Severe adverse effects of quinine: Report of seven cases

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenObjective: Quinine is a drug which is mainly used for prevention of nocturnal leg cramps. Serious side effects of this drug have been described in recent years, including cytopenias and the hemolytic-uremic syndrome. We report seven cases of severe adverse effects of quinine. Material and methods: Seven patients who were hospitalized with adverse effects of quinine during the period 1978-2000 are described. Medical records were reviewed with respect to clinical and laboratory features. Serum samples from three patients were tested for quinine-dependent antibodies against platelets and/or granulocytes by flow cytometry. Results: All patients were females aged 52 to 79 years, who were taking quinine for nocturnal leg cramps. Five of the patients experienced recurrent episodes of fever, chills, nausea and vomiting, and three had abdominal pain as well. Two of these patients had pancytopenia, one of whom had evidence for disseminated intravascular coagulation. One had leukopenia and thrombocytopenia. Two patients developed hemolytic-uremic syndrome associated with disseminated intravascular coagulation. One of them suffered irreversible renal failure requiring maintenance hemodialysis. One year later she underwent successful kidney transplantation. All patients had taken quinine several hours prior to the onset of symptoms. In two cases the clinical findings were reproduced by the administration of quinine. Quinine-dependent IgG antibodies against platelets were detected in two patients and against granulocytes in one patient. Conclusions: These cases illustrate the severe adverse effects that can be caused by quinine. Five patients had solid evidence for side effects of quinine being the cause of their illness and strong suggestions of association with the drug were present in two patients. In view of potentially life-threatening side effects, it appears prudent to prohibit the availability of quinine over the counter. Furthermore, it is important that physicians thoroughly consider the indication for each prescription of quinine and remain vigilant toward its side effects.Inngangur: Kínín er lyf sem nú er einkum notað til að fyrirbyggja vöðvakrampa í ganglimum að næturlagi. Á síðustu árum hefur verið lýst svæsnum aukaverkunum af völdum lyfsins, svo sem blóðkornafæð og blóðlýsu- og nýrnabilunarheilkenni. Við greinum frá sjö tilfellum alvarlegra aukaverkana kíníns. Efniviður og aðferðir: Lýst er sjö sjúklingum sem voru lagðir inn á sjúkrahús vegna aukaverkana kíníns á árunum 1978-2000. Aflað var upplýsinga úr sjúkraskrám um klínísk einkenni og niðurstöður rannsókna. Hjá þremur sjúklingum var gerð leit að kínínháðum mótefnum gegn blóðflögum og/eða kleyfkyrningum í sermi með flæðisfrumugreiningu. Niðurstöður: Allir sjúklingarnir voru konur á aldrinum 52-79 ára sem tóku kínín vegna vöðvakrampa í ganglimum. Fimm kvennanna fengu endurtekin skammvinn köst að næturlagi með hita, hrolli, ógleði og uppköstum og voru þrjár einnig með kviðverki. Tvær höfðu enn fremur blóðkornafæð og hafði önnur þeirra merki um blóðstorkusótt. Þá var ein kvennanna með fækkun á blóðflögum og hvítum blóðkornum. Tvær kvennanna fengu blóðlýsu- og nýrnabilunarheilkenni ásamt blóðstorkusótt. Svæsin nýrnabilun annarrar konunnar var óafturkræf og fékk hún blóðskilunarmeðferð um tíma en gekkst síðar undir nýrnaígræðslu með góðum árangri. Allir sjúklingarnir reyndust hafa tekið kínín fáeinum klukkustundum fyrir upphaf einkenna. Hjá tveimur sjúklingum voru klínísk einkenni framkölluð með gjöf kíníns. Þá fundust kínínháð IgG mótefni gegn blóðflögum hjá tveimur sjúklingum og gegn kleyfkyrningum hjá einum. Ályktanir: Þau tilfelli sem hér er lýst endurspegla vel þær alvarlegu aukaverkanir sem kínín getur valdið. Hjá fimm sjúklingum var sýnt fram á aukaverkun kíníns með traustum rökum og hjá tveimur voru sterkar vísbendingar um tengsl við lyfið. Með hliðsjón af lífshættulegum aukaverkunum lyfsins verður það að teljast skynsamleg ráðstöfun að heimila ekki sölu þess án ávísunar læknis. Mikilvægt er að læknar ígrundi vel hverja ábendingu fyrir ávísun kíníns og séu á varðbergi gegn hættulegum aukaverkunum þess

