Marklund N, Tegner Y, Bull V
… +5 more, Johansson K, Lundgren L, Swarén M, Zetterberg H, Saartok T
Lakartidningen
· 2025 Jun · PMID 40503565
Early recognition and management of sports-related concussion (SRC), including removal from the sports activity, is essential for player safety and to prevent long-term symptoms. A graduated, stepwise rehabilitation prot...Early recognition and management of sports-related concussion (SRC), including removal from the sports activity, is essential for player safety and to prevent long-term symptoms. A graduated, stepwise rehabilitation protocol is implemented to allow the athlete to return to sports. In 2022, the 6th international consensus statement on concussion in sports was presented, which has now been adapted to Swedish conditions. In the present overview, the updated recommendations for SRC in athletes are summarized.
Dementia with Lewy bodies (DLB) is the second most common form of neurodegenerative dementia. While its prevalence is commonly reported to be 5% of all dementia cases, DLB is severely under-diagnosed and under-recognized...Dementia with Lewy bodies (DLB) is the second most common form of neurodegenerative dementia. While its prevalence is commonly reported to be 5% of all dementia cases, DLB is severely under-diagnosed and under-recognized, with prevalence rates reported to be up to 25% in some studies. This article strives to increase social and professional awareness of DLB in Sweden, under the auspice of the Swedish Lewy Body Network. The article summarizes the key clinical and biological characteristics of DLB, including its prodromal stages. We discuss current challenges and provide practical recommendations to improve health care in DLB in Sweden. Treatment opportunities that modify the disease are lacking, while this article suggests several opportunities for symptomatic treatment that often improve the quality of life of people with DLB.
Tralla L, Gustavsson S, Sundström A
… +2 more, Thunander Sundbom L, Kugelberg F
Lakartidningen
· 2025 Jun · PMID 40457952
In 2019, 829 people died from drug poisoning according to the National Board of Forensic Medicine's database, of which 269 (32 percent) were assessed as suicide, 354 (43 percent) as unintentional poisonings and 206 (25 p...In 2019, 829 people died from drug poisoning according to the National Board of Forensic Medicine's database, of which 269 (32 percent) were assessed as suicide, 354 (43 percent) as unintentional poisonings and 206 (25 percent) as poisonings of undetermined intent. The proportion of the deceased that had a filled prescription (within one year preceding the death) for the substance that contributed to the death varied considerable between substances. The highest proportion of fatalities with a dispensed prescription was seen in intoxications with propiomazine (88 percent), zopiclone (85 percent) and alimemazine (84 percent). A filled prescription was very common amongst suicides, but less common amongst unintentional poisonings. When put in relation to sales of pharmaceuticals affecting the nervous system (ATC code N) in Sweden, however, the number of fatalities is low.
Disruptions to our biological clock can lead to metabolic consequences. Shift workers are therefore predisposed to chronic diseases. Chronobiology refers to the rhythms of bodily functions, being controlled by clock gene...Disruptions to our biological clock can lead to metabolic consequences. Shift workers are therefore predisposed to chronic diseases. Chronobiology refers to the rhythms of bodily functions, being controlled by clock genes. These inherent circadian rhythms are synchronized to a 24-hour period by daylight and behavior. Chrononutrition emphasizes the importance of timing eating for optimal health. While circadian variations in response to food were observed decades ago, there is now a renewed interest in this area. It is recommended to have breakfast, to maintain regular times for eating during the day and to avoid night eating. In the workplace, promoting healthy eating habits involves providing meal breaks, optimizing the physical meal environment, and providing guidance on mealtimes for both work hours and leisure time. Further systematic studies are needed to fully understand the impact of chrononutrition on overall health. Nordic Nutrition Recommendations do not include meal patterns.
