Lindau Liljekvist L, Millberg M, Djärv T
… +1 more, Dryver E
Lakartidningen
· 2025 Jan · PMID 39810471
Cardiac arrest is the most time-sensitive condition that personnel face in the emergency department. Optimal management consists of good quality cardiopulmonary resuscitation, the simultaneous performance of focused inve...Cardiac arrest is the most time-sensitive condition that personnel face in the emergency department. Optimal management consists of good quality cardiopulmonary resuscitation, the simultaneous performance of focused investigations to identify potential reversible causes, and the delivery of cause-specific treatments. In order to manage patients with cardiac arrest in an efficient manner, team members need to have clearly defined roles and ready access to required equipment. This article presents the latest guidelines for cardiopulmonary resuscitation of patients with cardiac arrest in the emergency department and specific initial therapies for reversible causes. The article highlights specific aspects of the management of patients with cardiac arrest due to major trauma and accidental hypothermia, as well as cardiac arrest in the setting of advanced pregnancy. The article also provides recommendations regarding role allocation to team members involved in cardiac arrest management.
Type 2 diabetes (T2D) is increasing relentlessly globally, affecting ever younger patients. Many T2D patients do not attain glycemic target levels, indicating a clear need for novel antihyperglycemic drugs. Ideally, thes...Type 2 diabetes (T2D) is increasing relentlessly globally, affecting ever younger patients. Many T2D patients do not attain glycemic target levels, indicating a clear need for novel antihyperglycemic drugs. Ideally, these should not only control glycemia, but also halt or slow the progressive loss of beta cells. Two entirely novel classes of antihyperglycemic agents - glucokinase activators and imeglimin - were recently approved in Asian markets and will be discussed in this review. These two novel drug classes will be a welcome addition and complement to existing treatments. Time will tell whether these new antihyperglycemic agents will add value to the current treatment paradigms against T2D and provide sustained antihyperglycemic effect, acceptable safety, usefulness in combination therapy, and effects on hard end-points such as cardiovascular disease.
The belching reflex involves transient lower oesophageal sphincter relaxation and relaxation of the cricopharyngeus (CP). In some individuals, the latter stage fails,leading to return of gas to the stomach. This pattern...The belching reflex involves transient lower oesophageal sphincter relaxation and relaxation of the cricopharyngeus (CP). In some individuals, the latter stage fails,leading to return of gas to the stomach. This pattern is then repeated, which is accompanied by chest pain and loud, gurgling noises. Abdominal distension, epigastric pain and excessive flatulence are other common symptoms. Since CP relaxation is normal during deglutition, the syndrome is called retrograde CP dysfunction (RCPD). The anamnesis should be supported by e.g. manometry under conditions stimulating belching to validate the diagnosis. First-line treatment is injection of botulinum toxin (botox) into the CP. The prevalence is unknown and although RCPD is rare, a large number of confirmed and self-diagnosed RCPD patients have emerged in social media after dissemination of the efficacy of botox. RCPD patients suffer considerably, and awareness of the disease must therefore increase in the medical community.
The use of nitrous oxide (N2O) as a recreational drug has significantly increased around the world in the last decade and has become a common occurrence in Sweden. Nitrous oxide can be easily accessed, purchased from par...The use of nitrous oxide (N2O) as a recreational drug has significantly increased around the world in the last decade and has become a common occurrence in Sweden. Nitrous oxide can be easily accessed, purchased from party stores and online, and is legal in Sweden. There is a common misconception that nitrous oxide is harmless because it is used in healthcare. However, chronic nitrous oxide abuse can lead to a functional state of B12 deficiency with neurological and thromboembolic complications. The present case illustrates that recreational use of nitrous oxide may also lead to acute complications, including seizures and rupture of the airways.
In patients with atrial fibrillation (AF) at risk of stroke, direct oral anticoagulants (DOAC) have been shown to be at least as effective as warfarin, offering advantages like reduced monitoring requirements and lower b...In patients with atrial fibrillation (AF) at risk of stroke, direct oral anticoagulants (DOAC) have been shown to be at least as effective as warfarin, offering advantages like reduced monitoring requirements and lower bleeding risks. Disadvantages include limited data in patients with severe chronic kidney disease and higher patient costs. In mid-2021, Region Örebro County, Sweden, decided to switch suitable patients with AF from warfarin to DOAC. Out of the 823 patients receiving warfarin therapy, 732 were identified as suitable candidates for DOAC, and 89 percent of these patients were successfully switched. Switching from warfarin to DOAC offers superiority and simplifies treatment and monitoring. However, individual needs and risk factors must be carefully considered before switching. As many patients in Sweden continue to be prescribed warfarin, this initiative could potentially model for other regions.
