Livälven P, Hagenäs Wendel I, Ängeby K
… +1 more, Jin Yang L
Lakartidningen
· 2026 Jan · PMID 41488986
Duplication of the vermiform appendix is a very rare anomaly that should be considered and suspected in patients who have previously undergone an appendectomy and present with low right quadrant abdominal pain, alongside...Duplication of the vermiform appendix is a very rare anomaly that should be considered and suspected in patients who have previously undergone an appendectomy and present with low right quadrant abdominal pain, alongside other differential diagnoses such as stump appendicitis and cecal diverticulitis. In previously known cases, appendix duplications have been missed on computed tomography and ultrasound examinations, illustrating the difficulty with diagnosis. Sometimes, duplication of the appendix is associated with other teratological phenomena in the gastrointestinal tract and the genitourinary system, which is why previous medical history or records from pediatrics can be of clinical value. A missed diagnosis can lead to increased morbidity and mortality.
Raith T, Makitan M, Gedeon P
… +5 more, Sabhan H, Rabin Bozorg S, Melander M, Marsal J, L Haas S
Lakartidningen
· 2026 Jan · PMID 41480665
Intestinal ultrasound (IUS), which is performed as transabdominal ultrasound, is a method of assessing inflammatory bowel disease (IBD) that has gained worldwide recognition in recent years. It is widely adopted by gastr...Intestinal ultrasound (IUS), which is performed as transabdominal ultrasound, is a method of assessing inflammatory bowel disease (IBD) that has gained worldwide recognition in recent years. It is widely adopted by gastroenterologists in large parts of Europe and North America, and its implementation continues to spread to new countries. IUS is non-invasive, complication-free, does not entail radiation, is cost-effective, does not have contraindications and is appreciated by patients. It does not require any patient preparation and can be used as a point-of-care examination. Energy and material consumption are minimal. IUS is included in the ECCO-ESGAR (European Crohn's and Colitis Organisation; European Society of Gastrointestinal and Abdominal Radiology) guidelines for diagnostic assessment of IBD and holds similar diagnostic sensitivity and specificity as other modalities such as MR and CT enterography. Recent research suggests that IUS can be used to evaluate early treatment response in acute severe colitis and to predict long-term response to therapy in IBD patients. The ability of IUS to assess transmural healing has led to the proposal of using IUS as an endpoint in clinical trials. Intestinal ultrasound has the potential to become a standard cross-sectional imaging modality for monitoring IBD patients and is currently underused in Sweden.
Björck S, Alvång J, Andersson T
… +2 more, Åberg M, Hjerpe P
Lakartidningen
· 2025 Dec · PMID 41410098
For Swedish patients with diabetes or recent myocardial infarction, there is good information about treatment through national quality registers. However, for the much larger patient group with essential hypertension, co...For Swedish patients with diabetes or recent myocardial infarction, there is good information about treatment through national quality registers. However, for the much larger patient group with essential hypertension, corresponding information is lacking. QregPV, a quality register in the Västra Götaland region, provides insight into 15 years of treatment of 250,000 patients in primary care with essential hypertension or coronary artery disease. Despite increasingly better treatment over 15 years, the register shows large unexplained practice differences with significant potential for reduced secondary morbidity and healthcare costs. These data from QregPV raise important questions about the implementation of guideline recommendations in real practice.
The updated Swedish guidelines for anaphylaxis, published by the Swedish Association for Allergology (SFFA) in the autumn of 2024, provide evidence-based recommendations for acute care. The guidelines highlight the impor...The updated Swedish guidelines for anaphylaxis, published by the Swedish Association for Allergology (SFFA) in the autumn of 2024, provide evidence-based recommendations for acute care. The guidelines highlight the importance of rapid intervention and clear diagnostic standards to ensure patient safety. Immediate intramuscular administration of adrenaline is the only evidence-based intervention in the acute phase and should occur without delay or consideration of severity grading. Routine use of corticosteroids is no longer recommended, and severity grading is replaced by NIAID/FAAN criteria. Antihistamines are reserved for post-stabilization. Documentation, observation, and control of serum tryptase levels are essential for continued care, diagnostic accuracy, and long-term management.
