up were primarily observed for patients with COVID-19 pneumonia that required intensive care treatment and/or had persistent imaging abnormalities.Peer reviewe

HLA alleles, disease severity, and age associate with T-cell responses following infection with SARS-CoV-2

Funding Information: We thank all of the participants that contributed samples for this study for their invaluable contribution to the research. We also thank our research staff at the Patient Recruitment Center for their thorough work. Publisher Copyright: © 2022, The Author(s).Memory T-cell responses following SARS-CoV-2 infection have been extensively investigated but many studies have been small with a limited range of disease severity. Here we analyze SARS-CoV-2 reactive T-cell responses in 768 convalescent SARS-CoV-2-infected (cases) and 500 uninfected (controls) Icelanders. The T-cell responses are stable three to eight months after SARS-CoV-2 infection, irrespective of disease severity and even those with the mildest symptoms induce broad and persistent T-cell responses. Robust CD4+ T-cell responses are detected against all measured proteins (M, N, S and S1) while the N protein induces strongest CD8+ T-cell responses. CD4+ T-cell responses correlate with disease severity, humoral responses and age, whereas CD8+ T-cell responses correlate with age and functional antibodies. Further, CD8+ T-cell responses associate with several class I HLA alleles. Our results, provide new insight into HLA restriction of CD8+ T-cell immunity and other factors contributing to heterogeneity of T-cell responses following SARS-CoV-2 infection.Peer reviewe

Hagfræðilegt mat á nálaskiptiþjónustu sem forvörn gegn útbreiðslu HIV meðal sprautufíkla á Íslandi

Frá árinu 2007 hefur fjöldi HIV smita aukist meðal sprautufíkla á Íslandi og síðastliðin tvö ár hafa þeir verið tæplega helmingur allra nýgreindra. Markmið rannsóknarinnar var að meta hvort nálaskiptiþjónusta væri kostnaðarhagkvæm sem forvörn gegn útbreiðslu HIV meðal sprautufíkla á Íslandi. Kostnaðarnytjagreining var gerð út frá samfélagslegu sjónarhorni. Verðlagsár greiningarinnar er 2011 og við núvirðingu var miðað við 3% afvöxtunarstuðul. Borið var saman tíu ára tímabil (2011 - 2020) með og án nálaskiptiþjónustu. Kostnaðarnytjahlutfallið var reiknað út frá kostnaði á hvert lífsgæðavegið lífár. Næmisgreining var gerð á öllum helstu forsendum. Niðurstöður sýndu að kostnaður samfélagsins vegna HIV smita meðal sprautufíkla á tímabilinu 2011 -2020 var metinn vera 1.062.608.598 kr án nálaskiptiþjónustu en 1.087.080.804 kr með nálaskiptiþjónustu. Umfram kostnaður vegna nálaskiptiþjónustu var því 24.472.207 kr. Með nálaskiptiþjónustu var hægt að koma í veg fyrir 4,53 HIV smit og bjarga 7,39 lífsgæðavegnum lífárum á tímabilinu. Kostnaður vegna hvers aukalegs lífsgæðavegins lífárs var 3.313.572 kr. Ályktanir: Samkvæmt viðmiði Alþjóðaheilbrigðisstofnunarinnar er aðgerð kostnaðarhagkvæm ef hún skilar einu lífsgæðavegnu lífári undir þrefaldri vergri landsframleiðslu á einstakling. Árið 2011 var þreföld verg landsframleiðsla á Íslandi 15.329.757 kr. Næmisgreining á helstu forsendum skilaði kostnaði innan þessara marka. Niðurstöður rannsóknarinnar benda því til þess að nálaskiptiþjónusta sé kostnaðarhagkvæm forvörn gegn útbreiðslu HIV meðal sprautufíkla á Íslandi

Needle Exchange Programs are a cost-effective preventative measure against HIV in Iceland.

