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[Chronic coronary syndrome - new ESC guidelines]. 慢性冠状动脉综合征——新的ESC指南。
Lakartidningen Pub Date : 2025-08-11
Kasper Andersen, Sara Bentzel, Ellinor Bergdahl, Josef Dankiewicz, Ludvig Elfwén, Elin Falås, Moa Simonsson, Anna Holm
{"title":"[Chronic coronary syndrome - new ESC guidelines].","authors":"Kasper Andersen, Sara Bentzel, Ellinor Bergdahl, Josef Dankiewicz, Ludvig Elfwén, Elin Falås, Moa Simonsson, Anna Holm","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The European Society of Cardiology has released new 2024 guidelines on chronic coronary syndrome. These guidelines emphasize that patients with this condition should be actively assessed and treated to reduce the risk of future events. Key updates include the introduction of a risk factor-based clinical probability model to aid in this process. Furthermore, the guidelines stress that coronary CT angiography is recommended as the first-line diagnostic method for patients with a low to moderate probability of coronary artery disease. In cases of moderate to high probability, functional tests such as stress echocardiography, PET-CT, or perfusion MRI are advised, depending on availability. The guidelines recommend that all patients with chronic coronary artery disease receive high-intensity lipid-lowering treatment, with a target LDL level of less than 1.4 mmol/L. For patients with non-obstructive coronary artery disease who continue to experience persistent angina pectoris, further investigation of the microcirculation is recommended.</p>","PeriodicalId":17988,"journal":{"name":"Lakartidningen","volume":"122 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144817053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[An updated review of The Swedish National Patient Register as a data source]. [对瑞典国家患者登记作为数据来源的最新回顾]。
Lakartidningen Pub Date : 2025-08-08
Ola Olén, Åsa H Everhov
{"title":"[An updated review of The Swedish National Patient Register as a data source].","authors":"Ola Olén, Åsa H Everhov","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The Swedish National Patient Register (NPR) is vital for epidemiological research. A 2010 review assessed the validity of inpatient diagnoses, but outpatient data were excluded. A recent review in the European Journal of Epidemiology examined validation studies for inpatient diagnoses post-2010 and outpatient data since 2001. Across 89 publications, median positive predictive value (PPV) was 84% for diagnoses (range: 18-100%) and 97% for surgical codes. Sensitivity was lower, median 73% (range: 45-80%). PPV and sensitivity varied depending on diagnosis, coding, reference standard, and data source. Different diagnostic criteria are needed depending on research question. Combining NPR with other registers can enhance accuracy. Limitations include incomplete outpatient data in early years, gaps in private healthcare reporting, and insufficient coverage of certain medical codes. Despite this, the NPR remains a reliable and central data source for medical research when limitations are considered.</p>","PeriodicalId":17988,"journal":{"name":"Lakartidningen","volume":"122 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144799520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Familial hyperkalemic hypertension - a case report with patients in three generations]. [家族性高钾血症高血压——三代患者一例报告]。
Lakartidningen Pub Date : 2025-08-05
Mikael Oscarson, Lisa Juntti-Berggren
{"title":"[Familial hyperkalemic hypertension - a case report with patients in three generations].","authors":"Mikael Oscarson, Lisa Juntti-Berggren","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Recent advancements in sequencing technologies have enabled both the identification of many monogenic diseases and the development of precision medicine, enabling tailored therapies for many patients. This case presentation describes four patients across three generations diagnosed with hyperkalemia of unclear origin. Genetic testing revealed a pathogenic variant in the KLHL3 gene, linked to familial hyperkalemic hypertension. Treatment with hydrochlorothiazide essentially normalised the potassium levels for all patients, and the oldest patient, with a resistant hypertension since a young age, had a dramatic improvement in blood pressure. This case underscores the importance of a detailed family history combined with genetic testing, which can lead to tailored and effective treatments.</p>","PeriodicalId":17988,"journal":{"name":"Lakartidningen","volume":"122 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144789510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Gas embolism during endoscopic procedures]. [内窥镜手术中的气体栓塞]。
