Case report: A young woman with dyspnea and hypoxemia

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenTuttugu og þriggja ára gömul kona leitaði til bráðamóttöku vegna mæði. Hún hafði fjögurra vikna sögu um versnandi mæði við áreynslu og mæddist mjög við að ganga hratt upp eina hæð í húsi. Þessu fylgdi hósti, glær uppgangur, þreyta, lystarleysi og megrun um 25 kg á nokkrum mánuðum. Fyrra heilsufar hennar var almennt gott utan aðgerðar á liðþófa og asma í æsku. Ofnæmi ekki þekkt og tók engin lyf. Hún var barnlaus nemi og ekki í sambúð. Við skoðun var hún föl með bláma á vörum. Blóðþrýstingur var 125/75 mmHg, púls 125/mín, hitalaus, öndunartíðni 24/mín og súrefnismettun 79% án súrefnis. Við lungnahlustun heyrðust bronchial öndunarhljóð beggja megin. Greinilegir kylfufingur. Að öðru leyti var skoðun eðlileg. Blóðgas án súrefnisgjafar sýndi pH 7,34, PCO2 40 mmHg og PO2 49 mmHg. Röntgenmynd af lungum var eðlileg. Blóðrannsóknir sýndu hækkun á hvítum blóðkornum 11,2x109 /L, sökk 24 mm/klst og D-dímer innan eðlilegra marka. Einkenni hennar og hypoxemía vöktu grun um segarek til lungna og var því fengin sneiðmynd af lungnaæðum og lungnavef sem reyndist vera eðlileg. Einnig var tekin háskerpusneiðmynd af lungnavef til þess að útiloka millivefjasjúkdóma (e. pulmonary fibrosis) og langvinna berkjubólgu með bronchiectasis. Myndin sýndi mjög vægar dreifðar örbreytingar í millivef beggja lungna en þær voru ekki taldar útskýra hypoxemíu

Case report: hypertension with hypokalemia in pregnant woman

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenCase report: Hypertension with hypokalemia in pregnant womanSjúkratilfelli Þrjátíu og níu ára þunguð kona í annarri meðgöngu greindist með háþrýsting og kalíumbrest í 25. viku. Ekki saga um háþrýsting í fyrri meðgöngu fimm árum áður, en þá fæddi hún dreng með Downs heilkenni. Í færslum í sjúkraskrá frá heimilislækni skömmu fyrir getnað var getið kvartana um þyngsli fyrir brjósti og þreytu. Blóðþrýstingsgildi á bilinu 140-150/90-100 mmHg og kalíumgildi í serum var 3,3 mmól/l mælt tvisvar, með viku millibili. Í fyrsta mæðraeftirliti á heilsugæslu í 12. viku mældist blóðþrýstingur 180/100 mmHg. Sjúklingi var því vísað í frekara eftirlit á Miðstöð mæðraverndar. Blóðþrýstingur mældist þar hár næstu tíu vikurnar, eða á bilinu 140-170/80-95 mmHg. Helstu kvartanir á þessum tíma voru höfuðverkur ásamt þreytu. Orsökin talin vera háþrýstingur af óþekktri orsök (essential hypertension). Engin merki voru um prótín í þvagi

Treatment pattern and results in an outpatient population with type 2 diabetes in Iceland