The geology and hydrology of the CarbFix2 site, SW-Iceland

Injection of CO2 and H2S emissions from the Hellisheidi Geothermal Power Plant, SW-Iceland, as part of the CarbFix project, is currently taking place in the Húsmúli reinjection zone. Here we present detailed descriptions of the geology of the reservoir rock in Húsmúli including descriptions of its intrusions, secondary mineralogy and sources of permeability. We further present preliminary results from a modelling study of the Húsmúli reinjection zone that was conducted to obtain better understanding of flow paths in the area. The model was calibrated using results from an extensive tracer test that was carried out in 2013-2015

The chemistry and potential reactivity of the CO 2 -H 2 S charged injected waters at the basaltic CarbFix2 site, Iceland

The CarbFix2 project aims to capture and store the CO2 and H2S emissions from the Hellisheiði geothermal power plant in Iceland by underground mineral storage. The gas mixture is captured directly by its dissolution into water at elevated pressure. This fluid is then injected, along with effluent geothermal water, into subsurface basalts to mineralize the dissolved acid gases as carbonates and sulfides. Sampled effluent and gas-charged injection waters were analyzed and their mixing geochemically modeled using PHREEQC. Results suggest that carbonates, sulfides, and other secondary minerals would only precipitate after it has substantially reacted with the host basalt. Moreover, the fluid is undersaturated with respect to the most common primary and secondary minerals at the injection well outlet, suggesting that the risk of clogging fluid flow paths near the injection well is limited

Demographic reconstruction from ancient DNA supports rapid extinction of the great auk

The great auk was once abundant and distributed across the North Atlantic. It is now extinct, having been heavily exploited for its eggs, meat, and feathers. We investigated the impact of human hunting on its demise by integrating genetic data, GPS-based ocean current data, and analyses of population viability. We sequenced complete mitochondrial genomes of 41 individuals from across the species’ geographic range and reconstructed population structure and population dynamics throughout the Holocene. Taken together, our data do not provide any evidence that great auks were at risk of extinction prior to the onset of intensive human hunting in the early 16th century. In addition, our population viability analyses reveal that even if the great auk had not been under threat by environmental change, human hunting alone could have been sufficient to cause its extinction. Our results emphasise the vulnerability of even abundant and widespread species to intense and localised exploitation

Congenital heart defects in Icelandic twins

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenObjective: Several investigations have been published on the incidence of congenital heart defects (CHD), showing the incidence to be 0.8-1.1%. Few studies have dealt with the incidence of CHD in twins, but they indicate higher incidence of CHD among twins compared to singletons. The purpose of this study was to investigate the incidence of CHD and the different types of defects among twins born in Iceland over a 10 year period and compare the data to the incidence of CHD in the Icelandic population. Material and methods: Information was obtained on all twins born alive in Iceland from 1986-1995 at the Icelandic Statistical Bureau. That list was compared to a list of all children born in Iceland over the same period and diagnosed with CHD, thus finding all twins with diagnosed CHD. The incidence of CHD for the period of 1986-1990 and 1991-1995 was studied separately. Causes of death, whether the patients needed treatment or not, and the results of treatment were studied. Chi-squared test for statistical analysis was used when appropriate. Results: Incidence: Of 1089 liveborn twins 35 had CHD or 3.21% compared to an incidence rate of 1.0% among singletons, which is a statistically significant difference (p0.05). Twin types: Of the twins with CHD 34% were male-female pairs, 26% were male-male pairs and 40% were female-female pairs. Age at diagnosis: Thirteen patients were diagnosed in the first week of life and 20 from one week to five months of age. After six months of age only two patients have been diag¬nosed with CHD. Treatment: Twelve patients have been operated for CHD, one patient was treated in an interventional cardiac catheterization and 10 patients received medical treatment. Mortality: Six twins died as a consequence of their heart defect (17%). The mortality rate was significantly higher among twins with major CHD compared to the control population (p0,05). Samsetning tvíburahópsins: Af tvíburum með hjartagalla voru 34% pör þar sem annar tvíburinn var drengur en hinn stúlka, 26% voru drengjapör og 40% stúlknapör. Aldur við greiningu: Flestir tvíburanna greindust á fyrstu fimm mánuðum ævinnar. Einungis tvö börn hafa greinst eftir sex mánaða aldur. Meðferð: Tólf barnanna hafa gengist undir hjartaskurðaðgerð, eitt var meðhöndlað í hjartaþræðingu og 10 hafa fengið lyfjameðferð. Dánartíðni: Sex tvíburar létust vegna afleiðinga hjartagallans (17%). Dánartíðnin meðal tvíburanna er marktækt hærri en meðal samanburðarhóps (p<0,005). Ályktun: Meðfæddir hjartagallar eru algengari meðal tvíbura en hjá samanburðarhópi. Nýgengi þeirra er hærra á seinni hluta rannsóknartímabilsins. Dánartíðni er einnig hærri meðal tvíburanna. Árið 1991 hófust glasafrjóvganir á Íslandi sem leiddu til mikillar fjölgunar tvíburafæðinga. Frá sama tíma eykst nýgengi meðfæddra hjartagalla meðal tvíbura. Frekari rannsókna er þörf til að kanna möguleg tengsl þessa

