The long-awaited guidelines for the management of myocarditis and pericarditis were published by the European Society of Cardiology in 2025. The aim is to improve detection, management, and long-term outcomes in patients...The long-awaited guidelines for the management of myocarditis and pericarditis were published by the European Society of Cardiology in 2025. The aim is to improve detection, management, and long-term outcomes in patients with inflammatory myocardial and pericardial disease. A central new umbrella term introduced in the document is Inflammatory Myopericardial syndrome (IMPS), a concept covering the entire spectrum, including the overlap of myocardial and pericardial inflammation. Advanced imaging with cardiac magnetic resonance (CMR) now allows for diagnosis, follow-up, and risk stratification of myocarditis. Because inflammatory heart disease can overlap with cardiomyopathies, the guidelines recommend obtaining a family history, and genetic testing should be considered in specific cases. Routine viral serology is no longer recommended except in selected situations, while invasive endomyocardial biopsy is reserved for advanced cases. Treatment management is individualized. A minimum of one month of physical activity restriction is recommended during the acute phase, with return to exercise and work guided by individual recovery and clinical/imaging remission rather than fixed timeframes. Long-term follow-up is advised, particularly for patients with complicated myocarditis.
Tot B, Birnefeld J, Uneus E
… +6 more, Ahlström Floderus T, Ögren J, Eklöf V, Masoe E, Björck F, Henze A
Lakartidningen
· 2026 Apr · PMID 42023772
Mechanical thrombectomy in acute ischemic stroke is highly effective and results in less disability compared to standard care. The treatment is time-sensitive, and delays lead to worse outcomes. Delivering mechanical thr...Mechanical thrombectomy in acute ischemic stroke is highly effective and results in less disability compared to standard care. The treatment is time-sensitive, and delays lead to worse outcomes. Delivering mechanical thrombectomy in sparsely populated rural areas, such as Northern Sweden, is challenging due to long and resource-demanding transports. An alternative to the traditional approach of transporting the patient to the thrombectomy center is to instead transport the thrombectomist to the patient, enabling treatment at the local primary stroke center. Observational studies have demonstrated benefits from this model of stroke care in terms of time savings and improved functional outcomes. This article describes an ongoing initiative in Northern Sweden aimed at improving stroke care, including an attempt to transport the thrombectomist to a primary stroke center for local treatment in collaboration with on-site endovascular specialists.
Hansson E, Gümüscü R, Sandman L
… +2 more, Paganini A, Elander A
Lakartidningen
· 2026 Apr · PMID 41968901
Aesthetic surgery has become increasingly common in Sweden, and complications from privately performed procedures sometimes require treatment in the public healthcare system. This national register-based study investigat...Aesthetic surgery has become increasingly common in Sweden, and complications from privately performed procedures sometimes require treatment in the public healthcare system. This national register-based study investigated the proportion of women undergoing cosmetic breast augmentation who received public specialised care for postoperative complications within three months. Data from 3512 women registered in the Swedish Breast Implant Registry (BRIMP, 2014-2024) were analysed using ICD-10 codes from the National Patient Register. In total, 38 women (1.1%) were treated in the public system for complications, most commonly wound rupture (61%) and bleeding (26%); severe systemic complications were rare (0.14%). The findings suggest that only a minority of complications after cosmetic breast augmentation are managed within the public healthcare system. However, the study has methodological flaws, and improved national reporting is necessary to inform future healthcare planning and policy.
Physicians in Sweden devote much time to assessing sickness absence. Despite this, there is a lack of evidence regarding the consequences of sick leave for patients. The last systematic review that attempted to answer th...Physicians in Sweden devote much time to assessing sickness absence. Despite this, there is a lack of evidence regarding the consequences of sick leave for patients. The last systematic review that attempted to answer this question was conducted in 2003. It identified only five studies, from which no conclusions could be drawn. The aim of this review was to determine what evidence has emerged since then. A PubMed search was conducted for randomized trials and cohort studies that examined the consequences of sick leave in Nordic countries. 36 relevant studies were identified, all of which were cohort studies. All were judged to carry a critical risk of bias. The conclusion is that evidence is still lacking regarding the benefits and harms of sick leave. What is clear, though, is that sick leave is associated with a higher risk of multiple negative outcomes for patients, with patients on sick leave at higher risk of low income, unemployment, suicide, and death.