Open science aims to make research accessible to all, enhancing transparency and promoting replication. It involves practices such as open access publishing, sharing statistical code, and making non-sensitive data a avai...Open science aims to make research accessible to all, enhancing transparency and promoting replication. It involves practices such as open access publishing, sharing statistical code, and making non-sensitive data a available to encourage critical review, reduce errors and prevent selective reporting of favorable results. A key component of open science is preregistration, where researchers outline their hypotheses and planned analysis methods in advance, minimizing bias and promoting accountability. Despite its benefits, misconceptions about open science practices hinder its widespread adoption among researchers. Common myths include the belief that preregistration prevents any deviation from the original plan, that it only applies to clinical trials, or that it's unnecessary if data have already been collected. By challenging these misunderstandings, we can leverage open science practices to improve the integrity and quality of research.
There is a breathtakingly rapid development in various areas that take advantage of the ever-improving possibilities to record and analyze the electrical activity generated in the brain. In this article, we attempt to br...There is a breathtakingly rapid development in various areas that take advantage of the ever-improving possibilities to record and analyze the electrical activity generated in the brain. In this article, we attempt to briefly describe some of these areas, including AI-assisted EEG interpretation, the use of BCI (brain-computer interface) in a medical setting, and the possible new applications connected to the development of very small wearable EEG devices. Furthermore, we discuss the concerns and challenges presented by these advancements in neurotechnology.
Granberg T, Börjesson Hanson A, Fällmar D
… +2 more, Basun H, Wahlund LO
Lakartidningen
· 2024 Nov · PMID 39600165
Approximately 100,000 persons live with Alzheimer's disease in Sweden. As the population ages, the need for diagnostics and disease-modifying treatment grows. Previously available treatments provide moderate symptom reli...Approximately 100,000 persons live with Alzheimer's disease in Sweden. As the population ages, the need for diagnostics and disease-modifying treatment grows. Previously available treatments provide moderate symptom relief but do not affect disease progression. New antibody treatments show promising results and are typically well tolerated. However, adverse events include brain edema and hemorrhages, which can be detected early by MRI. These treatments require substantial resources, including increased use of MRI and radiological expertise. The introduction of new therapies will lead to higher regional healthcare costs and demands for specialized diagnostics. Implementing these therapies therefore necessitates national preparation and planning for coordinated and efficient management, addressing the significant societal and economic challenges posed by Alzheimer's disease.
The global shortage of surgical and anesthesiologic specialists is partly overbridged by task sharing to unspecialized physicians (often called "medical officers" and non-physician staff (often called »associate clinicia...The global shortage of surgical and anesthesiologic specialists is partly overbridged by task sharing to unspecialized physicians (often called "medical officers" and non-physician staff (often called »associate clinicians"). Task sharing is defined as the delegation of specific tasks from those who traditionally carry them out, to someone with shorter training. There is ample evidence for good patient outcomes after surgeries carried out through task sharing to associate clinicians, especially for hernia repairs, acute laparotomies, orthopaedic surgeries, and caesarean sections. There is limited research on the role of medical officers, and further research is also needed to assess which procedures are appropriate for task sharing. In Sweden, task sharing is also widespread, but not as far-reaching as in many low-income countries. This article provides an overview of task sharing globally and suggests that there may be lessons to learn for high-income countries like Sweden.
Despite evidence that cesarean section rates above 10 percent at the population level do not reduce maternal or neonatal mortality, global rates continue to rise and are projected to reach 30 percent by 2030. The factors...Despite evidence that cesarean section rates above 10 percent at the population level do not reduce maternal or neonatal mortality, global rates continue to rise and are projected to reach 30 percent by 2030. The factors behind this increase are complex and vary across contexts, emphasizing the need for a local understanding in order to design and implement effective interventions to curb overuse. In contrast to many other high-income countries, Nordic countries exemplify how robust obstetric practices, midwifery led care and evidence-based guidelines can achieve excellent outcomes while maintaining low cesarean section rates. This success underscores the potential for healthcare systems worldwide to optimize cesarean use without compromising maternal and neonatal health.
An increased focus on essential care could avert more preventable deaths among critically ill patients in the world than the current focus on advanced technologies. Intensive care is expensive and high-risk in absence of...An increased focus on essential care could avert more preventable deaths among critically ill patients in the world than the current focus on advanced technologies. Intensive care is expensive and high-risk in absence of training and safety standards. Identification and basic care of failing vital organs across hospitals are the fundaments of all critical care. EECC comprises 40 such life-saving clinical processes that are affordable and practical enough to be applied in any hospital ward worldwide. Ensuring EECC is provided to all critically ill patients across hospitals has the potential to save many lives.
