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Cardiac arrest due to accidental overdose with norepinephrine dissolved in crystalloid.
Get PDFTo access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadVasoactive agents should be administered through a controlled well-marked infusor pump, ideally via a central venous catheter if given over longer periods of time. During transfer of haemodynamically unstable patients with limited staffing and resources on site, a peripheral vasopressor infusion is sometimes resorted to as a temporary measure of optimising haemodynamic parameters. We report a case of accidental norepinephrine overdose after such practice, resulting in cardiac arrest. It illustrates the importance of careful use and labelling of vasoactive agents during the transport and handover of critically ill patients. Finally, we explore human factor issues associated with transfer from the pre-hospital to the in-hospital environment when such preparations are used.
Keywords: adult intensive care; anaesthesia; resuscitation; safety; toxicology
The genetic architecture of age-related hearing impairment revealed by genome-wide association analysis.
Get PDFTo access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadAge-related hearing impairment (ARHI) is the most common sensory disorder in older adults. We conducted a genome-wide association meta-analysis of 121,934 ARHI cases and 591,699 controls from Iceland and the UK. We identified 21 novel sequence variants, of which 13 are rare, under either additive or recessive models. Of special interest are a missense variant in LOXHD1 (MAF = 1.96%) and a tandem duplication in FBF1 covering 4 exons (MAF = 0.22%) associating with ARHI (OR = 3.7 for homozygotes, P = 1.7 × 10-22 and OR = 4.2 for heterozygotes, P = 5.7 × 10-27, respectively). We constructed an ARHI genetic risk score (GRS) using common variants and showed that a common variant GRS can identify individuals at risk comparable to carriers of rare high penetrance variants. Furthermore, we found that ARHI and tinnitus share genetic causes. This study sheds a new light on the genetic architecture of ARHI, through several rare variants in both Mendelian deafness genes and genes not previously linked to hearing
Is snoring during pregnancy a predictor of later life obstructive sleep apnoea? A case-control study.
No full textTo access publisher's full text version of this article click on the hyperlink belowBackground: Obstructive sleep apnoea (OSA) appears common in pregnancy. Complications of pregnancy such as gestational diabetes and hypertension predispose women to cardiometabolic disease in later life. It is unknown if snoring during pregnancy is a risk marker for later-life OSA.
Methods: We analysed data from N = 897 women in the Sleep Apnea Global Interdisciplinary Consortium (SAGIC), which recruited patients attending sleep clinics at 11 sites. There were 577 cases with current OSA and 320 controls. Cases were further categorised into mild, moderate, and severe OSA based on apnoea-hypopnoea index. Retrospective self-report of snoring during pregnancy was the exposure of interest and was reported by 2.9% of cases and 3.4% of controls.
Results: Multinomial regression demonstrated that snoring during a previous pregnancy was not significantly associated with mild (OR 0.34, 95% CI 0.09-1.25, p = 0.10), moderate (OR 0.69, 95% CI 0.21-2.19, p = 0.52), or severe OSA (OR 1.86, 95% CI 0.77-4.48, p = 0.17) compared to no snoring during pregnancy. Results were unchanged after adjustment for age, body mass index, and ethnicity. 79% of women reported current snoring but all who snored during pregnancy reported current snoring.
Conclusions: Women who snore during pregnancy continue snoring in later-life but do not appear more likely to develop OSA. These findings are limited by self-reported data, recall bias, and small numbers of women who reported snoring during pregnancy. A prospective study with objective measurement of sleep and snoring during pregnancy is needed to examine the links between sleep disorders in pregnancy with health in later life.
Keywords: Gestation; Risk markers; Sleep disturbance; Sleep-disordered breathing; Snoring; Women.Russian Federation Governmen
Toward Predicting Motion Sickness Using Virtual Reality and a Moving Platform Assessing Brain, Muscles, and Heart Signals.
