October sixth; a historic day in the fight against malaria

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Landspitali – National University Hospital during an epidemic

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Chemical injuries of the eye - management of alkali burns

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenChemical injuries are among the most severe injuries to the eye. Young men are most often affected. Work related injuries are more common than other types of injuries. Immediate treatment is paramount in preventing blindness. In the case of an alkali injury, an opaque cornea and a white edematous conjunctiva indicate a serious injury. In contrast, a clear cornea and a mildly to moderately irritated conjunctiva indicate a better prognosis. Copious irrigation is always the first treatment for all chemical injuries to the eye. Irrigation should be initiated as soon as possible and is to be continued until the tearfluid has regained a normal pH. Antibiotic ointment, lubrication and cycloplegic drops (e.g. Cyclogyl®) form the basis of treatment.Basabrunar á auga sem og áverkar af völdum sýru og annarra ætandi efna eru meðal alvarlegustu áverka sem auga verður fyrir. Ungir karlmenn við vinnu verða oftast fyrir þessum skaða. Fumlaus fyrstu viðbrögð geta skilið á milli blindu og sjónar. Tærleiki hornhimnu og æðateikning slímhúðar gefa góðar upplýsingar um umfang skaðans. Ógegnsæ hornhimna og hvít bjúgkennd slímhúð benda til alvarlegs skaða. Á sama hátt eru tær hornhimna án skaða á yfirborðsþekju og ert slímhúð með kröftugri æðateikningu jákvæð teikn eftir basaskaða. Fyrstu viðbrögð við alla efnaskaða í augum eru ávallt skolun með vatni. Skolun skal byrja strax eftir slysið og halda áfram þar til sýrustig táravökvans er orðið hlutlaust. Aðskotahluti verður að hreinsa vandlega í burtu. Að lokinni skolun eru sýklalyfjasmyrsli, gervitár og "cyklóplegísk" lyf (sjáaldursútvíkkandi lyf) (svo sem Cyclogyl®) grunnmeðferð

An Unusal Case of Pneumocystis Pneumonia - Case report and review

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenA 63 year old woman seeks medical attention for symptoms of fever, headache and increasing dyspnoea. She has a history of psoriatic-arthritis and uses 10 mg/week of methotrexate as arthritic treatment. There is also a history of severe alcohol abuse. She is in respiratory failure, with basal pulmonary crackles and increased serum inflammatory markers, a normal white-cell count but with a lowered lymphocyte count. A CT-scan reveals ground-glass lung changes. Bronchial biopsy reveals the fungus P. jiroveci which infects immunodeficient hosts. After extensive testing it was concluded that the patient's immunodeficiency was attributed to the combination of methotrexate, ethanol and psoriatic-arthritis. In this article, a case of pneumocystis pneumonia is reviewed as well as the infective mechanism of P. jiroveci and host-defence against the fungus. Additionally, symptoms and signs of the infection, diagnostic approach and treatment are reviewed. Because the combination of methotrexate and ethanol played a significant role in the immunodeficiency of the patient, their effect on the immune system is addressed. Keywords: Pneumocystis, PCP, methotrexate, ethanol. Correspondence: Olafur Baldursson [email protected]íu og þriggja ára kona leitar á Landspítala vegna hita, höfuðverks og vaxandi mæði. Saga er um sóraliðagigt og notkun metótrexats í skammtinum 10 mg/viku þess vegna. Einnig er saga um verulega áfengisneyslu. Við komu reynist hún með öndunarbilun og með brak yfir neðanverðum lungum. Í blóði sést hækkun á bólgumiðlum, eðlileg hvítfrumutalning en lækkun á eitilfrumum. Á TS-mynd af lungum sjást hélubreytingar. Í berkjuspeglun er tekið sýni sem leiðir í ljós sveppinn P. jiroveci, sem veldur eingöngu sýkingu hjá ónæmisbældum. Eftir ítarlegar rannsóknir var ályktun meðferðaraðila að ónæmisbæling hennar væri vegna metótrexats, etanóls og liðagigtar. Í þessari grein er farið yfir tilfelli pneumocystis lungnabólgu og einnig farið yfir smitleiðir P. jiroveci og hýsilvarnir gegn sveppnum. Auk þess er sagt frá teiknum og einkennum sýkingarinnar, rannsóknum til greiningar og meðferð. Þar sem í þessu tilfelli virðist sem metótrexat og etanól hafi átt ríkan þátt í ónæmisbælingunni er fjallað um víðtæk áhrif þessara tveggja efna á ónæmiskerfið

