Landspítali University Hospital Research Archive
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Increase in the incidence of alcoholic pancreatitis and alcoholic liver disease in Iceland: impact of alcohol consumption.
No full textTo access publisher's full text version of this article click on the hyperlink belowObjective: To analyze the incidence of acute alcoholic pancreatitis and of severe alcoholic liver disease (ALD) and its association with per capita alcohol consumption with identification of both alcoholic cirrhosis (AC) and severe alcoholic hepatitis (AH), in a population-based setting.Methods: A search was undertaken in diagnoses database for diagnostic codes in order to find patients hospitalized with incident acute alcoholic pancreatitis (AP) and alcoholic liver disease in Iceland in 2001-2015. Diagnoses were verified in all patients who were retrospectively reviewed. Those with ALD had either AC or AH. Alcohol sales during the study period were obtained from Statistics Iceland.Results: Overall, 273 patients with acute AP, mean age at diagnosis 50 (14) years, 74% males and 159 patients with ALD, mean age 57 (11) years, 73% males, were identified. Mean per capita alcohol consumption was 6.95 (0.4) liters and increased by 21% over the study period. The annual incidence of AP increased from 4.2 per 100.000 to 9.5 and ALD from 1.6 to 6.1 per 100.000. Trend analysis showed a significant annual increase of 7% (RR 1.07, 95%CI 1.04-1.10) for AP and an annual increase of 10.5% (RR 1.10, 95%CI 1.06-1.15) for ALD. The increase was only significant in males.Conclusions: Increase per capita alcohol consumption over a 15 year study period was associated with an increase in the incidence of severe alcoholic liver disease and alcohol-related acute pancreatitis in males but not in females
Occlusion of the vertebrobasilar artery. Case presentation and literature review
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 DownloadHér er lýst sjúkratilfelli 22 ára gamallrar hraustrar konu sem komið
var með meðvitundarlausa á bráðamóttöku Landspítala sumarið
2018. Tölvusneiðmynd af heila við komu sýndi stórt drep í litla heila
hægra megin og mikinn bjúg sem þrengdi að fjórða heilahólfi. Æðamynd við komu vakti grun um flysjun í vinstri hryggslagæð og lokun
botnslagæðar sem var staðfest síðar við innæðameðferð. Hafin var
segaleysandi meðferð en síðan farið í segabrottnám og fékkst góð
enduropnun æðar. Daginn eftir fór hún í skurðaðgerð vegna illvígs
dreps í litla heila. Henni farnaðist vel og skoraði 1 stig á endurbættum Rankin-kvarða 90 dögum eftir úrskrift af sjúkrahúsi.This paper is a case report of a 22 year old, previously healthy
woman that presented comatose to the Emergency Room
at Landspitali University Hospital Iceland. A CT image of the
head on admission revealed a large right cerebellar infarct
with oedema compressing the fourth ventricle. A CT angiogram on admission was suspicious for a dissection of the
left vertebral artery (confirmed during endovascular treatment)
and a total occlusion of the distal third of the basilar artery.
Thrombolytic therapy with t-PA was initiated followed by
thrombectomy with good recanalization. The following day
the patient underwent suboccipital craniotomy for malignant
cerebellar infarction. She made a good clinical recovery to a
modified Ranking scale of 1 at 90 days after discharge from
the hospital. Following the case is a literature review on the
clinical aspects of occlusion of the vertebrobasilar system,
use and utility of imaging and treatment with (anticoagulation,
IV and IA thrombolysis) modalities that have been tried.
Finally, the evidence regarding thrombectomy and the role of
craniotomy for malignant stroke are reviewed
Are symptoms of insomnia related to respiratory symptoms? Cross-sectional results from 10 European countries and Australia.
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 DownloadObjectives: To compare the prevalence of different insomnia subtypes among middle-aged adults from Europe and Australia and to explore the cross-sectional relationship between insomnia subtypes, respiratory symptoms and lung function.
Design: Cross-sectional population-based, multicentre cohort study.
Setting: 23 centres in 10 European countries and Australia.
Methods: We included 5800 participants in the third follow-up of the European Community Respiratory Health Survey III (ECRHS III) who answered three questions on insomnia symptoms: difficulties falling asleep (initial insomnia), waking up often during the night (middle insomnia) and waking up early in the morning and not being able to fall back asleep (late insomnia). They also answered questions on smoking, general health and chronic diseases and had the following lung function measurements: forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and the FEV1/FVC ratio. Changes in lung function since ECRHS I about 20 years earlier were also analysed.
Main outcome measures: Prevalence of insomnia subtypes and relationship to respiratory symptoms and function.
