Patient Safety and the Increasing Complexity of Modern Healthcare

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Cervicofascial subcutaneous emphysema and pneumomediastinum following routine restorative dentistry--two case reports

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/Open Allur texti - Full textAlthough a well-known complication of dental treatment, cervicofacial subcutaneous emphysema is uncommon, especially with co-existing pneumomediastinum. This complication is usually attributed to high-speed air-driven handpieces or air-water syringes. Pneumomediastinum is usually self-limiting but potentially life threatening. We present two cases where both patients suffered from cervicofacial subcutaneous emphysema, one additionally having pneumomediastinum following routine restorative dentistry.Húðbeðsþemba (subcutaneous emphysema) á andlits- og hálssvæði er sjaldgæfur en vel þekktur fylgikvilli tannviðgerða, einkum eftir tannúrdrátt. Einnig er sjaldgæft að loftmiðmæti (pneumomediastinum) hljótist af slíku inngripi. Orsökin er yfirleitt innblástur lofts undir þrýstingi inn í mjúkvefi munnhols frá tækjum tannlækna. Ástandið gengur oft yfir sjálfkrafa, en getur valdið lífshættulegum fylgikvillum. Hér eru kynnt tvö sjúkratilfelli þar sem húðþemba og loftmiðmæti komu í kjölfar minniháttar tannviðgerð

Do opioids, sedatives and proton-pump inhibitors increase the risk of fractures?

Efst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinnTilgangur: Um er að ræða lyfjafaraldsfræðilega rannsókn sem var gerð til að kanna hugsanleg tengsl milli töku nokkurra lyfja og beinbrota. Efniviður/aðferðir: Rannsóknarþýðið var einstaklingar 40 ára og eldri sem greindust með beinbrot á bráðamóttöku Landspítala á 10 ára tímabili (2002-2011). Einnig voru rannsakaðir einstaklingar sem samkvæmt Lyfja­gagnagrunni landlæknis höfðu leyst út 90 dagsskammta eða meira af þeim lyfjum sem rannsóknin beindist að á höfuðborgarsvæðinu á rannsóknartímabilinu. Ópíöt og bensódíazepín (svefn- og róandi lyf) voru borin saman við HMG-CoA redúktasa-hemla (statín), gigtarlyf (NSAID) og beta-blokka. Prótónupumpu-hemlar (PPI) og H2-andhistamín voru einnig skoðuð. Tengsl lyfjanna við beinbrot voru könnuð með því að samkeyra upplýsingar úr Sögu, rafrænni sjúkraskrá, við Lyfjagagnagrunn landlæknis. Niðurstöður: Alls greindust 29.056 brot hjá 22.891 einstaklingum. Konur með beinbrot voru bæði marktækt eldri og fleiri en karlar í öllum lyfjaflokkum nema fyrir statín. Ekki var marktækur munur á hlutfallslegri áhættu gigtarlyfja, statína eða beta-blokka við beinbrot. Beta-blokkarnir höfðu hlutfallslega áhættu á milli gigtarlyfja og statína og því valdir til viðmiðunar fyrir ópíöt, svefn- og róandi lyf, PPI og H2-andhistamín. Hlutfallsleg áhætta á beinbrotum var næstum tvöfalt meiri eftir töku ópíata, 40% meiri eftir töku svefn- og róandi lyfja og 30% meiri eftir töku PPI. Notkun H2-andhistamína tengdist ekki hættu á beinbrotum. Ályktun: Þessi rannsókn sýndi að tengsl eru milli töku ópíata eða svefn- og róandi lyfja og beinbrota. Einnig var aukin tíðni beinbrota hjá einstaklinga á PPI-meðferð sem er athyglisvert í ljósi mikillar notkunar þessara lyfja í samfélaginu.Introduction: A pharmacoepidemiological study was conducted to analyse the relationship between bone fracture and the use of certain drugs. Material/methods: The study includes patients 40 years and older, diagnosed with bone fractures in the Emergency Department of Landspitali University Hospital in Reykjavik, Iceland, during a 10-year period (2002-2011). Also were included those who picked up from a pharmacy 90 DDD or more per year of the drugs included in the study in the capital region of Iceland during same period. Opiates, benzodiazepines/hypnotics (sedatives) were compared with HMG-CoA reductase inhibitors (statins), non-steroid anti-inflammatory drugs (NSAID) and beta blockers. Proton-pump inhibitors (PPI) and histamine H2-antagonists were also examined. To examine the association between above drugs and fractures the data from electronic hospital database were matched to the prescription database run by the Directorate of Health. Results: A total of 29,056 fractures in 22,891 individuals were identified. The females with fractures were significantly older and twice as many, compared to males. The odds ratio (OR) for fractures was not significantly different between the NSAID, statins and beta blockers. OR for opiates showed almost double increased risk of fractures, 40% increased risk for sedatives and 30% increased risk for PPIs compared to beta blockers. No increased fracture-risk was noted in patients taking H2 antagonists. Conclusion: This study shows a relationship between the use of opiates, sedatives and bone fractures. The incidence of fractures was also increased in patients taking PPIs which is interesting in the light of the wide-spread use of PPIs in the communit