Svartling Peterson S, Birgersdotter A, Flodkvist E
… +1 more, Johan Sundberg C
Lakartidningen
· 2025 Nov · PMID 41379308
Costs related to overweight and obesity, including costs of health care and productivity losses of production, correspond to 2 % of Sweden's Gross Domestic Product (GDP) and is projected to reach 2.4 % of GDP by 2060. In...Costs related to overweight and obesity, including costs of health care and productivity losses of production, correspond to 2 % of Sweden's Gross Domestic Product (GDP) and is projected to reach 2.4 % of GDP by 2060. In middle income countries, obesity costs to society increase even faster, projected to reach 4-5 % of GDP by 2060. However, the total cost of obesity is not just financial, but also social and environmental. Addressing obesity successfully requires action at both individual and societal levels, and across several sectors. Treatment at the individual level needs to be combined with general preventive actions. International examples of such actions include Health Holland, the Commissioner for the Wellbeing of Future Generations in Wales, and VicHealth in Australia. With inspiration from these initiatives, the organization A healthier Sweden aims to facilitate turning knowledge into practice for systems change for better health.
Combined lifestyle management is the foundation of all obesity treatment. Through person-centered dialogue, patients are supported in designing an individualized plan. The plan may include guidance on energy-reduced heal...Combined lifestyle management is the foundation of all obesity treatment. Through person-centered dialogue, patients are supported in designing an individualized plan. The plan may include guidance on energy-reduced healthy eating, increased physical activity, stress management strategies or improved sleep. Treatment can be delivered in-person or online, either individually or in groups. Regular evaluation is a key component of treatment, and an empathetic approach is essential for the treatment alliance.
Sörberg Wallin A, Tiger A, Ahlberg R
… +1 more, Ohlis A
Lakartidningen
· 2025 Dec · PMID 41368773
Co-occurring diagnoses of autism spectrum disorder (ASD) and borderline personality disorder (BPD) have received growing attention in recent years. In a register-based study of ASD and BPD diagnoses established among ind...Co-occurring diagnoses of autism spectrum disorder (ASD) and borderline personality disorder (BPD) have received growing attention in recent years. In a register-based study of ASD and BPD diagnoses established among individuals aged 18-40 in the Stockholm region, we examined cases where both diagnoses were present. The number of individuals diagnosed with co-occurring ASD and BPD increased markedly between 2012 and 2022. This group demonstrated significantly higher risk (odds ratio) of other psychiatric diagnoses and inpatient care compared to individuals with only ASD, only BPD, or a clinical comparison group. Notably, there was a twenty-fold increased risk of suicide attempts and severe self-harm. These findings underscore the need for targeted treatment interventions for this vulnerable population.
Ljungman P, Löhmus Sundström M, Hansson E
… +2 more, C Semenza J, Vilhelmsson A
Lakartidningen
· 2025 Sep · PMID 41364903
Climate change is already impacting our environment and health, with rising sea levels, extreme weather, and higher temperatures. Greenhouse gas levels are at their highest in three million years, making climate-related...Climate change is already impacting our environment and health, with rising sea levels, extreme weather, and higher temperatures. Greenhouse gas levels are at their highest in three million years, making climate-related health risks increasingly urgent. Heatwaves, wildfires, and floods lead to mortality, trauma, and non-communicable diseases both in the short and long term. Climate change also alters the spread of infectious diseases in Sweden, increasing cases of Vibrio bacteria infections in brackish water and expanding the range of disease-carrying vectors like ticks and mosquitoes. Vulnerable populations, such as outdoor workers, children, elderly, and people with chronic illnesses, face higher risks. Addressing these challenges requires multidisciplinary research, proactive policy measures, and healthcare system adaptation. Additionally, the healthcare sector must reduce its own carbon footprint to mitigate climate change impacts.
