Carriage of group B beta-haemolytic streptococci among pregnant women in Iceland and colonisation of their newborn infants

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenObjective: To determine the carrier rate of group B beta-haemolytic streptococci (GBS) of pregnant women in Iceland and the colonisation of their newborns. Material and methods: A prospective study was conducted from October 1994 until October 1997, where culture specimens for GBS were taken from vagina and rectum of pregnant women attending the prenatal clinics at the Department of Obstetrics and Gynecology, Landspitali University Hospital and the Reykjavik Health Centre. The samples were taken at 23 and 36 weeks gestation and at delivery. Culture samples were also taken from axilla, umbilical area and pharynx of their newborn infants immediately after birth. Included in the study were pregnant women born on every fourth day of each month. Carrier state was not treated during pregnancy, but Penicillin G was given i.v. at delivery if the last culture before delivery was positive and gestational age was 12 hours before delivery or the mother had a fever >38 degrees C. Results: Cultures were taken from 280 women and their children. GBS carrier rate of pregnant women in Iceland was 24.3%. Twelve newborns had GBS positive cultures. No newborn had a confirmed septicemia. Cultures from 25% of newborns, who s mothers were still GBS carriers at birth, were positive for GBS. Positive predictive value of cultures taken at 23 weeks gestation was 64% and 78% at 36 weeks. Negative predictive value was 95% and 99% respectively. Conclusion: One out of every four pregnant women in Iceland is a GBS carrier. Twentyfive percent of newborns become colonised with GBS if the mother is a GBS carrier at delivery. When screening for GBS carrier state is done cultures from both vagina and rectum is more sensitive than cultures from vagina only. At least five percent of all newborns in Iceland are therefore expected to have positive skin cultures at birth. If the mother does not have positive GBS cultures during pregnancy, the likelihood that she will give birth to a GBS colonised child is almost none.Inngangur: Blóðsýkingar hjá nýburum eru enn alvarlegt sjúkdómsástand með hárri dánartíðni. Í rannsókn á faraldsfræði blóðsýkinga meðal nýbura á Íslandi á árunum 1976 til 1995 voru blóðsýkingar staðfestar hjá tveimur af hverjum 1000 lifandi fæddum börnum og dánartíðni var 17%. Nýgengi blóðsýkinga af völdum b-hemólýtískra streptókokka af flokki B (GBS) fór verulega vaxandi á rannsóknartímabilinu og var orðið 0,9/1000 á síðustu fimm árunum. Tilgangur þessarar rannsóknar var að kanna beratíðni GBS meðal þungaðra kvenna á Íslandi og smitun nýbura í fæðingu þess vegna. Efniviður og aðferðir: Gerð var framsýn rannsókn þar sem tekin voru strok frá neðri hluta legganga og endaþarmi þungaðra kvenna á 23. og 36. viku meðgöngu svo og í fæðingu. Einnig voru tekin strok frá holhönd, nafla og koki nýburanna þegar eftir fæðingu. Úrtakið voru þungaðar konur sem fæddar voru fjórða hvern dag hvers mánaðar og komu til mæðraeftirlits á Kvennadeild Landspítalans eða Heilsuverndarstöð Reykjavíkur á tímabilinu frá október 1994 til október 1997. Ekki voru gefin sýklalyf til að uppræta berastig á meðgöngu, en hins vegar var Penisillín G gefið í æð í fæðingunni ef síðasta ræktun fyrir fæðingu var jákvæð fyrir GBS og jafnframt einu eða fleiri af eftirtöldum skilyrðum fullnægt: Meðgöngulengd 12 klukkustundum fyrir fæðingu eða hiti >38°C. Niðurstöður: Sýni voru tekin frá 280 konum. Beratíðni þungaðra kvenna hérlendis reyndist vera 24,3%. Tólf börn reyndust hafa GBS í ræktunarsýnum sem tekin voru þegar eftir fæðingu. Ekkert barn í rannsókninni fékk staðfesta blóðsýkingu. Fjórðungur (25%) barna þeirra kvenna, sem enn voru GBS berar í fæðingunni, smitaðist. Jákvætt forspárgildi GBS sýnatöku við 23 vikna meðgöngu er 64% en 78% við 36 vikna meðgöngu. Neikvætt forspárgildi er samsvarandi 95% og 99%. Ályktun: Fjórðungur þungaðra kvenna á Íslandi ber GBS í leggöngum eða endaþarmi. Tuttugu og fimm prósent barna þeirra smitast af sýklinum við fæðingu. Þannig má reikna með að 5% allra nýbura á Íslandi á umræddu tímabili hafi smitast af GBS við fæðingu. Ef verðandi móðir er ekki GBS beri samkvæmt ræktunum frá leggöngum og endaþarmi á meðgöngunni, eru hverfandi líkur á að barn hennar smitist af GBS í fæðingunni

