Kmezic I, Eriksson A, Sundman E
… +1 more, Press R
Lakartidningen
· 2025 Mar · PMID 40135266
Autoimmune nodopathy (AN) is an emerging diagnostic category with antibodies targeting the peripheral node of Ranvier. Clinically, AN overlaps with Guillain-Barré syndrome (GBS) and acute-onset CIDP. However, the immunop...Autoimmune nodopathy (AN) is an emerging diagnostic category with antibodies targeting the peripheral node of Ranvier. Clinically, AN overlaps with Guillain-Barré syndrome (GBS) and acute-onset CIDP. However, the immunopathology of AN is different, hence AN is considered as a separate entity. Antibodies targeting all neurofascin isoforms are associated with a phenotype and immunopathology described as pan-neurofascin (panNF) AN. Here, we describe a clinical and serological work-up of two patients with anti-panNF IgG4 AN, as well as treatment response. Due to the high morbidity of panNF and its treatable nature, we suggest early antibody testing in severe cases of GBS, especially when a prolonged need for invasive ventilation occurs. Specialized intensive care rehabilitation promotes autonomy and recovery, and should be considered as an alternative to traditional ICU care.
An interesting article in this issue of Läkartidningen argues for the benefit of a broad HPV vaccination with catch-up vaccination also for men, and sheds more light on HPV-related cancer in men. There has been an increa...An interesting article in this issue of Läkartidningen argues for the benefit of a broad HPV vaccination with catch-up vaccination also for men, and sheds more light on HPV-related cancer in men. There has been an increase of HPV-related anal and oropharyngeal cancer in recent years, but no screening methods for these cancers have been implemented. A gender neutral catch-up vaccination would help to decrease the burden of oncogenic HPV in society, and would also be beneficial for females. Swedish authorities have now come to the conclusion that catch-up vaccination of men would be cost-effective, a decision that we strongly support.
Carlander C, Borgfeldt C, Hammarstedt Nordenvall L
Lakartidningen
· 2025 Mar · PMID 40070302
HPV-related cancers in men, particularly anal and oropharyngeal cancers, are increasing in Sweden and globally. Men who have sex with men, trans persons and people living with HIV are at especially high risk. HPV vaccina...HPV-related cancers in men, particularly anal and oropharyngeal cancers, are increasing in Sweden and globally. Men who have sex with men, trans persons and people living with HIV are at especially high risk. HPV vaccination effectively prevents HPV infection and related precancers when given up to age 26. The Public Health Agency of Sweden makes the assessment that catch-up vaccination of unvaccinated males up to 26 years of age is likely to be cost-effective. New international guidelines recommend annual anal cancer screening for high-risk groups from ages 35-45. There are no guidelines for anal cancer screening in Sweden, and screening capacity in Sweden is limited. Vaccinating men not only protects them individually but also indirectly benefits women by reducing HPV transmission and strengthening herd immunity. Increased vaccination coverage and improved screening methods are crucial to reduce the burden of HPV-related cancers in men and accelerate the elimination of cervical cancer.
Broman D, Andersson L, Beischer S
… +3 more, Sundemo D, Thoreson O, Mohaddes M
Lakartidningen
· 2025 Mar · PMID 40070301
The aim of the study was to investigate: 1) the proportion of referrals from primary care to orthopedic consultations that included the information requested by the national guidelines for patients with knee osteoarthrit...The aim of the study was to investigate: 1) the proportion of referrals from primary care to orthopedic consultations that included the information requested by the national guidelines for patients with knee osteoarthritis, and 2) the proportion of referrals that specified whether patients had completed first-line treatment. A total of 140 referrals were examined. None of the referrals adhered fully to the national guidelines, and none included information on whether the patient had completed first-line treatment. This suggests that the referral process for this patient group needs to be reviewed and improved. We propose three possible changes regarding the referral process, including an enhanced role for physical therapists and the patients themselves and a digital referral platform enabling easier communication between different professions.
Gennert Jakobsson C, Brändström H, Truedson M
… +1 more, Hedelin H
Lakartidningen
· 2025 Feb · PMID 40007262
The keys to successful treatment of freezing cold injuries are proper recognition and grading of the injury, followed by appropriate treatment within the first 24 hours. In the latter stages, challenges remain but are le...The keys to successful treatment of freezing cold injuries are proper recognition and grading of the injury, followed by appropriate treatment within the first 24 hours. In the latter stages, challenges remain but are less time sensitive. The thawing process, in a water bath with a temperature of 37-39°C, is painful and requires ambitious pain relief. Thawing initiates an inflammation cascade at the cellular level resulting in micro embolies disrupting the micro-circulation. This mechanism explains why more severe frostbite injuries can be successfully treated with thrombolytic therapy and drugs such as iloprost and NSAID. These treatments must, for the same reason, be initiated within the first days after thawing. Imaging methods such as angiography, CT or bone scintigraphy give valuable added information to complement clinical examination after thawing. Proper wound care is of essence and aggressive surgery, such as amputation, should be postponed until definite clinical demarcation of necrosis is established.
