Examensarbete 30 Hp, Läkarprogrammet

Permanent URI for this collectionhttps://gupea-staging.ub.gu.se/handle/2077/25558

Browse

Now showing 1 - 20 of 389

Patientupplevelsen av läkarkonsultationer vid funktionella mag-tarmsjukdomar
(2023-10-31) Fritiofsson, Anna; University of Gothenburg / Institute of Medicine; Göteborgs universitet / Institutionen för medicin
Flera av de intervjuade patienterna har aldrig fått en diagnos Både IBS, irritabel tarm, och funktionell dyspepsi – i folkmun kallad magkatarr – är vanliga sjukdomar som drabbar fyra respektive sju procent av världens befolkning. Sjukdomarna har stor påverkan på livskvalitet. Det har visats i andra studier att den här patientgruppen lider mer av sina besvär än vad personer med andra kroniska mag-tarmsjukdomar gör. Dessutom har många läkare en negativ attityd till de här patienterna. Den här studien har intervjuat åtta patienter som har dessa diagnoser med fokus på hur de har upplevt det bemötande de fått i sjukvården. Intervjuerna har följt en lös struktur och personerna har uppmanats att prata fritt om sina erfarenheter. Resultatet är slående – flera av de intervjuade upplever att de inte fått någon diagnos alls. De känner att de aldrig blivit erbjudna en förklaring till varför de mår som de gör. Upprepade gånger beskriver de brevsvar på undersökningar där det står att ”ingenting” hittas. De undrar över varför det är så svårt att bli remitterad till mag-tarmspecialist. Några har fått en tydlig diagnos på sina besvär men har fått den diagnosen i ett brev och utan uppföljande besök. De önskar få komma till en läkare och diskutera fortsättningen och bli insatta i hur diagnosprocessen egentligen har gått till. En del känner sig lämnade ensamma med sina besvär när väl diagnosen har ställts. Resultatet tyder på att det kan finnas brister i bemötandet vid IBS och funktionell dyspepsi. Möjligtvis kan den här studien ge idéer för vidare forskning för att ta reda på hur stor andel av patienterna som känner att de inte får en riktig diagnos. I förlängningen kan studien leda till att utbildningen för läkare förbättras – både när det gäller kommunikation med patienter och generell kunskap om IBS och funktionell dyspepsi. För den enskilda läkaren kan den här studien bidra med inspiration till att förklara för och vara extra tydlig gentemot sina patienter.
Upplevelse av sjukvårdskontakter bland patienter med förmodad hjärntrötthet.
(2023-10-31) Alzouby, Atiya; University of Gothenburg / Institute of Medicine; Göteborgs universitet / Institutionen för medicin
Upplevelse av sjukvårdskontakter hos patienter med förvärvad hjärntrötthet Hjärntrötthet är ett tillstånd som vissa patienter drabbas av efter en hjärnskada, exempelvis efter infarkt i hjärnan, hjärnblödning eller efter andra sjukdomar som drabbar vår hjärna. Tillståndet kännetecknas av trötthet som kan vara handikappande för personen i fråga, det beskrivs som en känsla av tidig utmattning och att den mentala liksom den fysiska energin plötsligt kan ta slut. Detta begränsar möjligheten till utbildning och arbete och minskar orken och motivationen. Det påverkar i varierande grad även patientens sociala liv och upplevelsen av delaktighet i samhället vilket skapar ökad social isolering hos de drabbade individerna och minskar deras livskvalitét. Tillståndet tillhör gruppen oförklarade medicinska tillstånd vilket innebär att man inte riktigt vet vad som sker i hjärnan och vad som orsakar den handikappande tröttheten, och det finns heller ingen effektiv och riktad behandling. Syfte med studien är att med en intervjubaserad undersökning ta reda på hur hjärntrötta individer upplevt sin kontakt med vården och Försäkringskassan och förhoppningsvis även kunna identifiera vanligt förekommande källor till dåligt fungerande kommunikation mellan läkare och patient. Vi intervjuade 8 deltagare med olika kön, ålder, bakgrund , olika bakomliggande orsaker och olika symptomgrad. Vi skrev ner alla de inspelade intervjuerna och försökte identifiera olika gemensamma teman. Resultaten synliggör centrala aspekter som är kopplade till patientupplevelserna av sin vård. Ett viktigt tema som kom upp var frustration och besvikelse över låg samtalskvalitet med pressade, stressade och oengagerade läkare där patienterna inte upplevde sig hörda eller förstådda. Ett annat centralt tema var upplevelsen av symptomens stora negativa påverkan på generell livskvalitet. Ett tredje tema var problem i samspelet med Försäkringskassan. Deltagarna upplever att deras situation inte tas på allvar samt att kunskapen om hjärntrötthet bland vårdpersonal inklusive läkare är otillräcklig, och att detta resulterar i bristande hjälp och stöd från vården. Patienterna betonar starkt vikten av att ha egen läkare, detta upplevs som trygghet för de flesta av deltagarna. Patienterna upplever en stor stress och press inför varje gång man ansöker om sjukpenning och känner sig ofta ifrågasatta. De återkommer hela tiden till kärnproblemet: den starka kontrasten mellan livet man hade innan och det förkrympta liv som skapas av hjärntröttheten, ett liv präglat av ett osynligt handikapp. Slutsatsen man kan dra från denna studie är att patienterna efterlyser en ökad kunskapsnivå och bättre förståelse från både vården och Försäkringskassan. De tror att detta skulle bidra till förbättrad livskvalité och ökat välbefinnande hos drabbade individer. Sammanfattningsvis är hjärntrötthet ett osynligt handikappande tillstånd som påverkar patientens alla livsaspekter. Drabbade patienter upplever ofta att vården misslyckas med att ge dem lämplig hjälp och stöd men upplever trygghet när de får en ”egen läkare” och en lyssnande handläggare på Försäkringskassan. Mer forskning behövs dels för att kartlägga hur vanliga dessa problem är och dels för att ta fram exempel på hur man kan förbättra vården för dessa patienter som hela tiden tvingas leva med och hantera sitt dolda handikapp.