Results: Overall, middle insomnia (31.2%) was the most common subtype followed by late insomnia (14.2%) and initial insomnia (11.2%). The highest reported prevalence of middle insomnia was found in Iceland (37.2%) and the lowest in Australia (22.7%), while the prevalence of initial and late insomnia was highest in Spain (16.0% and 19.7%, respectively) and lowest in Denmark (4.6% and 9.2%, respectively). All subtypes of insomnia were associated with significantly higher reported prevalence of respiratory symptoms. Only isolated initial insomnia was associated with lower FEV1, whereas no association was found between insomnia and low FEV1/FVC ratio or decline in lung function.
Conclusion: There is considerable geographical variation in the prevalence of insomnia symptoms. Middle insomnia is most common especially in Iceland. Initial and late insomnia are most common in Spain. All insomnia subtypes are associated with respiratory symptoms, and initial insomnia is also associated with lower FEV1.
Keywords: insomnia; respiratory symptoms; sleep medicine.National Health and Medical Research Council of Australia
Belgium: Antwerp South, Antwerp City: Research Foundation Flanders (FWO)
Estonia: Estonian Ministry of Education
France: Ministere de la Sante. Programme Hospitalier de Recherche Clinique (PHRC) national 2010
Bordeaux: INSERM U897 Universite Bordeaux segalen
Grenoble: Comite Scientifique AGIRadom 2011
Paris: Agence Nationale de la Sante, Region Ile de France, domaine d'interet majeur (DIM)
Germany: Erfurt: German Research Foundation
Germany: Hamburg: German Research Foundation
Iceland: Reykjavik: The Landspitali University Hospital Research Fund
Iceland: University of Iceland Research Fund
Iceland: ResMed Foundation, California, USA
Iceland: Orkuveita Reykjavikur (Geothermal plant)
Iceland: Vegageroin (The Icelandic Road Administration (ICERA)
Icelandic Research found
Italy: Italian Ministry of Health
Italy: Chiesi Farmaceutici SpA
Fondazione Cariverona
Education Ministry (MIUR)
Norway: Norwegian Research council
Norway: Western Norway Regional Health Authorities
Norway: Bergen Medical Research Foundation
Spain: Fondo de Investigacion Sanitaria
Spain: Servicio Andaluz de Salud
Spain: Sociedad Espanola de Neumologia y Cirurgia Toracica
Sweden: Swedish Heart and Lung Foundation
Sweden: Swedish Asthma and Allergy Association
Sweden: Swedish Association against Lung and Heart Disease
Sweden: Fondo de Investigacion Sanitaria
Barcelona: Fondo de Investigacion Sanitaria
Galdakao: Fondo de Investigacion Sanitaria
Huelva: Fondo de Investigacion Sanitaria
Servicio Andaluz de Salud Oviedo: Fondo de Investigacion Sanitaria
Swedish Research Council for health, working life and welfare (FORTE)
Swedish Research Council
Swedish Research Council for Health Working Life & Welfare (Forte)
Vasterbotten Country Council ALF grant
Swiss National Science Foundation (SNSF)
Switzerland: Federal Office for Forest, Environment and Landscape
Switzerland: Federal Office of Public Health
Switzerland: Federal Office of Roads and Transport
Switzerland: Canton's Government of Aargan
Switzerland: Canton's Government of Basel--Stadt
Switzerland: Canton's Government of Basel--Land
Switzerland: Canton's Government of Geneva
Switzerland: Canton's Government of Luzern
Switzerland: Canton's Government of Ticino
Switzerland: Canton's Government of Valais
Switzerland: Canton's Government of Zurich
Switzerland: Swiss Lung League
Switzerland: Canton's Lung League of Basel Stadt/Basel
Switzerland: Canton's Lung League of Landschaft
Switzerland: Canton's Lung League of Geneva
Switzerland: Canton's Lung League of Ticino
Switzerland: Canton's Lung League of Valais
Switzerland: Canton's Lung League of Zurich
Switzerland: SUVA
Switzerland: Freiwillige Akademische Gesellschaft
Switzerland: UBS Wealth Foundation
Switzerland: Talecris Biotherapeutics GmbH
Switzerland: Abbott Diagnostics
Switzerland: European Commission
Switzerland: Wellcome Trust
Medical Research Council UK (MRC)
National Institute for Health Research through the Primary Care Research Networ
Ashwagandha as a cause for liver injury.
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Feasibility of ActivABLES to promote home-based exercise and physical activity of community-dwelling stroke survivors with support from caregivers: A mixed methods study.
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: Technical applications can promote home-based exercise and physical activity of community-dwelling stroke survivors. Caregivers are often able and willing to assist with home-based exercise and physical activity but lack the knowledge and resources to do so. ActivABLES was established to promote home-based exercise and physical activity among community-dwelling stroke survivors, with support from their caregivers. The aim of our study is to investigate the feasibility of ActivABLES in terms of acceptability, demand, implementation and practicality.