Rawshani A, Strömsöe A, Aune S
… +3 more, Israelsson J, Nordberg P, Herlitz J
Lakartidningen
· 2025 Feb · PMID 40007261
The Swedish Registry of Cardiopulmonary Resuscitation started in 1990 and records the vast majority of resuscitation attempts in Sweden. The registry aims to monitor and improve the links in the chain of survival. The re...The Swedish Registry of Cardiopulmonary Resuscitation started in 1990 and records the vast majority of resuscitation attempts in Sweden. The registry aims to monitor and improve the links in the chain of survival. The registry charts critical events at the time of resuscitation as well as the subsequent follow-up of initial survivors concerning their ongoing treatment, long-term survival, and quality of life. Several quality indicators that involve the delay time to treatment and survival have demonstrated improvements in the treatment and outcomes since the start of the registry. Data from the registry are being used to enable the improvement through measurement principle. A doubling in survival is noted for out-of-hospital cardiac arrest, despite an increased ambulance response time and a diminishing prevalence of cardiac etiology, resulting in a decreased incidence of ventricular fibrillation as the first recorded rhythm among these victims. These factors may underestimate the true improvement of survival rates after cardiac arrest in Sweden.
A woman has the right to have an abortion without declaring any reason for it until the eighteenth week of the pregnancy. After that, abortion can be allowed upon application to the Legal Council of the National Board of...A woman has the right to have an abortion without declaring any reason for it until the eighteenth week of the pregnancy. After that, abortion can be allowed upon application to the Legal Council of the National Board of Health and Welfare. The number of abortions allowed for social reasons has been stable until 2020, when an increase of refusals occurred. The increase coincided with changes in meeting routines for the council. The procedure for handling requests for abortion is problematic. Opportunities for the members of the council to discuss are scarce. No reasons for denial of abortion are communicated and there are no minutes from the meetings.
Imamovic M, Dahlqvist P, Ragnarsson O
… +1 more, Einarsdottir M
Lakartidningen
· 2025 Feb · PMID 39935313
Glucocorticoid-induced adrenal insufficiency is an underdiagnosed condition that possibly contributes to increased mortality. Consensus regarding management of glucocorticoid-induced adrenal insufficiency in patients rec...Glucocorticoid-induced adrenal insufficiency is an underdiagnosed condition that possibly contributes to increased mortality. Consensus regarding management of glucocorticoid-induced adrenal insufficiency in patients receiving glucocorticoid therapy has previously been lacking, but the European Society of Endocrinology and the Endocrine Society have recently published joint international guidelines on the diagnosis and treatment, summarized in this article. To further support patients and healthcare professionals, and to prevent a potentially fatal adrenal crisis, a national blue corticosteroid treatment card has been introduced. The card is intended to be provided to patients treated with prednisolone >5 mg daily (or equivalent) for >3-4 weeks.
Andersen K, Larsson B, Björklund E
… +3 more, Mathilda Bergman E, Vikström G, Ebeling Barbier C
Lakartidningen
· 2025 Feb · PMID 39935312
Chronic thromboembolic pulmonary hypertension (CTEPH) can develop subsequent to acute pulmonary embolism, with exertional dyspnea being the predominant symptom. Initial evaluation of CTEPH patients should prioritize surg...Chronic thromboembolic pulmonary hypertension (CTEPH) can develop subsequent to acute pulmonary embolism, with exertional dyspnea being the predominant symptom. Initial evaluation of CTEPH patients should prioritize surgical intervention via pulmonary thromboendarterectomy (PEA). For cases where surgical intervention is not feasible, balloon pulmonary angioplasty (BPA) emerges as a potential treatment. Post-treatment, patients are expected to demonstrate both subjective and objective amelioration. The technique often requires multiple sessions. The safety profile of BPA is comparable to that of open surgical PEA. Further research is imperative to comprehensively evaluate the long-term efficacy and safety of this therapeutic modality.