A Comparison of Maternal and Reproductive Health in Nepal between 1996-2011
(2022-05-23) Bergendahl, Matilda; University of Gothenburg / Institute of Medicine; Göteborgs universitet / Institutionen för medicin
Background: Nepal is a South-Asian country facing many difficulties in health care. A particularly vulnerable group is pregnant women. Due to lack of education and accessibility to health care such as antenatal care, skilled birth attendance, and adequate family planning, Nepal has had a high maternal mortality rate. Most mothers die from preventable causes such as haemorrhage, infections, and complications from abortion. Demographic and Health Surveys (DHS) have been conducted in various countries worldwide, as well as in Nepal. This is to elucidate demographic characteristics, with a focus on maternal and child health, often used to measure achievements made towards global goals, such as the Millennium Development Goals. Aim: The aim of this study was to elucidate the development with regards to maternal and reproductive health among women in Nepal; has there been any advancement concerning the Millennium Development Goal no 5 “To improve maternal health”, by comparing Demographic and Health Surveys of Nepal conducted in the years 1996 and 2011. Methods: This was a retrospective study of women’s maternal and reproductive health in Nepal by comparing aggregated datasets from the DHSs of 1996 and 2011. The 1996 DHS served as a foundation of the study, and comparable data was analysed mainly using “individual confidence interval for the difference between proportions”. Results were presented in tables. Results: The maternal and reproductive health in Nepal has remarkably improved between 1996 and 2011 in nearly all variables over all regions. Contraceptive prevalence rate has increased. Less adolescents give birth. More women attend antenatal care and give birth with skilled birth attendance. Conclusions: The maternal and reproductive health appears to have improved in all studied regions; however remote areas tend to lag urban areas and the Millennium Development Goals are rather far from being fulfilled. A comparison of aggregated datasets implies statistical limitations, whereas the statistics should be approached with caution.
Analyzing animal model morphometrics and the cardiac proteome in heart failure with preserved ejection fraction
(2022-05-23) Kourieh, Antonio; University of Gothenburg / Institute of Medicine; Göteborgs universitet / Institutionen för medicin
Introduction and Aims: Heart failure with preserved ejection fraction (HFpEF) is a diastolic dysfunction with unknown underlying mechanisms and etiology. A HFpEF mouse model was recently established, with mice on a high fat diet and water containing L-NAME which induces hypertension. A double knockout (dKO) of Obscurin/Obscurin-like1 (Obsl1) may also serve as a new model for HFpEF. The main purpose of this study is to investigate and compare changes to cardiac proteome between healthy lean mice, HFpEF mice and obscurin/Obsl1 dKO mice. Methods: Cardiac samples from three male and three female HFpEF mice (HFL) were compared with three male and three female healthy lean mice (SFD). Depletion of actomyosin was made using dilution buffer and centrifugation, and before the samples were sent off to mass spectrometry for proteome-analysis, they were analyzed using SDS-page gel to see if the depletion had worked. Pre-existing lung-sections were deparaffinized and stained with Prussian Blue, pictures were then taken, and the HFC were counted. Student´s T-test and ANOVA with Post-Hoc Tukey test was used for statistical analysis between the groups on the proteomes, heart failure cells (HFC) and pre-existing data of the body weight, tibia lengths, water content in lungs and kidneys Results: 128 significantly changed proteins found in the females, 56 in the males. HFL mice express significantly higher mean water content in lungs and kidneys. The HFL and dKO mice are significantly heavier than the SFD. No difference in tibia lengths. Significantly greater amount of HFC in dKO mice. Conclusions: The results support the idea of HFpEF being a sex-specific disease that affects females more than males. Most proteins that are found in both the HFL and Obscurin/Obsl1 models are involved in the cardiac metabolism, mitochondrial function or in cardiac contractility, which supports the idea of the dKO model being a future HFpEF model.