Lakartidningen Pub Date : 2025-08-05
Marcus Fredriksson Sundbom, Anna Molin, Roberto Valente, Roman A'roch
{"title":"[Gas embolism during endoscopic procedures].","authors":"Marcus Fredriksson Sundbom, Anna Molin, Roberto Valente, Roman A'roch","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Endoscopic retrograde cholangiopancreatography (ERCP) is associated with gas embolism, which is often fatal when observed through clinical signs. Here we report the only case, to our knowledge, of a survivor of paradoxal gas embolism with a patent foramen ovale during ERCP. The patient suffered respiratory collapse with unmeasurable end-tidal carbon dioxide and severe hypoxemia. Total circulatory collapse was imminent, as demonstrated by severe hypotension and bradycardia with prominent S-T depressions on ECG. Transesophageal echocardiography (TEE) showed massive amounts of biventricular gas bubbles and a patent foramen ovale. After resuscitation with epinephrine, norepinephrine, crystalloid fluid boluses and a 100% fraction of inspired oxygen the patient's condition improved, and he was transferred to the intensive care unit. Repeat TEE showed that the gas bubbles had disappeared, and the patient was extubated that same evening. No neurological deficits were found before discharge. We want to highlight the importance of keeping gas embolism in mind when performing endoscopic procedures.</p>","PeriodicalId":17988,"journal":{"name":"Lakartidningen","volume":"122 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144789511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Increased use of antipsychotics to children and adolescents - monitoring of effect and safety is needed]. [增加儿童和青少年抗精神病药物的使用——需要监测其效果和安全性]。
Lakartidningen Pub Date : 2025-08-05
Elin Dahlén, Anders Sundström, Sverre Wikström, Ida Walles, Håkan Jarbin, Elin Kimland
{"title":"[Increased use of antipsychotics to children and adolescents - monitoring of effect and safety is needed].","authors":"Elin Dahlén, Anders Sundström, Sverre Wikström, Ida Walles, Håkan Jarbin, Elin Kimland","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Neuroleptics are important for the treatment of serious psychiatric conditions. Few neuroleptics are approved for use in children and adolescents. Side effects are common, and children experience them more often than adults, particularly metabolic effects. The number of prescriptions of neuroleptics to children aged 5-17 years has increased (from 5 to 23 per 1000 children during 2004-2023). Most children were prescribed second-generation antipsychotics, which is in accordance with national recommendations. The most prescribed drugs were risperidone and aripiprazole, but regional differences exist. Children treated with neuroleptics need to be monitored more frequently, but adequate follow-up measures are used according to our survey of 85 prescribers. There is a need for an in-depth analysis of children's use of antipsychotics and the risk of serious side effects.</p>","PeriodicalId":17988,"journal":{"name":"Lakartidningen","volume":"122 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144784623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Acute suppurative thyroiditis: A case report]. 急性化脓性甲状腺炎1例。
Lakartidningen Pub Date : 2025-08-04
Susanna Hofdam, Daniel Bengtsson, Etsko Engel Blaauwwiekel, Pär Wanby
{"title":"[Acute suppurative thyroiditis: A case report].","authors":"Susanna Hofdam, Daniel Bengtsson, Etsko Engel Blaauwwiekel, Pär Wanby","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Acute suppurative thyroiditis (AST) is an extremely rare and potentially life-threatening condition, which can at first be difficult to differentiate from the far more common subacute thyroiditis (SAT). AST is most often described in patients with immunosuppression, or in patients with a pre-existing thyroid disease or anatomical structural defect, such as a pyriform sinus fistula. Here, we describe a case where a 37-year-old immunocompromised woman presented with intermittent fever, fatigue, erythema and tenderness of the anterior neck. TSH was suppressed and free T3 and T4 were elevated. She was prescribed Prednisolone 30 mg due to suspicion of SAT, but her symptoms from the anterior neck escalated. She developed a thyroid abscess, and was successfully treated with surgical drainage and oral antibiotics.</p>","PeriodicalId":17988,"journal":{"name":"Lakartidningen","volume":"122 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144775769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Aggregated statistics from Swedish health registries has been used for evaluating compliance with a contraindication]. [来自瑞典健康登记处的汇总统计数据被用于评估禁忌症的遵守情况]。