Methods: A convergent design of mixed methods research in which quantitative results were combined with personal experiences of a four-week use of ActivABLES by community-dwelling stroke survivors with support from their caregivers. Data collection before, during and after the four-week period included the Berg Balance Scale (BBS), Activities-Specific Balance Confidence Scale (ABC), Timed-Up-and-Go (TUG) and Five Times Sit to Stand Test (5xSST) and data from motion detectors. Semi-structured interviews were conducted with stroke survivors and caregivers after the four-week period. Descriptive statistics were used for quantitative data. Qualitative data was analysed with direct content analysis. Themes were identified related to the domains of feasibility: acceptability, demand, implementation and practicality. Data was integrated by examining any (dis)congruence in the quantitative and qualitative findings.
Results: Ten stroke survivors aged 55-79 years participated with their informal caregivers. Functional improvements were shown in BBS (+ 2.5), ABC (+ 0.9), TUG (- 4.2) and 5xSST (- 2.7). More physical activity was detected with motion detectors (stand up/sit down + 2, number of steps + 227, standing + 0.3 h, hours sitting/lying - 0.3 h). The qualitative interviews identified themes for each feasibility domain: (i) acceptability: appreciation, functional improvements, self-initiated activities and expressed potential for future stroke survivors; (2) demand: reported use, interest in further use and need for follow-up; (3) implementation: importance of feedback, variety of exercises and progression of exercises and (4) practicality: need for support and technical problems. The quantitative and qualitative findings converged well with each other and supported the feasibility of ActivABLES.
Conclusions: ActivABLES is feasible and can be a good asset for stroke survivors with slight or moderate disability to use in their homes. Further studies are needed with larger samples.NordForsk ActivABLES project
Icelandic Physiotherapy Association
Icelandic Ministry of Welfar
Liver injury caused by oral anticoagulants: A population-based retrospective cohort study.
No full textTo access publisher's full text version of this article click on the hyperlink belowBackground & aims: Idiosyncratic drug-induced liver injury (DILI) is a rare adverse event. DILI caused by direct oral anticoagulants (DOACs) has been reported, however, data on the risk of DILI are limited. The aim of the study was to evaluate the frequency of DILI caused by oral anticoagulants (OACs) in a population-based setting.
Methods: A computerized database search in The National Prescription Database was performed identifying all patients in Iceland who were prescribed OACs (rivaroxaban, apixaban, dabigatran, edoxaban or warfarin) in 2008-2017. Personal identification numbers of these patients were linked with a database containing laboratory results for all hospitals and most outpatient clinics in Iceland. A medical chart review was performed in all cases where onset of liver injury followed intake of OACs. Patients with other specific causes of liver injury were excluded. Causality assessment with the RUCAM method was undertaken in cases with suspected DILI.
Results: Three cases of suspected DILI were identified. In all cases, rivaroxaban was the implicated agent among patients prescribed this product (n = 3446). All were women with a hepatocellular type of liver injury. One patient developed a suspected drug-induced autoimmune hepatitis and was treated with corticosteroids. No cases of DILI in patients on warfarin (n = 9101), apixaban (n = 1903), dabigatran (n = 1335) and edoxaban (n = 34) were identified.
Conclusions: Rivaroxaban was the only OAC associated with DILI during the 10-year study period. Approximately 1 in 1100 patients treated with rivaroxaban developed DILI. Other OACs were not associated with liver injury in this population-based study.
Keywords: anticoagulation; drug reactions; hepatotoxicity.Landspitali University Hospita
Association between lung function decline and obstructive sleep apnoea: the ALEC study.
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 DownloadPurpose: To study changes in lung function among individuals with a risk of obstructive sleep apnoea (OSA), and if asthma affected this relationship.
Methods: We used data from the European Community Respiratory Health Survey II and III, a multicentre general population study. Participants answered questionnaires and performed spirometry at baseline and 10-year follow-up (n = 4,329 attended both visits). Subjects with high risk for OSA were identified from the multivariable apnoea prediction (MAP) index, calculated from BMI, age, gender, and OSA symptoms at follow-up. Asthma was defined as having doctor's diagnosed asthma at follow-up. Primary outcomes were changes in forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) from baseline to follow-up.
Results: Among 5108 participants at follow-up, 991 (19%) had a high risk of OSA based on the MAP index. Participants with high OSA risk more often had wheeze, cough, chest tightness, and breathlessness at follow-up than those with low OSA risk. Lung function declined more rapidly in subjects with high OSA risk (low vs high OSA risk [mean ± SD]: FEV1 = - 41.3 ± 24.3 ml/year vs - 50.8 ± 30.1 ml/year; FVC = - 30.5 ± 31.2 ml/year vs - 45.2 ± 36.3 ml/year). Lung function decline was primarily associated with higher BMI and OSA symptoms. OSA symptoms had a stronger association with lung function decline among asthmatics, compared to non-asthmatics.