The effects of treatment with alcohol septal ablation in patients with Hypertrophic obstructive cardiomyopathy
(2022-05-23) Bakken Wold, Ane; University of Gothenburg / Institute of Medicine; Göteborgs universitet / Institutionen för medicin
Background: Hypertrophic Cardiomyopathy is the most common of the inherited cardiomyopathies. When the hypertrophic myocardium affects the interventricular septum, it can cause left ventricular outflow tract obstruction (LVOTO), resulting in Hypertrophic obstructive cardiomyopathy (HOCM). Patients are treated with negative ionotropic drugs in order to relieve symptoms. Patients who still have symptoms while on appropriate medical therapy are candidates for septal reduction therapy. Septal reduction therapy includes myectomy and the newer and less invasive alternative of alcohol septal ablation (ASA). Aim: To describe the group of patients who have been treated with ASA at Sahlgrenska University Hospital and assess the effectiveness of treatment. Methods: In this study, we used an observational cohort design. The cohort included 68 patients with HOCM who received treatment with ASA. Data was collected from preexisting medical records. Results: There was a reduction in New York Heart Association (NYHA) functional class from a mean of 2.8 at baseline to 2.1 at the time of follow-up (p<0.001). A decrease in LVOTO from a median of 81 mmHg to 20 mmHg was documented after treatment with ASA (p<0.001). The dosing of beta-blockers was reduced from a median of 175 mg/day at baseline to 150 mg/day at the time of follow-up examination (p=0.016). At baseline, 22.4% of patients had the anti-arrhythmic drug Disopyramide. This number was reduced to 11.5% at the time of follow-up (p=0.021). Time to follow-up after intervention had a mean of 6.3 months. Conclusion: ASA is an effective form of septal reduction therapy for selected patients with HOCM. Reduction of LVOTO led to symptomatic improvement for most of the patients. In addition, the observed reduction in use and dose of beta-blockade and Disopyramide after treatment with ASA further supports the effectiveness of treatment.
Retrospective Analysis of Swedish Colorectal Cancer Registry: Validation through comparison with medical records
(2022-05-23) Humayun, Jhangir; University of Gothenburg / Institute of Medicine; Göteborgs universitet / Institutionen för medicin
Introduction: The Swedish colorectal cancer registry (SCRCR) is a national registry that is considered complete, accurate and comprehensive regarding primary outcome measures, but recent studies have indicated underreporting regarding secondary outcome measures like postoperative complications. Aim(s) / Objective(s): The main aim of the study is to analyze the reliability of the SCRCR. The secondary objective is to present the comorbidity data and surrogate variables indicating possible frailty of the patients operated for colorectal cancer (CRC). Methods: 150 patients were included, and data was collected from SCRCR and patient medical records. Nine variables were selected for the reliability analysis. Comorbidity among the group was studied using Charlson Comorbidity Index (CCI). Furthermore, surrogate variables studied for frailty were, whether patient care planning was held and where patients were admitted from. Results: Out of 149 included, 82 males were male and mean age (SD) was 70.6 ± 12.1 years. The mean comorbidity score according to CCI (SD) was 5.74 ± 2.14 indicating circa 5% predicted 10-year survival rate. 91% of the patients were admitted from and discharge to home. 7% were admitted from emergency ward and 2 % from care home while 7 % were discharged to other care and 2% died. Before discharge, 26 % of the patients underwent patient care planning. Regarding validity of the registry, mean exact agreement was 91.5% and κ-value ranged from 0.078 indicating no agreement to 0.959 which indicates almost perfect agreement. Conclusion: This retrospective registry-based study reports that SCRCR shows good reliability. The strength and accuracy of SCRCR is in variables that are clearly defined and stated while variables with broad definition or that require further interpretation may be underreported. Current study also indicates that a substantial number of patients operated for CRC have several known comorbidities and other indicators for frailty.
Characteristics and prognosis for patients discussed at the multi-disciplinary heart transplantation board at Sahlgrenska University Hospital
(2022-05-23) Strandell, Kesia; University of Gothenburg / Institute of Medicine; Göteborgs universitet / Institutionen för medicin
The first heart transplant was performed in 1967 in South Africa, and since then approximately 118,000 heart transplants have been performed worldwide. Today, approximately 4000 heart transplants are performed annually, of which 60-70 are performed in Sweden. Heart transplantation (HTx) may be offered to patients with severe heart failure and in a few cases HTx is indicated as a final stage treatment for patients with arrhythmias as well as inoperable valve abnormalities. Approximately 60 - 70 patients are admitted to the multidisciplinary transplant board for HTx annually at Sahlgrenska University hospital and about 35 of these are accepted for heart transplantation. The underlying reasons why patients are not considered suitable for transplantation are comorbidity, noncompliance and malignancy. All patients referred for a transplant evaluation undergoes a comprehensive examination, both physical as well as psychiatric to rule out potential treatable causes of the end-stage heart syndrome, potential absolute exclusion criteria and sort out patients that may be eligible for an orthotropic heart transplantation. The main objective for this thesis, using data that was collected retrospectively from 2008 to 2018, to characterize patients discussed at the multidisciplinary transplantation board at Sahlgrenska University Hospital as well as survival. The patients were categorized into three different groups depending on the board decision, suitable to undergo HTx (cohort 1) or unsuitable for HTx, containing patients assessed as not sick enough (cohort 2) or too sick (cohort 3). The three different groups were analysed in relation to their background variables as well as overall survival. The overall survival rate for those patients that were not accepted in cohort 3 was bad, 60% 2-years and 40% 10-years survival rate, in comparison to cohort 2, where the 2- and 10-years survival rate was 90% respectively 80%. Concluding that those patients not accepted for a heart transplant who were judged not sick enough (cohort 2) had as good prognosis as those receiving a HTx (cohort 1). The study found that there were almost no differences in the background variables that the multidisciplinary board base their decision on between the three different groups, with some exceptions. Cohort 2 are considerably younger and cohort 3 has a significantly older age group. Co-morbidity increases with age and could be one explanatory reason. The most common diagnosis amongst patients denied HTx due to being too sick (cohort 3) is ischemic heart disease (IHD) at the same time as an increased mortality rate were detected for patient diagnosed with IHD that do receive a heart transplant (cohort 1). Furthermore, the study reveals elevated mean pulmonary artery pressure (MPAP) as one predictor that correlates with higher mortality risk for patients denied a heart transplant (cohort 3). In alignment with previous findings, patients that were not accepted for heart transplant because they were judged not sick enough (cohort 2) had a better functional level in cardiopulmonary exercise tests, regarding peak O2 and max watt.