Ballistic injuries to upper and lower limbs in local and international conflicts are common, where particularly peripheral nerve injuries should be highlighted. Handling of injured and destroyed tissues requires a fast a...Ballistic injuries to upper and lower limbs in local and international conflicts are common, where particularly peripheral nerve injuries should be highlighted. Handling of injured and destroyed tissues requires a fast and competent multidisciplinary management of the patient and depends on the extent and character of the injuries. Early experiences from conflicts have shown that peripheral nerve injuries are difficult to treat, often resulting in extensive permanent loss of function, risk for pain problems and life-long reduced quality of life. Early diagnosis, sometimes based on »active surveillance« of the nerve injury, initiation of appropriate surgical techniques from the panel of conventional and novel methods, and pharmacological treatment of nerve injuries are keystones and can improve the situation for the affected patient, where timing of treatment is crucial.
Fernell E, Lindblad I, Nordin-Olson E
… +4 more, Sandberg J, Söderström AK, Tideman E, Widengren H
Lakartidningen
· 2025 Feb · PMID 39910964
Diagnosing mild intellectual disability (ID) in children is very often challenging and may require multiple assessments over time to confirm the diagnosis with confidence. In Sweden, this diagnosis is typically made with...Diagnosing mild intellectual disability (ID) in children is very often challenging and may require multiple assessments over time to confirm the diagnosis with confidence. In Sweden, this diagnosis is typically made within the school health services, where close collaboration between psychologists, school doctors, and educators is essential. Children diagnosed with mild ID are entitled to attend specially adapted schools. It is important to recognise that many children with mild ID also experience other developmental, neurological, or neuropsychiatric conditions (ESSENCE). Beyond the initial evaluation in school health services, it is crucial that children be referred to specialised paediatric clinics for further investigation of potential underlying causes. In some cases, a child psychiatry consultation may also be necessary. Given the frequent presence of comorbidities, children with mild ID require ongoing clinical follow-up to support their development over time.
Gene editing is a novel technology within gene therapy, which changes sequences in chromosomal DNA with precision. Even if there are alternative strategies, the Nobel Prize-winning CRISPR/Cas technology has become the do...Gene editing is a novel technology within gene therapy, which changes sequences in chromosomal DNA with precision. Even if there are alternative strategies, the Nobel Prize-winning CRISPR/Cas technology has become the dominating principle. During recent years base editing and prime editing, permitting editing without DNA double-strand breaks, have been developed. The first clinical gene editing results were reported in 2021; since then many patients have been treated, and recently the first treatment was approved as a novel therapy in the UK and later in USA and in EU. This update describes various aspects including methodological developments and safety.
Larsson G, Herlitz J, Axelsson C
… +3 more, Hegardt Janson M, Albrecht S, Klementsson H
Lakartidningen
· 2025 Jan · PMID 39878689
The Swedish quality register AmbuReg collects all the country's ambulance missions. There is an increasing demand on the Emergency Medical Services (EMS) due to decreasing hospital resources and referral to self-care, pr...The Swedish quality register AmbuReg collects all the country's ambulance missions. There is an increasing demand on the Emergency Medical Services (EMS) due to decreasing hospital resources and referral to self-care, primary care and mobile teams. This, in combination with fast tracks for patients with myocardial infarction, stroke, hip fracture or sepsis, increases the requirement for optimal triage at the scene. The aim of the registry is to ensure the quality and identify limitations in the EMS that may threaten patient safety, such as documentation, assessment, triage and treatment. The development of decision support tools will be required in the future and in collaboration with other national quality registries. Regarding adherence to guidelines for assessment and treatment of symptoms, particularly pain, and the use and analysis of equipment such as ECG and analysis of serum glucose, different quality goals may be set. An example may be that at least 80% of strokes should be recognized at the scene.
