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Lifrarbólguveira E : Umræða um tvö íslensk tilfelli
(2020) Ólafsdóttir, Marta; Löve, Arthur; Jónasson, Jón Gunnlaugur; Björnsson, Einar Stefán; Læknadeild
Lifrarbólga E er veirusjúkdómur sem berst yfirleitt með menguðu vatni og gengur oftast yfir án sértækra inngripa. Hann er algengur á Indlandi og hefur valdið faröldrum, til að mynda í Asíu, Afríku og Mexíkó, en er sjaldséður á Íslandi. Hér er lýst tveimur tilfellum lifrarbólgu E sem greindust á Íslandi á síðasta ári. Hepatitis E is a viral disease that is usually transmitted through contaminated drinking water and most often causes a self-limiting infection that does not require specific treatment. It is common in India and has caused outbreaks in Asia, Africa and Mexico but has very rarely been diagnosed in Iceland. We describe two cases of hepatitis E diagnosed in Iceland in the last year.
Verk
Brca1 promoter methylation status in 1031 primary breast cancers predicts favorable outcomes following chemotherapy
(2019-12-11) Stefánsson, Ólafur A.; Hilmarsdóttir, Hólmfridur; Ólafsdóttir, Kristrún; Tryggvadóttir, Laufey; Sverrisdóttir, Ásgerdur; Jóhannsson, Óskar Þór; Jónasson, Jón Gunnlaugur; Eyfjörð, Jórunn Erla; Sigurdsson, Stefán Þórarinn; Faculty of Medicine
Background: Breast Cancer 1 gene (BRCA1) is known to be inactivated in breast tumors by promoter methylation. Tumor cells in patients carrying a germline mutation in BRCA1 are sensitive to cytotoxic drugs that cause DNA double strand breaks. However, very little is known on whether patients with BRCA1 promoter methylated tumors are similarly sensitive to cytotoxic drugs. In this study, we address this by making use of extensive follow-up data on patients treated with cyclophosphamide, methotrexate, and fluorouracil in Iceland between 1976 and 2007. Methods: We analyzed BRCA1 promoter methylation by pyrosequencing DNA from tumor samples from 1031 patients with primary breast cancer. Of those, 965 were sporadic cases, 61 were BRCA2, and five were BRCA1 germline mutation carriers. All cases were examined with respect to clinicopathological parameters and breast cancer-specific survival in patients treated with cytotoxic drugs. Information on chemotherapy treatment in noncarriers was available for 26 BRCA1 methylated tumors and 857 unmethylated tumors. Results: BRCA1 was promoter methylated in 29 sporadic tumors or in 3.0% of cases (29 of 965), whereas none of the tumors derived from BRCA germline mutation carriers were promoter methylated. Important to note, patients with BRCA1 promoter methylation receiving chemotherapeutic drug treatment show highly improved breast cancer-specific survival compared with unmethylated controls (hazard ratio 0.10, 95% confidence interval 0.01 to 0.75, two-sided P .02). Conclusions: BRCA1 promoter methylation is predictive of improved disease outcome in patients receiving cyclophosphamide, methotrexate, and fluorouracil drug treatment. Our results support the use of markers indicative of "BRCAness" in sporadic breast cancers to identify patients that are likely to benefit from the use of DNA-damaging agents.
