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  • 1.
    Aalto, Mervi Anneli
    University of Kalmar, School of Pure and Applied Natural Sciences.
    Vill kunder handla receptfria läkemedel i dagligvaruhandeln?: - En enkätundersökning2008Independent thesis Basic level (degree of Bachelor), 10 poäng / 15 hpStudent thesis
    Abstract [sv]

    Sammanfattning

    I Sverige har det statliga apoteketsmonopolet ifrågasatts en längre tid och regeringen utreder nu möjligheten att konkurrensutsätta läkemedelsförsäljningen. Det har även föreslagits i den statliga utredningen (SOU 2008:4 del 2) att ett begränsat sortiment av OTC läkemedel (over the counter = receptfria läkemedel) ska få säljas i dagligvaruhandeln utan farmaceutiskt kompetenskrav. Vid korrekt användning och tillgång till rätt rådgivning kan OTC läkemedel vara till en stor hjälp för den enskilde individen vid egenvård och därigenom också bidra till avlastning på sjukvårdens resursers. Vid felanvändning av OTC läkemedel (över/underdosering, fel indikationsområde etc.), kan de istället få motsatt effekt. Syftet med denna enkätstudie var därför att utforska om konsumenter av OTC läkemedel i Sverige önskar få tillgång till dessa läkemedel i t ex livsmedelsbutiker, där de inte har tillgång till personlig farmaceutisk rådgivning, vidare var avsikten att undersöka hur de i dagligvaruhandeln önskade få läkemedelsinformation. I februari 2008 gjordes en enkätstudie i Västervik som inkluderade 48 deltagare varav 29 kvinnor och 19 män. Studien visade att 71 % av deltagarna hade en positiv inställning till att köpa OTC läkemedel i livsmedelsbutiker, 58 % skulle skaffa information genom läkemedelsförpackning och bipacksedel i kombination med att de tidigare använt läkemedlet. Önskan om tillgång till personlig rådgivning på inköpsstället var störst i åldern ≤ 35 år, där 38 % ansåg sig vilja det. Slutsats av studien är att majoriteten vill kunna handla OTC läkemedel i dagligvaruhandeln och information skulle de få främst från läkemedelsförpackning/bipacksedel i kombination med erfarenheter från tidigare användning.

    2008:F5

  • 2.
    Abada, Mariam
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Vilka problem finns det med förfalskade läkemedel?2014Independent thesis Basic level (university diploma), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Världsmarknaden för läkemedlen beräknades år 2011 till 900 miljarder US$ enligt IMS-health. Marknaden för illegala läkemedel uppskattas vara värd mellan 75-200 miljarder dollar. I Sverige uppskattas den illegala läkemedelsmarknaden till motsvarande ≤0,5 %. Straffet för insmuggling av läkemedel till Sverige är böter eller max 2 års fängelse. Tullverket räknar med att man endast hittar 10 % av det som smugglas in. I andra länder kan straffet variera mellan böter (ekonomisk brottslighet i Afrika) till dödsstraff i Kina.

    I Utvecklingsländerna uppskattas 10-30 % av alla läkemedel som säljs vara förfalskade, jmf 1 % I-länderna. l. Förekomsten av förfalskade läkemedel har många allvarliga konsekvenser på människor som exempelvis, utebliven effekt, toxiska reaktioner, förgiftningar, som kan i värsta fall leda till döden. Ett annat alvarligt problem är resistensutveckling, ökad spridning av smittsamammasjukdomar som exempel, tuberkulos och/ eller HIV/AIDS.

    Syftet med detta examensarbete är att besvara frågan: Vilka problem ger den ökande förekomsten av förfalskade läkemedel i samhället. Undersökningen fokuserar på livstidsläkemedel, dvs ett läkemedel en person måste ta resten av sitt liv för behandling av sin kroniska sjukdom.

    För att komma till rätta med de problem, som förfalskade läkemedel, skapar krävs ett mer utvecklat samarbete mellan olika läkemedelsmyndigheter, läkemedelsföretag, internationella polisorganisationer, tull m.fl. Arbetet med att utveckla förpackningar som är svåra att förfalska bör intensifieras. Straffsatser bör kanske ses över. Det är viktigt att öka medvetandet bland allmänheten om risker med att köpa läkemedel utanför apotek (t ex via nätet).

