Introduction: Eclampsia is a serious complication of pregnancy and childbirth. Preeclampsia is considered to be its precursor and antenatal monitoring is of crucial importance. The study aimed to investigate the incidence of eclampsia at Landspítali, timing of seizures, signs of preeclampsia, subsequent diagnosis of neurological diseases and sequelae, and maternal mortality rate. Methods: The cohort consisted of women diagnosed with eclampsia at Landspítali between 1982 and 2022. Data was collected from forty medical records, excluding seven misdiagnosed cases. Statistical significance was calculated with Fisher’s exact test and a multinomial exact test. Results: During the study period, the incidence of eclampsia remained consistent at ~1:3610 births, i.e. 33 cases out of 119.125 births. The eclampsia occurred as follows: 52% antepartum, 27% intrapartum, and 21% postpartum. Twenty-four women were diagnosed with preeclampsia before the eclampsia occurred. Nine women had no signs of preeclampsia, and this subgroup was proportionally larger (though non-significant p=0.44) in the latter part of the study period. Five women were subsequently diagnosed with neurological disease or symptoms. All women for whom information was available (32 out of 33), were alive 42 days after the eclampsia. Conclusions: The incidence of eclampsia was low and remained consistent during the study period and the mortality rate approximates zero. Nothing indicates that the incidence will decrease unless we learn more about predictive factors. Few women were subsequently diagnosed with neurological disease or experienced neurological symptoms, but there appears to be a significant lack of good work practices for searching and follow-up of such symptoms and other consequences of eclampsia.
Medicines are the most common and, in many cases, the most effective treatment for disease. Medicine use is expected to continue to rise in the coming years, due in part to an ageing population. At the same time, knowledge of the environmental impact of pharmaceuticals has grown. *Therefore*, there is increasing discussion of the need for clinicians to take such impacts into account when selecting treatment for their patients. The World Health Organization has proposed the One Health approach, which emphasises the interconnection between human health, animal health and the environment. According to the One Health approach, all of these dimensions must be considered in order to respond effectively to contemporary health threats. Medicines are designed to have specific effects on living organisms, and many of them withstand a wide range of environmental conditions without breaking down or losing activity. Pharmaceuticals can have adverse environmental effects in three ways: through pollution and the carbon footprint associated with their manufacture and distribution; through excretion of unchanged drug or active metabolites into the environment via urine or faeces; or through improper disposal. This article discusses the environmental impact of pharmaceuticals, their potential effects on human health, the current situation in Iceland, and measures to mitigate adverse effects and counter further deterioration.
Transdiaphragmatic intercostal hernias (TDIH) are rare, and occur when abdominal viscera herniate through diaphragmatic and intercostal defects. They are often associated with trauma, but spontaneous cases (e.g., related to coughing) have also been described. We report a case of a male in his seventies with chronic obstructive pulmonary disease and obesity who developed TDIH following severe coughing due to a respiratory infection. Imaging revealed a right-sided diaphragmatic hernia with colon and small intestines extending into the thoracic cavity and between ribs. The patient underwent a successful open repair with a Gore-Tex mesh reinforcement for both diaphragmatic and intercostal defects.
Guillain-Barré syndrome (GBS) is an acute immune-mediated polyneuropathy marked by rapidly progressive, symmetrical paralysis, paresthesia, and hypo-/areflexia. Early recognition and management are crucial as the condition can rapidly become life-threatening. We report a healthy 51-year-old man who presented to a physician in Reyðarfjörður, eastern Iceland, with symmetrical hand weakness and paresthesia. Within 24 hours, weakness progressed to all four limbs. The patient was transferred by air ambulance to Akureyri where GBS was clinically diagnosed and intravenous immunoglobulin therapy was initiated. Nerve conduction study confirmed acute motor axonal neuropathy, a GBS variant. Treatment halted progression, and the patient is undergoing rehabilitation.
INTRODUCTION:Adjuvant endocrine therapy (tamoxifen/aromatase inhibitors) is used after surgery in hormone-receptor-positive breast cancer stage I-III. Administration for 5-10 years reduces recurrence and improves survival. Therapy adherence has not been assessed in Iceland. The main objective was to assess adherence to endocrine therapy among patients diagnosed with breast cancer in Iceland 2013-2018. Prognostic factors and the effect of adherence on prognosis were examined. MATERIAL AND METHODS:This retrospective, population-based cohort study obtained data from the Icelandic Cancer Registry, the Icelandic Prescription Medicine Register and medical records. Treatment adherence was defined as prescription refills for tamoxifen and/or aromatase inhibitors for five years or until the day of death/recurrence of breast cancer. Patients were considered adherent if prescriptions covered ≥80% of the treatment period. Descriptive statistics, logistic regression analysis, and Kaplan-Meier survival analysis were performed. RESULTS:The study included 1,008 patients, 990 women and 18 men, with a median age of 62.0 years. Logistic regression identified chemotherapy before and/or after surgery as a positive predictor (OR 2.04; 95%CI 1.36-3.10; < 0.001) and initial treatment with tamoxifen as a negative prognostic factor (OR 0.68; 95%CI: 0.50-0.94; p=0.02). Significant association was observed between treatment adherence and overall survival (p=0.025) and disease-free survival (p=0.0075). CONCLUSION:Among patients, 27.0% were non-adherent to treatment. Significant association was observed between survival and adherence. It is important to improve treatment adherence, for example through multidisciplinary approaches within the healthcare system and increased patient education.
