Examensarbete 30 Hp, Läkarprogrammet

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50 år av Hemoglobinnivåer hos kvinnor i Kvinnoundersökningen 1968-1969 till 2016-2017
(2020-09-23) Runevad, Rebecca; University of Gothenburg / Institute of Medicine; Göteborgs universitet / Institutionen för medicin
Introduction: Anemia is a global problem and women and children are the most affected. The symptoms of anemia are for example tiredness, dyspnea and headache. Previous studies of trends of anemia over time have not been conclusive whether anemia has decreased or increased. Furthermore, it is hard to find studies of trends of anemia and hemoglobin (Hb) levels in women for the last decades. Objective: To study trends of Hb and anemia in ten different cohorts of women aged 38 respectively 50 years old examined in 1968-69, 1980-81, 1992-93, 2004-05 and 2016-17. Methods: The Population Study of Women in Gothenburg is a prospective observational study initiated in 1968. A representative sample of women were invited for a free health examination including inquiry of health and social situation, medical examination and blood samples. New women have been invited in 1980, 1992, 2004 and 2016. Participation rate have been 59-90%, n=2450. Results: The relationship between birth year and Hb levels was U-formed with lowest values measured in the examination in 1992 for both 38- and 50-year-old women. This relationship remained after adjusting for confounders. Conclusion: Depending on year of birth, the Hb levels have varied since the population study of women in Gothenburg started in 1968-69. In the future, it is important to continue to observe trends of anemia and to find risk factors associated with this condition. The symptoms of anemia often have a negative impact on quality of life, therefore it is crucial to prevent anemia and thereby reduce suffering.
A Comparative Study of the Surgical Outcome of Internationally Adopted versus Swedish Born Children with Cleft Lip and/or Palate
(2016-07-12) Gravgaard, Kjeld; University of Gothenburg / Institute of Medicine; Göteborgs universitet / Institutionen för medicin
Abstract Degree Project thesis, Programme in Medicine Title: A Comparative Study of the Surgical Outcome of Internationally Adopted versus Swedish Born Children with Cleft Lip and/or Palate Author: Kjeld Gravgaard Department of Plastic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden, 2015 Background At Sahlgrenska University Hospital, internationally adopted patients with a cleft lip and/or palate (CL/P) are treated by a cleft team at the Department of Plastic Surgery. Earlier studies and clinical experience indicate a higher number of surgical complications compared to non-adopted children. Aim To show demographic and surgical statistics on adopted children with CL/P, and investigate the surgical outcome in internationally adopted patients compared to non-adopted patients. Patients and Methods Medical records of 158 adopted patients receiving surgical treatment at Sahlgrenska University Hospital were analyzed. Twenty-seven of these were selected according to diagnosis and type of surgical treatment and compared to a non-adopted control group, of 68 patients. Four parameters were compared: Bleeding and operation time during bone grafting surgery, as well as number of surgical procedures and number of palato-pharyngeal flap procedures at 10 years of age. The data was analyzed using SPSS, and the non-parametrical Mann-Whitney U test. Results The majority of patients had been adopted from China, and the majority of adopted patients had unilateral cleft lip and palate. There was a statistically significant higher number of palato-pharyngeal flap procedures in the adopted group compared to the control group (P=0,001). There were no statistically significant differences in bleeding, operation time and total number of surgical procedures between the groups. Conclusions Adopted CL/P-patients require significantly more speech improvement surgery compared to non-adopted CL/P-patients.
A comparative study on obstetric complications among adolescents at Kasangati Health Centre in Uganda
(2016-07-12) Ronnås, Hanna; University of Gothenburg / Institute of Medicine; Göteborgs universitet / Institutionen för medicin
Abstract A comparative study on obstetric complications among adolescents at Kasangati Health Centre in Uganda Degree Project thesis, Programme in Medicine Author: Hanna Ronnås Supervisors: Håkan Lilja and Ivan Nyenje Department of Obstetrics and Gynecology. Institute of clinical sciences at Sahlgrenska Academy, University of Gothenburg. Sweden 2015 Background. Uganda is a country with a high proportion of young individuals and where childbearing begins early. Twenty-four per cent are already mothers or pregnant with their first child at age nineteen. Several studies point towards an increased risk of adverse obstetric outcome becoming a mother in young age in low and middle income countries whether other studies state the contrary. Aim. To investigate the frequency of obstetric complications among primiparous women age 19 and below, giving birth at Kasangati, a suburban health centre outside Kampala. Methods. Both a retrospective and a prospective case-control method were used. Semi-structured interviews with questions on the women´s living condition and socioeconomic background were also performed. The controls were primiparous women in age 20 to 24 years registered during the same period. Results. It was found that a higher proportion of teenagers had an expected or found complication (35.6 per cent vs 28.9 per cent). However the difference was small and was not found significant. An association between low birth weight and teenage women was found (p-value= 0.003). This finding was supported by the results in the prospective study (p-value = 0.02). Due to uncertainty in determining gestational age, it´s difficult to make any further conclusions whether the cause is correlated to intrauterine growth restriction or to premature birth. A tendency towards a higher rate of adverse obstetric outcome like premature birth, prolonged labour, obstructed labour and preeclampsia among teenagers was also found. However none of these differences were found significant. Conclusions. To determine the underlying cause of low birth weight further studies should be made in a setting where more reliable estimation of gestational age and intrauterine growth could be done. Keywords: adolescent, teenager, childbirth, obstetric outcome, obstetric complications, low birth weight