Get PDFTo access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadMotion sickness (MS) and postural control (PC) conditions are common complaints among those who passively travel. Many theories explaining a probable cause for MS have been proposed but the most prominent is the sensory conflict theory, stating that a mismatch between vestibular and visual signals causes MS. Few measurements have been made to understand and quantify the interplay between muscle activation, brain activity, and heart behavior during this condition. We introduce here a novel multimetric system called BioVRSea based on virtual reality (VR), a mechanical platform and several biomedical sensors to study the physiology associated with MS and seasickness. This study reports the results from 28 individuals: the subjects stand on the platform wearing VR goggles, a 64-channel EEG dry-electrode cap, two EMG sensors on the gastrocnemius muscles, and a sensor on the chest that captures the heart rate (HR). The virtual environment shows a boat surrounded by waves whose frequency and amplitude are synchronized with the platform movement. Three measurement protocols are performed by each subject, after each of which they answer the Motion Sickness Susceptibility Questionnaire. Nineteen parameters are extracted from the biomedical sensors (5 from EEG, 12 from EMG and, 2 from HR) and 13 from the questionnaire. Eight binary indexes are computed to quantify the symptoms combining all of them in the Motion Sickness Index (I
MS
). These parameters create the MS database composed of 83 measurements. All indexes undergo univariate statistical analysis, with EMG parameters being most significant, in contrast to EEG parameters. Machine learning (ML) gives good results in the classification of the binary indexes, finding random forest to be the best algorithm (accuracy of 74.7 for I
MS
). The feature importance analysis showed that muscle parameters are the most relevant, and for EEG analysis, beta wave results were the most important. The present work serves as the first step in identifying the key physiological factors that differentiate those who suffer from MS from those who do not using the novel BioVRSea system. Coupled with ML, BioVRSea is of value in the evaluation of PC disruptions, which are among the most disturbing and costly health conditions affecting humans.Landspitali University Hospital, Reykjavi
Móttaka og starfsþróun hjúkrunarfræðinga af erlendum uppruna á Landspítala
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Cognitive pscyhology and vision science in the medieval Islamic world
No full textTo access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadAristóteles sagði að maðurinn mæti sjónskynjun öðrum skynfærum meira. Í gegnum heimspekiog
vísindasöguna hefur miklum tíma verið varið í rannsóknir á sjónskynjun og eru rannsóknir og
kenningar Keplers oft nefndar sem upphafspunktur nútímasjónskynjunarvísinda. En í þeirri frásögn
er horft fram hjá merku framlagi vísindamanna innan íslamska menningarheimsins á miðöldum.
Íslamskir vísindamenn varðveittu ekki einungis þekkingu Forn-Grikkja, heldur bættu þeir miklu
við hana. Vísindamenn eins og Ibn-Ishaq, Al-Kindí, Avicenna og þó sér í lagi Alhazen lögðu mikið
af mörkum til skilnings á sjónskynjun og vísindagrein þeirri sem nú er kölluð hugfræði og höfðu
mikil áhrif á sporgöngumenn sína á endurreisnartímanum, þar á meðal Kepler. Raunar er Bók
um ljósfræði eftir Alhazen eitthvert merkasta rit um sjónskynjun sem komið hefur út. Alhazen
kynnti til sögunnar hugmyndir um hvernig sólarljós endurvarpast í umhverfinu og berst inn í
augað og hvernig ímynd varpast á ljósnæm svæði innan augans, auk þess sem bókin er líklega
fyrsta heildstæða ritið um sálfræði skynjunar. Víðfræg lausn Keplers á gátunni um endurvarp ljóss
á sjónbotninn endurspeglar áhrif Alhazens úr ritum vísindamanna á 13. og 14. öld sem höfðu
aðgang að hugmyndum hans.
Efnisorð: saga sálfræðinnar, íslömsk sálfræði, skynjunarvísindi.Aristotle claimed that man valued the sense of sight over
the other senses. Visual perception has received a lot of
attention throughout the history of science. Johannes
Kepler‘s pioneering work is often mentioned as the starting
point for such research. But this narrative neglects the
considerable contributions of scientists working within
Islamic states in medieval times. These Islamic scientists
did not only translate and preserve the work of the ancient
Greeks but made many adjustments and clarifications.
Most importantly, they also made their own discoveries.