Sepsis is a life-threatening syndrome that occurs when a dysregulated host response to infection results in organ dysfunction. Globally, approximately 50 million cases of sepsis are diagnosed each year, with children accounting for nearly half. Despite advances in vaccination and medical treatment, sepsis remains one of the leading causes of childhood mortality worldwide, and many survivors experience long-term sequelae. The aim of this short review is to raise awareness of recent developments and to discuss key aspects of the diagnosis and management of pediatric sepsis. The clinical presentation of sepsis is often nonspecific, including symptoms such as fever, tachycardia, and increased respiratory rate, making diagnosis challenging. Systematic screening using clinical assessment tools, combined with targeted measurement of biomarkers, can facilitate earlier and more accurate diagnosis. Prognosis improves significantly when appropriate treatment is initiated promptly. It is therefore essential that physicians and other healthcare professionals maintain a high index of suspicion for sepsis, assess risk systematically, and actively seek clinical and biochemical signs of the condition. When sepsis is suspected, antimicrobial therapy should be administered as soon as possible, with blood cultures obtained beforehand if this does not cause significant delay. Judicious fluid resuscitation and frequent reassessment of the patient's condition are crucial, and in severe cases, initiation of intravenous or intraosseous adrenaline infusion should not be delayed. The authors hope that this review will appeal to a broad readership and support clinicians in the rapid and safe recognition and management of sepsis in children.
Congenital insensitivity to pain (CIP) refers to a group of extremely rare genetic disorders characterized by a lifelong inability to sense pain. Interestingly, in most cases, other neurological functions remain essentially intact. Here, we present the long-term follow-up of a 73 year old Icelandic male who, along with his two brothers, were diagnosed with CIP in childhood. This report details his clinical history, neurological findings, and whole genome sequencing results, which confirm and elucidate the genetic basis of his condition, explained by compound heterozygosity of two rare mutations in SCN9A. One has previously been described in CIP (p.Lys1659Ter). The other is a novel CIP variant consisting of a rare deletion (c.417-15_4174-14delAT) that causes exon 23 to be spliced out, and loss of 18 amino acids from the protein.
BACKGROUND:Small intestine adenocarcinoma is a rare cancer with poor prognosis. The only curative treatment is surgery to remove the tumor. If the tumor is located in the duodenum, a pancreaticoduodenectomy is recommended, while partial resection of the small intestine is advised for tumors located more distally. MATERIALS AND METHODS:Data was obtained from the medical records system at Landspítali. Variables were recorded in Excel, and descriptive statistics along with survival calculations were performed using the statistical software R. RESULTS:A total of 47 patients were diagnosed with small intestine adenocarcinoma, 32 in the duodenum and 15 more distally. Curative surgery was performed on 25 patients. Severe complications (≥3 on the Clavien-Dindo scale) occurred in 32% of cases. The recurrence rate was 24%. One-year survival for patients undergoing surgery was 80%, while five-year survival rate was 56%. Five-year survival was higher for tumors originating in the duodenum (70,6%) compared to other parts of the small intestine (25,0% p>0,05). CONCLUSION:Small intestine adenocarcinoma is a rare condition, with few patients diagnosed during the study period. A high proportion of patients underwent surgery, but one out of every four was diagnosed with recurrence during follow-up. No previous results for small intestine cancer in Iceland have been published, making comparisons with other countries difficult due to the low incidence of this cancer.
INTRODUCTION:Eclampsia is a serious complication of pregnancy and childbirth. Preeclampsia is considered to be its precursor and antenatal monitoring is of crucial importance. The study aimed to investigate the incidence of eclampsia at Landspítali, timing of seizures, signs of preeclampsia, subsequent diagnosis of neurological diseases and sequelae, and maternal mortality rate. METHODS:The cohort consisted of women diagnosed with eclampsia at Landspítali between 1982 and 2022. Data was collected from forty medical records, excluding seven misdiagnosed cases. Statistical significance was calculated with Fisher's exact test and a multinomial exact test. RESULTS:During the study period, the incidence of eclampsia remained consistent at ~1:3610 births, i.e. 33 cases out of 119.125 births. The eclampsia occurred as follows: 52% antepartum, 27% intrapartum, and 21% postpartum. Twenty-four women were diagnosed with preeclampsia before the eclampsia occurred. Nine women had no signs of preeclampsia, and this subgroup was proportionally larger (though non-significant p=0.44) in the latter part of the study period. Five women were subsequently diagnosed with neurological disease or symptoms. All women for whom information was available (32 out of 33), were alive 42 days after the eclampsia. CONCLUSIONS:The incidence of eclampsia was low and remained consistent during the study period and the mortality rate approximates zero. Nothing indicates that the incidence will decrease unless we learn more about predictive factors. Few women were subsequently diagnosed with neurological disease or experienced neurological symptoms, but there appears to be a significant lack of good work practices for searching and follow-up of such symptoms and other consequences of eclampsia.