Beregninger av nitrogenbalansen på 50 gårdsbruk i kommunene Midsund, Fræna, Gjemnes, Surnadal og Rindal

Landbruk Nordvest har gjennomført nitrogenbalanse-beregninger på 50 gårdsbruk ikommunene Midsund, Fræna, Gjemnes, Surnadal og Rindal. Dette er et ledd i ”klima-arbeidet” i de fem kommunene. På samtlige melke-produksjonsbruk i undersøkelsen ble det kjøpt inn langt mer nitrogen og fosfor enn hva som ble solgt ut igjen, slik at gårdene tilførte flere næringsstoffer enn hva de fjernet. Det er en betydelig variasjon mellom enkeltbruk. Nitrogen-balanseberegningene for de 4 sauebrukene med økologisk drift viser at det også her er overskudd på nitrogen

Pulmonary vein ablation as a therapy for atrial fibrillation

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenAtrial fibrillation is a common arrhythmia and frequently difficult to treat. Despite therapeutic options, such as antiarrhythmic drugs and electrical cardioversion, many patients with this arrhythmia have recurrences. Radiofrequency catheter ablation has been a developing therapeutic option for patients with atrial fibrillation. Pulmonary vein ablation, where atrial tissue in the pulmonary veins is targeted, has been the most promising ablation strategy. This atrial tissue is a frequent source of ectopic beats which can induce atrial fibrillation. Recently, this was utilised for the first time on Icelandic patients. These two case reports and a description of the procedure are the focus of this paper.Gáttatif er algeng takttruflun og oft á tíðum erfið í meðhöndlun. Þrátt fyrir að bæði lyfjameðferð og rafvendingu sé beitt dugar það ekki í mörgum tilfellum. Á allra síðustu árum hafa orðið talsverðar framfarir í brennsluaðgerðum gáttatifs, sér í lagi í brennslu á gáttavef sem teygir sig upp í lungnabláæðar og er oft uppspretta aukaslaga sem koma af stað gáttatifi. Þessari tækni var nýlega beitt í fyrsta sinn hjá íslenskum sjúklingum. Tveimur sjúkratilfellum er lýst og einnig brennsluaðgerðinni sem framkvæmd var hjá þeim

The new international guidelines for cardiopulmonary resuscitation and emergency cardiovascular care

Hægt er að lesa greinina í heild sinni með því að smella á hlekkinn View/OpenRecently the American Heart Association and the European Resuscitation Council published new guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. These new guidelines are the result of extensive review of the scientific literature in this field by The International Liason Committee on Resuscitation. There are some important changes in the new guidelines with a major emphasis on the importance of basic life support, especially chest compressions. The guidelines also promote early defibrillation while the role of pharmacologic therapy during cardiopulmonary resuscitation is not as clear. This article discusses the highlights of the new guidelines

