Azari A, Kristjánsdóttir I, Gatti P
… +2 more, Berge A, Gadler F
Lakartidningen
· 2025 Sep · PMID 40937597
Lead extraction is safe and effective in patients with systemic and local infections with a cardiac implantable electronic device. 30-day mortality and 1-year mortality rates were 2.5% and 9.9%, respectively. Systemic in...Lead extraction is safe and effective in patients with systemic and local infections with a cardiac implantable electronic device. 30-day mortality and 1-year mortality rates were 2.5% and 9.9%, respectively. Systemic infection and chronic kidney disease were independently associated with 30-day and 1-year mortality. Clinical frailty scale 5-7 correlated independently with 1-year mortality. These risk factors should be considered during pre-procedure risk stratification.
Medical certificates for the Swedish Migration Agency are vital documents to prove injuries or illnesses claimed in the asylum process. Our purpose is to provide guidance on the legal bases for the use of medical evidenc...Medical certificates for the Swedish Migration Agency are vital documents to prove injuries or illnesses claimed in the asylum process. Our purpose is to provide guidance on the legal bases for the use of medical evidence in the asylum process. To illustrate, we give examples from our study of 74 decisions with medical certificates. Cases were identified from a random sample of 500 files from 590 000 asylum decisions made by the Swedish Migration Agency 2006-2022. Medical certificates were not unanimously taken into account in decisions. For high evidentiary value, the certificates should demonstrate the physician's competence, be based on verifiable sources and include a detailed prognosis and the effects of not receiving adequate treatment. Importantly, certificates can also be used to undermine the patient's trustworthiness if the certificate fails to prove or contradicts claims made by the applicant.
Wojcicka E, Schizas N, Gerdhem P
… +1 more, Blixt S
Lakartidningen
· 2025 Sep · PMID 40928932
Thoracic and lumbar fractures are common injuries that can be treated either surgically or non-surgically. This study investigated if socioeconomic and demographic factors influence treatment choices in Sweden using data...Thoracic and lumbar fractures are common injuries that can be treated either surgically or non-surgically. This study investigated if socioeconomic and demographic factors influence treatment choices in Sweden using data from the Swedish Fracture Register and other national health registers. Results showed no significant association between socioeconomic factors and treatment choices. However, patients age 50-69 years were less likely to undergo surgery, probably because of factors such as osteoporosis and increased comorbidity. The study suggests that Swedish healthcare primarily bases treatment decisions on medical factors rather than socioeconomic background. This contrasts with findings from other countries where healthcare is more influenced by socioeconomic factors.
Spinal fractures are common, and distinct epidemiological patterns are well-known.In the young to middle age, high energy trauma is the most common etiology, and men are more afflicted than women. In the geriatric popula...Spinal fractures are common, and distinct epidemiological patterns are well-known.In the young to middle age, high energy trauma is the most common etiology, and men are more afflicted than women. In the geriatric population, osteoporotic vertebral fractures are common, and in this age category the women are most often affected. As vertebral fractures affect all socioeconomic groups in the society, the question arises if treatment of vertebral fractures differs according to the patient's socioeconomic status. A recent Swedish study from Uppsala, using national databases, confirmed the results from previous epidemiological studies and showed that socioeconomic factors do not influence how patients with vertebral fractures are treated in Swedish hospitals.
Hallengren J, Lindeman E, Söderberg C
… +3 more, K Jönsson A, Thunander Sundbom L, Nordmark Grass J
Lakartidningen
· 2025 Sep · PMID 40899919
In 2019 the Swedish Poisons Information Centre (SPIC) was contacted in 1 198 hospital cases of intentional poisonings with antidepressants. Severe poisonings identified using the Poison Severity Score were divided by the...In 2019 the Swedish Poisons Information Centre (SPIC) was contacted in 1 198 hospital cases of intentional poisonings with antidepressants. Severe poisonings identified using the Poison Severity Score were divided by the number of prescriptions for the respective antidepressant per 1 000 inhabitants, yielding a substance specific poisoning severity index (PSI). Amitriptyline, clomipramine, venlafaxine and bupropion had PSIs surpassing all other antidepressants by nearly an order of magnitude and comprised almost 80% of 101 serious poisonings. The same substances also scored very high in a suicide mortality index calculated by dividing the 81 antidepressant suicide deaths identified by the National Board of Forensic Medicine (NBFM) in 2019 by prescription rates. Both the SPIC and the NBFM cohorts demonstrate that the risk of severe toxicity from overdose is not uniform among antidepressants. The toxicity profile of the respective substance needs to be considered when antidepressants are prescribed.