Hultin M, Själander A, Werner M
… +7 more, Hultberg P, Ragnarsson O, Skoglund I, Gottsäter A, J Svensson P, Appelberg L, Dahlin M
Lakartidningen
· 2025 Jan · PMID 39876695
There are four paths to a Swedish medical license. A shared agreement exists for those converting from a European license to recognize qualifications granted in the respective countries mutually. Swedish medical graduate...There are four paths to a Swedish medical license. A shared agreement exists for those converting from a European license to recognize qualifications granted in the respective countries mutually. Swedish medical graduates and International Medical Graduates (IMGs) trained outside the EU/EES/Schweiz are assessed against the professional qualifications specified in the Higher Education Ordinance (1993:100). This paper discusses the different pathways to a Swedish Medical License, how they are interrelated and changing, and the number of licenses granted via the specific pathways in 2023 and the previous 7 years. In 2023, 2,318 Swedish medical licenses were awarded. The largest group (1,407/2,318) were graduates from a Swedish medical school (with a minimum of 18 months of internship (AT)). The second largest group (704/2,318) were licensed physicians from a country within the EU/EEA. The smallest group (207/2,318) were international medical graduates (IMGs) who had passed the proficiency test (with a 6-month internship) or a complementary medical education (KUL) at one of the Swedish universities (with a minimum of 18 months of internship (AT)). During 2016-2023, 826 IMGs passed the proficiency test, and 533 IMGs completed KUL. During the same period, 10,958 students graduated from Swedish medical programmes, and 6,844 medical licenses were approved based on education in the EU/EEC. The pathway for IMGs starts with applying to the National Board of Health and Welfare to be approved for the tests. The theoretical test is a 180-item exam with single-best answers covering the medical field with basic and clinical sciences. After passing the theoretical test, the practical skills are tested with an Objective Structured Clinical Examination (OSCE) with fourteen 6-minute and four 14-minute stations. After passing the practical test, the IMG is assessed during a 6-month internship and must take an online Swedish law course. When successfully passing these steps, the IMG applies for a Swedish medical license with a certificate of passing a language test in Swedish at the C1 level. The educational pathway consists of a 1- to 2-year-long complementary programme for international medical graduates (KUL) offered at five Swedish universities. The regular Swedish medical programmes are in transition from preparing for an internship to preparing to qualify directly for a medical license without an intermediate internship. Consequently, KUL also needs to develop new curricula, preparing for direct qualification for a medical license, from which the first students will most likely graduate in spring 2027.
Näslund E, Näslund I, Ottosson J
… +1 more, Stenberg E
Lakartidningen
· 2025 Jan · PMID 39810473
The Scandinavian Obesity Surgery Registry (Soreg) was initiated in 2007 in order to track the quality of bariatric surgery in Sweden during a period of rapid expansion. The main focus of Soreg is quality control and a ba...The Scandinavian Obesity Surgery Registry (Soreg) was initiated in 2007 in order to track the quality of bariatric surgery in Sweden during a period of rapid expansion. The main focus of Soreg is quality control and a base for research. All surgical units that perform bariatric surgery in Sweden report to Soreg, and to date about 93 000 patients are included in Soreg. The rate of laparoscopic access has increased and has been over 99 percent the last 10 years. The number of complications has continuously decreased, and bariatric surgery in Sweden has results in line with those published from international high-volume centers. About 160 peer-reviewed publications have used data from Soreg, many of them published in high impact journals. Two randomized controlled trials have used Soreg and 20 PhD theses have used data from Soreg. The focus of Soreg has shifted to long-term complications.
Mossberg K, Garwicz M, Henriksson P
… +4 more, Möller R, Naumburg E, Wahlberg J, M Wallerstedt S
Lakartidningen
· 2025 Jan · PMID 39810472
Several of the requirements for obtaining a medical degree according to the Swedish Higher Education Ordinance illustrate the scientific basis of the profession, and systematic reviews as well as health technology assess...Several of the requirements for obtaining a medical degree according to the Swedish Higher Education Ordinance illustrate the scientific basis of the profession, and systematic reviews as well as health technology assessments (HTA) constitute cornerstones in evidence-based medicine. In this study, medical students' experience of scientific education related to the profession was explored, and their knowledge achieved was sampled by five multiple-choice questions (MCQ). A total of 433 out of 641 students attending the final semester in six medical schools in Sweden participated (response rate: 68%). Most of them experienced that a majority of the scientifically related learning outcomes for the medical degree had been adequately examined. Regarding the steps of a systematic review, 60% stated that they had been trained to define a specific research question, 64% to find relevant literature according to such a specific research question, 72% to assess scientific articles according to a checklist, 40% to compile results from several studies, and 35% to assess the certainty of evidence according to GRADE. Only 6% stated that they had received education regarding HTA, a factor that was strongly associated with students' perception that they had obtained adequate skills regarding how patient work is based on scientific evidence (adjusted odds ratio [OR] 14.1; 95% CI 1.80-110). Such an association was also found for credit-awarded hands-on evidence-related learning activities during clinical courses (OR 2.72; 95% CI 1.02-7.24). The median student answered 3 of 5 MCQs correctly. The results of a case/control study, a forest plot, and the concept of cost-effectiveness were frequently interpreted erroneously. In conclusion, several aspects of the scientific basis for professional life as a medical doctor seem to be well covered in the medical degree program, whereas others deserve increased attention.