Surgical treatment for endocarditis in Iceland 1997-2013

Efst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinnInngangur: Opna hjartaaðgerð getur þurft að gera í alvarlegum tilfellum hjartaþelsbólgu. Tilgangur þessarar rannsóknar var að kanna árangur skurðaðgerða við hjartaþelsbólgu á Íslandi en slík rannsókn hefur ekki birst áður. Efniviður og aðferðir: Afturskyggn rannsókn á sjúklingum sem gengust undir hjartalokuaðgerð vegna hjartaþelsbólgu á Landspítala 1997-2013. Leitað var að sjúklingum í rafrænum kerfum Landspítala og upplýsingar fengnar úr sjúkraskrám. Heildarlifun var reiknuð með aðferð Kaplan-Meier og var meðaleftirfylgni 7,2 ár. Niðurstöður: Af 179 sjúklingum sem greindust með hjartaþelsbólgu á rannsóknartímabilinu gengust 38 (21%) undir skurðaðgerð. Tveimur sjúklingum var sleppt þar sem sjúkraskrár þeirra fundust ekki. Rannsóknarþýðið samanstóð því af 36 sjúklingum. Aðgerðum fjölgaði jafnt og þétt á rannsóknartímabilinu, eða úr 8 aðgerðum fyrstu 5 árin í 21 þau síðustu ((gagnlíkindahlutfall, OR – odds ratio; öryggisbil, CI – confidence interval) OR: 1,12, 95% CI: 1,05-1,21, p=0,002). Blóðræktanir voru jákvæðar hjá 81% sjúklinga og ræktaðist oftast S. aureus (19%). Þrír sjúklingar höfðu fyrri sögu um hjartaskurðaðgerð og 5 höfðu sögu um misnotkun fíkniefna. Algengustu staðsetningar sýkingar voru í ósæðarloku (72%) og míturloku (28%). Hjartaloku var skipt út í 35 tilvikum, í 14 tilvika með ólífrænni loku og í 21 tilviki með lífrænni loku. Tvær míturlokur var hægt að gera við. Algengustu fylgikvillar eftir aðgerð voru hjartadrep (35%), öndunarbilun (44%) og enduraðgerð vegna blæðingar (25%). Fjórir sjúklingar létust innan 30 daga frá aðgerð (11%) og 5 og 10 ára lifun var 59% og 49%. Umræða: Fimmti hver sjúklingur með hjartaþelsbólgu á Íslandi þurfti á hjartalokuaðgerð að halda, langoftast ósæðarloku- eða míturlokuskipti. Árangur er sambærilegur við erlendar rannsóknir en fylgikvillar eru tíðir, 30 daga dánartíðni hærri og langtímalifun lakari en eftir hefðbundnar lokuskiptaaðgerðir. Materials and methods: Retrospective nation-wide study of pa­­tients that underwent open-heart surgery for infective endocarditis at Landspitali University Hospital in 1997-2013. Variables were collected from hospital charts. Long-term survival was analysed using Kaplan- Meier methods. Mean follow-up time was 7.2 years. Results: Out of 179 patients diagnosed with endocarditis, 38 (21%) ­underwent open heart surgery. Two patients were excluded due to missing information leaving 36 patients for analysis. The number of operations steadily increased, or from 8 to 21 during the first and last 5-years of the study period (OR: 1.12, 95% CI: 1.05-1.21, p=0.002). The most common pathogen was S. aureus and 81% (29/36) of the patients had positive blood cultures. Three patients had history of previous cardiac surgery and five had history of intravenous drug abuse. The aortic valve was most often infected (72%), followed by the mitral valve (28%). The infected valve was replaced in 35 cases 14 with a mechanical prosthesis and 20 with a bioprosthesis. In addition two mitral valves were repaired. Postoperative complications included perioperative myocardial infarction (35%), respiratory failure (44%) and reoperation for bleeding (25%). Thirty-day mortality was 11% (4 patients) with 5- and 10-year survival of 59% and 49%, respectively. Conclusion: One out of five patients with endocarditis underwent surgery, most commonly aortic or mitral valve replacement. Outcomes were comparable to other studies. In comparison to elective valve replace­ment surgery the rate of post-operative complications and 30-day mortality were higher and long-term survival was less favorable

The usefullness of implantable loop recorders for evaluation of unexplained syncope and palpitations