Bäckryd E, Andréll P, Rivano Fischer M
… +6 more, Grinsvall C, Håkansson A, F Kallman T, Midlöv P, Ringqvist Å, Grelz H
Lakartidningen
· 2025 Aug · PMID 40832938
There is a lack of evidence for long-term opioid treatment of chronic non-cancer pain. According to European guidelines, opioids should not be used for primary chronic pains. It is important to continuously assess the b...There is a lack of evidence for long-term opioid treatment of chronic non-cancer pain. According to European guidelines, opioids should not be used for primary chronic pains. It is important to continuously assess the benefits and harms of each opioid treatment and, if indicated, discontinue it as early as possible to prevent an adverse trajectory. Long-term opioid treatment is a clinically complex situation in which the issue of tapering (deprescribing) should be considered. Tapering is a medical intervention that entails planned support and close follow-up. Potential benefits include increased safety, reversal of side effects, and an improved overall situation. Risks include acute and protracted withdrawal symptoms (including worsening pain) and impaired mental health. Problematic use of opioids (including opioid use disorder) occurs in this population, but prescribers should avoid a stereotypical and stigmatizing attitude.
Odeberg H, Ackermark P, Andersson U
… +3 more, van Geijt C, Jonsson K, Mårtensson B
Lakartidningen
· 2025 Aug · PMID 40827802
Comorbidity between NDD and chronic pain is common. For some pain patients, the NDD has not yet been diagnosed. Referral for diagnosis may interrupt and delay pain rehabilitation, which suggests that integration of such...Comorbidity between NDD and chronic pain is common. For some pain patients, the NDD has not yet been diagnosed. Referral for diagnosis may interrupt and delay pain rehabilitation, which suggests that integration of such assessment could be beneficial. In 2022-2023 the Regional Pain Rehabilitation unit of Nyköping ran a project in which an external psychologist performed diagnostic assessments, together with the unit's psychiatrist, of 20 patients with a suspected diagnosis of NDD. Nine patients were diagnosed with autism spectrum disorders and 10 with ADD/ADHD. At follow-up, a majority of these patients reported significantly improved overall health and well-being. For these patients, what dominated the clinical picture were the secondary consequences of their underlying developmental disorders, and the energy expended to compensate for them. How to address the needs of these patients is an important field of research.
Othman L, Nederby Öhd J, Rydgård C
… +1 more, Glans H
Lakartidningen
· 2025 Aug · PMID 40791139
Tularemia is a zoonotic disease caused by the contagious bacterium Francisella tularensis. In Sweden, the infection is primarily transmitted through mosquito bites with peak season from August to October. Depending on th...Tularemia is a zoonotic disease caused by the contagious bacterium Francisella tularensis. In Sweden, the infection is primarily transmitted through mosquito bites with peak season from August to October. Depending on the infection site, tularemia has six different clinical variants. Patients are often presented with the ulceroglandular form - fever, inoculation site ulcer and regional lymphadenopathy - but oculoglandular, glandular, oropharyngeal, pneumonic and typhoidal forms also occur. Historically endemic to northern Sweden, tularemia has spread further south since the first case was described in 1931. Due to clinical diversity and sometime prolonged course, the awareness of tularemia is important for multiple medical specialties. The diagnosis should be considered among patients with typical symptoms in Sweden during peak season.
Andersen K, Bentzel S, Bergdahl E
… +5 more, Dankiewicz J, Elfwén L, Falås E, Simonsson M, Holm A
Lakartidningen
· 2025 Aug · PMID 40787973
The European Society of Cardiology has released new 2024 guidelines on chronic coronary syndrome. These guidelines emphasize that patients with this condition should be actively assessed and treated to reduce the risk of...The European Society of Cardiology has released new 2024 guidelines on chronic coronary syndrome. These guidelines emphasize that patients with this condition should be actively assessed and treated to reduce the risk of future events. Key updates include the introduction of a risk factor-based clinical probability model to aid in this process. Furthermore, the guidelines stress that coronary CT angiography is recommended as the first-line diagnostic method for patients with a low to moderate probability of coronary artery disease. In cases of moderate to high probability, functional tests such as stress echocardiography, PET-CT, or perfusion MRI are advised, depending on availability. The guidelines recommend that all patients with chronic coronary artery disease receive high-intensity lipid-lowering treatment, with a target LDL level of less than 1.4 mmol/L. For patients with non-obstructive coronary artery disease who continue to experience persistent angina pectoris, further investigation of the microcirculation is recommended.