Verk
A nationwide population-based prospective study of cirrhosis in Iceland
(2021-06-01) Olafsson, Sigurdur; Rögnvaldsson, Sigurjon; Bergmann, Ottar M.; Jonasson, Jon G.; Benitez Hernandez, Ubaldo; Björnsson, Einar S.; Faculty of Medicine; Faculty of Life and Environmental Sciences
Background & Aims: The incidence of cirrhosis in Iceland has been the lowest in the world with only 3 cases per 100,000 inhabitants. Alcohol consumption has almost doubled in Iceland from 1980 to 2016. Obesity has also risen and hepatitis C virus has spread among people who inject drugs in Iceland. The aim of this study was to evaluate the effects of these risk factors on the incidence and aetiology of cirrhosis in Iceland. Methods: The study included all patients diagnosed with cirrhosis for the first time during 2010–2015. Diagnosis was based on liver histology or 2 of 4 criteria: cirrhosis on imaging, ascites, varices, and/or elevated INR. Results: Overall, 157 patients were diagnosed, 105 (67%) males, mean age 61 years. The overall incidence was 9.7 cases per 100,000 inhabitants annually. Alcohol was the only underlying cause in 48/157 (31%), non-alcoholic fatty liver disease (NAFLD) in 34/157(22%), and alcohol and hepatitis C together in 23/157(15%) were the most common causes. Only 6% of patients had an unknown cause of cirrhosis. Upon diagnosis, the median model for end-stage liver disease score was 11 (IQR 8–15), 53% were of Child-Pugh class A whereas 61 (39%) had ascites, 11% encephalopathy, and 8% variceal bleeding. In all, 25% of deaths were from HCC and 25% from liver failure. Conclusion: A major increase in incidence of cirrhosis has occurred in Iceland associated with increases in alcohol consumption, obesity, and hepatitis C. In a high proportion NAFLD was the aetiology and very few had unknown cause of cirrhosis. The highest death rate was from HCC. Lay summary: In a nationwide population-based study from Iceland, including all patients diagnosed with cirrhosis of the liver over a period of 5 years, we found the incidence of new cases had increased 3-fold compared with a previous study 20 years ago. The increase is attributable to increased alcohol consumption, an epidemic of diabetes and obesity, and infection with the hepatitis C virus. Furthermore, we found that with thorough investigations, a specific cause for cirrhosis could be found in 94% of patients. Patients with cirrhosis frequently die of liver cancer and other complications related to their liver disease.
Verk
Fertug kona með hósta og brjóstverk : Tilfelli mánaðarins
(2021-06) Kristjánsson, Haukur; Jónasson, Jón Gunnlaugur; Silverborn, Per Martin; Haraldsdóttir, Sigríður Ólína; Guðbjartsson, Tómas; Læknadeild
Verk
Encouraging rational antibiotic prescribing behaviour in primary care–prescribing practice among children aged 0–4 years 2016–2018 : an observational study
(2021-08-04) Gunnlaugsdóttir, María Rún; Linnet, Kristján; Jónsson, Jón Steinar; Blöndal, Anna Bryndís; Faculty of Medicine; Faculty of Pharmaceutical Sciences
OBJECTIVE: To study antibiotic prescriptions among 0- to 4-year-old children before and after implementing a quality project on prudent prescribing of antibiotics in primary healthcare in the capital region of Iceland. DESIGN: An observational, descriptive, retrospective study using quantitative methodology. SETTING: Primary healthcare in the Reykjavik area with a total population of approximately 220,000. SUBJECTS: A total of 6420 children 0-4 years of age presenting at the primary healthcare centres in the metropolitan area over three years from 2016 to 2018. MAIN OUTCOME MEASURES: Reduction of antibiotic prescriptions and change in antibiotic profile. Data on antibiotic prescriptions for children 0-4 years of age was obtained from the medical records. Out-of-hours prescriptions were not included in the database. RESULTS: The number of prescriptions during the study period ranged from 263.6 to 289.6 prescriptions/1000 inhabitants/year. A reduction of 9% in the total number of prescriptions between 2017-2018 was observed. More than half of all prescriptions were for otitis media, followed by pneumonia and skin infections. Amoxicillin accounted for over half of all prescriptions, increasing between 2016 and 2018 by 51.3%. During this period, the prescribing of co-amoxiclav and macrolides decreased by 52.3% and 40.7%, respectively. These changes were significant in all cases, p  < 0.0001. CONCLUSION: The results show an overall decrease in antibiotic prescribing concurrent with a change in the choice of antibiotics prescribed and in line with the recommendations presented in the prescribing guidelines implemented by the Primary Healthcare of the Capital Area, and consistent with the project's goals.Key pointsA substantial proportion of antibiotic prescribing can be considered inappropriate and the antibiotic prescription rate is highest in Iceland of the Nordic countries.After implementing guidance on the treatment of common infections together with feedback on antibiotic prescribing, a decrease in the total number of prescriptions accompanied by a shift in the antibiotic profile was observed.