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenAims: Type 2 diabetes mellitus is a major health problem all over the world. The prevalence of the disease is increasing markedly. Healthcare cost associated with type 2 diabetes is high and the long-term diabetic complications account for the greatest proportion of direct cost. Effective control of blood glucose, lipids and blood pressure can delay the development of complications. The purpose of this study was to examine the risk factors, treatment pattern and results in an Icelandic outpatient population with type 2 diabetes. Our results were compared especially with results from Sweden. Material and methods: Charts were reviewed for all patients (906) with type 2 diabetes that attended the Diabetes Outpatient Clinic at the University Hospital of Iceland in the year 2001. Information about clinical characteristics for the year 2002 were prospectively reviewed for the 380 patients from the year before and for 121 newly diagnosed patients. Clinical characteristics included were age, sex, diabetes duration, glycemic control (HbA1c), office blood pressure, body mass index (BMI), smoking habits, use of lipid- and blood pressure lowering drugs, diabetes treatment and diabetic retinopathy. Results: Mean age was 66 +/-13.1 (SD) years and the mean age at diagnosis was 57 +/-13.1 (SD) years. Sixty percent were men. The mean body mass index was 29.7 kg/m(2). About 85% of patients had body mass index >25 which is much higher than in 1987 when this proportion was about 67.3%. Mean HbA1c was 7.02 the year 2001 and 6.94% in 2002. The mean cholesterol level was 5.44 mmol/L, HDL 1,22 mmol/L and LDL 3.17 mmol/L in 2002 and 27% were taking lipid lowering drugs in 2002. More patients (61%) reached the blood pressure goal 140/80 mmHg during 2002 than the year before (55%). Sixty five percent were using oral hypoglycemic agents and 17,4% insulin alone. Prevalence of smoking was 13% and of retinopathy 17.1%. Conclusions: The mean body mass index has been increasing in Iceland as in other western countries. In our survey the mean glycosylated hemoglobin of 7% is somewhat lower than in comparable European surveys, indicating a better glycemic control here. However our survey and comparable surveys indicate that treatment of dyslipidemia and blood pressure has to be more aggressive.Markmið: Sykursýki og fylgikvillar hennar eru vaxandi vandamál um allan heim. Kostnaður vegna sjúkdómsins er mikill og stærsti hlutinn er vegna fylgi­kvilla. Góð meðferð blóðsykurs, blóðþrýstings og blóðfitu dregur verulega úr fylgikvillum. Markmið rannsóknarinnar var að skoða meðferðar­form, árangur meðferðar og áhættuþætti meðal sjúk­linga með sykursýki tegund 2 í eftirliti á sérhæfðri göngu­deild ásamt samanburði við niðurstöður frá Svíþjóð. Efniviður og aðferðir: Rannsóknin var tvískipt. Afturvirk skráning sjúklinga með sykursýki tegund 2 (906) í eftirliti árið 2001 og jafnhliða framvirk skráning upplýsinga frá sjúklingum (501) árið 2002 í eftirliti á Göngudeild sykursjúkra á Landspítala Hringbraut. Árið 2001 voru 94 (10,4%) nýgreindir en 121 (24,2%) árið 2002. Upplýsingar um 380 sjúklinga voru skráðar bæði árin. Eftirfarandi var skráð: greiningarár, aldur við grein­ingu, þyngdarstuðull (BMI), sykurbundinn blóð­rauði (HbA1c), blóðfitu- og blóðþrýstingsgildi, notkun blóð­fitu- og blóðþrýstingslækkandi lyfja, sykursýkisbreytingar í augnbotnum ásamt sykursýkismeðferð. Niðurstöður: Fleiri karlar (60%) voru í rannsóknarhópnum. Meðalaldur var 66 ár og meðaldur við greiningu 57 ár. Meðalþyngdarstuðull var 29,7 kg/m2 . Um 85% sjúklinganna voru með þyngdarstuðull >25 sem er talsverð aukning frá árinu 1987 en þá var samsvarandi hlutfall 67,3%. Færri konur en karlar náðu viðmiðunarmörkum á þyngdarstuðli samkvæmt alþjóðlegum skilmerkjum. Á blóðsykurlækkandi töflum eingöngu voru 66,5%, en 18,4% voru á insúlínmeðferð. Meðal HbA1c var 7,02% árið 2001 og 6,94% árið 2002. Meðalgildi blóðfitu voru: kólesteról 5,44 mmól /l, HDL 1,22 mmól /L og LDL 3,17 mmól/L árið 2002. Á blóðfitulækkandi lyfjum voru 27% árið 2002. Fleiri (61%) náðu blóðþrýstingsmarkmiðum ?140/80 mmHg árið 2002 en 2001 (55%). Af hópnum reyktu 13% og 17,1% voru með augnbotnabreytingar. Ályktanir: Meðalþyngdarstuðull hefur farið hækkandi hér eins og í öðrum vestrænum löndum. Meðal HbA1c var um eða undir 7,0% sem er lægra en í svipuðum rannsóknum í öðrum Evrópulöndum og bendir til betri blóðsykurstjórnunar hér. Fleiri ná settum blóðþrýstingsgildum árið 2002 en bæta má blóðþrýstingsstjórnun enn betur. Rannsókn okkar svo og erlendar rannsóknir sýna að blóðfitur eru vanmeðhöndlaðar hjá sykursjúkum