  • 3.
    Abdal Hadi, Jehan
    University of Kalmar, School of Pure and Applied Natural Sciences.
    Hur skiljer sig traditionella från nyare generationer antipsykotika åt vad gäller biverkningen viktökning?2008Independent thesis Basic level (degree of Bachelor), 10 poäng / 15 hpStudent thesis
    Abstract [sv]

    Antipsykotiska läkemedel är basen för behandling av schizofreni, en psykisk sjukdom som uppträder redan hos unga människor. Symtomen vid schizofreni brukar delas in i positiva symtom (hallucinationer, vanföreställningar, paranoida tankar), negativa symtom (koncentrationssvårigheter, nedsatt språk- och tankeförmåga, minskat intresse för omgivningen, och initiativlöshet), samt kognitiva symtom (minnesproblem, problem med uppmärksamhet och koncentration).

    Antipsykotiska läkemedel delas in i typiska (den äldre generationen) och atypiska (den nyare generationen) antipsykotika. För båda grupperna antipsykotiska läkemedel finns det risk för biverkningar. De vanligaste biverkningarna vid behandling med den äldre generationen antipsykotika är extrapyramidala biverkningar. En biverkning som förefaller mer specifik för de nya atypiska preparaten är viktökning, vilken även kan orsaka utveckling av många allvarliga sjukdomstillstånd.

    Syftet med detta arbete var att jämföra typiska och atypiska antipsykotiska läkemedel med avseende på utveckling av viktökning.

    För att få svar på min frågeställning har en litteraturstudie av fem vetenskapliga artiklar genomförts. De vetenskapliga artiklarna har hittats genom databassökningar i PubMed, medan övriga fakta har hämtats från andra källor.

    Resultatet av de vetenskapliga artiklarna visar att det finns skillnader mellan traditionella och nyare generationer antipsykotika vad gäller tendens att orsaka viktökning. Med några undantag, är flera antipsykotiska läkemedel, som tillhör den nyare generationen, associerade med högre risk för utveckling av viktökning jämfört med den äldre generationen antipsykotika. Viktökning orsakas mest av klozapin, följt av olanzapin och risperidon. Quetiapin orsakar, i likhet med haloperidol, mindre viktökning.

    På grund av detta faktum, forskar man numera kring orsakerna till denna skillnad för att förbättra biverkningsprofilen hos framtida antipsykotika.

    2008:F2

  • 4.
    Abdo, Jasmin
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Tidig insulinbehandling för typ II diabetiker2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Diabetes mellitus är en av de vanligaste endokrina sjukdomarna och de vanligaste formerna är typ I och typ II. Idag har ca 350 000 personer i Sverige diabetes och av dessa har 85-90% diabetes typ II. Typ II diabetes börjar med insulinresistens och så småningom blir det avtagande funktion av β- cellerna vilket leder till nedsatt insulinkänslighet och främsta orsakerna till typ II diabetes är övervikt och fetma. Det finns olika behandlingsrekommendationer för att behandla typ II diabetiker för att minska att sena komplikationer uppstår. Främst genom livsstilsförändringar som kost och fysisk aktivitet, men då dessa inte räcker till kan perorala läkemedel komma i efterhand och om inte det heller ger tillräcklig effekt kan insulinbehandling sättas in. Ca 50 % av typ II diabetiker får insulin efter 10 års sjukdom.

    Syftet med arbetet är att undersöka om det finns en god implikation av att sätta in insulin tidigare än det som redan är rekommenderat.

    Denna litteraturstudie är baserad på artiklar hämtade från databasen PubMed. Sammanlagt har fem randomiserade kontrollerade studier granskats.

    Resultaten visar att en HbA1c-sänkning med ca 1,5 - 2,0 % kan erhållas samt också en bibehållen β- cellfunktion vid insättning av insulin. Insulinbehandlingen bör sättas in så snart HbA1c går över 7,5 % istället för att vänta en viss tid. Den kan sättas in hos behandlingsnaiva personer med framträdande symtom eftersom insulin fortfarande sänker HbA1c och det finns inget som tyder på att insulin inte kan sättas in tidigare än det som är rekommenderat.

    Slutsatsen som dras är att stödja intensiv behandling som gör att HbA1c hålls på en så låg nivå det är möjligt och när målvärden för HbA1c inte kan hållas kan insulin med fördel sättas in hos typ II diabetiker som behandlats med perorala antidiabetika.

  • 5.
    Abdul Rahim, Ranya
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Kommunikationsproblem på svenska apotek: Förekomst och orsak2019Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The word communication originates from the Latin word communicare that means to do something in common. When human beings communicate with each other, we share thoughts, emotions, values and actions. The foundation in communication is found within the interpersonal communication, which is the act of communication between two persons. All types of communications include of verbal and nonverbal acts of communication.

