There is no clear consensus on when a certain amount of fat tissue becomes a health risk, and despite limited evidence supporting its accuracy, BMI continues to be used to define obesity at an individual level. Most anti...There is no clear consensus on when a certain amount of fat tissue becomes a health risk, and despite limited evidence supporting its accuracy, BMI continues to be used to define obesity at an individual level. Most anti-obesity drugs have been approved on the basis of their weight reduction effect, rather than on demonstrated health benefits". The expanding definition of obesity risks reinforcing stigma, especially as treatments are framed in moral and behavioral terms. Health care must balance medical necessity with awareness of social norms, ensuring that resources are directed to those most in need while acknowledging that not all larger bodies are unhealthy or in need of regulation.
Metabolic and bariatric surgery aims to achieve long-term weight loss with improvement of obesity-related diseases and quality of life, without negatively affecting daily life. Despite limited food intake, an individual...Metabolic and bariatric surgery aims to achieve long-term weight loss with improvement of obesity-related diseases and quality of life, without negatively affecting daily life. Despite limited food intake, an individual who has undergone this type of surgery should in principle be able to eat any food and not suffer from gastrointestinal problems or nutritional deficiencies. In cases of advanced obesity (BMI ≥35 kg/m2), we believe that bariatric surgery is the first-line treatment for individuals from 18 years of age. The type of procedure should be chosen in consultation with the patient, and gastric bypass has been recommended for individuals with type 2 diabetes or a BMI ≥35 kg/m2 for many years in Sweden. Individuals who have undergone metabolic and bariatric surgery need daily nutritional supplements and should be monitored throughout their lives. Long-term results are good with lasting weight loss and improvement in obesity-related diseases and physical quality of life. Recurrent weight gain and other issues should be managed in multidisciplinary teams. Swedish metabolic and bariatric surgery is generally well developed and of high quality.
Superior vena cava (SVC) syndrome is caused by obstruction of blood flow in the SVC resulting in swelling of the face, neck and upper extremities. Dyspnea and hoarseness are common. Distension of the veins in the neck an...Superior vena cava (SVC) syndrome is caused by obstruction of blood flow in the SVC resulting in swelling of the face, neck and upper extremities. Dyspnea and hoarseness are common. Distension of the veins in the neck and chest wall can be seen. The diagnosis is made by contrast-enhanced CT. The most common cause is malignancy. However, iatrogenic causes have increased due to an increasing number of central venous catheters and implantable cardiac devices. SVC syndrome is a rare but important differential diagnosis to angioedema. This case report presents a man with iatrogenic SVC syndrome who was misdiagnosed multiple times. To avoid misdiagnosis, increased knowledge of SVC syndrome, a readiness to reconsider the diagnosis and a thorough physical examination are important.
Dehdari B, Hedman J, Bengtsson J
… +4 more, Josefsson A, Ljungberg T, Ängeby L, Henje E
Lakartidningen
· 2025 Oct · PMID 41147816
Most patients can discontinue antidepressants without severe problems, while some experience significant withdrawal symptoms such as anxiety, dizziness, and sensory disturbances. These symptoms, which often occur in the...Most patients can discontinue antidepressants without severe problems, while some experience significant withdrawal symptoms such as anxiety, dizziness, and sensory disturbances. These symptoms, which often occur in the final stages of tapering, should not automatically be interpreted as a relapse of the underlying condition. Healthcare professionals must adopt a reassuring yet non-minimizing approach, providing clear, balanced information to normalize the process and reduce nocebo effects. Personalized tapering strategies, including gradual dose reductions based on hyperbolic curves or the so-called 10 procent rule, can ease the transition. More evidence-based examples of successful tapering methods are needed to support patients effectively through this challenging phase.
Duhanes M, Hedman P, Avesani C
… +1 more, Stenvinkel P
Lakartidningen
· 2025 Oct · PMID 41143580
Human and planetary health are interconnected. The UN's Sustainable Development Goals aim for a healthy, peaceful world, but climate change - accelerated by human activity - is a major threat. Rising temperatures, water...Human and planetary health are interconnected. The UN's Sustainable Development Goals aim for a healthy, peaceful world, but climate change - accelerated by human activity - is a major threat. Rising temperatures, water scarcity, pollution, and biodiversity loss contribute to worsening health crises. The healthcare sector itself is a major polluter, responsible for >5% of global CO₂ emissions. Chronic kidney disease (CKD) is increasingly linked to climate change, with extreme heat, air pollution, and water contamination exacerbating risks. Dialysis has a heavy environmental footprint, consuming vast amounts of water, energy, and plastic. Suggestions for development of a sustainable care system for kidney diseases are presented. To achieve sustainable nephrology, green dialysis and plant-based diets, are crucial. Reducing reliance on animal agriculture and ultraprocessed foods benefits both human and planetary health. Urgent action is needed to reform healthcare towards sustainability and align with the »One Health« approach, emphasizing the interdependence of human, animal, and environmental health.