Neonatal Immunization with a Single IL-4/Antigen Dose Induces Increased Antibody Responses after Challenge Infection with Equine Herpesvirus Type 1 (EHV-1) at Weanling Age

Neonatal foals respond poorly to conventional vaccines. These vaccines typically target T-helper (Th) cell dependent B-cell activation. However, Th2-cell immunity is impaired in foals during the first three months of life. In contrast, neonatal basophils are potent interleukin-4 (IL-4) producers. The purpose of this study was to develop a novel vaccine triggering the natural capacity of neonatal basophils to secrete IL-4 and to evaluate if vaccination resulted in B-cell activation and antibody production against EHV-1 glycoprotein C (gC). Neonatal vaccination was performed by oral biotinylated IgE (IgE-bio) treatment at birth followed by intramuscular injection of a single dose of streptavidin-conjugated gC/IL-4 fusion protein (Sav-gC/IL-4) for crosslinking of receptor-bound IgE-bio (group 1). Neonates in group 2 received the intramuscular Sav-gC/IL-4 vaccine only. Group 3 remained non-vaccinated at birth. After vaccination, gC antibody production was not detectable. The ability of the vaccine to induce protection was evaluated by an EHV-1 challenge infection after weaning at 7 months of age. Groups 1 and 2 responded to EHV-1 infection with an earlier onset and overall significantly increased anti-gC serum antibody responses compared to control group 3. In addition, group 1 weanlings had a decreased initial fever peak after infection indicating partial protection from EHV-1 infection. This suggested that the neonatal vaccination induced a memory B-cell response at birth that was recalled at weanling age after EHV-1 challenge. In conclusion, early stimulation of neonatal immunity via the innate arm of the immune system can induce partial protection and increased antibody responses against EHV-1.Funding for this project was provided by the Harry M. Zweig Memorial Fund for Equine Research at Cornell University ‘A Novel Strategy to Boost Antibody Production to EHV-1 in Neonates’ (http://vet.cornell.edu/research/Zweig/). Monoclonal antibody development for horse cell surface markers and cytokines was supported by USDA grant #2005-01812 ‘The US Veterinary Immune Reagent Network’ and #2015-67015-23072 ‘Equine Immune Reagents: Development of monoclonal antibodies to improve the analysis of immunity in horses’ (https://nifa.usda.gov/).Peer Reviewe

Pain rehabilitation’s effect on people in chronic pain : A prospective cohort study

Funding Information: Funding: The University of Akureyri Research Fund (R1508, R1609, R1705, R1906), Research Fund of Ingibjörg R. Magnúsdóttir, Memorial Fund of Kristín Thoroddsen, and KEA Research Fund are thanked for funding. Publisher Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland.Multidisciplinary long-term pain rehabilitation programs with a team of healthcare professionals are an integrated approach to treat patients with chronic non-malignant pain. In this longitudinal prospective cohort study, we investigated the long-term effects of multidisciplinary pain rehabilitation on the self-reported causes of pain, pain self-management strategies, sleep, pain severity, and pain’s interference with life, pre-and post-treatment. Eighty-one patients, aged 20–69 years, with chronic pain responded. The two most frequently reported perceived causes of pain were fibromyalgia and accidents. The difference in average self-reported pain severity decreased significantly at one-year follow-up (p < 0.001), as did pain’s interference with general activities, mood, walking ability, sleep, and enjoyment of life. At one-year follow-up, participants (21%) rated their health as good/very good and were more likely to state that it was better than a year before (20%). No change was found in the use of pain self-management strategies such as physical training at one-year follow-up. The intervention was effective for the participants, as reflected in the decreased pain severity and pain interference with life.Peer reviewe