Scientists such as Ibn-Ishaq, Al-Kindí, Avicenna and in
particular Alhazen made many important discoveries in
visual perception and cognitive psychology and had a
large influence on the scientists of the renaissance, including
Kepler. Alhazen‘s Book of Optics is undoubtedly one
of the greatest books on visual perception ever published.
Alhazen introduced how light from the sun is reflected
throughout the environment and enters the eye. Kepler‘s
well-known solution to the mystery of the retinal image
owes a considerable debt to Alhazens work through the
influence of western scientists who preceded Kepler and
had access to Alhazens work.
Keywords: History of psychology, Islamic psychology,
Perceptio
Complex regional pain syndrome, CRPS
Get PDFTo access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadVerkjaheilkennið er oftast í útlim með miklum hamlandi verkjum og
breyttri skynjun, oft með snertiviðkvæmni (allodyniu). Þroti er oft
samfara, ásamt litabreytingum á húð, breyttri svitamyndun og skertri
hreyfigetu. Einkennin eru raunar fjölþætt og mismunandi. Verkirnir eru
oftast til komnir eftir áverka og eru langt umfram upphaflega áverkann.
Sjúkdómurinn er fátíður, og taldist nýgengi hans vera um 5,5 á 100.000
íbúa í erlendri rannsókn. Nýgengi sjúkdómsins hér á landi í gagnagrunnum Embættis landlæknis reyndist vera 1,3 á hverja 100.000 íbúa á
ári sem vekur grun um að sjúkdómurinn gæti verið vangreindur.
Orsök sjúkdómsins er óþekkt. Talið er að um sé að ræða bólgusvörun
eftir áverka sem leiðir til sjálfsofnæmisviðbragða. Þá er einnig rætt
um verkjanæmingu í taugakerfinu. Bæði er um að ræða breytingar í
úttaugakerfi og í miðtaugakerfi, meðal annars með tilfærslu á virkni
svæða í heilaberki sem hafa að gera með sársaukaviðbrögð. Við greiningu er stuðst við skilmerki alþjóðafélagsins um verkjarannsóknir.
Þverfagleg teymisvinna er talin vera markvissasta meðferðin þar sem
unnið er eftir sálfélagslíkamlega módelinu. Einn þáttur í meðferð langt
gengins sjúkdóms er speglameðferð. Lyfjameðferð sjúkdómsins er
svipuð og við taugaverkjum. Vegna bólguviðbragða er hægt að nota
bólgueyðandi lyf eða stera. Einnig er ábending á bisfosfonöt, einkum ef
um beinþynningu er að ræða. NMDA-antagonistar eins og ketamín hafa
einnig verið notaðir. Þá hefur raförvun bakhorns mænu með rafstreng
virst gera gagn. Oftast gengur sjúkdómurinn yfir á nokkrum misserum,
en í hluta tilfella er hann þrálátur og hamlandi, jafnvel árum og áratugum saman.Complex regional pain syndrome, CRPS, occurs with severe disabling pain, usually in the
leg or hand, coupled with changes in pain perception, hyperesthesia and allodynia. There
is as well, edema, changes in the color of the skin, trophic changes, and dystonia. The pain
syndrome is often triggered by minor trauma. The pain perception is severe and out of
context with the initial trauma.
The syndrome is rare, occurring in a population-based study in the United States, with an
incidence of only 5.5 per hundred thousand people per year. The incidence in Iceland, from
the National Register of Diseases from the Directorate of Health, was 1.3 per annum, per
hundred thousand people.
The exact etiology of the disease is unknown. It is presumed that inflammation is the cause,
often resulting from an autoimmune reaction. The term pain sensitization is also used to
describe the pain mechanism, both in peripheral nerves and in the central nervous system.
There are changes and displacement of the area of the neocortex that is coupled with pain
perception. The criteria of the International Association for the Study of Pain (IASP) were the
basis for the diagnosis.