Lindow T, Pahlm O, Mokhtari A
… +3 more, Koul S, Hammarlund P, Ekelund U
Lakartidningen
· 2025 May · PMID 40421749
The classification of acute myocardial infarction (AMI) based on ECG changes has evolved over time. Before the revascularization era, AMI was classified based on Q-waves that indicate loss of myocardium. After thrombolys...The classification of acute myocardial infarction (AMI) based on ECG changes has evolved over time. Before the revascularization era, AMI was classified based on Q-waves that indicate loss of myocardium. After thrombolysis trials in the 1990s demonstrated a survival benefit, ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) classifications were introduced to guide immediate reperfusion therapy with thrombolysis or percutaneous coronary intervention. However, STEMI criteria have limitations. ST elevation is not synonymous with acute coronary occlusion and can occur in pericarditis, early repolarization, left ventricular hypertrophy and other disorders. The process of occlusion is dynamic, and temporary thrombus resolution may cause ST elevation to be absent at the time of ECG recording. Furthermore, ST elevation depends on vector orientation; posterior infarcts may only show ST depression. Studies show that many NSTEMI cases are caused by acute occlusions, which are associated with worse prognosis. The sensitivity of current STEMI criteria is low, and several ECG findings suggestive of acute coronary occlusion have been described. A new classification, »Occlusion Myocardial Infarction« (OMI), has been proposed to improve detection and guide intervention beyond strict STEMI criteria.
Acute kidney injury is a heterogeneous multifactorial syndrome. Despite the existence of new biomarkers, changes in creatinine level or diuresis - both measures of kidney function - are still used to rate kidney injury....Acute kidney injury is a heterogeneous multifactorial syndrome. Despite the existence of new biomarkers, changes in creatinine level or diuresis - both measures of kidney function - are still used to rate kidney injury. The kidney has several other functions, such as regulation of fluid balance, electrolyte balance, and hemodynamics. In addition, the kidney is endocrinologically active and secretes, among other things, renin and erythropoietin. All functions of the kidney can be impaired. Acute kidney injury is significantly associated with increased morbidity and mortality. Acute kidney injury often occurs secondarily to other diseases or organ failures. When encountering a patient with acute kidney injury in outpatient care, one must first assess whether life-threatening conditions such as hyperkalemia, severe metabolic acidosis, and fluid accumulation exist and, if so, promptly refer the patient to the emergency department. If there are no immediately life-threatening conditions, factors that can reverse kidney failure should be identified. If this is not successful, the patient should be referred to a nephrologist. Acute kidney injury in critically ill patients is often linked to other severe multi-organ failures. AKI should be carefully monitored and the kidneys should be protected as much as possible, and if kidney function deteriorates, renal replacement therapy should be initiated.
Research has highlighted the complexities in transitional care for adolescents and young adults, including decreased healthcare contacts and dispensed medication after transfer to adult healthcare. A survey of healthcare...Research has highlighted the complexities in transitional care for adolescents and young adults, including decreased healthcare contacts and dispensed medication after transfer to adult healthcare. A survey of healthcare professionals revealed that more than half do not adhere to key messages in existing national guidelines and focus more on the transfer process rather than on the transition to independent adulthood. To address the complexities in the transitional care for adolescents and young adults with asthma, there is a need for a comprehensive transition program applicable in both primary and specialist care settings, utilizing a multi-professional approach to gradually strengthen the young person's self-care skills and prepare them for adult healthcare. To bridge the gap in transitional care and improve long-term outcomes for adolescents and young adults with asthma, a pilot study is ongoing in the Stockholm region, with hopes for national implementation.
Primary care is responsible for diagnostics and follow-up of the majority of patients with asthma. The variable airway obstruction may contribute to difficulties in diagnosing asthma. The cornerstones of diagnostics are...Primary care is responsible for diagnostics and follow-up of the majority of patients with asthma. The variable airway obstruction may contribute to difficulties in diagnosing asthma. The cornerstones of diagnostics are patient history and lung function measurements. Even patients with only sporadic symptoms should be treated with inhaled corticosteroids (Step 1 in the asthma treatment track). Patient education is essential for good asthma control. Optimal asthma control means normal lung function, absence of symptoms and absence of exacerbations. This must always be assessed at a patient consultation. In uncontrolled asthma, treatment barriers such as inadequate inhalation technique, insufficient adherence to treatment, exposure to asthma triggers, and possible influence of co-morbidity should be assessed.