Hepatocellular Jaundice due to Hydroxycut in Monozygotic Twins

Publisher Copyright: © 2023 Indian National Association for Study of the LiverLiver injury associated with the use of a number of different of herbal and dietary supplements are increasingly recognized. It is though often unclear which of the sometimes multiple ingredients are responsible for the liver injury. Several case reports have been published on suspected liver injury due to Hydroxycut, which is a multi-ingredient supplement often used to induce weight loss. However, the hepatotoxic potential of Hydroxycut has though been disputed, and steatotic liver disease has also been implicated in patients who are found to have elevated liver enzymes while on Hydroxycut. We report clinically apparent liver injury with jaundice associated with the use of Hydroxycut in monozygotic twins with remarkably similar type of liver injury. Both had the genotype HLA-B 35:01 allele, a risk factor for green-tea extract induced liver injury, which is included in Hydroxycut.Peer reviewe

Herpes simplex encephalitis in Iceland 1987-2011.

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 Files. This article is open access.Herpes simplex encephalitis (HSE) is a serious disease with 10-20% mortality and high rate of neuropsychiatric sequelae. This study is a long-term, nationwide study in a single country, Iceland. Clinical data were obtained from patient records and from DNA PCR and antibody assays of CSF. Diagnosis of HSE was classified as definite, possible or rejected based on symptoms, as well as virological, laboratory and brain imaging criteria. A total of 30 definite cases of HSE were identified during the 25 year period 1987-2011 corresponding to incidence of 4.3 cases/106 inhabitants/year. Males were 57% of all patients, median age 50 years (range, 0-85). Fever (97%), cognitive deficits (79%), impaired consciousness (79% with GCS < 13), headache (55%) and seizures (55%) were the most common symptoms. Brain lesions were found in 24 patients (80%) by MRI or CT. All patients received intravenous acyclovir for a mean duration of 20 days. Three patients (10%) died within one year and 21/28 pts (75%) had a Karnofsky performance score of <70% with memory loss (59%), dysphasia (44%), frontal symptoms (44%) and seizures (30%) as the most frequent sequelae. Mean delay from onset of symptoms to treatment was 6 days; this was associated with adverse outcome. In conclusion, the incidence of `HSE is higher than recently reported in a national registry study from Sweden. Despite advances in rapid diagnosis and availability of treatment of HSE, approximately three of every four patients die or are left with serious neurological impairment

Bactrial osteomyelitis and arthritis in Icelandic children 1996-2005

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn Skoða/Opna(view/open)Objective: The main objective was to determine the incidence and causative pathogens of osteomyelitis and septic arthritis in Icelandic children, as well as presenting symptoms and diagnosis. Methods: A nationwide retrospective review was done of all children <18 year old, 1996-2005. Subjects were divided into three equal age groups, 0-5, 6-11 and 12-17 years old. Cultures were reviewed and postive and negative cases compared. Results: Over the study period 220 cases were identified, 161 osteomyelitis and 59 septic arthritis cases. The incidence increased significantly over the period (p=0.019), mostly in the youngest age group (p<0.001) with osteomyelitis. Incidence of cases with a pathogen identified was unchanged over the period while culture negative cases increased significantly (p<0.001). Median age for osteomyelitis (6,1 years) was higher than in cases of septic arthitis (1,8 years) (p=0.003). A pathogen was identified in 59% of cases with osteomyelitis and 44% with septic arthritis. S. aureus was most common (65% and 27%, respectively) and K. kingae was second most common pathogen (7% and 11%, respectively). Methicillin resistant S. aureus was not identified. The tibia and knee were the predominant sites for osteomyelitis and septic arthritis respectively. Conclusions: An increased incidence was found in the youngest age group with osteomyelitis, especially in cases without a pathogen identified. The most commonly cultured pathogen was S. aureus, followed by K. kingae. A more sensitive technique to identify pathogens might be indicated in culture negative cases.Tilgangur: Markmið rannsóknarinnar var að kanna nýgengi, sýkingarvalda, einkenni og greiningaraðferðir beina- og liðasýkinga í börnum á Íslandi. Efniviður og aðferðir: Rannsóknin var afturskyggn og náði til barna yngri en 18 ára sem lögðust inn vegna sýkinganna á tímabilinu 1996-2005. Upplýsingum var safnað úr sjúkraskrám. Tilfellum var skipt í þrjá jafna aldurshópa, 0-5 ára, 6-11 ára og 12-17 ára. Niðurstöður ræktana voru metnar og einnig breytingar á nýgengi á tímabilinu. Niðurstöður: Á tímabilinu greindust 220 tilfelli, 161 með beinasýkingu og 59 með liðasýkingu. Nýgengi jókst marktækt á tímabilinu (p=0,019). Nýgengisaukningin var nær eingöngu bundin við beinasýkingar hjá yngsta aldurshópnum. Nýgengi þar sem ræktun var jákvæð breyttist ekki en nýgengi með neikvæða ræktun jókst marktækt (p<0,001). Miðgildi aldurs sjúklinga með beinasýkingar (6,1 ára) var hærri en þeirra með liðasýkingar (1,8 ára) (p=0,003). Í 59% beinasýkinga og 44% liðasýkinga greindist baktería, S. aureus var algengust (65% beinasýkinga og 27% liðasýkinga), því næst K. kingae (7% beinasýkinga og 11% liðasýkinga). Methicillin- ónæmir S. aureus greindust ekki. Sköflungur (20%) og hnéliður (47%) voru algengustu staðir sýkinganna. Ályktanir: Rannsóknin varpar ljósi á mikilvæga þætti beina- og liðasýkinga á Íslandi. Nýgengið vex í yngsta aldurshópnum, einkum þar sem ræktun er neikvæð. Algengasti orsakavaldur er S. aureus,svo K. kingae. Meðalaldur, kynjahlutfall og staðsetning sýkinga er sambærilegt við erlendar rannsóknir. Þörf er á næmari sýklafræðilegum greiningaraðferðum hjá þeim sem eru með neikvæðar ræktanir