Prevalence of myotonic dystrophy in Iceland

Neðst á síðunni er hægt er að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenOBJECTIVE: Epidemiologic studies of Myotonic Dystrophy (Dystrophic Myotony, DM) have shown variable regional prevalence from 0,46 to 189/105. We carried out a total population survey of DM in Iceland in 2004 having Oct. 31 as the day of prevalence. MATERIAL AND METHODS: Patients were collected from multiple sources, including Landspitali University Hospital registry and through contact with neurologists, neuropaediatricians, paediatricians and rehabilitation specialists. All EMGs of DM patients were reviewed. Information was gathered about age, age of onset, family history of DM and clinical symptoms. RESULTS: Eighty-two patients were ascertained giving a crude prevalence of 28.2/105. The prevalence of the congenital form of DM was 7.9/105 (23 patients, 26%). Affected females outnumbered males with a gender ratio of 1.2:1 (NS). Mean age of onset of symptoms for those, who didn't have the congenital form was 27.5 years (range 5-70 years). Ten families with DM were identified and all prevalent patients belonged to those families. CONCLUSION: The prevalence of DM is high in Iceland and higher than generally reported. This study showed a three times higher total prevalence and a seven times higher prevalence of congenital DM than found in a previous study in Iceland. We believe that this increase in prevalence probably reflects increased awareness of inherited diseases in neonates and better detection of patients who have mild symptoms.Tilgangur: Að kanna algengi spennuvisnunar (Dystrophia Myotonica, DM) á Íslandi. Efniviður og aðferðir: Skimun var gerð á íslenskum sjúklingum með vöðvavisnunargreiningar á Landspítala, hjá taugalæknum, taugalífeðlisfræðingum, barnalæknum og endurhæfingarlæknum. Upplýsinga var aflað úr sjúkraskrám varðandi aldur, kyn, aldur við byrjun einkenna, einkenni og ættarsögu um DM. Niðurstöður: Alls fundust 82 einstaklingar með staðfesta DM-greiningu og var algengið á Íslandi 28,2/105. 26% sjúklinga höfðu meðfætt form sjúkdómsins. Meðalaldur við byrjun einkenna var 27,5 ára hjá þeim, sem ekki höfðu meðfædda formið (bil 5-70 ára) og meðalaldur við rannsókn var 43,5 ára fyrir allan hópinn (bil 1-85 ára). Sjúkdómurinn var heldur algengari meðal kvenna, 44 konur á móti 38 körlum. Könnun á innbyrðis skyldleika sjúklinga leiddi í ljós að sjúkdómurinn finnst meðal 10 íslenskra fjölskyldna. Ályktun: Spennuvisnun er algengari á Íslandi en sýnt hefur fram á í flestum þeim faraldsfræði­rannsóknum sem gerðar hafa verið erlendis. Í þessari rannsókn fannst þrefalt hærra algengi en í rannsókn Kjartans Guðmundssonar frá árunum 1954-64 og hlutfall sjúklinga með meðfædda spennuvisnun var sjöfalt hærra en í rannsókn hans. Líklega má rekja hærra algengi til betri greiningar á sjúkdómnum við tilkomu erfðarannsókna og meiri árvekni fyrir erfðasjúkdómum meðal lækna hérlendis