Congenital heart defects in Icelandic twins

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenObjective: Several investigations have been published on the incidence of congenital heart defects (CHD), showing the incidence to be 0.8-1.1%. Few studies have dealt with the incidence of CHD in twins, but they indicate higher incidence of CHD among twins compared to singletons. The purpose of this study was to investigate the incidence of CHD and the different types of defects among twins born in Iceland over a 10 year period and compare the data to the incidence of CHD in the Icelandic population. Material and methods: Information was obtained on all twins born alive in Iceland from 1986-1995 at the Icelandic Statistical Bureau. That list was compared to a list of all children born in Iceland over the same period and diagnosed with CHD, thus finding all twins with diagnosed CHD. The incidence of CHD for the period of 1986-1990 and 1991-1995 was studied separately. Causes of death, whether the patients needed treatment or not, and the results of treatment were studied. Chi-squared test for statistical analysis was used when appropriate. Results: Incidence: Of 1089 liveborn twins 35 had CHD or 3.21% compared to an incidence rate of 1.0% among singletons, which is a statistically significant difference (p0.05). Twin types: Of the twins with CHD 34% were male-female pairs, 26% were male-male pairs and 40% were female-female pairs. Age at diagnosis: Thirteen patients were diagnosed in the first week of life and 20 from one week to five months of age. After six months of age only two patients have been diag¬nosed with CHD. Treatment: Twelve patients have been operated for CHD, one patient was treated in an interventional cardiac catheterization and 10 patients received medical treatment. Mortality: Six twins died as a consequence of their heart defect (17%). The mortality rate was significantly higher among twins with major CHD compared to the control population (p0,05). Samsetning tvíburahópsins: Af tvíburum með hjartagalla voru 34% pör þar sem annar tvíburinn var drengur en hinn stúlka, 26% voru drengjapör og 40% stúlknapör. Aldur við greiningu: Flestir tvíburanna greindust á fyrstu fimm mánuðum ævinnar. Einungis tvö börn hafa greinst eftir sex mánaða aldur. Meðferð: Tólf barnanna hafa gengist undir hjartaskurðaðgerð, eitt var meðhöndlað í hjartaþræðingu og 10 hafa fengið lyfjameðferð. Dánartíðni: Sex tvíburar létust vegna afleiðinga hjartagallans (17%). Dánartíðnin meðal tvíburanna er marktækt hærri en meðal samanburðarhóps (p<0,005). Ályktun: Meðfæddir hjartagallar eru algengari meðal tvíbura en hjá samanburðarhópi. Nýgengi þeirra er hærra á seinni hluta rannsóknartímabilsins. Dánartíðni er einnig hærri meðal tvíburanna. Árið 1991 hófust glasafrjóvganir á Íslandi sem leiddu til mikillar fjölgunar tvíburafæðinga. Frá sama tíma eykst nýgengi meðfæddra hjartagalla meðal tvíbura. Frekari rannsókna er þörf til að kanna möguleg tengsl þessa