Pain, sleep, and health-related quality of life after multidisciplinary intervention for chronic pain

Funding: The University of Akureyri Research Fund (R1508, R1609, R1705, R1906), Research Fund of Ingibjörg R. Magnúsdóttir, Memorial Fund of Kristín Thoroddsen, and KEA Research Fund are thanked for funding. Publisher Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland.Multidisciplinary pain-management programs have the potential to decrease pain intensity, improve health-related quality of life (HRQOL), and increase sleep quality. In this longitudinal prospective cohort study, the aim was to investigate the long-term effects of multidisciplinary pain rehabilitation interventions in Iceland. More precisely, we (a) explored and described how individuals with chronic pain evaluated their pain severity, sleep, and HRQOL at pre-treatment and at one-year follow-up and (b) examined what predicted the participants’ one-year follow-up HRQOL. Seventy-nine patients aged 20–68 years, most of whom were women (85%), responded. The participants scored their pain lower at one-year follow-up (p < 0.001). According to their response, most of them had disrupted sleep, mainly because of pain. One year after the treatment, more participants slept through the night (p = 0.004), and their HRQOL increased. Higher pre-treatment mental component summary (MCS) scores and having pursued higher education predicted higher MCS scores at one-year follow-up, and higher pre-treatment physical component summary (PCS) scores predicted higher PCS scores at one-year follow-up. Sleep problems, being a woman, and having children younger than 18 years of age predicted lower MCS scores at one-year follow-up. These findings are suggestive that patients should be examined with respect to their mental status, and it could be beneficial if they received some professional support after completing the intervention.Peer reviewe

Importance of waist circumference measurements when following children with obesity: Serious abnormalities in blood values of Iceandic children with obesity