A comparison of Catheter-Related Infection in oncology patients with Peripherally Inserted Central Catheter versus Totally Implantable Centrall Acess Device
(2018-03-06) Bjerling, Lisa; University of Gothenburg / Institute of Medicine; Göteborgs universitet / Institutionen för medicin
A comparison of Catheter-Related Infection in oncology patients with Peripherally Inserted Central Catheter versus Totally Implantable Central Access Device. Author: Lisa Bjerling. Supervisor: Maria Werner, MD, PhD. Abstract Degree project, Programme in Medicine. A comparison of Catheter-Related Infection in oncology patients with Peripherally Inserted Central Catheter versus Totally Implantable Central Access Device. Lisa Bjerling, 2017, Department of Infectious Diseases and Infection Control, Södra Älvsborg Hospital, Borås, Sweden. University of Gothenburg, Gothenburg, Sweden. Supervisor: Maria Werner, MD, PhD. Introduction: Catheter-Related Infection (CRI) is an important factor for morbidity in patients with a Central Venous Access Device (CVAD). The CRI-incidence differ between CVADs. In oncological care, CVADs used are for example Totally Implantable Venous Access Device (TIVAD) and Peripherally Inserted Central Catheter (PICC). Aim: To find whether PICC or TIVAD gives the lowest incidence of CRI in patients with solid tumors. Method: Records from 556 patients with CVADs (328 PICC and 228 TIVAD) inserted between 2015-2016 at Södra Älvsborg Hospital (SÄS) in Sweden were reviewed. The comparison of the CRI-incidence was made in two groups: Confirmed CRI and Total CRI (Uncertain CRI-episodes included). Data was analyzed with Kaplan-Meier survival function and Cox regression. Result: 320 patients with 356 CVAD episodes (165 TIVAD and 191 PICC) were analyzed. 200 patients were excluded (mainly because of that the CVAD was not inserted at SÄS or age <18 years). In the Total TIVAD CRI-group, 46 CRIs was found (1.04 CRI/1000 catheter-days) and 26 CRIs was found (1.77 CRI/1000 catheter-days) in the Total PICC CRI-group. In the Confirmed TIVAD CRI-group, 24 CRIs was found (0.5 CRI/1000 catheter-days) and 2 CRIs (0.13 CRI/1000 catheter-days) in the PICC group. A significantly lower risk of CRI in patients with PICC was found in the Confirmed CRI-group (Hazard Ratio=0.093, 95% Confidence Interval=0.01-0.869, p=0.037) but not in the Total CRI-group (Hazard Ratio=1.029, 95% Confidence Interval=0.438-2.157, p=0.945). Conclusion: In patients with solid tumors there was no significant difference in CRI-incidence between PICC and TIVAD. Patients with PICC had a significantly lower CRI-incidence in the Confirmed CRI-group, indicating that PICC might be a safer alternative. The CRI-incidence in both groups were equivalent with earlier studies. Further prospective studies are needed.
A cross-section Study of Sleep Apnea Prevalence in the General Population age 71 years and its association with cardiovascular disease
(2016-07-12) Garcia, Stefano; University of Gothenburg / Institute of Medicine; Göteborgs universitet / Institutionen för medicin
Abstract Background: There is a lack of knowledge regarding obstructive sleep apnea (OSA) prevalence in older men from the general population. The aim of this cross-sectional study was to determine the prevalence of OSA in 71-year old men derived from the general population in Gothenburg, Sweden. Moreover, to study if OSA, is associated with cardiovascular diseases and if it is more common than other cardiovascular risk factors in this population. Material and Methods: This study is based on men who participated in the re-examination, in 2014, of participants from the “The study of men born in 1943”. All participants answered questionnaires on health status, quality of life. They were than examined at Sahlgrenska University Hospital/Östra in Gothenburg, Sweden, in addition sleep-apnea screening and thumb- EKG was performed in the participants’ homes. Results: A total 536 participants were included in our database, 412 of those underwent sleepapnea screening and were eligible for this study. 121 had obstructive sleep apnea (OSA), with AHI (apnea-hypopnea index) ≥ 15/h, and 191 did not. Thus, OSA (AHI ≥ 15) is common in the old general population. Moreover, it is the second most common risk factor for CVDs after hypertension in this population. The prevalence of OSA was 29.4% in this study. BMI showed significance with OSA (AHI ≥ 15). We found that sleep-disordered breathing is associated with prevalence of hypertension in older men; however after adjustment for BMI the association was no-longer significant. In the subgroup of patients with severe OSA (AHI ≥30) an association could be found between severe OSA and atrial fibrillation even after adjustment for BMI, OR 2.43 (1.02-5.76) Conclusions: Obstructive sleep apnea (OSA) is common in the old general population. There is a more than two fold risk increase for having atrial fibrillation among those that had sever OSA. Longitudinal studies on older general population is warranted to establish whether OSA is a risk factor for development of atrial fibrillation as well as other cardiovascular disease for all individuals and not only for those in certain disease cohorts or for those with day-time sleepiness.
