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Genetic predisposition to hypertension is associated with preeclampsia in European and Central Asian women.
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 DownloadPreeclampsia is a serious complication of pregnancy, affecting both maternal and fetal health. In genome-wide association meta-analysis of European and Central Asian mothers, we identify sequence variants that associate with preeclampsia in the maternal genome at ZNF831/20q13 and FTO/16q12. These are previously established variants for blood pressure (BP) and the FTO variant has also been associated with body mass index (BMI). Further analysis of BP variants establishes that variants at MECOM/3q26, FGF5/4q21 and SH2B3/12q24 also associate with preeclampsia through the maternal genome. We further show that a polygenic risk score for hypertension associates with preeclampsia. However, comparison with gestational hypertension indicates that additional factors modify the risk of preeclampsia.European Union (EU)
Wellcome Trus
Science and health care system - the importance of The Icelandic Medical Journal
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Revolutionary vaccine development
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Indications and outcomes of TAVI (transcatheter aortic valve implantation) in Iceland
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 DownloadINNGANGUR
Ósæðarlokuþrengsl eru algengasti lokusjúkdómurinn á Vesturlöndum. Hefðbundin meðferð við alvarlegum þrengslum hefur verið opin
ósæðarlokuskipti en síðastliðin ár hefur ósæðarlokuísetning með
þræðingartækni (TAVI) rutt sér til rúms hér á landi sem erlendis. Markmið rannsóknarinnar var að kanna árangur TAVI-aðgerða á Íslandi með
áherslu á ábendingar, fylgikvilla og lifun.
EFNIVIÐUR OG AÐFERÐIR
Rannsóknin var afturskyggn og tók til allra TAVI-aðgerða sem framkvæmdar hafa verið á Íslandi frá janúar 2012 til loka júní 2020. Skráðir
voru bakgrunnsþættir sjúklinga, afdrif og fylgikvillar en einnig heildarlifun sem borin var saman við íslenskt viðmiðunarþýði af sama kyni og
aldri. Meðal eftirfylgd var 2,4 ár.
NIÐURSTÖÐUR
Alls voru framkvæmdar 189 aðgerðir (meðalaldur 83 ± 6 ár, 41,8%
konur), allar með sjálfþenjandi lífrænni gerviloku. Flestir sjúklingar
(81,5%) höfðu alvarleg hjartabilunareinkenni (NYHA-flokkar III-IV) og
miðgildi EuroSCORE-II var 4,9 (bil 0,9-32). Á hjartaómskoðun fyrir
aðgerð var hámarks þrýstingsfallandi að meðaltali 78 mmHg og
lokuflatarmál 0,67 cm2
. Rúmlega fjórðungur (26,5%) sjúklinga þurfti
ísetningu varanlegs gangráðs í kjölfar TAVI-aðgerðar. Aðrir fylgikvillar
voru oftast æðatengdir (13,8%), en hjartaþröng greindist í 3,2% tilfella og
heilablóðfall í 2,6%. . Mikill randstæður leki við gerviloku sást hjá 0,5%
sjúklinga. Dánartíðni innan 30 daga frá aðgerð var 1,6% (n=3) og lifun
einu ári frá aðgerðadegi 93,5% (95% ÖB: 89.8-97.3). Heildarlifun var sambærileg lifun viðmiðunarþýðis af sama kyni og sama aldri (p=0,23).
ÁLYKTANIR
Árangur TAVI-aðgerða hér á landi er mjög góður, ekki síst þegar litið er
til lágrar 30 daga dánartíðni og heildarlifunar sem var sambærileg og
hjá viðmiðunarþýði. Auk þess var tíðni alvarlegra fylgikvilla lág.INTRODUCTION: Surgical aortic valve replacement (SAVR) has been the standard of
treatment for aortic stenosis but transcatheter aortic valve implantation (TAVI) is increasingly
used as treatment in Iceland and elsewhere. Our objective was to assess the outcome of TAVI
in Iceland, focusing on indications, complications and survival.
MATERIAL AND METHODS: This retrospective study included all TAVI-procedures performed
in Iceland between January 2012 and June 2020. Patient characteristics, outcome and
complications were registered, and overall estimated survival compared to an age and sex
matched Icelandic reference-population. The mean follow-up was 2.4 years.
RESULTS: Altogether 189 TAVI procedures (mean age 83±6 years, 41.8% females), were
performed, all with a self-expanding biological valve. Most patients (81.5%) had symptoms of
severe heart failure (NYHA-class III-IV) and median EuroSCORE-II was 4.9 (range: 0.9-32).