Helldén D, Persson I, Sturm A
… +3 more, de Bont J, Stephansson O, Alfvén T
Lakartidningen
· 2025 Sep · PMID 41364902
Climate change poses significant risks to the health and well-being of pregnant women and children. These groups are uniquely vulnerable to climate change events due to their changing physiology, behavioural patterns and...Climate change poses significant risks to the health and well-being of pregnant women and children. These groups are uniquely vulnerable to climate change events due to their changing physiology, behavioural patterns and dependence on family and caregivers. Climate change leads to a range of impacts such as intensification of extreme heat and weather events, spread of infectious diseases as well as ambient air pollution and allergens. This leads to a variety of health risks for pregnant women and children, from pregnancy complications such as preeclampsia and preterm birth to increased risk of infant and child mortality. The impact of climate change is not equally distributed. Vulnerable pregnant women and children, especially those in disadvantaged communities or with comorbidities, are at greatest risk. Climate-related hazards worsen existing disparities, affecting food security, water resources, and vital health infrastructure. Addressing these issues requires a comprehensive approach to mitigate and adapt to climate change impacts, reduce vulnerabilities, and strengthen protective systems for pregnant women and children.
Persson Cofina I, Laurell C, Regnér S
… +4 more, Mezger N, Brune C, Kihlborg C, Vilhelmsson A
Lakartidningen
· 2025 Sep · PMID 41364901
The medical profession plays a crucial role in tackling the health impacts of climate change and in promoting a green transition of society and the health sector. Despite this, opportunities for action are still quite un...The medical profession plays a crucial role in tackling the health impacts of climate change and in promoting a green transition of society and the health sector. Despite this, opportunities for action are still quite unknown within the profession, and no mandatory education is required in interns' or residents' education. Medical schools, on the contrary, both in Sweden (due to legislation) and abroad, have started integrating climate, health and sustainable healthcare into the medical curricula in line with international educational recommendations, thus preparing future generation physicians for the task. The following overview presents concrete and relevant pedagogical initiatives currently used in Sweden and abroad to enhance education and clinical implementation of climate medicine and sustainable healthcare for medical students and physicians. Furthermore, the significance of strong leadership and mandatory education is emphasized.
Unhealthy diets are a major contributor to obesity, type 2 diabetes, cardiovascular disease and cancer, but dietary improvements can significantly reduce disease risk and premature death. The food sector is responsible f...Unhealthy diets are a major contributor to obesity, type 2 diabetes, cardiovascular disease and cancer, but dietary improvements can significantly reduce disease risk and premature death. The food sector is responsible for one third of global greenhouse gas emissions and significant biodiversity loss, with animal-based foods having the highest environmental impact. Climate change threatens food production and nutritional quality, while over 2.3 billion people already face food insecurity. The 2023 Nordic Nutrition Recommendations (NNR) emphasize a shift towards plant-based diets for both health and environmental benefits. Achieving sustainable food systems requires political action, education, healthcare initiatives, and increased awareness. A dietary transition can improve public health, reduce environmental impact, and contribute to a sustainable future.
Climate transition has not been as prominent in healthcare as in other sectors of society. It is crucial to recognize the part and potential of healthcare in the climate transition, both as part of the problem and of the...Climate transition has not been as prominent in healthcare as in other sectors of society. It is crucial to recognize the part and potential of healthcare in the climate transition, both as part of the problem and of the solution. Healthcare professionals globally are aware of the negative consequences of climate change for patients but have insufficient knowledge and experience to be able to act. This overview aims to provide insight into how the environmental and climate footprint footprint from clinical activity can be reduced while increasing resilience against extreme weather and other climate-related health effects that risk affecting our activities. It also highlights the unique role of healthcare professionals in the climate transition of society.