A Descriptive Study of Spontaneous Elevation of Activated Partial Thromboplastin Time in Critically Ill Patients
(2020-04-29) Saari, Anniina; University of Gothenburg / Institute of Medicine; Göteborgs universitet / Institutionen för medicin
Introduction: Coagulation abnormalities are common in intensive care patients and are associated with higher risk of mortality. Activated Partial Thromboplastin Time (APTT) is one of the most frequently used tests to illustrate the coagulation status of patients. According to earlier observations, APTT tends to increase spontaneously after admission to intensive care. However, the details and relevance regarding this issue remain unclear. Objective: The purpose of this study was to investigate and describe how APTT evolves spontaneously in patients admitted to intensive care in order to improve their treatment and safety. Methods: A prospective, observational study was conducted on patients admitted to the Intensive Care Unit (ICU) between January and April 2019. Patients with known diseases or treatments that elevated APTT were excluded. Blood samples were collected and analyzed on a daily basis from admission until APTT was normalized. Results: 44 patients were included. APTT was significantly elevated on day 2 (p=0.01) and then subsequently normalized (APTT <32 seconds) from day 4-5. Median for the distance from lowest to highest point was 3.5sec (range 1.5-9.5) and maximum value, reached on average on day 2, was 33.5sec (range 29-52) which was 31% higher than the patient’s individual baseline. A linear increase in APTT was observed in all studied patients (p=0.00001), mean elevation of 15%, between the first two days of the first days of rising APTT. Conclusion: A significant spontaneous elevation of APTT above normal was observed in the ICU patients during the first days after admission with normalization within five days. This could indicate that an invasive procedure that infers a risk of bleeding in critically ill should either be done as soon as possible or has to be postponed for the first days in the ICU.
A follow-up on persons 5 years after subarachnoid hemorrhage
(2016-02-11) Carlsson, Lovisa; University of Gothenburg / Institute of Medicine; Göteborgs universitet / Institutionen för medicin
Degree Project Thesis, Programme in Medicine. TITLE: A follow-up on persons 5 years after subarachnoid hemorrhage. Background Subarachnoid hemorrhage (SAH) has high mortality, high morbidity among survivors, and is a major course of long-term disabilities. To develop treatment and rehabilitation for persons after SAH, long-term follow-up is needed. Several studies are published on short-term outcome with decreased Health-related Quality of Life (HRQoL), mental health and cognitive function, though outcome studies >12 months post-SAH are scarce. Aim The aim of this study was investigate physical/emotional status, participation and HRQoL, 5 years after SAH. Methods The study population were persons living in Gothenburg area, treated at Sahlgrenska University hospital after SAH 2009-2010. The study population received by regular mail in 2014 a questionnaire contained EuroQol-5Dimensions, Stroke Impact Scale, Occupational Gaps Questionnaire and Impact of Participation and Autonomy regarding their life situation, functioning, participation, and their HRQoL Results The questionnaires was sent to 42 persons where 26 (62%), average age 59, responded, in mean 5.1 years post SAH. The persons with SAH in this study had in general lower HRQoL compared to Swedish healthy norm values and particularly lower in the domain of anxiety and depression. Twenty-two of the persons with SAH had acceptable participation. Half of the study population was independent in their daily life, and 8 of 19 had returned to work full time. Emotional problems were common and several reported problems with fatigue, memory and executive function. Conclusions This long-term follow-up in persons 5 years after a SAH showed in general high level of physical function and autonomy, but lower HRQoL and emotional health. Most of the persons after SAH had acceptable participation. Keywords: subarachnoid haemorrhage, outcomes, quality of life, participation
A head-to-head comparison of Alzheimer’s disease plasma biomarkers as predictors of one-year decline in cognitive subdomains
(2022-02-23) Simrén, Joel; University of Gothenburg / Institute of Medicine; Göteborgs universitet / Institutionen för medicin
Objective There is scarce evidence how plasma biomarkers of Alzheimer’s disease (AD) relate cross-sectionally and longitudinally to cognitive subdomains. In this study, we investigated these features in a one-year prospective single-center memory clinic research cohort. Methods Individuals with AD dementia, mild cognitive impairment (MCI), non-AD neurodegenerative diseases (Non-AD) and community-dwelling cognitively unimpaired (CU) controls from the Translational Biomarkers of Aging and Dementia (TRIAD) cohort (McGill University, Canada) were included. Plasma and cerebrospinal fluid (CSF) (in a subset) biomarkers were measured at baseline. Positron emission tomography (PET) was used stratify groups for β-amyloid pathology. Measures of memory, language, executive function and global cognition were obtained at baseline and after one year (in a subset). Results 210 individuals (median age, % female) were included in the study, and comprised CU (n = 127; 71, 66), MCI (n = 48; 71, 54), AD (n = 18; 64, 61), and 17 (69; 47) individuals with non-AD neurodegenerative dementias. Phosphorylated (p)-tau 181 and p-tau231 in both CSF and SAHLGRENSKA ACADEMY plasma, and glial fibrillary acidic protein (GFAp) in plasma, increases along the AD continuum (defined as β-amyloid positive by PET) were seen compared to non-AD and CU without β-amyloid pathology. CU performed better on several neuropsychological measures after one year, whereas most were unaltered in cognitively impaired individuals. In CU, neuropsychological performance largely associated with age and years of education. However, for cognitively impaired individuals with β-amyloid pathology, associations were seen with plasma p-tau181, p-tau231 and GFAp in memory and global cognition. No associations were seen with baseline biomarker levels and subsequent cognitive decline in any of the measures. Conclusion Biomarkers in plasma reflect AD-specific pathophysiology, and significantly associate with severity of global cognitive and memory impairment. Furthermore, to investigate the prognostic capabilities of biomarker levels in cognitive subdomains, larger and longer studies are warranted.