Echocardiography pre-TAVI showed a mean aortic-valve area of 0.67 cm2
and a max aorticvalve gradient of 78 mmHg. One out of four patients (26.5%) needed permanent pacemaker
implantation following TAVI. Other complications were mostly vascular-related (13.8%) but
cardiac cardiac temponade and stroke occurred in 3.2 and 2.6% of cases, respectively and
severe paravalvular aortic valve regurgitation in 0.5% cases. Thirty-day mortality was 1.6%
(n=3) with one-year survival of 93.5% (95% CI: 89.8-97.3). Finally long-term survival survival of
TAVI-patients was similar to the matched reference population (p=0.23).
CONCLUSIONS: The outcome of TAVI-procedures in Iceland is good, especially regarding
30-day mortality and long-term survival that was comparable to a reference population.
Incidence of major complications was also low
Stofnfrumuígræðsla — meðferð í hraðri framþróun
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 DownloadCAST (Cellterapier och Allogen Stamcellstransplantation) er sérstakt svið innan Karolinska háskólasjúkrahússinsí Stokkhólmisem einblínir á ýmsar gerðir frumumeðferðar fyrirsjúklinga frá
3 mánaða upp í 75 ára. Sviðið skiptistí legudeild og göngudeild. Stofnfrumuígræðsla hefur verið
meginþáttur þeirrar meðferðarsem fram hefurfarið á sviðinu en aðrartegundirfrumumeðferðar
hafa verið að ryðja sér rúms, eins og CAR-T frumumeðferð, og munu að öllum líkindum verða
stærri hluti af þeim meðferðarúrræðum sem í boði verða fyrirsjúklinga í framtíðinni
Non-invasive structural and metabolic retinal markers of disease activity in non-proliferative diabetic retinopathy.
No full textTo access publisher's full text version of this article click on the hyperlink belowPurpose: Metabolic and structural microvascular retinal alterations are essential components in diabetic retinopathy (DR). The present study aimed to measure changes at different stages of non-proliferative DR (NPDR) and to explore interactions of imaging-based metrics.
Methods: This cross-sectional, cohort study included 139 eyes from 80 diabetic patients. Each patient underwent dilated fundal examinations including colour fundus photography, retinal oximetry and optical coherence tomography angiography (OCTA), analysed by semi-automated and automated software. Diabetic retinopathy (DR) severity was classified according to the International Clinical Diabetic Retinopathy (ICDR) Severity Scale, ranging from no DR to severe NPDR (level 0-3). Retinal metabolism was evaluated by oximetry as retinal arteriolar (raSatO2 ) and venular oxygen saturation (rvSatO2 ), and macular microvascular structure was measured by OCTA as the area of foveal avascular zone (FAZ), vessel density (VD), vessel diameter index (VDI), FAZ circularity and fractal dimension (FD) in the superficial and deep retinal capillary plexus.
Results: A trend for increasing rvSatO2 was found with increasing DR severity (51.3%, 53.3%, 54.2%, 59.8%, p = 0.02). Increasing severity of DR associated with decreasing FD in the superficial and deep plexus (p < 0.001 and p = 0.014), and in the superficial plexus decreasing VD (p < 0.001), increasing VDI (p = 0.003) and decreasing FAZ circularity (p = 0.006). A few interactions were identified between raSatO2 , rvSatO2 and VDI, but only in the deep capillary plexus (p < 0.01 and p < 0.01).
Conclusion: Alterations of the venular retinal vascular oxygen saturation and microvascular structural abnormities were found continuously throughout the DR-spectrum. Given the sparse correlations between metabolic and structural abnormalities, it seems that these occur independently in DR.
Keywords: diabetes; diabetic retinopathy; non-proliferative diabetic retinopathy; optical coherence tomography angiography; retinal oximetry.Odense University Hospital
University of Southern Denmark
A. P. Moller Foundation for the Advancement of Medical Science
OPEN, Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
Belfast Reading Centre
Royal Victoria Hospita
How do we use biologics in rheumatoid arthritis patients with a history of malignancy? An assessment of treatment patterns using Scandinavian registers.
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FOREU
Suicide rates in Iceland before and after the 2008 Global Recession: a nationwide population-based study.
No full textTo access publisher's full text version of this article click on the hyperlink belowBackground: Economic downturns have been associated with increased suicide rates. The 2008 global financial crisis varied across countries but hit Iceland relatively hard. We aimed to study potential changes in suicide rates in Iceland during this major economic transition.
Methods: Data were retrieved on all suicides in Iceland during 2002-14. The study period was divided into a pre-collapse period (2002-08) and a post-collapse period (2008-14). Poisson regression models were used to estimate the association between pre-to-post economic collapse and suicide rates, expressed as risk ratios (RR) with 95% confidence intervals (CIs). Analyses were stratified by age and sex.