The effect of bacterial flagellin on virus infection

Coinfection with bacteria and viruses is an understudied area of microbiology, despite its potential to modulate pathogen abundance and host survival. We investigated the effect of bacteria on virus infection and developed an $in$ $vitro$ system to study the first step: viral internalization. Our studies show that multiple bacterial species promote the entry of a diverse panel of viruses into lung and gut epithelial cells. Bacteria expressing the toll-like receptor (TLR)5 agonist, flagellin, are most efficient at inducing viral uptake and studies using recombinant flagellin or aflagellate bacterial strains confirm that flagellin has pro-viral activity. Flagellin promotes epithelial cells to support virus entry via TLR5-dependent activation of NF-KB. To extend these observations and study the role of flagellin in the complete viral replicative lifecycle, we studied human immunodeficiency virus (HIV)-1 replication in T cells. Flagellin augments HIV-1 entry and promoter activity and increases the production of extracellular virus. The data presented in this thesis highlight a new role for bacterial flagellin to promote diverse virus infection of epithelial barriers and enhance the spread of HIV-1. This has significant implications for understanding how exposure to multiple pathogens can alter susceptibility to infection and its associated pathogenesis

Non-cardiac chest pain and its association with persistent chest pain and poor mental well-being

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 FilesInngangur: Ótilgreindir brjóstverkir eru endurteknir brjóstverkir sem stafa ekki af kransæðasjúkdómi eða öðrum bráðum veikindum. Erlendar rannsóknir hafa sýnt að 50-75% heimsókna á hjartabráðadeildir séu vegna þeirra. Markmið þessarar rannsóknar var að meta algengi ótilgreindra brjóstverkja á bráðadeildum Landspítala og tengsl þeirra við áframhaldandi verkjaupplifun, andlega líðan, lífsgæði, og ánægju með meðferð. Efniviður og aðferðir: Þátttakendur voru 390 sjúklingar (18-65 ára) sem komu á Hjartagátt (236) eða bráðamóttöku Landspítala (154) vegna brjóstverkja frá október 2015 fram í maí 2016. Þátttakendur svöruðu stöðl­uðum spurningalistum, einum til átta mánuðum eftir útskrift, um líkamleg einkenni, andlega líðan og lífsgæði, auk spurninga um áframhaldandi verki og meðferð. Niðurstöður: Alls 72% (283) þátttakenda töldust hafa ótilgreinda brjóstverki og 24% sjúklinga (91) höfðu greiningu á hjartasjúkdómi. Sjúklingar með ótilgreinda brjóstverki höfðu svipaða byrði líkamlegra einkenna og þunglyndis, en ívið meiri kvíða og streitu en hjartasjúklingar. Jafnt hlutfall hjartasjúklinga og sjúklinga með ótilgreinda brjóstverki fundu fyrir brjóstverkjum eftir útskrift, eða 60%. Áframhaldandi brjóstverkir tengdust meiri kvíða (β=0,19, p<0,001) og þunglyndi (β=0,17, p<0,003) meðal sjúklinga með ótilgreinda brjóstverki, en ekki meðal hjartasjúklinga. Þrjátíu prósent sjúklinga með ótilgreinda brjóstverki skorti skýrar leiðbeiningar um viðbrögð við áframhaldandi verkjum (samanborið við 19% hjartasjúklinga, p<0,05) og einungis 40% sjúklinga með ótilgreinda brjóstverki fengu upplýsingar um aðrar mögulegar orsakir brjóstverkja. Ályktanir: Ótilgreindir brjóstverkir voru algengir meðal sjúklinga á bráðadeildum Landspítala. Meirihluti þeirra sjúklinga hafði áframhaldandi brjóstverki eftir útskrift sem tengdust andlegri vanlíðan, og þriðjungi þeirra fannst þá skorta skýringar á mögulegum orsökum brjóstverkjanna og leiðbeiningar um viðbrögð við frekari verkjum.Introduction: An estimated 50-75% of visits to cardiac emergency departments are due to chest pain which is non-cardiac in nature (non-cardiac chest pain (NCCP). This study evaluates the prevalence of NCCP in the emergency departments at Landspitali, and assesses its association with continued chest-pain post discharge, mental well-­being and the information-provision provided to NCCP patients during hospitalization. Material and methods: Participants were 390 patients (18-65 years) presenting with chest pain to the cardiac emergency or the general emergency department at Landspitali from October 2015-May 2016. Measurements included questionnaires assessing somatic symptoms, mental well-being and quality of life, and questions regarding continued chest-pain and information-provision during hospitalization. Results: In total 72% of participants (282) were considered having NCCP while 24% (92) had cardiac disease. NCCP patients experienced a similar burden of somatic and depressive symptoms, but slightly more anxiety and mental distress than cardiac patients. Equal proportions (60%) of NCCP and cardiac patients reported having experienced chestpain post discharge. Continued chest-pain was, however, associated with greater anxiety (β=0.18, p<0.001) and depression (β=0.18, p<0.003) among NCCP patients. Thirty percent of NCCP patients lacked instructions of how to respond to continued chest-pain and only 40% received information regarding other possible causes of chest pain. Conclusion: NCCP was prevalent among patients presenting to emergency departments at Landspitali. The majority of NCCP patients experienced continued chest-pain after discharge, and such pain experience was associated with mental distress. A third of NCCP patients lacked information about possible causes for the pain and advice about coping with symptoms.Rannsóknarsjóður Íslands og Vísindasjóður Landspítal