Efst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinnInngangur: Offita barna er vaxandi heilbrigðisvandamál í heiminum. Gegnum tíðina hefur líkamsþyngdarstuðull (Body Mass Index, BMI) verið helsti mælikvarði á offitu en ágæti hans hefur verið dregið í efa hjá börnum. Heilsuskólinn var stofnaður árið 2011 þegar þverfaglegt teymi var sett saman á Barnaspítala Hringsins til að aðstoða börn og fjölskyldur þeirra við að bæta lífsvenjur sínar. Markmið rannsóknarinnar var að finna þann mælikvarða á offitu barna sem hafði mest forspárgildi um frávik í blóðgildum auk þess að fá heildstæða mynd af frávikum í efnaskiptum barna með offitu í Heilsuskólanum. Efniviður og aðferðir: Rannsóknin var afturskyggn, lýsandi og náði til allra barna sem leitað höfðu til Heilsuskóla Barnaspítalans á tímabilinu 1. janúar 2011 til 15. mars 2013 (n=181). Upplýsingatæknisvið Landspítalans tók saman upplýsingar um hæð, þyngd, BMI, mittismál og niðurstöður blóðrannsókna. Niðurstöður: Frávik í einu eða fleiri blóðgildum fundust hjá 54 börnum (47%). Af þeim börnum sem upplýsingar voru til staðar um höfðu fjögur (4%) staðfesta fitulifur og 28 (28%) höfðu insúlínhækkun, þar af átta (8%) að því marki að þörf væri á inngripi (hyperinsulinemia). Eitt barn hafði bæði fitulifur og marktæka insúlínhækkun. Ályktun: Frávik í blóðgildum barna með offitu eru algeng. Mittismál virðist hafa meira forspárgildi um frávik í efnaskiptum tengdum offitu en BMI-SDS. Mittismál mætti nota til að skima fyrir þeim börnum sem þurfa á reglulegu eftirliti að halda með tilliti til frávika í efnaskiptum. Mittismál bætir mikilvægum upplýsingum við í áhættumati á börnum með offitu. Rannsóknin sýnir því mikilvægi þess að heilbrigðisstarfsfólk mæli mittismál barna sem þeir hafa til meðferðar og eftirlits.Introduction:Childhood obesity is a growing health problem worldwide. Body mass index (BMI) has been used as the main measurement of obesity for years but its quality for children has been questioned. In 2011 the Health School was formed at the Childrens Medical Center at Landspitali University Hospital for treatment of obese children and their families. The aim of this study was to find the best predictor of blood test abnormalities and to get a clear picture of abnormalities in blood values in the group of obese children referred to the Health School. Methods:All children referred to the Health School from January 1st 2011 until March 15th 2013 were retrospectively studied (n=181). Information was gathered on height, weight, BMI, waist circumference and available blood variables. Results:Abnormal blood values were found in 54 cases (47%). Of the children where information was available, four (4%) had Non-Alchoholic Fatty Liver Disease (NAFLD) and 28 (28%) had a raised fasting insulin levels whereof 8 (8%) needed treatment. One child had both NAFLD and raised fasting insulin. Conclusion: Abnormal blood values are common in obese children. Waist circumference appears to have a better predictive value of these abnormalities than BMI-SDS. Waist circumference could be used to screen for children who need physician supervision because of risk of metabolic disorders. Waist circumference adds important information to the risk assessment of obese children. This study emphasises the importance of care givers measuring waist circumference in obese children

Cul o 2 specific IgG3/5 antibodies predicted Culicoides hypersensitivity in a group imported Icelandic horses

Publisher's version (útgefin grein)Background: Culicoides hypersensitivity (CH) is induced in horses by salivary allergens of Culicoides midges. In Iceland, the causal Culicoides species for CH are not present. Previous epidemiological data indicated that Icelandic horses are more susceptible to CH when they are exported from Iceland and first exposed to Culicoides at adult age. Horses born in countries where Culicoides is endemic, develop the disease less frequently. Here, we established a longitudinal allergy model to identify predictive and diagnostic serological biomarkers of CH. Results: Sixteen adult Icelandic horses from Iceland were imported to the Northeastern United States (US) during the winter and were kept in the same environment with natural Culicoides exposure for the next two years. None of the horses showed clinical allergy during the first summer of Culicoides exposure. In the second summer, 9/16 horses (56%) developed CH. Allergen specific IgE and IgG isotype responses in serum samples were analysed using nine potential Culicoides allergens in a fluorescent bead-based multiplex assay. During the first summer of Culicoides exposure, while all horses were still clinically healthy, Cul o 2 specific IgG3/5 antibodies were higher in horses that developed the allergic disease in the second summer compared to those that did not become allergic (p = 0.043). The difference in Cul o 2 specific IgG3/5 antibodies between the two groups continued to be detectable through fall (p = 0.035) and winter of the first year. During the second summer, clinical signs first appeared and Cul o 3 specific IgG3/5 isotypes were elevated in allergic horses (p = 0.041). Cul o 2 specific IgG5 (p = 0.035), and Cul o 3 specific IgG3/5 (p = 0.043) were increased in late fall of year two when clinical signs started to improve again. Conclusions: Our results identified IgG5 and IgG3/5 antibodies against Cul o 2 and Cul o 3, respectively, as markers for CH during and shortly after the allergy season in the Northeastern US. In addition, Cul o 2 specific IgG3/5 antibodies may be valuable as a predictive biomarker of CH in horses that have been exposed to Culicoides but did not yet develop clinical signs.The importation and maintenance of the horses in this study were funded by research support from the Harry M. Zweig Memorial Fund for Equine Research at Cornell University. The equine isotype reagent described in this article were developed and characterized with funding from Agriculture and Food Research Initiative Competitive Grants no. #2005–01812 (The US Veterinary Immune Reagent Network). The serological allergen multiplex analysis of the samples was supported by research funds provided by Boehringer Ingelheim.Peer Reviewe