Results: A total of 470 suicides were recorded during the study period. The mean age at death was 45 years and 75% were males. The overall suicide rates per 100 000 were 13.3 pre-collapse and 15 post-collapse revealing no overall differences in pre-to-post collapse (RR 1.12; CI 0.94-1.35). This was true for both men and women (RR 1.18; CI 0.96-1.46 and RR 0.96; CI 0.67-1.38, respectively). An increase in the unemployment rate was not associated with the overall suicide rate (RR 1.07; CI 0.86-1.33), and neither were changes in gross domestic product (RR 1.29; CI 0.94-1.79) or balance of trade (RR 1.08; CI 0.96-1.22).
Conclusion: The economic collapse and rising unemployment rates in Iceland did not result in an overall increase in suicide rates. A strong welfare system and investing in social protection during the economic crisis may have mitigated suicide risk.Rannis-Icelandic Research fund
University of Iceland Research fun
Regular Physical Activity Levels and Incidence of Restrictive Spirometry Pattern: A Longitudinal Analysis of 2 Population-Based Cohorts.
No full textTo access publisher's full text version of this article click on the hyperlink belowWe estimated the association between regular physical activity and the incidence of restrictive spirometry pattern. Forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and physical activity were assessed in 2 population-based European cohorts (European Community Respiratory Health Survey: n = 2,757, aged 39-67 years; and Swiss Study on Air Pollution and Lung and Heart Diseases in Adults: n = 2,610, aged 36-82 years) first in 2000-2002 and again approximately 10 years later (2010-2013). Subjects with restrictive or obstructive spirometry pattern at baseline were excluded. We assessed the association of being active at baseline (defined as being physically active at least 2-3 times/week for ≥1 hour) with restrictive spirometry pattern at follow-up (defined as a postbronchodilation FEV1/FVC ratio of at least the lower limit of normal and FVC of <80% predicted) using modified Poisson regression, adjusting for relevant confounders. After 10 years of follow-up, 3.3% of participants had developed restrictive spirometry pattern. Being physically active was associated with a lower risk of developing this phenotype (relative risk = 0.76, 95% confidence interval: 0.59, 0.98). This association was stronger among those who were overweight and obese than among those of normal weight (P for interaction = 0.06). In 2 large European studies, adults practicing regular physical activity were at lower risk of developing restrictive spirometry pattern over 10 years.
Keywords: BMI; FVC; physical activity; restrictive spirometry; spirometry.Ageing Lungs in European Cohorts (ALEC) Study from the European Union's Horizon 2020 research and innovation program
National Science Foundation (NSF
The Expiry of Humira Market Exclusivity and the Entry of Adalimumab Biosimilars in Europe: An Overview of Pricing and National Policy Measures.
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 DownloadBackground: From October 2018, adalimumab biosimilars could enter the European market. However, in some countries, such as Netherlands, high discounts reported for the originator product may have influenced biosimilar entry. Objectives: The aim of this paper is to provide a European overview of (list) prices of originator adalimumab, before and after loss of exclusivity; to report changes in the reimbursement status of adalimumab products; and discuss relevant policy measures. Methods: Experts in European countries received a survey consisting of three parts: 1) general financing/co-payment of medicines, 2) reimbursement status and prices of originator adalimumab, and availability of biosimilars, and 3) policy measures related to the use of adalimumab. Results: In May 2019, adalimumab biosimilars were available in 24 of the 30 countries surveyed. Following introduction of adalimumab biosimilars, a number of countries have made changes in relation to the reimbursement status of adalimumab products. Originator adalimumab list prices varied between countries by a factor of 2.8 before and 4.1 after loss of exclusivity. Overall, list prices of originator adalimumab decreased after loss of exclusivity, although for 13 countries list prices were unchanged. When reported, discounts/rebates on originator adalimumab after loss of exclusivity ranged from 0% to approximately 26% (Romania), 60% (Poland), 80% (Denmark, Italy, Norway), and 80-90% (Netherlands), leading to actual prices per pen or syringe between €412 (Finland) and €50 - €99 (Netherlands). To leverage competition following entry of biosimilar adalimumab, only a few countries adopted measures specifically for adalimumab in addition to general policies regarding biosimilars. In some countries, a strategy was implemented even before loss of exclusivity (Denmark, Scotland), while others did not report specific measures. Conclusion: Even though originator adalimumab is the highest selling product in the world, few countries have implemented specific policies and practices for (biosimilar) adalimumab. Countries with biosimilars on the market seem to have competition lowering list or actual prices. Reported discounts varied widely between countries.KU Leuven
Fund on Market Analysis of Biologics and Biosimilars following Loss of Exclusivity (MABEL