Type 2 (T2) high asthma, characterized by T2 markers such as eosinophilia, is driven by type 2 innate lymphoid cells (ILC2) and allergen-activated T helper (Th2) cells. Epithelial-derived cytokines called alarmins, IL-33...Type 2 (T2) high asthma, characterized by T2 markers such as eosinophilia, is driven by type 2 innate lymphoid cells (ILC2) and allergen-activated T helper (Th2) cells. Epithelial-derived cytokines called alarmins, IL-33, TSLP, IL-25 and TL1A, acting on dendritic cells and ILC2, are key in driving both allergic and non-allergic T2 high asthma. Alarmins are produced in response to allergens, pathogens, pollutants etc. Cytokines produced by Th2 cells and ILC2 cause the immunopathology of asthma including eosinophilia, mast cell activation, goblet cell hyperplasia and fibrosis, which in turn causes airway hyperresponsiveness, bronchoconstriction, tissue remodeling and mucus hypersecretion. However, asthma also occurs in patients devoid of T2 markers. The immunological mechanisms of so called T2 low asthma seems to be related to IL-22/IL-17 cytokines and/or inflammasome activation, but much research remains to unravel the etiology and mechanisms to identify ways of effectively treating T2 low asthma.
Malinovschi A, Kjellberg S, Romberg K
… +1 more, Wollmer P
Lakartidningen
· 2025 May · PMID 40371566
Spirometry with bronchodilator test is the most frequently used test for asthma diagnosis. PEF variability can prove variable airflow obstruction when asthma was not confirmed by spirometry with bronchodilator test. Bro...Spirometry with bronchodilator test is the most frequently used test for asthma diagnosis. PEF variability can prove variable airflow obstruction when asthma was not confirmed by spirometry with bronchodilator test. Bronchial challenge tests can demonstrate airway hyperresponsiveness. Measuring exhaled nitric oxide received increased support in the recent asthma diagnosis guidelines. Peripheral airways involvement is common in asthma, can occur despite normal spirometry and be identified by oscillometry and nitrogen gas washout. It is important to continue investigation even if a certain diagnostic test shows negative results when the clinical asthma suspicion persists.
Severe asthma is a relatively common, chronic, heterogeneous inflammatory disease affecting around 4-10% of all asthmatics. Most of these have uncontrolled eosinophilic asthma, the treatment of which accounts for >50% of...Severe asthma is a relatively common, chronic, heterogeneous inflammatory disease affecting around 4-10% of all asthmatics. Most of these have uncontrolled eosinophilic asthma, the treatment of which accounts for >50% of healthcare costs attributed to the disease. Management of severe asthma requires a thorough investigation to exclude comorbidities and determine the underlying type of inflammation and resulting asthma phenotype, so that suitable treatments can be chosen. Systematic assessment and evaluation of treatment must then be performed every 3-6 months. Severe asthma is mostly driven by type 2 inflammation, and we now have several specific biological therapies targeting this inflammation, yet some patients remain poorly controlled due to the heterogenous nature of this disease with its many sub-phenotypes. Therefore, research must determine which clinical and patient reported outcomes as well as biomarkers best reflect response to therapy and thus should be monitored in the clinic.
Asthma is one of the most common non-communicable chronic diseases in the world, with a prevalence that historically has increased and now seems to have plateaued at around 10 percent of the general population in high-in...Asthma is one of the most common non-communicable chronic diseases in the world, with a prevalence that historically has increased and now seems to have plateaued at around 10 percent of the general population in high-income countries like Sweden. Some phenotypes, especially the allergic asthma, may however still be increasing. Remission is common in children but less common in adults. Future urbanization and changes in lifestyle may lead to increased asthma prevalence, while further improvements in air quality, treatment and care may lead to decreases and benefit those already affected. It is important that we continuously follow trends in asthma prevalence, incidence, remission and risk factor patterns.
The incidence of cervical cancer after a normal cytology test has been increasing, and now women with a normal cytology have a cancer risk almost as high as the general population. The incidence of cervical cancer after...The incidence of cervical cancer after a normal cytology test has been increasing, and now women with a normal cytology have a cancer risk almost as high as the general population. The incidence of cervical cancer after a negative HPV test is about 7 times lower than after a normal cytology test. The 2015 Swedish national screening program recommended HPV screening for women aged 30-70, but some regions did not start implementing HPV screening until 2021. Conceivably, high cancer risks after normal cytology could be explained if women with a recent normal cytology have not been offered HPV screening. The regional HPV test coverage varies between 62% and 89%, with higher coverage linked to lower cancer incidence (r=-0.50; p=0.022). Efforts to increase the coverage of HPV screening as soon as possible are advisable for imminent control of cervical cancer.