A Methodological Study Comparing Two Motor Cortex Plasticity Paradigms in Healthy Adults
(2020-09-28) Hodzic, Kenan; University of Gothenburg / Institute of Medicine; Göteborgs universitet / Institutionen för medicin
Background: Neural plasticity is an important function of the brain allowing for change in synaptic transmissions. Modulation in plasticity arises through activity-dependent strengthening; long-term potentiation (LTP), or weakening; long-term depression (LTD), of synaptic transmissions. Such plasticity may be induced by repeated pairing of transcranial magnetic stimulation (TMS) to the human motor cortex, with peripheral median nerve stimulation (PNS), a method called paired associative stimulation (PAS). PAS induces LTP-like (i.e. PASLTP) or LTD-like (i.e. PASLTD) cortical changes in excitability, measured as motor evoked potentials (MEPs) using electromyography (EMG) of the targeted hand muscle. Aims: In order to utilize the PAS-method to investigate aberrant neuroplasticity in pathologies, we compared two well-established PAS-paradigms regarding their capacity to induce either PASLTP or PASLTD, the impact of time efficiency and frequency of reported adverse events. Methods: In the present double-blinded, crossover study we compared two different PAS-paradigms in 14 healthy subjects: 180 paired TMS + PNS stimulations (PAS-180) at 0.1Hz and 225 paired TMS + PNS stimulations (PAS-225) at 0.25Hz. Each paradigm consisted of two protocols: PASLTP utilizing an interstimulus interval (ISI) between pairings of 25ms inducing increased excitability, and PASLTD utilizing an ISI of 10ms inducing decreased excitability. Results: Responders were defined as having a grand mean of MEPs larger than the averaged baseline for PASLTP, and a lower grand mean of MEPs for PASLTD. Both paradigms successfully induced PASLTP in responders (N=9), however no PASLTD effects were found in either paradigm. PAS-225 had a lower frequency of reported adverse events and was more time efficient. Conclusions: Both paradigms induced equivalent PASLTP effects in subjects. Due to PAS-225 being more time efficient and associated with less reported adverse events, it is seen as preferential and will be used in future studies examining neural plasticity.
A mouse model of myocardial infarction in Filamin B deficient mice
(2016-02-10) Svedlund, Elin; University of Gothenburg / Institute of Medicine; Göteborgs universitet / Institutionen för medicin
Degree Project Thesis, Programme in Medicine. TITLE: A mouse model of myocardial infarction in Filamin B deficient mice. Abstract Background Myocardial infarction (MI) is the most common endemic disease and the condition is the leading cause of death in all industrialized countries. Animal models of MI plays a significant role in the development of diagnosis and therapeutic strategies in human MI, as it enables studies of pathobiological and pathophysiological mechanisms. A mechanism that could be interesting as a therapeutic strategy to treat cardiovascular diseases is the induction of angiogenesis. The protein FLNB has been shown to stimulate angiogenesis and it is therefore interesting to investigate its effects on the myocardium post MI since neovascularization is crucial for the healing process. Objectives My first aim was to develop a method of inducing MI in mice. My second aim was to use the method to induce MI in FLNB deficient mice and in wild types in order to examine differences between the groups regarding the ischemic injury. Methods When the method was established a baseline echocardiography was performed one day prior to surgery. The echocardiography procedure was repeated at three time points in order to quantify the area of infarction. Ten weeks post-surgery the hearts were fixed for histological sections and staining. Survival, cardiac function and healing process were analyzed. Results and discussion The protocol of permanent ligation of LAD at the atrioventricular junction ensured a statistically significant and reproducible MI. No difference in size of the infarct area between the groups was indicated by the analysis but the experiment needs to be repeated with a larger number of animals in order to obtain significant statistical basis. A Fisher Exact test suggested that wild-type mice survive myocardial injury to a greater extent than the mice that are partly deficient of FLNB. Although, death occurred during the critical days post-surgery and no conclusion about survival can therefore be drawn.
