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3.
Blood Cancer J ; 11(5): 94, 2021 05 17.
Artículo en Inglés | MEDLINE | ID: mdl-34001889

RESUMEN

Monoclonal gammopathy of undetermined significance (MGUS) precedes multiple myeloma (MM). Population-based screening for MGUS could identify candidates for early treatment in MM. Here we describe the Iceland Screens, Treats, or Prevents Multiple Myeloma study (iStopMM), the first population-based screening study for MGUS including a randomized trial of follow-up strategies. Icelandic residents born before 1976 were offered participation. Blood samples are collected alongside blood sampling in the Icelandic healthcare system. Participants with MGUS are randomized to three study arms. Arm 1 is not contacted, arm 2 follows current guidelines, and arm 3 follows a more intensive strategy. Participants who progress are offered early treatment. Samples are collected longitudinally from arms 2 and 3 for the study biobank. All participants repeatedly answer questionnaires on various exposures and outcomes including quality of life and psychiatric health. National registries on health are cross-linked to all participants. Of the 148,704 individuals in the target population, 80 759 (54.3%) provided informed consent for participation. With a very high participation rate, the data from the iStopMM study will answer important questions on MGUS, including potentials harms and benefits of screening. The study can lead to a paradigm shift in MM therapy towards screening and early therapy.


Asunto(s)
Gammopatía Monoclonal de Relevancia Indeterminada/diagnóstico , Mieloma Múltiple/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Islandia/epidemiología , Masculino , Persona de Mediana Edad , Gammopatía Monoclonal de Relevancia Indeterminada/epidemiología , Mieloma Múltiple/epidemiología , Mieloma Múltiple/prevención & control , Factores de Riesgo
4.
Laeknabladid ; 102(1): 11-7, 2016 Jan.
Artículo en Islandés | MEDLINE | ID: mdl-26734718

RESUMEN

INTRODUCTION: ST-segment Elevation Myocardial Infarction (STEMI) is a life-threatening disease and good outcome depends on early restoration of coronary blood flow. Primary percutaneous coronary intervention (PPCI) is the treatment of choice if performed within 120 minutes of first medical contact (FMC) but in case of anticipated long transport or delays, pre-hospital fibrinolysis is indicated. The aim was to study transport times and adherence to clinical guidelines in patients with STEMI transported from outside of the Reykjavik area to Landspitali University Hospital in Iceland. MATERIALS AND METHODS: Retrospective chart review was conducted of all patients diagnosed with STEMI outside of the Reykjavik area and transported to Landspitali University Hospital in Reykjavik in 2011-2012. Descriptive statistical analysis and hypothesis testing was applied. RESULTS: Eighty-six patients had signs of STEMI on electrocardiogram (ECG) at FMC. In southern Iceland nine patients (21%) underwent PPCI within 120 minutes (median 157 minutes) and no patient received fibrinolysis. In northern Iceland and The Vestman Islands, where long transport times are expected, 96% of patients eligible for fibrinolysis (n=31) received appropriate therapy in a median time of 57 minutes. Significantly fewer patients received appropriate anticoagulation treatment with clopidogrel and enoxaparin in southern Iceland compared to the northern part. Mortality rate was 7% and median length of stay in hospital was 6 days. CONCLUSIONS: Time from FMC to PPCI is longer than 120 minutes in the majority of cases. Pre-hospital fibrinolysis should be considered as first line treatment in all parts of Iceland outside of the Reykjavik area. Directly electronically transmitted ECGs and contact with cardiologist could hasten diagnosis and decrease risk of unnecessary interhospital transfer. A STEMI database should be established in Iceland to facilitate quality control.


Asunto(s)
Atención a la Salud/organización & administración , Infarto del Miocardio/terapia , Intervención Coronaria Percutánea , Servicios de Salud Rural/organización & administración , Tiempo de Tratamiento/organización & administración , Transporte de Pacientes/organización & administración , Adulto , Anciano , Anciano de 80 o más Años , Anticoagulantes/uso terapéutico , Electrocardiografía , Servicios Médicos de Urgencia/organización & administración , Femenino , Adhesión a Directriz , Hospitales Universitarios , Humanos , Islandia , Masculino , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/mortalidad , Inhibidores de Agregación Plaquetaria/uso terapéutico , Guías de Práctica Clínica como Asunto , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Factores de Riesgo , Terapia Trombolítica , Factores de Tiempo , Resultado del Tratamiento
6.
Laeknabladid ; 99(4): 183-6, 2013 04.
Artículo en Islandés | MEDLINE | ID: mdl-23695968

RESUMEN

INTRODUCTION: Perforation of the heart is a serious complication following pacemaker implantation that can cause life threatening bleeding and cardiac tamponade. Here we describe five cases that were diagnosed in Iceland during a four year period. MATERIALS AND METHODS: This population-based case series includes five patients diagnosed with cardiac perforation following pacemaker insertion at Landspítali and Akureyri Hospital from January 1, 2007 to December 31, 2010. The mode of detection, treatment given and outcome were studied. RESULTS: Altogether five patients (mean age 71 years, three females) were diagnosed with cardiac perforation in Iceland during the study period, one in 2008 and four in 2009. Chest pain was the most common presenting symptom (n=4) and no patient had acute cardiac tamponade. In all five cases the diagnosis was obtained with computed tomography scan or echocardiography. No perforation was detected intraoperatively but four of the cases were diagnosed within three weeks of the operation. Three patients were treated with surgical evacuation of blood via sternotomy and suture of the perforation. In the other two cases the pacemaker leads were removed in the operating room with trans-oesophageal echocardiographic guidance. Four patients survived the treatment and were discharged but one died of pneumonia in the intensive care unit. CONCLUSION: Cardiac perforation is a serious complication and should be kept in mind in patients with chest pain following pacemaker insertion.