Tidblad L, Askling J, Berglin E
… +3 more, Karlberg L, Olofsson T, Ljung L
Lakartidningen
· 2025 May · PMID 40336293
SRQ is a nationwide quality registry with information on disease activity and treatment of patients with rheumatic diseases. The purpose is to continuously improve the clinical management and follow-up of rheumatic disea...SRQ is a nationwide quality registry with information on disease activity and treatment of patients with rheumatic diseases. The purpose is to continuously improve the clinical management and follow-up of rheumatic diseases. Patient-reported outcome measures (PROM) are adapted to the specific rheumatic diseases and represent an important part of the description of the RA disease activity and treatment outcomes. Results from SRQ are presented for each rheumatology unit in quarterly reports. There are also several interactive reports available on the websites srq.nu and »Vården i siffror«. Data from SRQ, often combined with other national registries, form the basis for a large number of research projects.
L Wickström S, A Nilsson J, Lundqvist A
… +4 more, Helgadottir H, Carneiro A, Ny L, Kiessling R
Lakartidningen
· 2025 May · PMID 40314377
Therapy for advanced cutaneous melanoma with tumor infiltrating lymphocytes (TIL) has shown promising clinical results for 35 years. Owing to advanced production and treatment methods, TIL therapy has only been accessibl...Therapy for advanced cutaneous melanoma with tumor infiltrating lymphocytes (TIL) has shown promising clinical results for 35 years. Owing to advanced production and treatment methods, TIL therapy has only been accessible in a few centers in Europe and the USA. Recently, following a company phase 2 trial and an academic Phase III trial with superior response rate compared to patients treated with the immune checkpoint inhibitor (ICI) ipilimumab, TIL therapy gained FDA approval. Several studies are now ongoing where patients with other tumor diagnoses such as cervical cancer and non-small-cell lung cancer are recruited, some of which are testing combinations with ICI. At Karolinska University Hospital in Stockholm, an academic study combining TIL with a dendritic cell tumor vaccine is ongoing. At Sahlgrenska Academy a TIL study on metastatic uveal melanoma has started. In this review we summarize the recent developments in TIL therapy and provide a discussion about its future.
Lindblom R, Welin S, Forsblad J
… +4 more, Holmström A, Amin A, Bergsten J, Albåge A
Lakartidningen
· 2025 May · PMID 40314376
Neuroendocrine tumours (NET) constitute a heterogenous population of malignancies most often originating from the gastrointestinal tract. NETs cause substantial morbidity, both from local growth and from their ability to...Neuroendocrine tumours (NET) constitute a heterogenous population of malignancies most often originating from the gastrointestinal tract. NETs cause substantial morbidity, both from local growth and from their ability to produce hormones that affect systemic physiology. About 20% of patients with metastatic NET disease and carcinoid syndrome develop carcinoid heart disease, a condition dominated by primarily right-sided heart failure caused by structural deterioration of the tricuspid and pulmonary valves. Ultimately, valve replacement may be indicated and has been shown to reduce heart failure symptoms and increase long-term survival. Bioprostheses are the valves of choice but have been shown to degenerate early in some patients due to chronic tumour-associated hormonal activity. New transcatheter treatment options are emerging, both as valve-in-valve procedures but potentially also as primary interventions, both in the tricuspid and pulmonary valve position.
Eckerdal G, Lindberg J, Birr A
… +6 more, Björkhem-Bergman L, Rehnberg AS, Gogineni M, Karlsson M, Schmitz L, Dettmann S
Lakartidningen
· 2025 Apr · PMID 40289665
Palliative sedation is a good medical treatment to relieve suffering at the end of life that is judged not to be adequately relieved by other means. The treatment decision should be made by a palliative care physician, p...Palliative sedation is a good medical treatment to relieve suffering at the end of life that is judged not to be adequately relieved by other means. The treatment decision should be made by a palliative care physician, preferably in consultation with another palliative care physician and, in some cases, an anesthesiologist. The depth of sedation should be appropriate to the needs of the patient. Informed consent should be obtained from the patient, if possible, and significant others should be informed and cared for during the process. In the case of continuous deep palliative sedation, the medical and ethical risks of reducing the patient's level of consciousness until death should be balanced against the great benefit of the treatment to the patient. The treatment should be thoroughly documented and followed up. The depth of sedation and relief of symptoms should be monitored.