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Short-term, intermediate-term and long-term risks of acute coronary syndrome in cohorts of patients with RA starting biologic DMARDs : results from four Nordic countries
(2022-03-22) Delcoigne, Benedicte; Ljung, Lotta; Provan, Sella A; Glintborg, Bente; Hetland, Merete Lund; Grøn, Kathrine Lederballe; Peltomaa, Ritva; Relas, Heikki; Turesson, Carl; Guðbjörnsson, Björn; Michelsen, Brigitte; Askling, Johan; Faculty of Medicine
OBJECTIVES: To compare the 1-year, 2-year and 5-year incidences of acute coronary syndrome (ACS) in patients with rheumatoid arthritis (RA) starting any of the biologic disease-modifying antirheumatic drugs (bDMARDs) currently available in clinical practice and to anchor these results with a general population comparator. METHODS: Observational cohort study, with patients from Denmark, Finland, Norway and Sweden starting a bDMARD during 2008-2017. Time to first ACS was identified through register linkages. We calculated the 1-year, 2-year and 5-year incidence rates (IR) (on drug and ever since treatment start) and used Cox regression (HRs) to compare ACS incidences across treatments taking ACS risk factors into account. Analyses were further performed separately in subgroups defined by age, number of previous bDMARDs and history of cardiovascular disease. We also compared ACS incidences to an individually matched general population cohort. RESULTS: 24 083 patients (75% women, mean age 56 years) contributing 40 850 treatment courses were included. During the maximum (5 years) follow-up (141 257 person-years (pyrs)), 780 ACS events occurred (crude IR 5.5 per 1000 pyrs). Overall, the incidence of ACS in RA was 80% higher than that in the general population. For all bDMARDs and follow-up definitions, HRs were close to 1 (etanercept as reference) with the exception of the 5-year risk window, where signals for abatacept, infliximab and rituximab were noted. CONCLUSION: The rate of ACS among patients with RA initiating bDMARDs remains elevated compared with the general population. As used in routine care, the short-term, intermediate-term and longer-term risks of ACS vary little across individual bDMARDs.
Verk
Complement-Binding Donor-Specific Anti-HLA Antibodies : Biomarker for Immunologic Risk Stratification in Pediatric Kidney Transplantation Recipients
(2022-03-16) Sigurjónsdóttir, Vaka Kristín; Purington, Natasha; Chaudhuri, Abanti; Zhang, Bing M.; Fernandez-Vina, Marcelo; Pálsson, Runólfur; Kambham, Neeraja; Charu, Vivek; Piburn, Kim; Maestretti, Lynn; Shah, Anika; Gallo, Amy; Concepcion, Waldo; Grimm, Paul C.; Faculty of Medicine
Antibody-mediated rejection is a common cause of early kidney allograft loss but the specifics of antibody measurement, therapies and endpoints have not been universally defined. In this retrospective study, we assessed the performance of risk stratification using systematic donor-specific antibody (DSA) monitoring. Included in the study were children who underwent kidney transplantation between January 1, 2010 and March 1, 2018 at Stanford, with at least 12-months follow-up. A total of 233 patients were included with a mean follow-up time of 45 (range, 9–108) months. Median age at transplant was 12.3 years, 46.8% were female, and 76% had a deceased donor transplant. Fifty-two (22%) formed C1q-binding de novo donor-specific antibodies (C1q-dnDSA). After a standardized augmented immunosuppressive protocol was implemented, C1q-dnDSA disappeared in 31 (58.5%). Graft failure occurred in 16 patients at a median of 54 (range, 5–83) months, of whom 14 formed dnDSA. The 14 patients who lost their graft due to rejection, all had persistent C1q-dnDSA. C1q-binding status improved the individual risk assessment, with persistent; C1q binding yielding the strongest independent association of graft failure (hazard ratio, 45.5; 95% confidence interval, 11.7–177.4). C1q-dnDSA is more useful than standard dnDSA as a noninvasive biomarker for identifying patients at the highest risk of graft failure.
Verk
Útgjöld ríkisins í Norðausturkjördæmi og tekjur ímyndaðs "Norðausturríkis"
(2013-06-15) Bjarnason, Þóroddur; Heiðarsson, Jón Þorvaldur
Hlutdeild einstakra landshluta í tekjuöflun þjóðarinnar og skipting ríkisútgjalda milli höfuðborgar og landsbyggða eru meðal umdeildustu mála í íslenskri byggðaumræðu. Slík umræða endurspeglar ólík viðhorf til félagslegs réttlætis og ólíka hagsmuni íbúa mismunandi landssvæða. Þrátt fyrir harðvítugar deilur um mikla hagsmuni eru rannsóknir á dreifingu ríkisútgjalda eftir landsvæðum af skornum skammti. Í þessari rannsókn er sjónum beint að útgjöldum ríkisins í Norðausturkjördæmi á grundvelli fjárlaga ársins 2011 og viðbótarupplýsinga sem safnað var hjá einstökum stofnunum og ráðuneytum. Niðurstöður sýna að starfsemi ríkisins á Norðurlandi eystra er um 11% minni en mannfjöldi segir til um eða sem nemur rúmlega 74 þúsund krónum á hvern íbúa á ári. Starfsemi ríkisins á Austurlandi er um 23% minni en mannfjöldi segir til um eða sem nemur rúmlega 159 þúsund krónum á hvern íbúa á ári. Á hinn bóginn leggur ríkið til svipaða upphæð til að stuðla að því að þjónusta sveitarfélaga sé sambærileg því sem gerist annars staðar og til að styðja við landbúnað á þessum svæðum. Ef áætlaðar tekjur ríkisins eru bornar saman við útgjöld ríkisins í kjördæminu kemur í ljós að útgjöldin eru hærri sem nemur 625 Mkr eða 1,2% af skatttekjum miðað við fjárlög ársins 2011. Til samanburðar var halli af rekstri íslenska ríkisins skv. fjárlögum 2011 um 7,9% eftir vaxtagreiðslur. Þetta er vísbending um að ímyndað, sjálfstætt „Norðausturríki“ gæti staðið á eigin fótum en til að svara því þyrfti þó mun viðameiri rannsóknir.
Verk
Obstructive Sleep Apnea Symptom Subtypes and Cardiovascular Risk : Conflicting Evidence to an Important Question
(2021-12-13) Keenan, Brendan T; Magalang, Ulysses J; Mazzotti, Diego R; McArdle, Nigel; Gíslason, Þórarinn; Singh, Bhajan; Maislin, Greg; Pack, Allan I; Faculty of Medicine
Verk
Surviving sepsis campaign : International guidelines for management of sepsis and septic shock in adults 2021 - endorsement by the Scandinavian society of anaesthesiology and intensive care medicine
(2022-02-16) Rehn, Marius; Chew, Michelle S.; Olkkola, Klaus T.; Sigurðsson, Martin Ingi; Yli-Hankala, Arvi; Hylander Møller, Morten; Faculty of Medicine
The Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine endorses the clinical practice guideline Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. The guideline serves as a useful bedside decision aid for clinicians managing adults with suspected and confirmed septic shock and sepsis-associated organ dysfunction.