Intensive care patients with influenza A (H1N1) infection in Iceland 2009

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn Skoða/Opna(view/open)BACKGROUND: We describe the main characteristics of patients that required intensive care due to the influenza (H1N1) outbrake in 2009. METHODS: Retrospective and prospective analysis of medical records from patients admitted to ICU with positive RT-PCR for (H1N1). RESULTS: During a six week period in the fall of 2009, 16 patients were admitted to intensive care in Iceland with confirmed H1N1 infection. Mean age was 48 years (range 1-81). Most patients were considered quite healthy but the majority had risk factors such as smoking, obesity or hypertension. All but one had fever, cough, dyspnea and bilateral infiltrates on chest x-ray and developed any organ failures (mean SOFA score 7). 12 needed mechanical ventilation and two extra corporeal membrane oxygenation (ECMO). Mean APACHE II score was 20. No patient died in the ICU but one elderly patient with multiple underlying diseases died a few days after being discharged from the ICU. CONCLUSIONS: (1) The incidence of severe influenza A (H1N1) that leads to ICU admission appears to be high in Iceland. (2) Many patients developed acute respiratory distress syndrome in addition to other organ failures, and required additional measures for oxygenation such as prone position, nitric oxide inhalation and ECMO. (3) 28 day mortality was low. (4) This study will aid in future outbreak planning in Iceland. Key words: influenza A, pneumonia, multiple organ failure, death rate, intensive care, ventilator therapy, ECMO.Tilgangur: Að lýsa helstu einkennum og afdrifum þeirra sem lögðust inn á gjörgæsludeildir á Íslandi vegna inflúensusýkingar af A stofni (H1N1) haustið 2009. Aðferðir: Aflað var upplýsinga um sjúklinga sem lögðust inn á gjörgæsludeildir á Íslandi með staðfesta H1N1 2009 sýkingu. Niðurstöður: 16 sjúklingar lögðust inn á gjörgæsludeildir vegna inflúensu A (H1N1) sýkingar, meðalaldur 48 ár (1-81). Flestir töldust vera tiltölulega frískir fyrir, en 13 höfðu þó sögu um reykingar, offitu eða háþrýsting. 15 höfðu hita, hósta, öndunarþyngsli og dreifðar íferðir í báðum lungum á lungnamynd og margir fengu fjöllíffærabilun. Allir fengu veirulyf og 12 voru meðhöndlaðir í öndunarvél, þar af tveir einnig í hjarta- og lungnavél. Enginn sjúklingur lést á gjörgæsludeild, en einn fjölveikur aldraður sjúklingur lést síðar á legudeild. Ályktanir: (1) Tíðni alvarlegra sjúkdómseinkenna af völdum inflúensu A (H1N1) sem leiða til gjörgæslumeðferðar er há á Íslandi. (2) Þessir sjúklingar fá flestir, auk annarra líffæratruflana, mjög alvarlega öndunarbilun sem oft lætur ekki undan hefðbundinni öndunarvélameðferð. (3) Árangur meðferðar á íslenskum gjörgæsludeildum hefur verið góður. (4) Niðurstöður þessarar rannsóknar geta nýst yfirvöldum við mat á meðferðarmöguleikum og fyrirbyggjandi aðgerðum gegn þessum lífshættulega sjúkdómi