Asunto(s)
Lesiones Cardíacas/etiología , Marcapaso Artificial/efectos adversos , Anciano , Anciano de 80 o más Años , Procedimientos Quirúrgicos Cardíacos , Dolor en el Pecho/etiología , Remoción de Dispositivos , Ecocardiografía Transesofágica , Femenino , Lesiones Cardíacas/diagnóstico , Lesiones Cardíacas/mortalidad , Lesiones Cardíacas/cirugía , Humanos , Islandia , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Neumonía/etiología , Neumonía/mortalidad , Valor Predictivo de las Pruebas , Esternotomía , Técnicas de Sutura , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del Tratamiento
7.
Laeknabladid ; 98(2): 83-8, 2012 02.
Artículo en Islandés | MEDLINE | ID: mdl-22314509

RESUMEN

OBJECTIVE: Sudden cardiac death in young athletes is relatively uncommon and is usually caused by occult underlying cardiovascular disease. Studies have indicated that preparticipation screening may reduce the incidence of sudden death. Our aim was to study the feasibility of standardized preparticipation screening in young competitive Icelandic athletes. The prevalence of risk factors was studied in order to evaluate how often further examination is indicated and to assess possible costs. MATERIAL AND METHODS: A total of 105 randomly selected competitive athletes (70 men, 35 women) between the age 18-35 received standard screening with medical history, cardiac examination and 12 lead ECG. RESULTS: The most frequent complaints revealed by medical history were allergy, excema, asthma, dyspnea on exercise, chest pain on exercise, palpitations on exercise, dizziness and fainting on exercise. Physical examination was abnormal in 20 (19%). 12 lead ECG was distinctly abnormal in 22 (21%) and mildly abnormal in 23 (22%). Transthoracal echocardiography (TTE) was performed on 19 (18%). Of those, TTE was normal in six athletes (32%) and mildly abnormal in 13 (68%), none had abnormal findings indicating structural heart disease. CONCLUSION: Symptoms associated with cardiac disease are frequently described among young athletes. Abnormal ECG was commonly found. Further examination with echocardiography may be indicated in one of every four athletes screened.


Asunto(s)
Atletas , Muerte Súbita Cardíaca/prevención & control , Cardiopatías/diagnóstico , Pruebas de Función Cardíaca , Tamizaje Masivo/métodos , Adolescente , Adulto , Factores de Edad , Muerte Súbita Cardíaca/epidemiología , Muerte Súbita Cardíaca/etiología , Ecocardiografía , Electrocardiografía , Estudios de Factibilidad , Femenino , Cardiopatías/complicaciones , Cardiopatías/epidemiología , Cardiopatías/terapia , Humanos , Islandia/epidemiología , Masculino , Examen Físico , Valor Predictivo de las Pruebas , Medición de Riesgo , Factores de Riesgo , Adulto Joven
8.
Laeknabladid ; 96(3): 159-65, 2010 03.
Artículo en Islandés | MEDLINE | ID: mdl-20197594

RESUMEN

INTRODUCTION: A good outcome of patients presenting with STEMI (ST-Segment Elevation Myocardial Infarction) depends on early restoration of coronary blood flow. Pre-hospital fibrinolysis is recommended if primary percutaneous coronary intervention (PPCI) cannot be performed within 90 minutes of first medical contact (FMC). The purpose of this study was to study transport times for patients with STEMI who were transported with air-ambulance from the northern rural areas of Iceland to Landspitali University Hospital in Reykjavík, and to assess if the medical management was in accordance with clinical guidelines. MATERIALS AND METHODS: Retrospective chart review identified 33 patients with STEMI who were transported with air-ambulance to Landspitali University Hospital in Reykjavík during the years 2007 and 2008. RESULTS: The total time from first medical contact to arrival at Landspitali University Hospital emergency room was 3 hours and 7 minutes (median). All patients received aspirin and 26 (78.8%) received clopidogrel and enoxaparin. 16 patients (48.5%) received thrombolytic therapy in median 33 minutes after FMC and 15 patients had PPCI performed in median 4 hours and 15 minutes after FMC. Estimated PCI related delay was 3 hours and 42 minutes (median). One patient died and one was resuscitated within 30 hospital days. Mean hospital stay was 6.0 days. CONCLUSIONS: First medical contact to balloon time of less than 90 minutes is impossible for patients with STEMI transported from the northern rural areas to Landspitali University Hospital in Reykjavík. Medical therapy was in many cases suboptimal and PCI related delay too long.


Asunto(s)
Ambulancias Aéreas , Angioplastia Coronaria con Balón , Servicios Médicos de Urgencia , Hospitales Universitarios , Infarto del Miocardio/terapia , Inhibidores de Agregación Plaquetaria/uso terapéutico , Servicios de Salud Rural , Terapia Trombolítica , Anciano , Anciano de 80 o más Años , Ambulancias Aéreas/organización & administración , Servicios Médicos de Urgencia/organización & administración , Femenino , Adhesión a Directriz , Accesibilidad a los Servicios de Salud , Hospitales Universitarios/organización & administración , Humanos , Islandia/epidemiología , Tiempo de Internación , Masculino , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/mortalidad , Guías de Práctica Clínica como Asunto , Calidad de la Atención de Salud , Estudios Retrospectivos , Servicios de Salud Rural/organización & administración , Factores de Tiempo , Resultado del Tratamiento
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