The Swedish National Patient Register (NPR) is vital for epidemiological research. A 2010 review assessed the validity of inpatient diagnoses, but outpatient data were excluded. A recent review in the European Journal of...The Swedish National Patient Register (NPR) is vital for epidemiological research. A 2010 review assessed the validity of inpatient diagnoses, but outpatient data were excluded. A recent review in the European Journal of Epidemiology examined validation studies for inpatient diagnoses post-2010 and outpatient data since 2001. Across 89 publications, median positive predictive value (PPV) was 84% for diagnoses (range: 18-100%) and 97% for surgical codes. Sensitivity was lower, median 73% (range: 45-80%). PPV and sensitivity varied depending on diagnosis, coding, reference standard, and data source. Different diagnostic criteria are needed depending on research question. Combining NPR with other registers can enhance accuracy. Limitations include incomplete outpatient data in early years, gaps in private healthcare reporting, and insufficient coverage of certain medical codes. Despite this, the NPR remains a reliable and central data source for medical research when limitations are considered.
Fredriksson Sundbom M, Molin A, Valente R
… +1 more, A'roch R
Lakartidningen
· 2025 Aug · PMID 40767340
Endoscopic retrograde cholangiopancreatography (ERCP) is associated with gas embolism, which is often fatal when observed through clinical signs. Here we report the only case, to our knowledge, of a survivor of paradoxal...Endoscopic retrograde cholangiopancreatography (ERCP) is associated with gas embolism, which is often fatal when observed through clinical signs. Here we report the only case, to our knowledge, of a survivor of paradoxal gas embolism with a patent foramen ovale during ERCP. The patient suffered respiratory collapse with unmeasurable end-tidal carbon dioxide and severe hypoxemia. Total circulatory collapse was imminent, as demonstrated by severe hypotension and bradycardia with prominent S-T depressions on ECG. Transesophageal echocardiography (TEE) showed massive amounts of biventricular gas bubbles and a patent foramen ovale. After resuscitation with epinephrine, norepinephrine, crystalloid fluid boluses and a 100% fraction of inspired oxygen the patient's condition improved, and he was transferred to the intensive care unit. Repeat TEE showed that the gas bubbles had disappeared, and the patient was extubated that same evening. No neurological deficits were found before discharge. We want to highlight the importance of keeping gas embolism in mind when performing endoscopic procedures.
Recent advancements in sequencing technologies have enabled both the identification of many monogenic diseases and the development of precision medicine, enabling tailored therapies for many patients. This case presentat...Recent advancements in sequencing technologies have enabled both the identification of many monogenic diseases and the development of precision medicine, enabling tailored therapies for many patients. This case presentation describes four patients across three generations diagnosed with hyperkalemia of unclear origin. Genetic testing revealed a pathogenic variant in the KLHL3 gene, linked to familial hyperkalemic hypertension. Treatment with hydrochlorothiazide essentially normalised the potassium levels for all patients, and the oldest patient, with a resistant hypertension since a young age, had a dramatic improvement in blood pressure. This case underscores the importance of a detailed family history combined with genetic testing, which can lead to tailored and effective treatments.
Dahlén E, Sundström A, Wikström S
… +3 more, Walles I, Jarbin H, Kimland E
Lakartidningen
· 2025 Aug · PMID 40761070
Neuroleptics are important for the treatment of serious psychiatric conditions. Few neuroleptics are approved for use in children and adolescents. Side effects are common, and children experience them more often than adu...Neuroleptics are important for the treatment of serious psychiatric conditions. Few neuroleptics are approved for use in children and adolescents. Side effects are common, and children experience them more often than adults, particularly metabolic effects. The number of prescriptions of neuroleptics to children aged 5-17 years has increased (from 5 to 23 per 1000 children during 2004-2023). Most children were prescribed second-generation antipsychotics, which is in accordance with national recommendations. The most prescribed drugs were risperidone and aripiprazole, but regional differences exist. Children treated with neuroleptics need to be monitored more frequently, but adequate follow-up measures are used according to our survey of 85 prescribers. There is a need for an in-depth analysis of children's use of antipsychotics and the risk of serious side effects.