Hultin H, Ljungman D, Rutegård J
… +2 more, Wladis A, Muhrbeck M
Lakartidningen
· 2024 Nov · PMID 39600161
More than 5 billion humans cannot access essential surgery if needed. Surgery was for a long time not a part of the global health agenda, generally considered a luxury. However, the realization that a large proportion of...More than 5 billion humans cannot access essential surgery if needed. Surgery was for a long time not a part of the global health agenda, generally considered a luxury. However, the realization that a large proportion of the global burden of disease can be reduced by surgery has gained momentum. The publication of the Lancet Commission on Global Surgery and the Disease Control Priorities volume on surgery, along with the WHO resolution on access to essential and emergency surgical care, has been pivotal in this paradigm shift. Access to surgery is in many settings hampered by a mix of lack of leadership, skilled workforce, equipment, and financial risk protection for patients, to name a few. Importantly, the provision of surgery requires comprehensive health systems which, once established, allow for numerous other health interventions. This cannot be achieved without partnerships, responsible leadership and good governance that prioritizes health care in general and surgery in particular.
Tegnell E, Idh J, Jörnvall H
… +1 more, Mellin-Olsen J
Lakartidningen
· 2024 Nov · PMID 39600160
The article explores the role of anaesthesia in global health and highlights key initiatives such as the Lancet Commission on Global Surgery and the National Surgical, obstetric and Anaesthesia Plans (NSOAP). Recognizing...The article explores the role of anaesthesia in global health and highlights key initiatives such as the Lancet Commission on Global Surgery and the National Surgical, obstetric and Anaesthesia Plans (NSOAP). Recognizing the global disparities in anaesthesia education, the article mentions the varying standards of training for anaesthesia providers worldwide as well as the problem of low status of providers. The article underscores a shift in focus from traditional aid models to capacity-building approaches, risks associated with indiscriminate donations of tools and technology to low and middle-income countries, as well as both positive and negative aspects of investing in education and training programs. Furthermore, the article calls for the anaesthesia community to continue to provide decision makers with evidence to support investment in anaesthesia services.
Almost 100 years ago, the French physician Pierre Mauriac described a syndrome named after him, resulting from poorly controlled type 1 diabetes, with growth retardation, delayed puberty, Cushingoid features and hepatome...Almost 100 years ago, the French physician Pierre Mauriac described a syndrome named after him, resulting from poorly controlled type 1 diabetes, with growth retardation, delayed puberty, Cushingoid features and hepatomegaly. With modern diabetes care, this is very rare but does occur; however, despite the condition having important clinical implications and being easily treatable, this diabetes complication remains relatively unknown. We present here an authentic patient case in the form of a young man with glycemically poorly controlled type 1 diabetes who developed hepatomegaly, hyperlactatemia and histopathological changes in the liver consistent with glycogenosis, a state readily reversed by normalization of glycemia.
The efficacy of escitalopram in treating social anxiety disorder is significantly influenced by expectations shaped through communication, contributing to about half the improvement. Overt SSRI treatment with accurate in...The efficacy of escitalopram in treating social anxiety disorder is significantly influenced by expectations shaped through communication, contributing to about half the improvement. Overt SSRI treatment with accurate information about its effectiveness doubled the clinical outcome compared to covert treatment with misinformation about the therapeutic effect. Clinical improvements are not solely due to serotonin reuptake inhibition, as indicated by similar serotonin transporter occupancy in both treatment types, without correlation to anxiety reduction. There was, however, notable correlation between clinical improvement and reduced dopamine transporter availability in the overt SSRI group, possibly due to increased dopamine turnover. This was also observed in a study on combined CBT and SSRI treatment. Conversely, clinical improvement after CBT combined with placebo showed an inverse correlation with dopamine transporters and did not inhibit serotonin transporters.
In 1924 the German psychiatrist Hans Berger made the first electroencephalographical (EEG) recording of cerebral activity in humans. Worldwide, EEG developed into a widely used diagnostic method and was introduced in Swe...In 1924 the German psychiatrist Hans Berger made the first electroencephalographical (EEG) recording of cerebral activity in humans. Worldwide, EEG developed into a widely used diagnostic method and was introduced in Sweden in 1937. Today EEG is an essential diagnostic and monitoring standard in epilepsy, sleep disorders, neonatology and intensive care, and provides prognostic information after perinatal asphyxia and cardiac arrest. Like ECG, EEG is an old electrophysiological method that today, and in the future, provides unique diagnostic information.