When considering emergency surgery in extremely frail patients, decision-making should include the patient's own goals and chances of survival with maintained reasonable quality of life. Sweden has a very high proportion...When considering emergency surgery in extremely frail patients, decision-making should include the patient's own goals and chances of survival with maintained reasonable quality of life. Sweden has a very high proportion of patients undergoing surgery for hip fractures compared to other countries. Equivalent data for emergency abdominal surgery are unknown. Non-surgical treatment and focus on palliative care is more common in e.g. the Netherlands, from where research in the area is published. It is unknown how often patients are involved in discussions about operative or non-operative treatments, and to what extent factors other than survival are weighed into the decision. External validation of international prediction models for assessment of an individual's postoperative risk has so far been sparse in Sweden. There are scientifically evaluated models for structured discussions on transitioning to palliative care in the emergency surgical setting.
There is strong evidence that improved blood glucose control in individuals with diabetes mellitus reduces the risk of complications and leads to better long-term health outcomes. However, a rapid reduction in blood gluc...There is strong evidence that improved blood glucose control in individuals with diabetes mellitus reduces the risk of complications and leads to better long-term health outcomes. However, a rapid reduction in blood glucose levels can also lead to microvascular complications. Treatment-induced neuropathy in diabetes (TIND) is a painful neuropathy that may occur following a rapid decrease in blood glucose in patients with previously poorly controlled diabetes. This case report describes a woman who developed burning pain and sleep disturbances after being diagnosed with type 1 diabetes and undergoing a rapid reduction in blood glucose levels. Further investigations revealed diabetes-induced small fiber neuropathy consistent with TIND. Some studies suggest limiting the rate of blood glucose to reduce the risk of TIND, although current evidence is insufficient to support general recommendations. In patients with established TIND, increasing glucose levels is not advised. Management is instead symptomatic, focusing on relief of neuropathic pain and addressing any autonomic involvement. The prognosis is generally favourable.
Vladic Stjernholm Y, Stefopoulou M, A Nordström J
… +4 more, Lindblad Wollmann C, Hulthén-Varli I, Kassymova G, Conner P
Lakartidningen
· 2026 Jan · PMID 41885117
The incidence of placenta accreta spectrum (PAS) has increased globally to estimated 0,2% (CI 0,14-0,19) of all pregnancies as an effect of increasing cesarean section (CS) rates. Advanced PAS with trophoblast invasion i...The incidence of placenta accreta spectrum (PAS) has increased globally to estimated 0,2% (CI 0,14-0,19) of all pregnancies as an effect of increasing cesarean section (CS) rates. Advanced PAS with trophoblast invasion into the uterine myometrium or into adjacent tissues or organs is one of the most severe complications in the obstetric field. These patients should be referred to a tertiary center with a multidisciplinary team. The previously recommended standard treatment, CS.
Liedberg F, Holmberg L, Järvholm B
… +2 more, Liv P, Bobjer J
Lakartidningen
· 2026 Mar · PMID 41885043
Compared with lung cancer (excluding lung adenocarcinoma), where a decreased incidence has been reported in Sweden following a decline in the prevalence of daily smokers, we observed an increased incidence of bladder can...Compared with lung cancer (excluding lung adenocarcinoma), where a decreased incidence has been reported in Sweden following a decline in the prevalence of daily smokers, we observed an increased incidence of bladder cancer, especially in older men. Given that approximately half of the individuals diagnosed with either malignancy are current or former smokers, the reasons for this paradoxical shift in incidences between the diseases remain unclear. However, it is noteworthy that bladder cancer mortality did not rise in parallel with the increased incidence, and even decreased among men.
Dharmadasa V, Kapraali M, Peira N
… +1 more, Vitols S
Lakartidningen
· 2026 Mar · PMID 41873467
Health Technology Assessment (HTA) Region Stockholm conducted a systematic review evaluating the risk of flare-ups from use of non-steroidal anti-inflammatory drugs (NSAID) in patients with inflammatory bowel disease (IB...Health Technology Assessment (HTA) Region Stockholm conducted a systematic review evaluating the risk of flare-ups from use of non-steroidal anti-inflammatory drugs (NSAID) in patients with inflammatory bowel disease (IBD). Patients with IBD, such as ulcerative colitis and Crohn's disease, often experience pain including joint pain, pain from kidney stones, menstrual pain, and headache. Effective pain management is crucial for maintaining daily function and quality of life. There are concerns that NSAIDs may increase the risk of IBD flare-ups, and international guidelines vary in their recommendations. The overview indicates that short-term NSAID use is likely associated with a minimal or negligible increase in risk among patients with well-controlled IBD in remission. The findings are however uncertain due to limited data and methodological limitations in the included studies.