Serological markers of Bornavirus infection found in horses in Iceland

BACKGROUND: In a stable of eight horses in Northern Iceland, six horses presented with clinical signs, such as ataxia and reduced appetite, leading to euthanasia of one severely affected horse. Serological investigations revealed no evidence of active equine herpes virus type 1 infection, a common source of central nervous system disease in horses, nor equine arteritis virus and West Nile virus. Another neurotropic virus, Borna disease virus, was therefore included in the differential diagnosis list. FINDINGS: Serological investigations revealed antibodies against Borna disease virus in four of five horses with neurological signs in the affected stable. One horse without clinical signs was seronegative. Four clinically healthy horses in the stable that arrived and were sampled one year after the outbreak were found seronegative, whereas one of four investigated healthy horses in an unaffected stable was seropositive. CONCLUSIONS: This report contains the first evidence of antibodies to Borna disease virus in Iceland. Whether Borna disease virus was the cause of the neurological signs could however not be confirmed by pathology or molecular detection of the virus. As Iceland has very restricted legislation regarding animal imports, the questions of how this virus has entered the country and to what extent markers of Bornavirus infection can be found in humans and animals in Iceland remain to be answered

Effect of circadian rhythm, age, training and acute lameness on serum concentrations of cartilage oligomeric matrix protein (COMP) neo-epitope in horses

Molecular serum markers that can identify early reversible osteoarthritis (OA) in horses are lacking. Objectives: We studied serum concentrations of a novel cartilage oligomeric matrix protein (COMP) neo-epitope in horses subjected to short-term exercise and with acute lameness. The effects of circadian rhythm and age were also evaluated. Study design: Longitudinal studies in healthy horses and cross-sectional comparison of lame and non-lame horses. Methods: Sera were collected from five horses before and after short-term interval exercise and during full-day box rest. Sera from 32 acutely lame horses were used to evaluate age-related effects. Independent samples from control horses (n = 41) and horses with acute lameness (n = 71) were included. COMP neo-epitope concentrations were analysed using custom-developed inhibition ELISAs validated for equine serum. The presence of COMP neo-epitope was delineated in healthy and osteoarthritic articular cartilage with immunohistochemistry. Results: COMP neo-epitope concentrations decreased after speed training but returned to baseline levels post-exercise. No correlations between age and serum COMP neo-epitope concentrations were found (r = 0.0013). The mean (±s.d.) serum concentration of COMP neo-epitope in independent samples from non-lame horses was 0.84 ± 0.38 μg/mL, and for lame horses was 5.24 ± 1.83 μg/mL (P<0.001). Antibodies against COMP neo-epitope did not stain normal articular cartilage, but intracytoplasmic staining was found in superficial chondrocytes of mild OA cartilage and in the extracellular matrix of moderately osteoarthritic cartilage. Main limitations: ELISA was based on polyclonal antisera rather than a monoclonal antibody. There is a sex and breed bias within the groups of horses, also it could have been of value to include horses with septic arthritis and tendonitis and investigated joint differences. Conclusions: This COMP neo-epitope can be measured in sera, and results indicate that it could be a biomarker for pathologic fragmentation of cartilage in connection with acute joint lameness.Western Region Research Funding (ALF GBG‐716171), the Swedish‐Norwegian Foundation for Equine Research (H0947014), Swedish Research Council grant (VR 2015‐02959) and the Swedish Research Council for Environment, Agricultural Sciences and Spatial Planning (FORMAS 221‐2013‐317) supported this research.Peer Reviewe