Efst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinnÁrið 2007 varð snögg aukning á HIV-smitum meðal sprautufíkla á Íslandi. Frá 2007-2011 greindust 34 HIV-nýsmit meðal sprautufíkla samanborið við fjögur nýsmit árin 2002-2006. Markmið rannsóknarinnar var að meta hvort nálaskiptiþjónusta væri kostnaðarhagkvæm forvörn gegn HIV meðal sprautufíkla á Íslandi. Efniviður og aðferðir: Kostnaðarnytjagreining var gerð út frá samfélagslegu sjónarhorni. Verðlagsár greiningarinnar er 2011 og við núvirðingu var miðað við 3% afvöxtunarstuðul. Borið var saman 10 ára tímabil, 2011-2020 með og án nálaskiptiþjónustu. Kostnaðarnytjahlutfall var reiknað út frá kostnaði á hvert lífsgæðavegið lífár. Næmisgreining var gerð á öllum helstu forsendum. Niðurstöður: Heildarkostnaður samfélagsins vegna HIV-sýkinga sprautufíkla á tímabilinu 2011-2020 var áætlaður 914.369.621 kr. án nálaskiptiþjónustu en 947.653.758 kr með nálaskiptiþjónustu. Umframkostnaður samfélagsins vegna nálaskiptiþjónustu á tímabilinu er því 33.284.137 kr. Nyt samfélagsins af nálaskiptiþjónustu eru 7,39 lífsgæðavegin lífár. Jafnframt kemur nálaskiptiþjónusta í veg fyrir 4-5 HIV-sýkingar á tímabilinu. Kostnaðarnytjahlutfallið af því að veita nálaskiptiþjónustu í stað engrar er 4.506.720 kr. Ályktanir: Samkvæmt viðmiði Alþjóðaheilbrigðisstofnunarinnar er aðgerð kostnaðarvirk ef hún skilar einu lífsgæðavegnu lífári fyrir minna en þrefalda verga landsframleiðslu á einstakling á ári. Árið 2011 var þreföld árleg verg landsframleiðsla á íbúa á Íslandi 15.329.757 kr. Næmisgreining á helstu forsendum skilaði kostnaði innan þessara marka. Nálaskiptiþjónusta er kostnaðarvirk forvörn gegn útbreiðslu HIV meðal sprautufíkla á Íslandi.Objective: In 2007 there was a sudden increase in HIV cases among intravenous drug users (IDUs) in Iceland. In 2007 - 2011 there were 34 new HIV cases among IDUs compared to four in the previous four year period. The purpose of this study was to assess whether needle exchange programs (NEPs) were cost-effective in preventing the spread of HIV among IDUs in Iceland. Materials and methods: Cost-utility analysis was conducted from a societal perspective. Costs are presented at the 2011 price level and values were discounted using a 3% discount rate. A ten year period, 2011 - 2020 was compared with and without NEPs. The Incremental Cost-Utility Ratio (ICUR) was calculated as societal cost per quality adjusted life year (QALY). Sensitivity analysis was performed on study assumptions. Results: The estimated societal costs associated with HIV infections among IDUs from 2011 - 2020 was 914.369.621 ISK without NEP and 947.653.758 ISK with NEP. Excess societal cost due to NEP was 33.284.137 ISK. Societal utility from NEP was 7,39 QALYs. Additionally, NEP prevented 4-5 HIV infections. The ICUR of providing NEP was 4.506.720 ISK. Conclusion: According to WHO an intervention is considered cost-effective if the ICUR is less than three-fold national GDP per capita. In 2011 the GDP per capita in Iceland was 15.315.000 ISK. Sensitivity analysis on study assumptions yielded a societal cost within the WHO limit. Therefore, the results indicate that NEPs are cost-effective in preventing the spread of HIV among IDUs in Iceland

Bráð vandamál Landspítala

This work was supported by the Foundation of the Sichuan Province Council of Science and Technology