A Non-Response Study 24-months Following Hip Arthroscopy
(2020-04-24) Olsson, Harald; University of Gothenburg / Institute of Medicine; Göteborgs universitet / Institutionen för medicin
Title: A Non-Response Study 24-months following Hip Arthroscopy. Author, year: Harald Olsson, 2019. Supervisor: Mikael Sansone. Institution: Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg. Background: Clinics in Gothenburg, Sweden, have since 2011 documented the patient reported outcome measures (PROMs) in a local Hip Arthroscopy Registry in order to evaluate different subgroups, improve diagnostics and further refine treatments. PROMs are collected pre-operatively and with a follow-up time of 1, 2 respectively 5 years post-surgery. One of the main concerns of registry studies is the loss to followup as the proper evaluation of data obtained from a registry require a high response rate. The accepted percentage of Non- response could be anywhere from 20% to 60%, which is dependent on the level of Non-response bias. Aim: The primary aim of this study is to compare potential outcome differences between the Responders and the Late-responders. The secondary aim is to compare baseline characteristics. Methods: Prospective observational study of registry data. All 503 (397 Responders and 107 Nonresponders) participants underwent Hip Arthroscopy in 2015 and/or 2016 due to Hip pain. Non-responders were contacted during July 2019 and encouraged to participate in this study, which includes comparisons of Baseline characteristics and Clinical outcomes at Follow-up. Results: There were no differences in The Copenhagen Hip and Groin Outcome Score, The International Hip Outcome Tool-12, European Quality of life-5 domains-5 levels, Hip function-Visual analogue scale. However, Late-responders were 16.5% (95% CI: -26.6, -6,4) less satisfied with their operation. This study found four significant differences in baseline characteristics: 1) The Late-responders were 4.10 years younger (95% confidence interval (CI): 1.51, 7.12) 2) Konan type 1b cartilage lesion: Responders 1.7% (95% CI: 0.8, 3.1) versus Late-responders 5.1% (95% CI: 2.2, 9.7) 3) Hip sports activity scale-before symptom onset: Responders 5.40 (95% CI: 5.21, 5.49) versus Late-responders 5.92 (95% CI: 5.53, 6.32) 4) Hip sports activity scale-during adolescence: Responders 5.80 (95% CI: 5.61, 5.99) versus Lateresponders 6.42 (6.08, 6.76). There were no significant differences in body mass index, sex, pathologies, symptom duration, Hip sports activity scale-at surgery or other chondral lesions. Conclusion: The Late-responders have comparable outcomes to that of the Responders. Some baseline characteristics suggest that the Late-responders might differ from the Responders.
A pilot study on the role of intravenous Vitamin C, Thiamine and Steroids in the treatment of Sepsis in the ICU, Kathmandu, Nepal
(2021-05-19) Kjellberg, Jacob; University of Gothenburg / Institute of Medicine; Göteborgs universitet / Institutionen för medicin
Sepsis, tidigare kallad blodförgiftning, är en allvarlig sjukdom som drabbar 19 miljoner människor och orsakar fem miljoner dödsfall världen över varje år. Sepsis beror på att kroppen reagerar överdrivet på en infektion vilket innebär att immunförsvaret orsakar skada på de egna organen. Detta kan leda till att patientens blodtryck sjunker på grund av att vätska tränger ut från blodkärlen till vävnaden, och även till lungorna, vilket kan vara dödligt. Idag finns ingen definitiv bot för sepsis, istället ges vätskebehandling direkt i blodet för att höja blodtrycket i kombination med antibiotika som täcker ett stort antal bakterier, så kallad bredspektrumantibiotika. Innan antibiotika ges tas prover och blododlingar för att försöka ta reda på vilken bakterie som ligger bakom infektionen och vilken antibiotika den är känslig för. När provsvaren kommit sätts en antibiotika med smalare spektrum in i syfte att undvika resistensutveckling. Idag pågår intensiv forskning om nya behandlingar för sepsis. På senaste tiden har C-vitamin fångat forskarnas intresse. Forskning har visat att C-vitamin kan dämpa den kraftiga reaktionen från immunförsvaret och hjälpa till att få undan vätskan ifrån lungorna. De flesta djur kan bilda C-vitamin själva, människan har dock förlorat denna funktion till följd av en förändring i vårt DNA. Detta gör att C-vitamin är en så kallad essentiell vitamin vilket innebär den måste tillföras via kosten. Jacob Kjellberg 2020-02-17 2 I studien har C-vitamin getts till patienter med sepsis eller septisk chock (en allvarlig form av sepsis med bland annat väldigt lågt blodtryck) tillsammans med Tiamin (även kallat vitamin B1) och steroider (även kallat kortison). Tiamin är, precis som C-vitamin, en essentiell vitamin som är viktig för vår ämnesomsättning samt för utvecklingen av fostrets nervsystem. Steroider har en kraftfull dämpande effekt på immunförsvaret och har visats ha en positiv effekt på utkomsten vid sepsis. Tyvärr fanns inget C-vitamin tillgängligt när studien genomfördes på intensivvårdsavdelningen i Kathmandu, Nepal. Data från patienter som tidigare behandlats för sepsis samlades in och jämfördes med andra studier som gjorts på området. Det har visats att C-vitamin har en positiv effekt på dödligheten i sepsis om det ges tidigt i sjukdomsförloppet och vidare under minst fyra dagar. Mer forskning behövs inom området och flera studier genomförs idag som kommer undersöka C-vitaminets roll i behandlingen för sepsis.