Localization of a gene for migraine without aura to chromosome 4q21.

To access publisher full text version of this article. Please click on the hyperlink in Additional Links fieldMigraine is a common form of headache and has a significant genetic component. Here, we report linkage results from a study in Iceland of migraine without aura (MO). The study group comprised patients with migraine recruited by neurologists and from the registry of the Icelandic Migraine Society, as well as through the use of a questionnaire sent to a random sample of 20,000 Icelanders. Migraine diagnoses were made and confirmed using diagnostic criteria established by the International Headache Society. A genome-wide scan with multipoint allele-sharing methods was performed on 289 patients suffering from MO. Linkage was observed to a locus on chromosome 4q21 (LOD=2.05; P=.001). The locus reported here overlaps a locus (MGR1) reported elsewhere for patients with migraine with aura (MA) in the Finnish population. This replication of the MGR1 locus in families with MO indicates that the gene we have mapped may contribute to both MA and MO. Further analysis indicates that the linkage evidence improves for affected females and, especially, with a slightly relaxed definition of MO (LOD=4.08; P=7.2 x 10(-6))

Absence of miRNA-146a Differentially Alters Microglia Function and Proteome

Background: MiR-146a is an important regulator of innate inflammatory responses and is also implicated in cell death and survival. Methods: By sorting CNS resident cells, microglia were the main cellular source of miR-146a. Therefore, we investigated microglia function and phenotype in miR-146a knock-out (KO) mice, analyzed the proteome of KO and wild-type (WT) microglia by LC-MS/MS, and examined miR-146a expression in different brain lesions of patients with multiple sclerosis (MS). Results: When stimulated with LPS or myelin in vitro, microglia from KO mice expressed higher levels of IL-1β, TNF, IL-6, IL-10, CCL3, and CCL2 compared to WT. Stimulation increased migration and phagocytosis of WT but not KO microglia. CD11c+ microglia were induced by cuprizone (CPZ) in the WT mice but less in the KO. The proteome of ex vivo microglia was not different in miR-146a KO compared to WT mice, but CPZ treatment induced differential and reduced protein responses in the KO: GOT1, COX5b, CRYL1, and cystatin-C were specifically changed in KO microglia. We explored discriminative features of microglia proteomes: sparse Partial Least Squares-Discriminant Analysis showed the best discrimination when control and CPZ-treated conditions were compared. Cluster of ten proteins separated WT and miR-146a KO microglia after CPZ: among them were sensomes allowing to perceive the environment, Atp1a3 that belongs to the signature of CD11c+ microglia, and proteins related to inflammatory responses (S100A9, Ppm1g). Finally, we examined the expression of miR-146a and its validated target genes in different brain lesions of MS patients. MiR-146 was upregulated in all lesion types, and the highest expression was in active lesions. Nineteen of 88 validated target genes were significantly changed in active lesions, while none were changed in NAWM. Conclusion: Our data indicated that microglia is the major source of miR-146a in the CNS. The absence of miR-146a differentially affected microglia function and proteome, and miR-146a may play an important role in gene regulation of active MS lesions