Metabolic acid-base disturbances often result from several independent processes. These processes are difficult to tease out using traditional bicarbonate-centred approaches. According to standard base excess partitionin...Metabolic acid-base disturbances often result from several independent processes. These processes are difficult to tease out using traditional bicarbonate-centred approaches. According to standard base excess partitioning, standard base excess is the sum of the acid-base effects of changes in the concentration of sodium, chloride, lactate, albumin and an unspecified entity termed »Other Ions«. Since the first five of these entities are routinely analysed, »Other Ions« can be calculated at the bedside. In this article, five short case vignettes are used to illustrate how standard base excess partitioning provides a more complete understanding of the patient's acid-base disturbance, and how it may allow for more physiologically appropriate therapy.
Mahmoud A, Hammarlund P, Ekström U
… +6 more, Mokhtari A, David Dolata C, Engberg A, Svensson J, Bjellerup P, Hammarsten O
Lakartidningen
· 2025 Oct · PMID 41116727
High-sensitive cardiac troponins are essential biomarkers in the diagnostics of myocardial infarction. However, analytical interference such as macrotroponin, where troponin forms stable complexes with endogenous antibod...High-sensitive cardiac troponins are essential biomarkers in the diagnostics of myocardial infarction. However, analytical interference such as macrotroponin, where troponin forms stable complexes with endogenous antibodies, can lead to persistently elevated levels without actual myocardial injury. The first case report presents a young woman with recurrent chest pain and prolonged troponin I elevation over several years, which ultimately could be attributed to macrotroponin I. The second case report describes a young man presenting with intermittent chest pain and stable troponin I elevation. Following extensive investigations, the elevation was ultimately attributed to macrotroponin. These cases highlight the clinical importance of recognizing this diagnostic pitfall, especially when elevated troponin level lacks correlation with symptoms, ECG or imaging findings. In case of suspected macrotroponin, contact your local laboratory for further investigation.
We investigated how many of first-time fragility fracture patients were followed up in primary care and treated with bone-specific drugs. By combining data from multiple health data registers, we included 11,102 patients...We investigated how many of first-time fragility fracture patients were followed up in primary care and treated with bone-specific drugs. By combining data from multiple health data registers, we included 11,102 patients aged 60 years or older who sustained a fragility fracture in Region Stockholm between January 1, 2021, and June 30, 2022. The follow-up period extended up to 6 months after the fracture. Follow-up was defined as a visit to a primary care physician together with one of the following: 1) osteoporosis diagnosis, 2) bone-specific drug treatment or 3) dual-energy X-ray absorptiometry. Our findings revealed that less than 1 out of 5 patients were followed up in primary care after their first fragility fracture. Follow-up was more common among women, older patients, and for central fractures (hip, pelvis, lumbar spine). Moreover, just over 5% received bone-specific drugs within 6 months.
In this reflective practice paper, the author reports on his supervisorship of medical students in their small-group literature and ethics discussion seminars during the first five semesters at medical school in Linköpin...In this reflective practice paper, the author reports on his supervisorship of medical students in their small-group literature and ethics discussion seminars during the first five semesters at medical school in Linköping, Sweden. To ensure an open dialogue, it seems important to help students distinguish between genuinely complex medical ethical questions, on which reasonable people may have different opinions, and extremist viewpoints. Furthermore, the seminar discussions can help students realize the difference between law and ethics. Finally, the value of helping students verbalize their (often) intuitive ethical views is emphasized. In this context, a distinction is made between conversation and debate. A conversation, unlike a debate, is not about winning. Verbalizing their own views in a safe non-debate setting helps students understand the perspective of fellow students.