Infectious complications after transrectal ultrasound guided prostate biopsy in a prostate cancer screening trial
(2022-05-23) Eriksson, Karl; University of Gothenburg / Institute of Medicine; Göteborgs universitet / Institutionen för medicin
Background: Globally, prostate cancer is the second most diagnosed cancer among men. Prostate biopsies are necessary to obtain a histological diagnosis. Prostate biopsies can lead to different complications. Minor complications include hematuria, hematochezia, hematospermia and urinary tract infections. Major complications are uncommon and consists mainly of rectal bleeding and sepsis. This study investigates the infectious complication rate after transrectal prostate biopsy in a screening population. Materials & Methods: For this study, data was taken from the Göteborg prostate cancer screening 2 trial study. The study population consisted of 810 men aged 50-60 years. All men were asked to answer questionnaires prior and post prostate biopsy. Questionnaires consisted of questions regarding basic health characteristics and whether the patient had suffered any complications post biopsy. Some questionnaires lacked information, therefore a total of 207 medical charts were reviewed. The primary outcome for this study was to evaluate the infectious rate post biopsy. The secondary outcome was to investigate whether there was a difference in infection rates between systematic and targeted biopsies and furthermore the cause for the infections. This study is approved by the Regional Ethical Review Board in Gothenburg, January 2015 (registration number 890-14). Results: A large proportion of men in the questionnaire group were asymptomatic (7.8%) or had mild lower urinary tract symptoms (34.5%). Median age was 58.7 years. Out of the total study population of 810 men, infectious complications rate after transrectal biopsies in the population-based Göteborg prostate cancer screening 2-trial resulted in 1.7% patients with urinary tract infection (UTI) and 0.5% needing hospital care due to UTI. There was no significant result regarding biopsy approach and infection rates. Conclusion: Infectious complications post transrectal biopsy are rare in a screening population in men aged 50-60 years. These results can be used as a reference for further screening studies as well as in clinical practice.
Investigating Cardiac Protein Expression in two Diastolic Heart Failure Mouse Models
(2022-05-23) Rudbäck, Petter; University of Gothenburg / Institute of Medicine; Göteborgs universitet / Institutionen för medicin
Introduction / Background: The treatment of heart failure with preserved ejection fraction (HFpEF) remains challenging as common heart failure drugs fail to reduce mortality in the patient group. There is a lack of knowledge of what molecular mechanisms are responsible for the disease and a lack of animal models to emulate the disease. There are however two new HFpEF mouse models, the High Fat diet + L-NAME (HFL) mouse model and the Obscurin/Obsl1 dKO model. Aim(s) / Objective(s): To investigate the expression profile of key structural, metabolic and sarcoplasmic reticulum (SR) proteins in the HFL mouse model and to compare the results with previous unpublished results from the Obscurin/Obsl1 mouse model. Methods: The concentration of 24 different proteins in 3 female and male controls as well as 3 female and male HFL mice were investigated using western blotting. The blots were then quantified using the computer program Fiji and analyzed using SPSS. The localization of Obscurin, Obsl1 and smooth muscle actin inside the tissue was visualized using immunofluorescence. Results: In female HFL mice, a statistically significant decrease of Obscurin and an increase of Obsl1 was seen. No change was seen in male mice. For metabolism, protein changes that indicate a metabolic switch to increased fat metabolism was seen. In the sarcoplasmic reticulum (SR) there were significant changes calcium handling proteins. Conclusion(s) / Implication(s): Both models saw changes to SR proteins, but the specific proteins affected differed between the models. However, there are signs that both SR function and the expression of structural proteins Obscurin and Obsl1 are affected in the disease and could be underlying mechanisms. The metabolic profile on the other hand does not seem to be altered in any specific way in the disease.
Associations between high concentrations of air pollution and psychiatric emergency department visits during the COVID-19 pandemic: a register-based study
(2022-05-23) Olsson, Jenny; University of Gothenburg / Institute of Medicine; Göteborgs universitet / Institutionen för medicin
Introduction / Background: Converging results has suggested a link between increased exposure to air pollution and acute exacerbation of mental disorders such as depression, substance abuse, psychotic disorders and even suicide. However, what happens to this association during a large societal change such as the COVID-19 pandemic, remains unknown. Aim(s) / Objective(s): The aim of this study is to investigate the association between increased levels of particulate matter (PM) and number of visits to a psychiatric emergency department before and during the COVID-19 pandemic. Further, this study aims to identify if there are any specific risk groups who are more susceptible to the effects of air pollution by studying sex, age, and outpatient status. Methods: Data on number of visits to the psychiatric emergency unit at Sahlgrenska University Hospital in Gothenburg was provided by hospital administration and compared to daily levels of PM10 and PM2.5. The data was analyzed statistically using a time-stratified case-crossover design. Results: A significant association between exposure to PM10 and PM2.5 and increasing number of visits to the psychiatric emergency department could be seen during the control period for day 0-1 post exposure for females and for patients with ongoing outpatient contact. Remaining results in this study did not reach statistical significance. However, a positive association could be seen numerically for several of the analyses. For males, the age groups 18-24 and >65 years and individuals without ongoing psychiatric outpatient contact, this association seemed to increase during the pandemic. Conclusion(s) / Implication(s): Although not significant, several of the analyses indicate that there might be a positive association between increased levels of air pollution and number of visits to the psychiatric emergency department, and that this association changed during the pandemic. Additional studies on a larger population and for a longer period are needed to further explore how the pandemic has affected the suggested relationship between increased air pollution and mental illness.