Interdisciplinary team management according to the biopsychosocial model is thought to be
the preferred treatment approach. The members of the team are occupational therapists,
physiotherapists, social workers, psychologists, nurses, and medical doctors, augmented
by other disciplines as needed. One treatment option is mirror therapy, where the diseased
extremity is held behind a mirror during the training and the patient observes movements
of the healthy extremity. Initially treatment is aimed at treating the inflammation, often with
NSAID drugs, or with steroids. Medical treatments are the same as apply for the treatment
of neural pain, with drugs such as Gabapentin, or anti depressive agents as duloxetine or
imipramine. There is an indication to use bisphosphonates such as alendronate, especially if
there is osteoporosis.
It is assumed that the function of the NMDA receptor has changed in the central nervous
system and treatment with intravenous ketamine, is an option. Spinal cord stimulation of the
dorsal horns of the spine has been effective as well.
In majority of cases the syndrome resolves in the first two years, but for the rest the
prognosis is dire, symptoms getting worse and persisting for years and even decades
Hsa-miR-21-3p associates with breast cancer patient survival and targets genes in tumor suppressive pathways.
Get PDFTo access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadBreast cancer is the cancer most often diagnosed in women. MicroRNAs (MIRs) are short RNA molecules that bind mRNA resulting in their downregulation. MIR21 has been shown to be an oncomiR in most cancer types, including breast cancer. Most of the effects of miR-21 have been attributed to hsa-miR-21-5p that is transcribed from the leading strand of MIR21, but hsa-miR-21-3p (miR-21-3p), transcribed from the lagging strand, is much less studied. The aim of the study is to analyze whether expression of miR-21-3p is prognostic for breast cancer. MiR-21-3p association with survival, clinical and pathological characteristics was analyzed in a large breast cancer cohort and validated in three separate cohorts, including TCGA and METABRIC. Analytical tools were also used to infer miR-21-3p function and to identify potential target genes and functional pathways. The results showed that in the exploration cohort, high miR-21-3p levels associated with shorter survival and lymph node positivity. In the three validation cohorts, high miR-21-3p levels associated with pathological characteristics that predict worse prognosis. Specifically, in the largest validation cohort, METABRIC (n = 1174), high miR-21-3p levels associated with large tumors, a high grade, lymph node and HER2 positivity, and shorter breast-cancer-specific survival (HR = 1.38, CI 1.13-1.68). This association remained significant after adjusting for confounding factors. The genes with expression levels that correlated with miR-21-3p were enriched in particular pathways, including the epithelial-to-mesenchymal transition and proliferation. Among the most significantly downregulated targets were MAT2A and the tumor suppressive genes STARD13 and ZNF132. The results from this study emphasize that both 3p- and 5p-arms from a MIR warrant independent study. The data show that miR-21-3p overexpression in breast tumors is a marker of worse breast cancer progression and it affects genes in pathways that drive breast cancer by down-regulating tumor suppressor genes. The results suggest miR-21-3p as a potential biomarker.This research was funded by grants to IR, RBB, BAA, OTJ and AdAr from the Icelandic Centre for Research (grant number 152530-051, www.rannis.is), The Scientific Fund of Landspitali – The National University Hospital in Iceland (grant numbers A-2016-033 and A-2019-042, www.landspitali.is), The Scientific Fund of The Icelandic Cancer Society (year 2017, www.krabb.is/english/), Gongum saman (https://gongumsaman.is/; years 2013 and 2017) and a grant to ArAm and IR from Gongum saman in 2018. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript
Long term effects of burn injury on health-related quality of life of adult burn survivors in Iceland: a descriptive cross-sectional study and validation of the Icelandic version of the Burn Specific Health Scale-Brief (BSHS-B)
No full textTo access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadTILGANGUR
Tilgangur rannsóknarinnar var að meta langtímaáhrif brunaáverka
á heilsu og heilsutengd lífsgæði fullorðinna og meta próffræðilega
eiginleika íslenskrar útgáfu matstækisins Burn Specific Health Scale-Brief
(BSHS-B).
EFNIVIÐUR OG AÐFERÐIR
Í þessari lýsandi þversniðsrannsókn var öllum 18 ára og eldri sem
brenndust á húð á barns- eða fullorðinsaldri, og dvöldu á Landspítala
í sólarhring eða lengur, á 15 ára tímabili, boðin þátttaka (N=196).
