Development of severe alcohol related liver disease over four decades in Iceland: impact of increased access and use of alcohol.

OBJECTIVE: Limited data exist on the association between per capita alcohol consumption and incidence of alcohol related liver disease (ARLD). The aims were to analyse this relationship and assess prevalence of ARLD in Iceland and among patients treated for alcohol use disorder (AUD) and its impact on outcomes. METHODS: A retrospective study on all patients diagnosed with severe ARLD: alcohol related cirrhosis (ARC) and alcohol related hepatitis (ARH) in Iceland 1984-2020. Medical records were scrutinized for clinical features, severity of ARLD, proportion undergoing treatment for AUD, data on abstinence and long-term outcomes. RESULTS: A total of 314 patients, males 76%, median age 56 years, fulfilled the predetermined criteria for ARLD. Median MELD was 17, 73% with Child-Pugh B/C and 70/314 (22%) who had ARH. Incidence of ARLD increased from 0.77 cases per 100 000 inhabitants annually 1984-2000 to 6.1 per 100 000 in 2016-2020. Per capita alcohol consumption increased from 4.3 Liters to 7.5 L in in the same time periods. Overall 220/314 (70%) with ARLD had undergone treatment for AUD. Of all individuals who had AUD treatment during the study period (n = 21.845), 1% were diagnosed with ARLD. Patients who underwent treatment for AUD after the ARLD diagnosis had better prognosis than those who had treatment prior to ARLD diagnosis (hazard ratio 2.5 [95% CI 1.3-5.0]). CONCLUSIONS: The incidence of ARLD increased 8-fold during the study period coinciding with 74% increase in per capita alcohol consumption. Patients with prior diagnosis of AUD had worse prognosis that needs special attention.

Treatment as Prevention for Hepatitis C (TraP Hep C) - a nationwide elimination programme in Iceland using direct-acting antiviral agents.

A nationwide programme for the treatment of all patients infected with hepatitis C virus (HCV) was launched in Iceland in January 2016. By providing universal access to direct-acting antiviral agents to the entire patient population, the two key aims of the project were to (i) offer a cure to patients and thus reduce the long-term sequelae of chronic hepatitis C, and (ii) to reduce domestic incidence of HCV in the population by 80% prior to the WHO goal of HCV elimination by the year 2030. An important part of the programme is that vast majority of cases will be treated within 36 months from the launch of the project, during 2016-2018. Emphasis is placed on early case finding and treatment of patients at high risk for transmitting HCV, that is people who inject drugs (PWID), as well as patients with advanced liver disease. In addition to treatment scale-up, the project also entails intensification of harm reduction efforts, improved access to diagnostic tests, as well as educational campaigns to curtail spread, facilitate early detection and improve linkage to care. With these efforts, Iceland is anticipated to achieve the WHO hepatitis C elimination goals well before 2030. This article describes the background and organization of this project. Clinical trial number: NCT02647879.

Prescribing syringes to prevent HIV: a survey of infectious disease and addiction medicine physicians in Rhode Island.

This article describes the assessment of physicians' attitudes and practices regarding prescribing syringes to injection drug users (IDUs). A brief, anonymous, self-administered questionnaire was sent to all Infectious Disease and Addiction Medicine specialists in Rhode Island. Of 49 eligible physicians, 39 responded (response rate 80%). Most (95%) indicated that there is a legitimate medical reason for IDUs to obtain sterile syringes. Many (71%) agreed that they would prescribe syringes to prevent disease in IDUs if it were clearly legal to do so. We can conclude that physician syringe prescription to IDUs may be an acceptable supplement to existing HIV prevention strategies.

[Is there a connection between skin temperature and appendicitis? A prospective study on the predictive value of traditional tests and skin temperature for acute appendicitis.].

INTRODUCTION: Appendicitis is a common disease, still its diagnosis can be difficult. Of resected appendices, every fifth to sixth is histologically normal. It has been suggested that local skin temperature could be helpful to diagnose appendicitis. The hypothesis was that skin temperature above an inflamed appendix was higher than elsewhere. MATERIAL AND METHODS: Patients suspected of acute appendicitis admitted to Landspitalinn University Hospital, February through June 1993, were enrolled. Thirty six patients, 20 males and 16 females, aged 12 to 77, average 29, entered the study. Skin temperature was measured over McBurney's point and at a comparable spot on the left side of the abdomen. Beside the skin temperature there were also noted some symptoms from the history and examination and some lab results. For each of these variables sensitivity, specificity and prospective values for appendicitis, were calculated. RESULTS: Of those 36 patients, 27 underwent surgery, 22 had appendicitis but 14 did not. Six of the patients had 5=0.5 degrees C higher temperature at McBurney's point but only two of them had appendicitis. The other 30 patients did not have that temperature difference but still 16 of them had appendicitis. The predictive value of a positive and a negative test was 33% each, for skin temperature measurements, sensitivity was 9% and specificity 71%. These results do not suggest any connections between skin temperature and appendicitis and therefore the test is useless for appendicitis in our opinion. White blood cells count showed the best results in this study, with prospective value of a positive test 91%, prospective value of a negative test 86%, sensitivity 91% and specificity 86%. Other traditional tests and symptoms turned out to be useless individually in evaluating patients suspected of appendicitis. CONCLUSION: Skin temperature measurement is unfortunately an useless diagnostic tool. It is sobering to see that the traditional tests and symptoms for appendicitis are nearly useless too. On the other hand it is fascinating and challenging to know that the diagnosis of this common disease is still dependent on the clinical judgement of the patient's physician.