Hofdam S, Bengtsson D, Engel Blaauwwiekel E
… +1 more, Wanby P
Lakartidningen
· 2025 Aug · PMID 40755124
Acute suppurative thyroiditis (AST) is an extremely rare and potentially life-threatening condition, which can at first be difficult to differentiate from the far more common subacute thyroiditis (SAT). AST is most often...Acute suppurative thyroiditis (AST) is an extremely rare and potentially life-threatening condition, which can at first be difficult to differentiate from the far more common subacute thyroiditis (SAT). AST is most often described in patients with immunosuppression, or in patients with a pre-existing thyroid disease or anatomical structural defect, such as a pyriform sinus fistula. Here, we describe a case where a 37-year-old immunocompromised woman presented with intermittent fever, fatigue, erythema and tenderness of the anterior neck. TSH was suppressed and free T3 and T4 were elevated. She was prescribed Prednisolone 30 mg due to suspicion of SAT, but her symptoms from the anterior neck escalated. She developed a thyroid abscess, and was successfully treated with surgical drainage and oral antibiotics.
Westerholt M, Ocias LF, von Horn E
… +6 more, Santos-Martin D, Bläckberg J, Wilhelmsson C, Lilja B, Windahl U, Sondén K
Lakartidningen
· 2025 Jul · PMID 40755018
Cowpox is an infection caused by the cowpox virus, a zoonotic DNA virus belonging to the genus Orthopoxvirus. The infection presents as a febrile illness with a characteristic eschar-like lesion. Humans are typically inf...Cowpox is an infection caused by the cowpox virus, a zoonotic DNA virus belonging to the genus Orthopoxvirus. The infection presents as a febrile illness with a characteristic eschar-like lesion. Humans are typically infected through contact with rodents or cats who have been in contact with rodents. The diagnosis is made using PCR. In this case series, we present eight cases of cowpox contracted in Sweden.
The daily regulatory work with pharmacovigilance includes requirements of risk minimisation measures (RMM). However, when it comes to evaluating the efficacy of RMM, methodological issues have been raised regarding commo...The daily regulatory work with pharmacovigilance includes requirements of risk minimisation measures (RMM). However, when it comes to evaluating the efficacy of RMM, methodological issues have been raised regarding commonly used surveys, and the updated Guideline on good pharmacovigilance practices, Module XVI Addendum II, proposes using mixed methods when RMM outcome is evaluated. The Swedish Medical Products Agency has used aggregated national register data to evaluate compliance to the contraindication for cyproterone in patients with previous or current meningioma. Among 13 036 patients diagnosed with meningioma during the period 2005-2022, 21 to 63 individuals had filled a prescription of cyproterone ever after diagnosis. This is regarded as a resource-efficient method to assess compliance to contraindications, although anonymous aggregated statistics entail an uncertainty of measurement because the data must not be granular enough to be attributed to single individuals.
Sjöström K, G Mount J, Klocker AK
… +2 more, Lindahl S, Arthurson V
Lakartidningen
· 2025 Jun · PMID 40525479
Hormonal therapy is widely used to treat different conditions in humans; a well-known indication being the relief of menopausal symptoms in women. Transdermal delivery of hormonal drugs is common and may pose a risk to h...Hormonal therapy is widely used to treat different conditions in humans; a well-known indication being the relief of menopausal symptoms in women. Transdermal delivery of hormonal drugs is common and may pose a risk to humans and animals through secondary exposure. This report raises awareness of risks associated with secondary exposure to transdermal hormone-containing drugs, based on evidence from spontaneous reporting of suspected adverse events. Clinical signs in humans included precocious puberty, unresolved virilisation, accelerated growth rate, alopecia, foetal death, and female infertility. In animals, clinical signs included persistent oestrus, poor growth rate and birth defects. Risks of secondary exposure must be acknowledged when prescribing hormonal drugs and as a possible aetiology of clinical signs in humans and animals.