Lakartidningen Pub Date : 2025-08-01
Karl-Mikael Kälkner, Anders Sundström, Rickard Ljung
{"title":"[Aggregated statistics from Swedish health registries has been used for evaluating compliance with a contraindication].","authors":"Karl-Mikael Kälkner, Anders Sundström, Rickard Ljung","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The daily regulatory work with pharmacovigilance includes requirements of risk minimisation measures (RMM). However, when it comes to evaluating the efficacy of RMM, methodological issues have been raised regarding commonly used surveys, and the updated Guideline on good pharmacovigilance practices, Module XVI Addendum II, proposes using mixed methods when RMM outcome is evaluated.    The Swedish Medical Products Agency has used aggregated national register data to evaluate compliance to the contraindication for cyproterone in patients with previous or current meningioma. Among 13 036 patients diagnosed with meningioma during the period 2005-2022, 21 to 63 individuals had filled a prescription of cyproterone ever after diagnosis. This is regarded as a resource-efficient method to assess compliance to contraindications, although anonymous aggregated statistics entail an uncertainty of measurement because the data must not be granular enough to be attributed to single individuals.</p>","PeriodicalId":17988,"journal":{"name":"Lakartidningen","volume":"122 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144775770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Cowpox - an underdiagnosed disease in Sweden?] 牛痘——瑞典一种未被确诊的疾病？］
Lakartidningen Pub Date : 2025-07-31
Marc Westerholt, Lukas Frans Ocias, Ellen von Horn, Dolores Santos-Martin, Jonas Bläckberg, Christina Wilhelmsson, Bamse Lilja, Ulrika Windahl, Klara Sondén
{"title":"[Cowpox - an underdiagnosed disease in Sweden?]","authors":"Marc Westerholt, Lukas Frans Ocias, Ellen von Horn, Dolores Santos-Martin, Jonas Bläckberg, Christina Wilhelmsson, Bamse Lilja, Ulrika Windahl, Klara Sondén","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Cowpox is an infection caused by the cowpox virus, a zoonotic DNA virus belonging to the genus Orthopoxvirus. The infection presents as a febrile illness with a characteristic eschar-like lesion. Humans are typically infected through contact with rodents or cats who have been in contact with rodents. The diagnosis is made using PCR. In this case series, we present eight cases of cowpox contracted in Sweden.</p>","PeriodicalId":17988,"journal":{"name":"Lakartidningen","volume":"122 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144775771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Secondary exposure to hormonal drugs]. [二次接触激素药物]。
Lakartidningen Pub Date : 2025-06-17
Karin Sjöström, James G Mount, Anna-Karin Klocker, Susanne Lindahl, Veronica Arthurson
{"title":"[Secondary exposure to hormonal drugs].","authors":"Karin Sjöström, James G Mount, Anna-Karin Klocker, Susanne Lindahl, Veronica Arthurson","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Hormonal therapy is widely used to treat different conditions in humans; a well-known indication being the relief of menopausal symptoms in women. Transdermal delivery of hormonal drugs is common and may pose a risk to humans and animals through secondary exposure. This report raises awareness of risks associated with secondary exposure to transdermal hormone-containing drugs, based on evidence from spontaneous reporting of suspected adverse events. Clinical signs in humans included precocious puberty, unresolved virilisation, accelerated growth rate, alopecia, foetal death, and female infertility. In animals, clinical signs included persistent oestrus, poor growth rate and birth defects. Risks of secondary exposure must be acknowledged when prescribing hormonal drugs and as a possible aetiology of clinical signs in humans and animals.</p>","PeriodicalId":17988,"journal":{"name":"Lakartidningen","volume":"122 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144317326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
ATLS – 30 år i Sverige 2026.
Lakartidningen Pub Date : 2025-06-12
Jacob Broms, Robert Zürner
{"title":"ATLS – 30 år i Sverige 2026.","authors":"Jacob Broms, Robert Zürner","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":17988,"journal":{"name":"Lakartidningen","volume":"122 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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