The Swedish guideline on post covid-19 and related syndromes classify six overlapping conditions. A functional perspective, as used in Denmark, distinguishes physiological reactions from diseases, aiding understanding an...The Swedish guideline on post covid-19 and related syndromes classify six overlapping conditions. A functional perspective, as used in Denmark, distinguishes physiological reactions from diseases, aiding understanding and treatment. Functional symptoms arise from dysregulated adaptation systems reacting excessively. This dysregulation can persist, leading to various symptoms. Effective treatment focuses on stabilizing these systems through knowledge, behavioral changes and gradual exposure to discomfort. A biopsychosocial model addressing biological, psychological, and social factors is key. Denmark's structured approach has improved care, and similar competence-building efforts in Sweden could enhance treatment for post-infectious and long term functional conditions.
Oudin A, Åström C, Lundgren-Kownacki K
… +1 more, Mattisson K
Lakartidningen
· 2025 Sep · PMID 40994359
Increasing heat is the largest direct health risk associated with climate change, and urban environments exacerbate the problem through the urban heat island effect. Vulnerable groups, including the elderly, individuals...Increasing heat is the largest direct health risk associated with climate change, and urban environments exacerbate the problem through the urban heat island effect. Vulnerable groups, including the elderly, individuals with chronic illnesses, pregnant women, children, and socially disadvantaged populations, are particularly at risk. Densification policies may contribute to more sustainable cities but can at the same time increase heat exposure by limiting green spaces. While solutions like tree planting can mitigate heat, they must be balanced with competing urban development needs. Climate adaptation measures, such as urban greening, should be implemented with a justice perspective to avoid reinforcing social inequalities. Moving forward, urban planning strategies must integrate climate adaptation with public health to reduce heat-related health risks and create more sustainable, liveable cities. Green spaces not only help lower urban temperatures but also provide other health benefits such as promoting physical activity and stress relief.
Kristenson M, Andersson Gäre B, Berkius J
… +5 more, Fagerström C, Orwelius L, Petersson C, Stern S, Årestedt K
Lakartidningen
· 2025 Sep · PMID 40990568
PROMs provide valuable information from patients about their health and health-related problems. These measures complement medical measures and are critical for developing optimized, co-produced and person-centred health...PROMs provide valuable information from patients about their health and health-related problems. These measures complement medical measures and are critical for developing optimized, co-produced and person-centred healthcare, as they add important perspectives, offering a holistic view of health. Valid and reliable PROMs have been developed since a long time and are increasingly used in research. Digital PROMs are today available at 1177.se but seldom utilized in clinical practice. To utilize PROMs in clinical care, healthcare professionals need to understand their value and how to analyse data and use results. Therefore, to support the increased interest to implement PROMs, this knowledge needs to be disseminated among all professionals. In order to effectively use PROMs in improvement work, we also need to address significant technical and legal obstacles. Integrating PROM data into electronic medical records should be prioritized in the ongoing development of infrastructure for health data collection.
Hasani L, Olin S, Bengtsson A
… +5 more, Jönsen A, Ohlsson S, Elf J, Strevens H, Zetterberg E
Lakartidningen
· 2025 Sep · PMID 40960363
The new ACR/EULAR classification criteria for APS differ from the previous Sydney criteria by incorporating a broader range of clinical manifestations beyond venous/arterial thromboembolism and obstetric complications. T...The new ACR/EULAR classification criteria for APS differ from the previous Sydney criteria by incorporating a broader range of clinical manifestations beyond venous/arterial thromboembolism and obstetric complications. These include microvascular disease, heart valve disease and thrombocytopenia. We applied both classification systems to a cohort of 139 individuals diagnosed with primary APS in Southern Sweden. Of these, 76 met the ACR/EULAR criteria, while 78 fulfilled the Sydney criteria. Subsequently, only a marginal difference in diagnostic yield was observed between the two classification systems. However, the ACR/EULAR criteria are particularly advantageous as they provide clear definitions and encompass a broader spectrum of clinical manifestations, aligning more closely with the clinical management of patients with APS compared to the Sydney criteria.
Rutegård J, Ullmann C, Ekberg L
… +1 more, Olsson D
Lakartidningen
· 2025 Sep · PMID 40947970
Airborne infection is considered a significant cause of postoperative wound infections (surgical site infections - SSI). In low-income countries, the risk is elevated. A simple concept based on electrostatic air cleaning...Airborne infection is considered a significant cause of postoperative wound infections (surgical site infections - SSI). In low-income countries, the risk is elevated. A simple concept based on electrostatic air cleaning has, after extensive testing, been shown to effectively reduce the levels of particles and bacteria in the air. This has been demonstrated in laboratory environments and in simulated operating room environments at Kungälv Hospital, as well as in field studies at two hospitals in a low-income country (the Democratic Republic of the Kongo).