Söderqvist I, Ocias LF, Rönnberg C
… +2 more, Rydgård C, Blomqvist K
Lakartidningen
· 2025 Oct · PMID 41364896
Leptospirosis is a zoonotic infection caused by slow-growing spirochetes of the genus Leptospira. The clinical picture varies from asymptomatic disease and mild flu-like symptoms to severe infection with jaundice, renal...Leptospirosis is a zoonotic infection caused by slow-growing spirochetes of the genus Leptospira. The clinical picture varies from asymptomatic disease and mild flu-like symptoms to severe infection with jaundice, renal failure and pulmonary haemorrhage (Weil's disease). Brown rats are the most important reservoir for human infection, and the animals excrete the bacteria in their urine. Humans are infected either through direct contact with infected animals or indirectly through contaminated fresh water and soil via wounds, damaged skin or mucous membranes. Here we present two cases of indigenous leptospirosis in Sweden, one of whom developed Weil's disease.
Lindberg F, Ljungman C, Hage C
… +6 more, Olsson L, Forssell A, Jonsson Å, Benson L, Savarese G, H Lund L
Lakartidningen
· 2025 Dec · PMID 41362961
A growing number of pharmacological and device-based therapies are available to improve well-being and prognosis for patients with heart failure. The increasing complexity of the treatment algorithm also makes implementa...A growing number of pharmacological and device-based therapies are available to improve well-being and prognosis for patients with heart failure. The increasing complexity of the treatment algorithm also makes implementation of optimal therapy challenging for the healthcare system and the physician. Recent years have seen increasing implementation of heart failure therapies in Sweden, but there is still meaningful room for improvement. Key factors to enable continued progress include knowledge dissemination and clinical decision-support systems that might include alerts and/or »nudging« in the electronic health record system, increased resources to improve the access to heart failure nurses and specialist cardiology care, heart failure registries, and digital/registry-based screening for missed diagnoses or treatment of heart failure.
Skarstam R, Long Chen L, Pascal D
… +1 more, Rück C
Lakartidningen
· 2025 Dec · PMID 41355482
Obsessive-compulsive disorder (OCD) affects approximately 1.3% of adults and is characterized by intrusive thoughts (obsessions) and repetitive behaviors (compulsions) aimed at alleviating distress. Despite its impact on...Obsessive-compulsive disorder (OCD) affects approximately 1.3% of adults and is characterized by intrusive thoughts (obsessions) and repetitive behaviors (compulsions) aimed at alleviating distress. Despite its impact on daily functioning, OCD remains underdiagnosed. Models suggest that OCD arises from maladaptive learning processes and/or biological factors, such as genetic predispositions and dysfunctional abnormalities in the cortico-striato-thalamo-cortical loops. First line treatment for OCD in Sweden is exposure and response prevention (ERP), a form of cognitive behavioral therapy (CBT). Selective serotonin reuptake inhibitors (SSRI) are first line pharmacological treatment. If treatment response is inadequate, low-dose antipsychotics can be added, followed by a switch to clomipramine. Deep transcranial magnetic stimulation (dTMS) and deep brain stimulation (DBS) may be considered for severe, treatment-resistant OCD.
Kärrholm J, Axenhus M, Sköldenberg O
… +1 more, Hailer N
Lakartidningen
· 2025 Dec · PMID 41347859
Approximately 2, 000 patients in Sweden currently require active follow-up due to metal-on-metal (MoM) hip implants. These patients are at risk of complications such as elevated metal ion levels and adverse local tissue...Approximately 2, 000 patients in Sweden currently require active follow-up due to metal-on-metal (MoM) hip implants. These patients are at risk of complications such as elevated metal ion levels and adverse local tissue reactions (e g pseudotumors) (Fig 1). Identified risk factors include female sex, suboptimal implant selection, and, in resurfacing arthroplasties, the use of smaller femoral heads (.