A quantitative study investigating if the life situation is affected in a positive direction by literacy and numeracy training among semiliterate women and men in Uganda
(2018-03-06) Efraimsson, Emelie; University of Gothenburg / Institute of Medicine; Göteborgs universitet / Institutionen för medicin
ABSTRACT A quantitative study investigating if the life situation is affected in a positive direction by literacy and numeracy training among semiliterate women and men in Uganda Degree project in Medicine Emelie Efraimsson, 2017 Supervisors: Henrik sjövall and Aloysius Mutebi Sahlgrenska Academy, Department of global health, Gothenburg, Sweden Background Nearly 17% of the world´s adult population is still not literate, two thirds of them being women. People lacking basic skills in reading, writing and arithmetics are very vulnerable in many different ways. They are not only vulnerable to corruption, discrimination, violence and poverty; they are also vulnerable to poorer health and sickness. It is generally assumed that teaching poor women and men to read and perform simple arithmetics is beneficial for health literacy, quality of life and a cost-effective way of using foreign aid, but this assumption is surprisingly poorly documented. Therefore, it is of great relevance to investigate how women's and men´s lives are affected by reading and writing skills. Aim to evaluate the effects of adult literacy training on empowerment variables, socioeconomic situation, quality of life and health literacy among poor semiliterate Ugandan women and men. Method This is an observational cohort study comparing an intervention group consisting of 70 former students of a three year long adult literacy course with a control group consisting of 71 current applicants for the same adult education. The study is based on questionnaires covering the topics language skills, empowerment, socioeconomic situation, health and hygiene situation, health literacy, situation of children, future perspectives and assessment of the adult literacy course. The study was conducted in autumn 2017 in the Wakiso district of Uganda. Results and conclusions This study showed that literacy training in Uganda results in clear positive effects when it comes to empowerment betterments, socioeconomic situation, situation of children and future perspectives. Regarding health, hygiene and health literacy, there were no measurable effects. Keywords: Illiteracy, adult literacy, empowering women
A Statistical Analysis of Bowel Function and Quality of Life after Anterior Resection for Rectal Cancer
(2020-04-29) Andersson, Amanda; University of Gothenburg / Institute of Medicine; Göteborgs universitet / Institutionen för medicin
Abstract A Statistical Analysis of Bowel Function and Quality of Life after Anterior Resection for Rectal Cancer Amanda Andersson, Degree Project in Medicine, 2019 Department of Surgery, Sahlgrenska Academy at University of Gothenburg, Sweden Supervisors: Professor Eva Angenete and Associate Professor Marie-Louise Lydrup Background Colorectal cancer is the third most common cancer in Sweden and about a third is localized within the rectum. During the last decades, the 5-year survival rate has increased markedly due to improved oncological and surgical treatment. The postoperative morbidity is yet substantial, in terms of bowel dysfunction and impaired quality of life, motivating future research in this field. Objective The aim of this study was to investigate if the surgical technique partial mesorectal excision is superior to total mesorectal excision regarding bowel function and quality of life in patients with rectal cancer. Method The cohort was identified through the Swedish Colorectal Cancer Registry and consisted of 1495 patients treated with anterior resection for rectal cancer 2007-2013 at 15 Swedish hospitals. All patients alive received questionnaires about bowel function and quality of life. Bowel function was measured with a scoring system based on clusters of postoperative bowel symptoms, called low anterior resection syndrome (LARS), where "major LARS" represents the most severe form. Patients no longer alive or with permanent stoma were excluded (n=483) and registry data was completed with data from medical records. Univariate analyses for included patients were performed with Chi-square test for categorical data and ANOVA/Mann Whitney U test for continues data. The association between surgical procedure and bowel dysfunction was evaluated using binary logistic regression, with adjustments for potential confounders. Results Of the 254 patients suffering from major LARS, 81,1% were operated with total mesorectal excision and 18.9% with partial mesorectal excision (p<0.001). Odds Ratio for major LARS comparing total- to partial mesorectal excision was 1.82 (95% CI 1.12 to 2.95, p=0.016). Partial mesorectal excision was also associated with better social function and less diarrhea (p<0.001). Conclusion Patients operated with anterior resection for rectal cancer has a higher risk of developing severe bowel dysfunction, social dysfunction and higher frequency of diarrhea when treated with
A systematic review of histology and imaging methods detecting carotid plaque components associated with ischemic stroke
(2015-05-29) Dalne, Cajsa; University of Gothenburg / Institute of Medicine; Göteborgs universitet / Institutionen för medicin
Master thesis, Programme in Medicine TITLE: A systematic review of histology and imaging methods detecting carotid plaque components associated with ischemic stroke. Background: Rupture of atherosclerotic plaques in the carotid circulation is one of the major causes of ischemic stroke. The recent risk-stratifier for evaluating stroke risk is based on area of lumen narrowing although recent research indicates that plaque components and morphology might be of greater importance. A lot of research is in progress with the aim to find a cost-effective and non-invasive imaging method that adequatly can detect plaque components associated with an increased risk of creating ischemic events. Objective: The aim of this systematic review was to evaluate the scientific evidence for which imaging method of CT and MRI that best identify carotid plaque components associated with an increased risk of creating ischemic events. Methods: Two literature searches (one for each imaging method) was performed in