Copper deficiency is a rare and often overlooked cause of anemia, neutropenia, and neuropathy. We describe a case where a 47-year-old man sought medical attention because of weight loss, fatigue, and neurological symptoms. Initial evaluation suggested myelodysplastic syndrome, with anemia and neutropenia. Furthermore, the bone marrow was hypercellular with prominent cytoplasmic vacuoles in myeloid precursors. Subsequently, the clinical picture was determined to result from severe copper deficiency secondary to excessive zinc exposure. Further history revealed long-term use of a zinc-containing denture adhesive. After copper supplementation and discontinuation of the adhesive, blood status normalized and symptoms largely resolved. This case highlights the importance of considering copper deficiency in unexplained bone marrow failure.
INTRODUCTION:Esophageal cancer is the seventh leading cause of cancer-related death worldwide. Curative treatment typically involves surgery with or without neoadjuvant chemoradiotherapy. The study aimed to describe patient characteristics and evaluate outcomes after partial esophagectomy at a low-volume center in Iceland. MATERIALS AND METHODS:This retrospective cohort study included all patients diagnosed with localized esophageal cancer in Iceland from 2015 to 2020 who were accepted for curative esophagectomy. Primary outcomes included postoperative complications, recurrence, and 5-year survival. Complications were categorized using the Clavien-Dindo classification, and descriptive analyses were performed. Recurrence was evaluated with all-cause mortality as a competing event, and survival rates assessed with Kaplan-Meier analysis. RESULTS:Overall, 33 patients underwent esophagectomy. The median age was 66 years, and 76% were male. Neoadjuvant therapy was administered in 94% of cases. Clavien-Dindo >3a occurred in 45% of patients and anastomotic leakage was the most frequent complication, occurring in 30% of cases. Mortality at 30 and 90 days were 0% and 6%, respectively. Five-year overall survival was 44%, and disease-free survival was 30%. Cumulative incidence of recurrence was 21% after one year and 55% after five years. CONCLUSION:Esophagectomy for esophageal cancer in Iceland is associated with acceptable postoperative morbidity and operative mortality despite being performed in a low-volume setting. Although the incidence of anastomotic leakage is somewhat higher than in international cohorts, the 30-day mortality rate is low, and long-term survival is comparable to outcomes reported in Nordic countries.
INTRODUCTION:To investigate the epidemiology of high-energy thoracic and lumbar spine fractures at Landspítali and evaluate their treatment and associated injuries using international injury classification systems. MATERIALS AND METHODS:Medical records were reviewed with regard to age, sex, nationality, length of hospital stay, mechanism of injury, associated injuries, treatment, neurological injury, seasonality, and injury location. Imaging studies were used for diagnosis and for classification of fractures according to the AO injury classification system. RESULTS:A total of 424 individuals were diagnosed with 596 fractures during the study period. On average, there were 21.2 injuries per year; the mean age was 40.3 years, and men accounted for just over 62% of cases. Motor vehicle collisions were the cause in approximately 21% of cases, rollovers in about 20%, and among rollover accidents, just over 31% involved foreign individuals. The most common fracture levels were L1 (approximately 19% of all fractures) and Th12 (just over 11%). Neurological injury was present in just over 20% of cases involving fractures at Th12, L1, and Th7. Overall, 36% of patients underwent surgical treatment, and an additional 17% received external support. Associated injuries to other parts of the body were present in just over 63% of cases. CONCLUSION:On average, approximately two thoracic and lumbar spine fractures caused by high-energy trauma were treated per month at Landspítali during the period 2003-2022. A typical case was a fracture at Th12 or L1 in a 40-year-old man. Patients without neurological deficits had a significantly shorter length of hospital stay. The number of injuries decreased over time, although not statistically significantly; this trend could, for example, be explained by improved vehicle safety equipment.
Antimicrobial resistance is now one of the leading threats to global public health. The development of new antibiotics has not kept pace with the rapid emergence and spread of multidrug-resistant bacteria, whose prevalence continues to rise. The burden is greatest in countries with high antibiotic use and limited access to clean water and sanitation. Multidrug-and extensively-resistant enteric bacteria, particularly Escherichia coli and Klebsiella pneumoniae, are of greatest concern. While the situation in the Nordic countries remains favorable, Icelanders traveling to high-prevalence regions or seeking medical care abroad are at increased risk of acquiring and importing these bacteria. Major risk factors include antibiotic exposure, use of acid-suppressing drugs, and consumption of contaminated food and water. This article outlines strategies to reduce these risks including prudent antibiotic use, strict hygiene, careful food and beverage choices, and caution when accessing healthcare outside the Nordic region. The Icelandic society is in a unique position, with minimal use of antibiotics in agriculture and a low prevalence of resistant bacteria. Physicians have a pivotal role in educating patients and the public, thereby maintaining Iceland's low disease burden from resistant bacteria and helping to curb the spread of this "silent pandemic".