Cytomegalovirus infections in healthy adults

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenBackground: Primary cytomegalovirus (CMV) infections in healthy adults are considered extremely rare. To study the extent of this problem in Iceland we undertook a two year (1989-1990) retrospective study of all new CMV infections in adults. Methods: All positive tests for CMV antibodies in clinical samples (194) were identified in the sole virology laboratory in Iceland. Patients younger than 16 years and all patients with underlying diseases that could cause immunosuppression were excluded (154). The 40 remaining patients were contacted, their case histories reviewed and their serology for CMV, Epstein-Barr and HIV antibodies remeasured. Primary CMV infection was not confirmed in 14 patients leaving 26 immune competent patients who fullfilled our criteria for primary sym-tomatic CMV infection by the presence of IgM anti-CMV antibodies. Results: Duration of illness in the 26 study patients varied from 1 to 25 weeks, usually 7-10 weeks. Fifteen patients were hospitalized. Diagnostic delay was considerable. Immunological tests (DTH skin test, serum immunoglobulines and lymphocyte differential counts) done 172-2 years after the illness did nor reveal any persistent immune abnormalities except for an absolute increase in the number of CD8+ T lymphocytes Conclusions: We conclude that primary CMV infections in adults are not uncommon and probably underdiagnosed. When adult patients present with non-specific symptoms such as low grade fever, malaise and unexplained fatigue, CMV should be considered or excluded with appropriate serological tests.Megintilgangur þessarar rannsóknar var að athuga veikindi vegna cytomegaloveirusýkinga hjá heilbrigðum, fullorðnum einstaklingum. Farið var yfir öll veirurannsóknarsvör tveggja ára og leitað að einstaklingum með teikn um nýlega cytomegaloveirusýkingu. Upplýsingum um einkenni, skoðim og rannsóknarniðurstöður var safnaö úr sjúkraskrám og auk þess voru allir sjúklingarnir rannsakaðir á göngudeild hálfu til tveimur árum eftir veikindi. Á þeim tveimur árum sem athuguð voru fundust 26 annars hraustir, fullorðnir einstaklingar sem veikst höfðu af völdum cytomegaloveiru. Oftast höfðu sjúklingar verið veikir í meira en tvær vikur áður en leitað var að mótefnum gegn cytomegaloveiru og lengst dróst greining í 12 vikur. Flestir höfðu væg almenn sýkingareinkenni en nokkrir urðu alvarlega veikir. Fimmtán sjúklingar lögðust inn á sjúkrahús og tveir voru lengi á spítala, annar í 19 daga og hinn í tvo mánuði. Athyglisvert er að flestir voru lengi að ná sér að fullu eftir veikindin, flestir voru frá vinnu í meira en mánuð og einn einstaklingur var óvinnufær í hálft ár. Rannsóknir hálfu til tveimur árum eftir veikindi bentu ekki til neinnar ónæmisbiiunar eöa annarra veikinda sem gætu hafa átt þátt í cytomegaloveirusýkingu. Niðurstöður okkar benda til þess að veikindi af völdum cytomegaloveiru hjá annars heilbrigðum, fullorðnum einstaklingum séu mun algengari en almennt hefur verið talið og aö greining sjúkdómsins dragist oft lengi. Full ástæða er til að hafa þessa veiru í huga þegar almenn og oft óljós sýkingareinkenni dragast á langinn