PubMed and Cochrane Central Register of Controlled Trials (CENTRAL). Inclusion criterias was defined and used to select relevant articles. Data were extracted and presented in tables. The quality of the individual articles was assessed. Statistical analyzes could not be performed. Findings: The literature search resulted in 648 articles about CT and 915 about MRI. 6 articles about CT and 8 articles about MRI was included in the analysis. Direct comparisons between studies were not possible because of incomparable methods and outcome measures. Due to this it was not possible to perform any statistical analyze. Instead, a table highlighting the diversity between the articles was performed for each imaging method. However, the results indicated that MRI is a more researched method with better ability to identify plaque components than CT. Interpretation: There is a significant gap in scientific knowledge on this subject. The researchers will need to agree on inclusion criterias, methods to perform imaging, and the use of outcome measures. A standardized list of recommendations of how to perform research on this subject needs to be established in this field. In combination with larger trials and representative populations, the results could be comparable, analyzes could be performed and conclusions be reliable. Keywords: ”Carotid stenosis”, ”Vulnerable plaque”, ”Ischemic stroke”, ”Computed Tomography”, ”Magnetic Resonance Imaging
A Systematic Review of the Effects and Side Effects of Treatment with Oral Tetracycline in Acne Vulgaris
(2013-11-20) Werner, Evelina; University of Gothenburg / Institute of Medicine; Göteborgs universitet / Institutionen för medicin
Background: Commonly prescribed therapies in adolescent Acne vulgaris are topical regimens and oral therapy, with first line antibiotic tetracycline. With the evident increasing resistance of Propionibacterium acnes to oral tetracycline, treatment failures are a consequence. Aim: The aim of this systematic review was to evaluate the currently published data investigating the efficacy and side effects of treatment with oral tetracycline versus other commonly prescribed acne therapies. The secondary aim was to evaluate the treatment outcome related to propionibacterium acnes resistance to tetracycline. Methods: An electronic hand search was done in PubMed, Scopus and Cochrane Library databases. Selected studies were limited to those in the English language with a 10-year span ranging from 2002-2012. Search terms conducted for all 3 databases were “Acne vulgaris” and “Tetracycline”. Only Randomized controlled trials (RCT) were included to provide the highest evidence. For each study the risk of bias were assessed and a summary evaluation of the level of evidence (GRADE) were conducted. Findings: The search provided a total of 95 studies in which they were analysed meeting the predetermined eligibility criteria. In the final qualitative analysis 3 RCT studies were included. There were no significant differences in efficacy comparing topical regimens with antimicrobials versus oral tetracycline. Oral isotretinoin proved to have a superior efficacy compared to oral tetracycline. Adverse effects were predictable for each therapy and oral isotretinoin gave the most severe events. Interpretation: Oral tetracycline is an effective therapy in moderate to severe inflammatory acne. Even in the presence of resistant Propionibacterium acnes it is a successful treatment, most possibly relating to its anti-inflammatory fashion. Topical therapy with antimicrobials have similar efficacy as oral tetracycline. Although oral isotretinoin provides the best efficacy compared to oral tetracycline it is well known that it gives more adverse effects.
Abortion – Knowledge and attitudes in Amp Pipal, Nepal
(2016-02-11) Hörnell, Lovisa; University of Gothenburg / Institute of Medicine; Göteborgs universitet / Institutionen för medicin
Degree Project Thesis, Programme in Medicine. TITLE: Abortion – Knowledge and attitudes in Amp Pipal, Nepal. Background: 50,000 young women worldwide die every year due to unsafe abortions, whereof 99% in low-income countries. Nepal used to have one of the highest maternal mortality ratios in the world, but the numbers are rapidly decreasing after abortion legalization in 2002. Still the majority of the population is not aware of the new law, and common attitudes hinder women from seeking safe abortions. Aim: The aim of this study was to investigate knowledge about and attitudes towards induced abortion among adults at Amp Pipal Community Hospital in Nepal, and to analyse differences between age groups, individuals with different education levels, ethnicities, sex or between medical students and other people. Methods: The study was based on structured interviews with questions in Nepali, using a translator. Results: 118 patients and 7 medical students were included. Only 10% knew that abortion was legal until week 12 of pregnancy regardless the reason. A significant difference in knowledge was mostly seen between medical students and the other study participants. The attitudes differed significantly depending on the reasons for abortion, and became more positive with increased knowledge. Conclusions: Knowledge about the abortion law was poor in this study. Most of the study participants thought abortion was justified after rape or because of medical conditions. Few thought abortion was justified due to poverty or sex-selection, or when only one parent wanted to abort. Implications: Even where abortions are legal, far from everybody are aware of this. Safe abortions are considered a human right, and should be evaluated based on availability, accessibility, acceptability and quality to further reduce the maternal mortality. Key words: abortion, legalization, knowledge, attitudes
Adherence and effectiveness of guidelines for prevention of mother to child transmission of HIV at Kilimanjaro Christian Medical Centre, Moshi, Tanzania
(2016-02-11) Lundberg, Maria; University of Gothenburg / Institute of Medicine; Göteborgs universitet / Institutionen för medicin