Antibiotic use for Treatment of Pneumonia in Department of Internal Medicine
(2022-05-23) Samad Imran, Abdul; University of Gothenburg / Institute of Medicine; Göteborgs universitet / Institutionen för medicin
Background Pneumonia is a common diagnosis in every hospital department. Misuse of antibiotics, too much broad-spectrum agents and too long duration of therapy, in the treatment of pneumonia has impact on the evolving trend of antibiotic resistance. Reports from a national quality register for pneumonia (NQRP11) of 5334 patients, 2011 show that there are shortcomings in the use of antibiotics for pneumonia treated in different infectious disease departments. Swedish Society of Infectious Diseases has put forward quality measures in the in-hospital treatment of community-acquired pneumonia. There is a lack of information about the quality of care for pneumonia in departments of internal medicine. The purpose of the present study is to compare the antibiotic use for treatment of pneumonia in internal medicine wards and infectious disease wards. Methods and results Review of the medical records of 80 patients who were treated for community- acquired pneumonia during 2011 in internal medicine wards in Skaraborg hospital, Skövde. Different quality parameters were studied during case review. For example: initial antibiotic treatment, antibiotic therapy after day 3, treatment duration, diagnostic use of respiratory tract culture. Cases were chosen randomly with equal gender presentation accordingly 40 male and 40 female patients. The results were compared with NQRP11. The patients in the study were older and suffered from more comorbid illnesses but the percentage with severe pneumonia were equal to the national cohort in infectious disease wards. Broad-spectrum antibiotics were used more often both empirically and as follow-up therapy. More patients received inappropriate long duration of therapy and a higher proportion was not subject to respiratory tract culture. Conclusions Patients with pneumonia cared for in various departments are not treated in the same way. This could be due to differences in age, concomitant diseases and disease severity. Patients in medical wards had higher median age and more comorbid illnesses but disease severity was equal. Overall antibiotic use for therapy of pneumonia had lower quality in medical wards than infectious disease wards. More studies are needed to elucidate the reasons for this. Educational efforts and increased awareness are needed in order to increase penicillin use, to reduce duration of antibiotic treatment, and to increase diagnostic procedures.
Barriers to initial stroke care in Zanzibar - a qualitative study on the perspectives of doctors at Mnazi Mmoja Hospital
(2022-05-23) Ditlevsen, Elias; University of Gothenburg / Institute of Medicine; Göteborgs universitet / Institutionen för medicin
Background The global stroke burden is unevenly distributed, with Sub-Saharan Africa (SSA) especially affected. Despite stroke being very common in SSA, there however exists both uncertainty and barriers that impede its optimal management. To date, knowledge of the perspectives of stroke care professionals (SCPs) in SSA is scarce. As such knowledge greatly facilitates improvement of stroke care, the aim of this study was to understand the perspectives of doctors involved in initial stroke care at Mnazi Mmoja Hospital (MMH) in Zanzibar, on the care they provide and on the barriers they perceive to providing it. Methods Seven semi-structured interviews were conducted, followed by qualitative content analysis. Results SCPs at MMH overall consider the quality of the stroke care they provide as suboptimal. Five categories of barriers with 16 sub-categories were identified. These were barriers on the patient (lacking knowledge, ignorance, poor compliance, poor health seeking behavior and alternative beliefs), community (family and societal level), health professional (insufficient knowledge and confidence, poor teamwork amongst doctors, low degree of investment), hospital (inadequate quality, insufficient resources, inadequate staffing, insufficient organization and insufficient staff education) and policy level. Conclusions The results are generally similar to those from studies previously carried out in SSA, with some differences in underlying context. The perceived barriers also share commonalities with those found in high-income countries, although with even greater difference in the context shaping them. The results of this study can be of great value to decision-makers in Tanzania, and especially Zanzibar, when considering means to combat the growing stroke problem. They also contribute to a field where research is scarce. More research is needed to assess to what degree the similarities uncovered extend to other parts of SSA.