Severe adverse effects of quinine: Report of seven cases

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenObjective: Quinine is a drug which is mainly used for prevention of nocturnal leg cramps. Serious side effects of this drug have been described in recent years, including cytopenias and the hemolytic-uremic syndrome. We report seven cases of severe adverse effects of quinine. Material and methods: Seven patients who were hospitalized with adverse effects of quinine during the period 1978-2000 are described. Medical records were reviewed with respect to clinical and laboratory features. Serum samples from three patients were tested for quinine-dependent antibodies against platelets and/or granulocytes by flow cytometry. Results: All patients were females aged 52 to 79 years, who were taking quinine for nocturnal leg cramps. Five of the patients experienced recurrent episodes of fever, chills, nausea and vomiting, and three had abdominal pain as well. Two of these patients had pancytopenia, one of whom had evidence for disseminated intravascular coagulation. One had leukopenia and thrombocytopenia. Two patients developed hemolytic-uremic syndrome associated with disseminated intravascular coagulation. One of them suffered irreversible renal failure requiring maintenance hemodialysis. One year later she underwent successful kidney transplantation. All patients had taken quinine several hours prior to the onset of symptoms. In two cases the clinical findings were reproduced by the administration of quinine. Quinine-dependent IgG antibodies against platelets were detected in two patients and against granulocytes in one patient. Conclusions: These cases illustrate the severe adverse effects that can be caused by quinine. Five patients had solid evidence for side effects of quinine being the cause of their illness and strong suggestions of association with the drug were present in two patients. In view of potentially life-threatening side effects, it appears prudent to prohibit the availability of quinine over the counter. Furthermore, it is important that physicians thoroughly consider the indication for each prescription of quinine and remain vigilant toward its side effects.Inngangur: Kínín er lyf sem nú er einkum notað til að fyrirbyggja vöðvakrampa í ganglimum að næturlagi. Á síðustu árum hefur verið lýst svæsnum aukaverkunum af völdum lyfsins, svo sem blóðkornafæð og blóðlýsu- og nýrnabilunarheilkenni. Við greinum frá sjö tilfellum alvarlegra aukaverkana kíníns. Efniviður og aðferðir: Lýst er sjö sjúklingum sem voru lagðir inn á sjúkrahús vegna aukaverkana kíníns á árunum 1978-2000. Aflað var upplýsinga úr sjúkraskrám um klínísk einkenni og niðurstöður rannsókna. Hjá þremur sjúklingum var gerð leit að kínínháðum mótefnum gegn blóðflögum og/eða kleyfkyrningum í sermi með flæðisfrumugreiningu. Niðurstöður: Allir sjúklingarnir voru konur á aldrinum 52-79 ára sem tóku kínín vegna vöðvakrampa í ganglimum. Fimm kvennanna fengu endurtekin skammvinn köst að næturlagi með hita, hrolli, ógleði og uppköstum og voru þrjár einnig með kviðverki. Tvær höfðu enn fremur blóðkornafæð og hafði önnur þeirra merki um blóðstorkusótt. Þá var ein kvennanna með fækkun á blóðflögum og hvítum blóðkornum. Tvær kvennanna fengu blóðlýsu- og nýrnabilunarheilkenni ásamt blóðstorkusótt. Svæsin nýrnabilun annarrar konunnar var óafturkræf og fékk hún blóðskilunarmeðferð um tíma en gekkst síðar undir nýrnaígræðslu með góðum árangri. Allir sjúklingarnir reyndust hafa tekið kínín fáeinum klukkustundum fyrir upphaf einkenna. Hjá tveimur sjúklingum voru klínísk einkenni framkölluð með gjöf kíníns. Þá fundust kínínháð IgG mótefni gegn blóðflögum hjá tveimur sjúklingum og gegn kleyfkyrningum hjá einum. Ályktanir: Þau tilfelli sem hér er lýst endurspegla vel þær alvarlegu aukaverkanir sem kínín getur valdið. Hjá fimm sjúklingum var sýnt fram á aukaverkun kíníns með traustum rökum og hjá tveimur voru sterkar vísbendingar um tengsl við lyfið. Með hliðsjón af lífshættulegum aukaverkunum lyfsins verður það að teljast skynsamleg ráðstöfun að heimila ekki sölu þess án ávísunar læknis. Mikilvægt er að læknar ígrundi vel hverja ábendingu fyrir ávísun kíníns og séu á varðbergi gegn hættulegum aukaverkunum þess

CarbFix2: CO₂ and H₂S mineralization during 3.5 years of continuous injection into basaltic rocks at more than 250 °C

The CarbFix method was upscaled at the Hellisheiði geothermal power plant to inject and mineralize the plant’s CO₂ and H₂S emissions in June 2014. This approach first captures the gases by their dissolution in water, and the resulting gas-charged water is injected into subsurface basalts. The dissolved CO₂ and H₂S then react with the basaltic rocks liberating divalent cations, Ca^{2+}, Mg^{2+}, Fe^{2+}, increasing the fluid pH, and precipitating stable carbonate and sulfide minerals. By the end of 2017, 23,200 metric tons of CO₂ and 11,800 metric tons of H₂S had been injected to a depth of 750 m into fractured, hydrothermally altered basalts at >250 °C. The in situ fluid composition, as well as saturation indices and predominance diagrams of relevant secondary minerals at the injection and monitoring wells, indicate that sulfide precipitation is not limited by the availability of Fe or by the consumption of Fe by other secondary minerals; Ca release from the reservoir rocks to the fluid phase, however, is potentially the limiting factor for calcite precipitation, although dolomite and thus aqueous Mg may also play a role in the mineralization of the injected carbon. During the first phase of the CarbFix2 injection (June 2014 to July 2016) over 50% of injected carbon and 76% of sulfur mineralized within four to nine months, but these percentages increased four months after the amount of injected gas was doubled during the second phase of CarbFix2 (July 2016 – December 2017) at over 60% of carbon and over 85% of sulfur. The doubling of the gas injection rate decreased the pH of the injection water liberating more cations for gas mineralization. Notably, the injectivity of the injection well has remained stable throughout the study period confirming that the host rock permeability has been essentially unaffected by 3.5 years of mineralization reactions. Lastly, although the mineralization reactions are accelerated by the high temperatures (>250 °C), this is the upper temperature limit for carbon storage via the mineral carbonation of basalts as higher temperatures leads to potential decarbonation reactions