Conclusion: In the general population, a high probability of obstructive sleep apnoea was related to faster lung function decline in the previous decade. This was driven by a higher BMI and more OSA symptoms among these subjects. The association between OSA symptoms and lung function decline was stronger among asthmatics.
Keywords: Asthma; Lung function; Lung function decline; Sleep apnoea.Uppsala University
European Union (EU
Beating the odds with systematic individualized care: Nationwide prospective follow-up of all patients with COVID-19 in Iceland.
No full textTo access publisher's full text version of this article click on the hyperlink belowThe current pandemic of a novel coronavirus disease 2019 (COVID‐19) began in December 2019 in Wuhan, China, and has since spread worldwide. Pandemic preparedness has been an ongoing project in Iceland since the Severe Acute Respiratory Syndrome (SARS) epidemic in 2003‐2004. In mid‐January 2020, The Directorate of Health (DOH) and The Department of Civil Protection and Emergency Management (DCPEM) revised the current pandemic preparedness response plan. The DOH and DCPEM, in close collaboration with the Department of Clinical Microbiology and Internal Medicine Services at Landspitali–The National University Hospital (LUH) and deCODE genetics, initiated a nationwide surveillance program for COVID‐19, including diagnostic testing which began on 31 January. A report on the extensive screening efforts in Iceland has recently been published
GWAS of thyroid stimulating hormone highlights pleiotropic effects and inverse association with thyroid cancer.
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 DownloadThyroid stimulating hormone (TSH) is critical for normal development and metabolism. To better understand the genetic contribution to TSH levels, we conduct a GWAS meta-analysis at 22.4 million genetic markers in up to 119,715 individuals and identify 74 genome-wide significant loci for TSH, of which 28 are previously unreported. Functional experiments show that the thyroglobulin protein-altering variants P118L and G67S impact thyroglobulin secretion. Phenome-wide association analysis in the UK Biobank demonstrates the pleiotropic effects of TSH-associated variants and a polygenic score for higher TSH levels is associated with a reduced risk of thyroid cancer in the UK Biobank and three other independent studies. Two-sample Mendelian randomization using TSH index variants as instrumental variables suggests a protective effect of higher TSH levels (indicating lower thyroid function) on risk of thyroid cancer and goiter. Our findings highlight the pleiotropic effects of TSH-associated variants on thyroid function and growth of malignant and benign thyroid tumors.United States Department of Health & Human Services
National Institutes of Health (NIH) - USA
United States Department of Health & Human Services
National Institutes of Health (NIH) - USA
NIH National Human Genome Research Institute (NHGRI)
Medical Research Council Integrative Epidemiology Unit at the University of Bristol
United States Department of Health & Human Services
National Institutes of Health (NIH) - USA
University of Michigan System
Research Council of Norway
Liaison Committee for Education, Research and Innovation in Central Norway
St Olav's Hospital
Faculty of Medicine and Health Sciences, NTN
Promoter CpG Density Predicts Downstream Gene Loss-of-Function Intolerance.
No full textTo access publisher's full text version of this article click on the hyperlink belowThe aggregation and joint analysis of large numbers of exome sequences has recently made it possible to derive estimates of intolerance to loss-of-function (LoF) variation for human genes. Here, we demonstrate strong and widespread coupling between genic LoF intolerance and promoter CpG density across the human genome. Genes downstream of the most CpG-rich promoters (top 10% CpG density) have a 67.2% probability of being highly LoF intolerant, using the LOEUF metric from gnomAD. This is in contrast to 7.4% of genes downstream of the most CpG-poor (bottom 10% CpG density) promoters. Combining promoter CpG density with exonic and promoter conservation explains 33.4% of the variation in LOEUF, and the contribution of CpG density exceeds the individual contributions of exonic and promoter conservation. We leverage this to train a simple and easily interpretable predictive model that outperforms other existing predictors and allows us to classify 1,760 genes-which are currently unascertained in gnomAD-as highly LoF intolerant or not. These predictions have the potential to aid in the interpretation of novel variants in the clinical setting. Moreover, our results reveal that high CpG density is not merely a generic feature of human promoters but is preferentially encountered at the promoters of the most selectively constrained genes, calling into question the prevailing view that CpG islands are not subject to selection.
Keywords: CpG density; CpG islands; GC content; dosage sensitivity; epigenetics; gnomAD; haploinsufficiency; loss-of-function; promoters; selection.United States Department of Health & Human Services
National Institutes of Health (NIH) - USA
NIH National Institute of General Medical Sciences (NIGMS)
Maryland Genetics, Epidemiology, and Medicine (MD-GEM) training program - Burroughs Wellcome Fund
Louma G. Foundatio