Micronutrient Deficiencies and Nutritional Status among Children and Women in Nepal
(2022-05-23) Carlsson, Amanda; University of Gothenburg / Institute of Medicine; Göteborgs universitet / Institutionen för medicin
Background: For decades, nutritional deficiencies have been major public health concerns in Nepal, where children and women are most vulnerable. Deficiencies in the micronutrients vitamin A, iodine and iron are among the most common. The Sustainable Development Goal no 2 “Zero Hunger”, declared by the United Nations, aims to defeat hunger by 2030. Aim: To elucidate the development regarding anemia, iodine deficiency, vitamin A deficiency and the nutritional status among children and women of reproductive age in Nepal. Methods: A retrospective analyzing study using the Nepal National Micronutrient Status Survey from 1998 and 2016 among children mainly aged 6-59 months and women aged 15-49 years. Since the datasets consist of aggregated data of Hemoglobin, S-Retinol and Urinary Iodine Concentration and anthropometric measures for nutritional status, “individual confidence interval for the difference between proportions” was mainly used for the statistical analysis. Results: The prevalence of anemia, vitamin A deficiency and iodine deficiency were statistically decreased for both children and women during this period. Iodine deficiency was eliminated as a public health concern, while anemia and vitamin A deficiency still were considered as mild to moderate public health concerns. Similarly, the prevalence of stunted children, as well as underweight among both children and women, were significantly decreased, but the high prevalence remained. In contrast, the prevalence of wasted children significantly increased. Conclusions: Altogether, the nutritional health among children and women has remarkably improved during the last decades in Nepal. Despite this, Nepal is far from achieving the nutritional targets of “Zero Hunger” since, except iodine deficiency, major nutritional deficiencies persist, where children and women in rural areas are more exposed. Alarmingly and unexplainable, an increased prevalence of wasted children was found throughout Nepal, but most prominent in rural areas and in the Terai.
Connection between seasonality in hospitalizations and sleeping traits in bipolar disorder
(2022-05-23) Markkanen, Alexi; University of Gothenburg / Institute of Medicine; Göteborgs universitet / Institutionen för medicin
Background: Bipolar disorder (=BD) is a relatively common mood disorder which is characterized by episodes of depression and mania/hypomania. These episodes are not evenly distributed along the year but show a seasonal trend: there are more manic episodes during spring and summer and more depressive episodes during autumn and winter. This phenomenon is called seasonality. Leading theory explaining this phenomenon is so called light hypothesis; amount of sunlight through the year affect mood of BD patients and therefore acts a episode provoking factor. Additionally genetic predisposition to BD is considered high (73-93%) but exact genes and mechanism is widely unknown. It has been previously pointed out that sleep traits differ between normal population and those with BD. For example ”night owl” -chronotype, hypersomnia and insomnia are more common with those with BD. Whether this has to do with lifestyle or has a connection to genetic factors is unknown. It has been hypothesized that society living on 8-16 schedule is harmful to the ”night owl” chronotype and therefore could be BD provoking factor, on the other hand there is a speculation that same genes that determinate chronotype and other sleeping traits also play a role with predisposition to BD. Additionally previous studies have pointed out that one mechanism for developing BD is malfunction of clock genes that control our circadian rhythm, both on daily- and seasonal level. Most important of these genes are PER- and CRY- gene families. Furthermore, one of the most potent drug against BD is lithium that affects expression of the exact same clock genes. This leads to hypothesis that there could be same genetic factors that contribute to both seasonality and sleeping traits. Aims: Purpose of this master thesis work is to further clarify the role of chronotype and other sleeping traits in BD. More specific our aim was to study connection between genetic predisposition to following sleeping traits: chronotype, daytime sleepiness, sleep duration and insomnia and their connection to seasonality in BD. Furthermore this thesis focuses on trying to understand genetic predisposition to BD itself and it most distinguish subtypes BD-I and BD-II. Methods: Genetic patient data for this study has been provided by Swedish Bipolar Collection (SWEBIC 2009-2013). SWEBIC consists of data of over 6000 Swedish BD patients. Data includes both information of patient’s hospitalization history and genetic information in form of GWAS (genome wide association study). We used statistical programming software R to generate phenotype using clinical data from NPR (National Patient Register) to represent seasonality in hospitalizations among BD patients. As a result we got a specific value that describes seasonality for every individual in our database that fulfills inclusion criteria of our study. Our geneticist created PRS’s (polygenic risk score) for every individual in our database that describes individual’s genetic predisposition to sleeping traits we are examining: chronotype, sleep duration, daytime sleepiness and insomnia. Lastly, we calculated OR (Odds Ratio) comparing correlation between our phenotype and all of our genotypes separately using linear regression analysis. Results: Our preliminary findings suggest that there is slight, yet statistic significant connection between seasonality in hospitalizations and both daytime sleepiness and sleep duration genotypes. On the other hand, we could not find statistic relevant connection between seasonality of hospitalizations and two other genotypes, chronotype and insomnia. Conclusions: Our results suggest that among BD patients chronotype and other sleeping traits do play a role in the disease and its role should be further investigated.