Þátttakendur svöruðu spurningalista um heilsu (BSHS-B), um heilsutengd
lífsgæði (EQ-5D-5), spurningum um brunatengd einkenni og um reynslu
sína af sjúkrahúsdvölinni.
NIÐURSTÖÐUR
Þátttakendur voru 66 (svarhlutfall 34%), karlar voru 77%, meðalaldur
var 45,7 ár (sf=18,3, spönn 18-82 ár) og meðalaldur við bruna 34,0
(sf=20,1, spönn 1-75) ár. Miðgildi tíma frá bruna var 11,5 ár (spönn 1-44)
og voru 32% þátttakenda yngri en 18 ára þegar þeir brenndust. Áhrif
bruna á heilsu samkvæmt kvörðum BSHS-B listans mældist á bilinu 4,4-
5,0 (miðgildi) og mældist heilsa (EQ-5Dvas) þeirra 80 (miðgildi, spönn
10-100). Þeir sem höfðu misst líkamshluta eða fengið húðágræðslu höfðu
neikvæðari líkamsímynd og þurftu að sinna meiri sjálfsumönnun en hinir
(p<0,05). Hópur brunasjúklinga glímir við íþyngjandi áhrif brunaslyssins,
svo sem kláða (48%), verki (37%), kvíða/þunglyndi (29%) og neikvæða
líkamsímynd (37%). Af þeim sem svöruðu spurningunni um hvað var
erfiðast að glíma við eftir útskrift, nefndu 67% þeirra skort á upplýsingum,
eftirliti og stuðningi. Íslensk þýðing BSHS-B spurningalistans reyndist
áreiðanleg en gera þarf frekari rannsóknir á réttmæti hans.
ÁLYKTUN
Meirihluti þátttakenda taldi sig hafa náð góðri heilsu eftir brunaslysið
og áleit lífsgæði sín ásættanleg. Þó glímir hluti hópsins við langvinnar
líkamlegar og sálfélagslegar afleiðingar brunans. Huga þarf að vönduðum
undirbúningi fyrir útskrift af sjúkrahúsi og byggja þarf upp heildræna og
þverfaglega heilbrigðisþjónustu sem felur í sér langtímaeftirlit, ráðgjöf og
stuðningOBJECTIVES: The aim of the study was to assess the long-term effects of burn injury on the healthrelated quality of life of adult burn survivors in Iceland and to validate the translated Icelandic version
of the Burn Specific Health Scale-Brief (BSHS-B).
MATERIALS AND METHODS: The participants of this descriptive cross-sectional study were all burn
survivors, 18 years or older, admitted to hospital for 24 hours or more because of skin burn during a 15
years period (N=196). They completed questionnaire about their health (BSHS-B), health related quality
of life (EQ-5D-5) and additional questions on burn-related symptoms and their burn experience.
RESULTS: Response rate was 34% (N=66). Men were 77%, mean age 45.7 years (sf=18.3 and range
18-82 years), mean age when burned was 34.0 (sf=20,1, range 1-75), median time from burn accident
was 11.5 years (range 1-44 years) and 32% had been burned when under 18 years of age. Burnspecific health was 4.4-4.0 (median) and health on the EQ5D-5vas scale was 80 (median, range
10-100). Those who lost a body part or had skin transplantation had more negative body image and
needed more selfcare than others (p<0.05). A significant proportion of participants reported physical
and psychosocial symptoms such as itch (48%), persistent pain (37%), anxiety/depression (29%) and
negative self-image (37%). Majority (67%) believed they did not get enough information, follow-up, or
support after discharge from hospital. The Icelandic version of the Burn Specific Health Scale-Brief
(BSHS-B) was reliable, but more research is needed to establish its validity.
CONCLUSION: These findings suggest that most Icelandic burn survivors report acceptable health and
health-related quality of life. The study identified a subgroup of survivors that experience persistent
physical and psychosocial symptoms. Team approach with holistic support after discharge, for a
prolonged period of time aiming at preventing physical and psychiatric morbidity, is recommendedRannsóknarsjóður Háskóla Ísland
Aftanlærismeiðsli og þjálfun. Rannsóknarrýni - Er Semitendinosus týndi hlekkurinn? Fyrri hluti
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