Läkartidningen
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Early repolarization defined as antero-lateral ST-segment elevation exists in 1-2 % of the general population and has been considered a benign ECG finding for decades. However, early repolarization, defined as infero-lateral J-waves, has in recent studies been associated with an increased - albeit low - risk of sudden and cardiovascular death. This ECG pattern is present in 3-13% of the general population. ⋯ In athletes, early repolarization, regardless of type, is considered benign. In asymptomatic non-athletes, the absolute risk is too low to use this ECG finding in clinical practice. In individuals with J-wave syndrome, on the other hand, ICD implantation should be strongly considered to prevent sudden cardiac death.
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A thorough investigation is warranted when a person presents to health care services with signs and symptoms of schizophrenia. Positive (hallucinations and delusions) as well as negative symptoms (blunted affect, avolition, and loss of speech content) should be assessed in order to confirm the diagnosis. Further, psychosocial functioning must be evaluated. ⋯ Case management in a multiprofessional »Assertive Community Treatment« (ACT) setting should be used as an organizational model for psychiatric teams caring for persons with first onset psychoses as well as those with long-term psychotic illness. Collaboration between psychiatric and social services is central and mandatory by law. Models for collaboration need to be examined further.
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Lipid rescue is increasingly used as treatment of various types of poisoning despite weak scientific evidence. Some experimental studies have confirmed a positive effect, but others have failed. Clinical studies are lacking, wherefore we decided to do a systematic review of all published human cases. ⋯ No correlation was found between the ratings of the cases and the fat solubility of the respective toxins. The findings do not support the predication that lipid rescue is an effective antidote, not even in cases involving local anaesthetics. In view of the potentially negative effects of lipid rescue, it seems reasonable to strictly limit its indication to life-threatening situations where conventional therapies have failed.
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Ketoacidosis is a life threatening condition usually caused by diabetes mellitus or alcohol. In this case report we present a lactating woman who developed a severe ketoacidosis a few weeks post partum. ⋯ Five case reports regarding ketoacidosis in lactating women have previously been described in the literature. This case report highlights the importance of nutrition during periods of breast feeding.
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The reliability of official registers of diagnosis depends on proper adherence to guidelines for diagnosis and diagnosis coding. Such guidelines for severe sepsis and septic shock have changed over the years, reflecting improved knowledge of these serious conditions. ⋯ Thus, severe sepsis appears to be underappreciated in official registers of diagnosis in Sweden. It is important to improve the adherence to the present diagnosis guidelines in order for the registers to be reliable.