Detection of poststroke epilepsy and accompanying anti-seizure treatment using Swedish national registers – a validation study
(2022-05-23) Karlsson, Rikard; University of Gothenburg / Institute of Medicine; Göteborgs universitet / Institutionen för medicin
Introduction Stroke is the most common cause of epilepsy, causing an estimated 14-21% of all epilepsy cases. Unfortunately, there is limited knowledge regarding the optimal treatment for post-stroke epilepsy (PSE) and there has been done few studies on PSE because of the difficulty in following elderly patients with multimorbidity over time; epileptic treatments can continue for years and many studies on the field has only evaluated 12 months. Swedish National Patient Register (NPR) can give unique possibilities in following large patient cohorts over a long term, but to know whether certain conclusions from register studies are accurate, it is important to validate the registers. Aim The goal of this study was to evaluate the accuracy of register-based criteria associated with post-stroke epilepsy in the Swedish NPR. Methods This was a retrospective validation study with a total study population of 177 deceased individuals who have been identified by The Swedish National Board of Health and Welfare that fulfiled register-based criteria of PSE. Medical records from these patients were examined thoroughly to see if stroke and subsequent epilepsy could be confirmed, and the collected data were filled into protocols. The data were analysed and positive predictive value (PPV) was used as a method to validate the outcome, calculated as a ratio between the number of patients who had likely or definite epilepsy after stroke to the total number of patients. Results From the 177 patients who were identified, a total of 133 (PPV: 75%, 95%CI 0.69-0.82) had epileptic seizures after stroke. 105 out of 133 epileptic patients were prescribed anti-seizure medication (ASM). Conclusions/implications The results of the study are informative for future register-based studies on PSE. Compared to another recent study validating epilepsy codes in several countries, this result can be seen as high: in our study, at least 75% of the identified patients actually had PSE. Considering the risk of misdiagnosis in epilepsy, register studies will always identify some patients who do not meet the diagnostic criteria for PSE. The accuracy of the register codes may be further increased by requiring that the patients had received an anti-seizure medication, or to only identify patients diagnosed with epileptic seizures; our study also included unspecified seizures which identified some patients who had experienced seizures unrelated to epilepsy.
How can we identify misdiagnosis in rheumatoid arthritis?
(2022-05-23) Hallberg, Sophie; University of Gothenburg / Institute of Medicine; Göteborgs universitet / Institutionen för medicin
Background: Rheumatoid arthritis (RA) is a common systemic autoimmune disease, with largely unknown pathogenesis, mainly affecting joints, leading to deformities with loss of function. The prevalence is 0.5 – 1.0 % in the general population. Diagnosis in an early stage of the disease is difficult but essential for suppressing inflammation and preventing damage and deformities in joints. As diagnosis criteria for RA are missing, the diagnosis is often established based on classification criteria. Objectives: This study examines differences between actual and misdiagnosed in a long-term cohort where patients were included based on the ACR1987 classification criteria for rheumatoid arthritis. Methods: Of the 2541 patients from the BARFOT (Better Anti Rheumatic Pharmaco Therapy) cohort, the RA diagnosis was changed in 44 patient (RA-change group). This group is compared patients who kept their RA (RA-keep group) during the follow-up time regarding (15 years for the majority of the patients). At inclusion all patients fulfilled the ACR 1987 classification criteria for RA. The two groups were compared regarding the number and type of classification criteria as well disease activity, medication, and radiographic changes. Results: Half of the RA-change group were classified as RA 5 years after diagnosis. The RA-keep group had a higher proportion of RF-positivity (63.1% vs 21.4% in RA-change group, p=0.001) and was more likely to fulfill >4 ACR1987 criteria (63.5% vs 34.1%, p=0.001). There was a higher proportion of patients with radiographic joint destruction at inclusion in RA-keep (26.5%) vs RA-change (12.2%, p=0.04). The erythrocyte sedimentation rate was incrased in the RA-keep compared to the RA-change group over 2 years from diagnosis (p=0.02). Conclusions: Diagnosis of RA should be reconsidered for patients who are RF-negative and do not fulfil more than 4 ACR1987 criteria.
Antiplasmodial activity of natural products
(2022-05-23) Carlsson, Camilla; University of Gothenburg / Institute of Medicine; Göteborgs universitet / Institutionen för medicin
Antiplasmodial Activity of Natural Products, by Camilla Carlsson, Degree Project, Program in Medicine, 2020, the Sahlgrenska Academy, Gothenburg, Sweden and Department of Biochemistry, University of Pretoria, South Africa. Introduction Malaria remains one of the leading causes of morbidity and mortality in low income countries. In the sub-Saharan region, a majority of these casualties are caused by the species of malaria parasite known as Plasmodium falciparum, which therefore has been chosen as the focus of this study. As resistance against current anti-malarial medication has emerged, finding new medications with activity against drug resistant Plasmodium falciparum is now an urgent matter. Aim The aim of the study was to screen extracts of four different plant species for in vitro activity against the intra-erythrocytic asexual stages of the Plasmodium falciparum parasite. Methods Four acetone extracts of plants were screened in vitro against drug sensitive (NF54 strain) and drug resistant (K1 strain) asexual Plasmodium falciparum parasites using the Synergy Brands (SYBR) Green I assay (full dose-response investigations). Results Of the four plant extracts screened, Artemisia afra showed the most promise with an average IC50 of 12.3 and 10.1 μg/ml (micrograms of plant extract per milliliter of complete culture medium) against drug susceptible (NF54 strain) parasites and drug resistant (K1 strain) parasites respectively, and a resistance index of 0.8. It was closely followed by Catha edulis and Trichilia emetica, (IC50 values ranging between 15-20 μg/ml) whereas Turrea floribunda exhibited less activity (IC50 ≥35 μg/ml). Conclusions Our findings clearly demonstrate the antiplasmodial activity of the investigated plants. Furthermore, they indicate that potent anti-malarial medications remain to be found amongst natural products and findings regarding Artemisia afra especially warrants for further analysis.