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/Open Allur texti - Full textSyncope is a common complaint and determining the underlying cause can be difficult despite extensive evaluation. The purpose of this study was to evaluate the usefulness of an implantable loop recorder for patients with unexplained syncope and palpitations. This was a retrospective analysis of 18 patients, five of whom still have the device implanted. All patients had undergone extensive evaluation for their symptoms before getting the loop recorder implanted and this was therefore a highly select group. Of the thirteen patients where use of the device was completed, the mean age was 65±20 years. The loop recorder was in use for a mean time of 20±13 months. Unexplained syncope, eleven of thirteen, was the most common indication. The other two received the loop recorder for unexplained palpitations. Four patients had sick sinus syndrome during monitoring, three had supraventricular tachycardia and one had ventricular tachycardia. Further three had typical symptoms but no arrhythmia was recorded and excluding that as a cause. Two patients had no symptoms the entire time they had the loop recorder. Of the five patients still with the device three had syncope as the indication for monitoring and two have the device as a means of evaluating the results of treatment for arrhythmia. This study on our initial experience with implantable loop recorders shows that these devices can be useful in the investigation of the causes of syncope and palpitations.Yfirlið eru algeng og getur reynst erfitt að greina orsök þeirra. Markmið rannsóknarinnar var að kanna frumárangur af notkun ígræddra taktnema við mat á orsökum óútskýrðra yfirliða og hjartsláttarþæginda. Efniviður/aðferðir: Rannsóknin var afturskyggn og náði til 18 sjúklinga sem fengið hafa ígræddan taktnema hérlendis. Af þessum 18 eru 5 enn með tækið ígrætt og ekki komin endanleg niðurstaða af vöktun hjartatakts hjá þeim. Þessir sjúklingar höfðu farið í gegnum ítarlegar rannsóknir án þess að skýring hefði fundist og var því um valinn hóp einstaklinga að ræða. Af þeim 13 sjúklingum þar sem vöktun hjartatakts var lokið var meðalaldur 65±20 ára. Í öllum tilfellum nema einu var taktnemi hafður inni þar til skýring á einkennum var fundin eða rafhlaða kláraðist, meðaltími í sjúklingi var 20±13 mánuðir. Óútskýrt yfirlið var algengasta ábendingin, eða hjá 11 sjúklingum, en hjá hinum tveimur var tækið sett inn vegna óútskýrðra hjartsláttaróþæginda. Hjá fjórum fannst merki um sjúkan sinushnút, hjá þremur ofansleglahraðtaktur og í einu tilfelli sleglahraðtaktur. Hjá þremur sjúklingum var hægt að útiloka truflun á hjartatakti sem orsök einkenna þar sem reglulegur sinustaktur sást samfara dæmigerðum einkennum. Tveir sjúklingar fengu engin einkenni á meðan þeir voru með taktnemann. Af þeim 5 sjúklingum sem eru enn með taktnemann inni og vöktun enn í gangi var ábendingin yfirlið hjá þremur en hjá tveimur er tækið notað til að fylgjast með árangri meðferðar á hjartsláttartruflunum. Þessar frumniðurstöður sýna fram á skýran ávinning af notkun ígrædds taktnema við rannsóknir á óútskýrðum yfirliðum og hjartsláttaróþægindum

Overdrive pacing of early ischemic ventricular tachycardia: evidence for both reentry and triggered activity

To access publisher full text version of this article. Please click on the hyperlink in Additional Links fieldEntrainment can be a useful method to identify reentry as a mechanism of ventricular tachycardia (VT). In this study, we evaluated the effect of gradually decreasing cycle lengths of overdrive pacing for stable VT induced in a canine model 1-3 h after coronary occlusion. Intact dogs underwent anterior descending coronary artery occlusion after instrumentation of the risk zone with 21 multipolar plunge needles, each recording 6 bipolar electrograms. Overdrive pacing was attempted if the animals had sustained hemodynamically stable VT, looking for evidence of entrainment. Subsequent three-dimensional mapping determined the mechanism of VT. Fifteen of the 21 dogs studied demonstrated entrainment with overdrive pacing by progressive QRS fusion alone (1), the first nonpaced QRS entrained to the paced cycle length only (7), or both (7). Five of these 15 dogs also had postpacing acceleration of the VT at a subsequent faster pacing cycle length. The mechanism of acceleration in four was a change to a VT with a focal origin. The prepacing mechanism in all 15 dogs was subsequently mapped to reentry. Regarding the six VTs, which demonstrated no evidence for entrainment, the site of earliest activity was mapped to a focal origin in all. These data showing entrainment of inducible reentrant VTs and lack of such for focal VTs support that the focal VTs seen in this study are unlikely the result of microreentry but possibly a mechanism as triggered activity

Major cardiac rupture following surgical treatment for deep sternal wound infection.

To 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 Files. This article is open access.We report a case of an 80-year old male patient who sustained a major rupture of the right ventricle after surgical revision of an infected sternotomy wound following coronary artery bypass surgery. The rupture of the right ventricle occurred despite an early wound debridement and the use of negative pressure wound therapy on the sternum that did not provide sufficient stability to the sternum after the sternal wires were removed. The rupture resulted in a major bleeding but by establishing emergent cardiopulmonary bypass, the patient was saved

The uses and abuses of the past: cultural rhetoric and the unmaking of a moral universe

It is well established ethnographically that history is a particularly important and celebrated aspect of Icelandic identity. Paraphrasing Hastrup, it could be argued that Icelandic culture is a culture of the past. The collapse in Iceland in 2008 problematised this valorisation of history. In this paper we draw on Carrithers’ ideas of cultural rhetoric to analyse how Icelanders made sense of the collapse particularly in relation to their understanding of their own history. Following Johnson, we look at the play of agency, intention and responsibility evident in the accounts offered for the collapse. Through that we seek to highlight how these accounts, even when highly critical of Icelandic political and cultural practices, tend to allow for and even encourage the on-going identification with the nation-form.Peer Reviewe