Ros A, Danielsson C, Dahlgren A
… +4 more, Ekstedt M, Pukk Härenstam K, Unbeck M, Walfridsson H
Lakartidningen
· 2025 Dec · PMID 41328885
High-quality and safe care is a core principle of healthcare. Since 2020, a Swedish national action plan has outlined four conditions for safer care, one of them is adequate knowledge and competence. In 2024, national co...High-quality and safe care is a core principle of healthcare. Since 2020, a Swedish national action plan has outlined four conditions for safer care, one of them is adequate knowledge and competence. In 2024, national competency goals for patient safety were introduced in Sweden, developed by the National Board of Health and Welfare in cooperation with patient safety academics. Covering 15 areas of knowledge, skills, and attitudes, they define what patient safety entails. The goals target leaders, physicians, nurses, and other professionals in healthcare. Though implementation is demanding, raising competence is essential to improve safety. Physicians play a key role for patient safety by identifying risks, preventing harm, and managing adverse events. As clinical experts and leaders, they must understand and apply patient safety principles. To strengthen this, continuous education in patient safety is needed in both undergraduate training and professional practice. The national competency goals are aiming to support this.
Larsson E, Albert J, Frostell C
… +1 more, Jakobsson J
Lakartidningen
· 2025 Dec · PMID 41321052
Appendectomy is the most common acute abdominal surgery worldwide, with an incidence of 96.5-100 cases per 100,000 people. Mortality rates are very low, ranging from 0.09% to 0.24% in countries with modern healthcare. In...Appendectomy is the most common acute abdominal surgery worldwide, with an incidence of 96.5-100 cases per 100,000 people. Mortality rates are very low, ranging from 0.09% to 0.24% in countries with modern healthcare. In Sweden, no recent studies have reported mortality rates following appendectomy. The primary aim of this study was to investigate changes in 30-day mortality following appendectomy between 2017 and 2021. A secondary aim was to adjust for age and ASA classification when analyzing 30-day mortality. Data for this study was obtained from the national Swedish prioperative quality registry, SPOR. The study population included 38,572 appendectomy cases, with inclusion criteria requiring patients to be over 18 years old and have undergone surgery between 2017 and 2021. The overall mortality rate was 0.07%. with 26 deaths in 38,572 cases, with no statistically significant difference in 30-day mortality across the study period. No patient deceased on the day of surgery, and 9 patients deceased within 1 week. Early mortality did not change during the period studied. The 90-day mortality, total 47 patients, varied (p.
Sarcoidosis is a rare granulomatous inflammatory disease of unknown etiology that affects the nervous system in 5-10% of cases, which is referred to as neurosarcoidosis. The clinical symptoms depend on the localization a...Sarcoidosis is a rare granulomatous inflammatory disease of unknown etiology that affects the nervous system in 5-10% of cases, which is referred to as neurosarcoidosis. The clinical symptoms depend on the localization and the extent of the lesions. Cranial nerves and leptomeninges are the most common sites affected. In rare cases, the disease can also affect the peripheral nervous system. In the updated 2018 classification, the disease is defined as »definite neurosarcoidosis« when confirmed by a biopsy from the nervous system. »Probable neurosarcoidosis« is defined by typical clinical findings and positive pathological findings in biopsy from systemic manifestations of sarcoidosis. »Possible neurosarcoidosis« is diagnosed when clinical observations suggest sarcoidosis, exclude alternative diagnoses, and there is no pathological confirmation. The clinical evaluation includes a thorough medical history, MRI of the central nervous system (CNS) with contrast, blood tests, and cerebrospinal fluid (CSF) analysis to detect signs of inflammation in the nervous system. There are no specific blood or CSF markers for the disease. High-resolution computed tomography (HRCT) of the chest and whole-body FDG-PET scans are used to search for systemic manifestations and find appropriate biopsy sites. A comprehensive differential diagnostic work-up should be part of the disease investigation. The cornerstone of the treatment is initially high doses of steroids, followed by tapering oral steroid doses, usually in combination with other immunosuppressive agents, including TNF-alpha inhibitors.