Comparison of a Hydrophobic and Hydrophilic Acrylic Intraocular Lens regarding Posterior Capsule Opacification in Patients with and without Uveitis
(2022-05-23) Khalaj Samadi, Jasmin; University of Gothenburg / Institute of Medicine; Göteborgs universitet / Institutionen för medicin
Introduction: Posterior capsule opacification (PCO) is the most common complication after cataract surgery. PCO rates vary between intraocular lenses (IOLs) implanted. Hydrophobic and hydrophilic lenses are widely used, and it is important to investigate which lens has less PCO development, not least in patients with uveitis, who have higher risk of developing PCO. Aim: To compare PCO after cataract surgery with a hydrophobic or hydrophilic sharp edged IOL in patients with and without uveitis. Methods: In this randomized controlled study, patients with and without uveitis eligible for bilateral cataract surgery with a hydrophobic and hydrophilic IOL between 2017-2020 were included. PCO incidence and proportion of PCO on the posterior capsule after 1 year was assessed by two graders. Results: 20 patients (40 eyes) were included. Most eyes in in the study did not develop PCO. PCO occurred in 7 eyes (38.9 %) with uveitis and 7 eyes (31.8 %) without uveitis (p = 0.641). PCO developed in 6 eyes (30 %) with the hydrophobic IOL and 8 eyes (40 %) with the hydrophilic IOL (p = 0.507). The median of the proportion of the posterior capsule covered with PCO was 43 % in the uveitic group and 36 % in the non-uveitic group (p = 0.522). The median of the proportion of the posterior capsule covered with PCO was 35 % for the hydrophobic IOL and 39.5 % for the hydrophilic IOL (p = 0.332). Conclusions: No significant difference in PCO development between patient groups nor IOL types were seen. The higher incidence in uveitic eyes could indicate higher risk for uveitic patients of developing PCO. The lower PCO incidence in hydrophobic IOLs could suggest that hydrophobic IOLs are valuable for minimizing PCO development. These findings should be confirmed in larger studies.
Evidence for physical activity in treatment of adult patients with chronic low back or neck pain - a systematic literature study
(2022-02-24) Ankarborg, Charlotte; University of Gothenburg / Institute of Medicine; Göteborgs universitet / Institutionen för medicin
BACKGROUND. Chronic primary pain has been recognized as a disease by WHO (World Health Organization). The definition of chronic pain is pain that lasts or recurs for longer than three months. In Sweden physical exercise has a major part in the rehabilitation of chronic pain. AIM. To investigate the current evidence for physical activity as treatment in adult patients with chronic low back or neck pain. METHODS A systematic search in five databases for systematic reviews with or without meta-analysis, published between 2017- January 2021, was conducted. A systematic screening strategy, the PICO model, was used to limit the search. RESULTS. Out of 781 articles, 8 systematic reviews were selected for synthesis (chronic low back pain n=5; chronic neck pain n= 3). There is low to moderate evidence that physical exercise (both mindful exercises and aerobic exercises) improves disability and gives pain relief in patients with low back pain at <3-6 months follow-up. There is limited to low evidence that physical exercise improves disability and gives pain relief in patients with chronic neck pain at <3-6 months follow-up. There is moderate evidence that physical exercise compared to nonactive control had no effect on pain relief or disability at long-term follow-up (≥12 months) in neither of the patient groups. No serious adverse events from using the physical interventions investigated were found. CONCLUSION. Physical exercise is effective for pain relief and disability in the rehabilitation of patients with chronic low back pain and chronic neck pain in <3- 6 months. However, at ≥12 months of follow-up, there was no difference between the exercise intervention group and the non-active group in neither pain relief nor disability. Physical exercise is not associated with any serious adverse events.
Outcomes of hydrocephalus ventriculoperitoneal shunt surgery at a rural hospital
(2022-02-24) Forsberg, Louise; University of Gothenburg / Institute of Medicine; Göteborgs universitet / Institutionen för medicin
Introduction Idiopathic normal pressure hydrocephalus (iNPH) is a disease portrayed by a triad of symptoms, gait disturbance, incontinence, and cognitive impairment. iNPH is common among the elderly population with a 3.7 % prevalence (65 years or older). The main treatment is shunt insertion, to transport cerebrospinal fluid (CSF) from the ventricles to the peritoneal cavity, a ventriculoperitoneal (VP) shunt. Aim To evaluate the shunt response, complication and mortality rate among patients who received a VP-shunt at a rural hospital. Methods Sixty-seven patients underwent surgery at Östersund’s Hospital from 2016 to 2020 after being chosen by a neurologist and a neurosurgeon. In this retrospective study, the medical records of all patients who received a shunt were reviewed, and data were collected using protocols from the Swedish National Hydrocephalus Registry. Patients were tested preoperatively, 3 months and 12 months postoperatively. A modified version of the iNPH score was used to evaluate shunt response. Mortality and cause of death was observed using the death certificate. Complications were found in medical records. Results Three months postoperatively, 82 % of the patients improved significantly in their modified iNPH-score, and 79 % significantly improved in the twelve-months postoperative examination. The six months revision rate was 6 %, caused by infection, subdural hematoma, and distal catheter obstruction. All complications amounted to 9 %, with 3 % being subdural hematoma. Mortality was 15%, with a mean time of 24 months since surgery when the patient died (span: 11-49 months). Conclusion VP shunt surgery for iNPH at a rural hospital resulted in a shunt response rate of 89 %, and a low complication rate (6 %) compared to the literature.

Browse

Recent Submissions