Björnson E, Brinck J, Hagström E
… +1 more, Borén J
Lakartidningen
· 2026 Mar · PMID 41859989
Lipoprotein(a) [Lp(a)] is a risk factor for atherosclerotic cardiovascular disease and aortic valve stenosis. The level is genetically determined and remains stable during life, and elevated levels may be inherited. The...Lipoprotein(a) [Lp(a)] is a risk factor for atherosclerotic cardiovascular disease and aortic valve stenosis. The level is genetically determined and remains stable during life, and elevated levels may be inherited. The 2025 ESC/EAS Management of Dyslipidaemias Focused Update recommends measuring Lp(a) at least once in adulthood. It further recommends considering Lp(a) >105 nmol/L (>50 mg/dL) as a risk-enhancing factor to refine risk classification, particularly near treatment thresholds. In Sweden, an estimated 10-20 procent of the population (1-2 million people) exceed the 105 nmol/L or 50 mg/dL threshold, hundreds of thousands of whom may be reclassified as being eligible for primary preventive treatment, according to the updated guidelines. While specific Lp(a)-lowering therapies are not yet available, individuals with elevated Lp(a) should receive intensified management of traditional risk factors, primarily lower LDL cholesterol. Scalable approaches are needed to identify and follow high-risk individuals without overburdening primary care.
Idiopathic granulomatous mastitis (IGM) is a rare inflammatory condition of the breast with unknown etiology, primarily affecting women of childbearing age. IGM commonly presents with culture-negative abscesses, often le...Idiopathic granulomatous mastitis (IGM) is a rare inflammatory condition of the breast with unknown etiology, primarily affecting women of childbearing age. IGM commonly presents with culture-negative abscesses, often leading to significant scarring, hyperpigmentation, and deformation of the affected breast. Breast cancer and tuberculosis are important differential diagnoses. IGM is confirmed by the presence of non-caseating granulomas and microabscesses on histopathological examination. The literature mainly consists of case studies, and there is no evidence-based treatment. A regional multidisciplinary collaboration group was formed in Stockholm. The purpose of this collaboration was to develop a guideline to assist physicians in the investigation and management of patients with suspected IGM. A literature search was conducted in NCBI Pubmed and thirty relevant studies were included. Flowcharts were developed for the investigation and treatment of IGM. Investigation includes wound bacterial cultures, DNA sequencing (for fungi and bacteria), core needle biopsy, blood tests and skin punch biopsy. Ultrasound-guided drainage is recommended for abscesses, and surgery should be avoided. An initial treatment option when diagnosis has been established consists of daily application of topical group III corticosteroids for 2-3 weeks. Second-line therapy involves a combination of oral corticosteroids and methotrexate for 1-2 months, followed by a tapering of corticosteroids, with continuation of methotrexate monotherapy for an additional six months. Due to the complexity and suffering associated with IGM, patients should be managed by a team of specialists with a specific interest in the condition.The EUBREAST Network has an upcoming IGM registry study, which is expected to provide valuable insights into the understanding and management of this condition.
Measles is a highly contagious viral disease, with a substantial risk for serious complications. Contact tracing following a measles case is crucial in order to reduce further transmission, but can involve a large number...Measles is a highly contagious viral disease, with a substantial risk for serious complications. Contact tracing following a measles case is crucial in order to reduce further transmission, but can involve a large number of individuals and is often labour-intensive. The Association for County Medical Officers for Communicable Disease Control in Sweden has recently published a national guideline on contact tracing and preventive measures for measles. The guideline provides a more precise definition of which individuals should be offered immunoglobulins as post-exposure prophylaxis, clarifies the contact tracing process, and offers recommendations for managing healthcare personnel with uncertain immunity to measles. The new national guideline is intended to facilitate more efficient, aligned and equitable contact tracing for measles.
Dotevall L, Sundell N, Bergström T
… +1 more, Studahl M
Lakartidningen
· 2026 Mar · PMID 41787923
Despite the existence of a highly effective vaccine, measles may appear in some vaccinated individuals after exposure to wild type measles virus. Reduced circulation of the measles virus in the population in low-endemic...Despite the existence of a highly effective vaccine, measles may appear in some vaccinated individuals after exposure to wild type measles virus. Reduced circulation of the measles virus in the population in low-endemic countries results in an absence of viral challenge and may cause waning of immunity over time after vaccination. Another reason for breakthrough infection is primary vaccine failure due to immunological conditions or defective measles virus vaccine. Exposition to a high dose of measles virus without proper protective respiratory masks may increase the risk of breakthrough measles, as has been reported in some outbreaks where health care workers were exposed. The clinical symptoms in breakthrough measles are often milder than in primary measles. Respiratory symptoms and conjunctivitis are less common than in primary measles. The contagiousness of breakthrough measles is low and in some cases negligible.