Degree Project Thesis, Programme in Medicine. TITLE: Adherence and effectiveness of guidelines for prevention of mother to child transmission of HIV at Kilimanjaro Christian Medical Centre, Moshi, Tanzania. Background Mother-to-child transmission (MTCT) is the second most common mode of HIV transmission after heterosexual contact. The estimated rate of MTCT without any interventions is 25-40% but with the adequate prevention including HIV-testing, antiviral treatment and breastfeeding advices the MTCT could be less than 1%. Aim To identify factors that influence MTCT of HIV. Method An observation study was performed on the adherence among consecutive HIV-positive mothers to the current guidelines on prevention of MTCT of HIV. Results In total 98 HIV-positive mothers with children born between 1998 and 2014 were included in the study, 26 of the mothers had a HIV-positive child, 43 had a HIV-negative child, 20 had children with unknown HIV-status and 9 were excluded due to insufficient data. The transmission rate of HIV during 2014 was 14%. The mothers with HIV-positive children had a lower CD4-count than the mothers with HIV-negative children (p=0.003). The mothers who were diagnosed after delivery had a higher prevalence of infected children in comparison to those who were diagnosed before the pregnancy (p<0.004). A tendency towards that the mothers with HIV-positive children received treatment to a lesser extent than those with HIV-negative children was seen (p=0.07). The children who acquired the infection also received treatment to a lesser extent then the negative children (p<0.001). Nevirapine prophylactic treatment to the child had the strongest impact on the MTCT and reduced the transmission rate with one fifth. It was also seen that exclusive breastfeeding for six months reduce the transmission rate with 43%. Discussion and conclusion: This study showed that the rate of MTCT of HIV is strongly correlated on the extent of the adherence to the guidelines of prevention. The prevention programs of MTCT in the western world today are very effective and to halter the MTCT in developing countries the programs must be available and accepted by all pregnant women with a high compliance. Keywords: HIV, prevention, pregnancy, resource limited settings
Adherence to antiretroviral therapy among women living with HIV with previous participation in prevention of mother-to-child transmission programmes in Moshi, Tanzania
(2018-07-10) Jönsson, Linnea; University of Gothenburg / Institute of Medicine; Göteborgs universitet / Institutionen för medicin
ABSTRACT Adherence to antiretroviral therapy among women living with HIV with previous participation in prevention of mother-to-child transmission programmes in Moshi, Tanzania Linnea Jönsson Degree Project, Programme in Medicine, 2018. Department of Infectious Diseases, Gothenburg, Sweden. Background To optimize adherence to antiretroviral therapy (ART) in prevention of mother-to-child transmission (PMTCT) programmes, it is important to know ART adherence patterns among women. Increased knowledge of this can increase compliance to ART and further on decrease transmission of HIV from mother to child. Aim Investigate the effects of previous participation in PMTCT programmes on ART adherence among women living with HIV attending the PMTCT programme. Methods This cohort study was conducted at health centres in Moshi, Tanzania, March–April 2018. A semistructured questionnaire was administered to women attending Care and Treatment Clinics and antenatal clinics. In addition, information from medical charts was collected. Adherence was defined as number of missed doses during the last week. Good adherence was defined as an intake of 95% or more. Results Twenty-one participants were enrolled. Nineteen women (90%) were adherent to their medication during the last week. Eight women (38%) had previously participated in a PMTCT programme and among those, two women had ended prematurely. There was no significant difference in ART adherence among mothers participating in the PMTCT programme for the first time compared to those who had participated before (p = 0.51). Conclusion Adherence rate among the women attending the PMTCT programme in Moshi is high. No correlation between previous participation in PMTCT programme and ART adherence was found.
Adrenal Incidentaloma: Clinical Assessment of 483 Patients between 2014-2018.
(2019-12-30) Jabarkhel, Fatema; University of Gothenburg / Institute of Medicine; Göteborgs universitet / Institutionen för medicin
Abstract Introduction: Adrenal incidentaloma (AI) is defined as a mass or lesion in the adrenal glands that is discovered incidentally by an imaging modality performed for reasons unrelated to the adrenals. Worldwide, AI is detected in up to 5% of patients who undergo an abdominal CT. In the West Gotaland County in Sweden, AI was found in 4.5% of all abdominal CT performed between 2002-2004. Once AI is detected, further investigations should be performed to see if the lesion is benign or malignant and if the lesion overproduces adrenal hormones. Aim: The aim of this study was to see how common AI is in the modern era and to describe its characteristics as well as its management in the healthcare system. Methods: A retrospective descriptive study was performed at Sahlgrenska University Hospital in Gothenburg. Clinical, radiological, biochemical and histopathological data of all AI referred to the departments of endocrinology and endocrine surgery, between the years 2014 to 2018, were reviewed. Results: A total of 483 patients had an AI, 289 (60%) women and 194 (40%) men. The median age was 69 years (range 70; IQR 17). The AI was detected by a CT-scan in 456 (94%) and 340 (70%) were followed-up with additional imaging. Four hundred fifty-seven (95%) patients underwent biochemical screening. Benign and inactive lesions were detected in 431 (89%) cases. Malignant tumours were found in 14 (3%) patients; 8 (1.7%) adrenal metastases, 4 (0.8%) adrenocortical carcinoma and 2 (0.4%) primary adrenal leiomyosarcoma. Hormonally active tumours were found in 38 (8%) patients; 21 (4.3%) pheochromocytoma, 13 (2.7%) primary aldosteronism and 4 (0.8%) hypercortisolism. Adrenalectomy was performed in 54 (11%) cases. Conclusion: The clinical, biochemical and radiological characteristics show that AIs are in most cases benign and inactive lesions, that do not require any medical or surgical treatment, and excess follow-up should be avoided. However, a small but significant amount of the lesions are either hormone-producing or malignant tumours that need thorough management and treatment.

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