    The verbal communication consists of words either in speech or writing, the nonverbal act implies gestures, frequency of the tone and facial expressions.

    Within the pharmaceutical profession, good communication between the pharmacist and the customer is important and can affect the customer’s health and quality of life in both direct as well as indirect ways. In recent years, the pharmacist's role in the pharmacy has drastically changed. Nowadays the care of the customer has gained more significance than before. To improve customer health and quality of life it is important that the pharmacist acts to promote a good relationship with the customer and the foundation for this relationship should be built on good terms of communication.

    The purpose of this study was to study how common it is with communication errors between pharmacist and customer, and to demonstrate probable underlying causes. Secondary questions were, how is the drug advice the pharmacist provides affected by communication errors?

    Collection of data for the study was done with structured observation charts, where the customer and pharmacist were strictly observed. A total of 316 meetings were observed and the data collected referred to prescriptions. In more than one-third of the observed meetings, there were communication errors between the pharmacist and the customer. Communication errors that arose concerned lack of eye contact, language barriers, choice of questions, background noise from colleagues and customers and discussions from generic exchanges. To reduce future communication errors, the pharmacist's actions should be strengthened, such as eye contact, clear follow-up questions and improved feedback.

  • 6.
    Adolfsson, Matilda
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Anthelmintika mot hästens inälvsparasiter: en studie av effekt, resistensförekomst och försäljning2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 7.
    Aeinehband, Shahin
    et al.
    Karolinska Institutet.
    Lindblom, Rickard P. F.
    Karolinska Institutet.
    Al Nimer, Faiez
    Karolinska Institutet.
    Vijayaraghavan, Swetha
    Karolinska Institutet.
    Sandholm, Kerstin
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Khademi, Mohsen
    Karolinska Institutet.
    Olsson, Tomas
    Karolinska Institutet.
    Nilsson, Bo
    Uppsala University.
    Nilsson Ekdahl, Kristina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences. Uppsala University.
    Darreh-Shori, Taher
    Karolinska Institutet.
    Piehl, Fredrik
    Karolinska Institutet.
    Complement Component C3 and Butyrylcholinesterase Activity Are Associated with Neurodegeneration and Clinical Disability in Multiple Sclerosis2015In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 4, article id e0122048Article in journal (Refereed)
    Abstract [en]

    Dysregulation of the complement system is evident in many CNS diseases but mechanisms regulating complement activation in the CNS remain unclear. In a recent large rat genomewide expression profiling and linkage analysis we found co-regulation of complement C3 immediately downstream of butyrylcholinesterase (BuChE), an enzyme hydrolyzing acetylcholine (ACh), a classical neurotransmitter with immunoregulatory effects. We here determined levels of neurofilament-light (NFL), a marker for ongoing nerve injury, C3 and activity of the two main ACh hydrolyzing enzymes, acetylcholinesterase (AChE) and BuChE, in cerebrospinal fluid (CSF) from patients with MS (n = 48) and non-inflammatory controls (n = 18). C3 levels were elevated in MS patients compared to controls and correlated both to disability and NFL. C3 levels were not induced by relapses, but were increased in patients with >= 9 cerebral lesions on magnetic resonance imaging and in patients with progressive disease. BuChE activity did not differ at the group level, but was correlated to both C3 and NFL levels in individual samples. In conclusion, we show that CSF C3 correlates both to a marker for ongoing nerve injury and degree of disease disability. Moreover, our results also suggest a potential link between intrathecal cholinergic activity and complement activation. These results motivate further efforts directed at elucidating the regulation and effector functions of the complement system in MS, and its relation to cholinergic tone.

  • 8.
    Ahmad Ghafour, Soz
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Kan behandling med antidepressiva läkemedel påverka sjukdomens svårighetsgrad och självmordstankar/självmordshändelser hos barn och ungdomar med egentlig depression?2018Independent thesis Basic level (degree of Bachelor), 180 HE creditsStudent thesis
    Abstract [en]

    Abstract

    Suicide is a public health problem that, in addition to loss of human life, leads to extensive psychological suffering and impairment of the health of relatives. It is common that suicide occurs under the influence of mental illness such as personality disorders and depression. Depression is a serious condition that often causes severe suffering. Depression can affect all ages, i.e. children, adolescents, adults and the elderly and it is as costly as heart disease. In Sweden, depression is one of the most common psychiatric diagnoses. About 19 percent of the population (16-84 years) have been diagnosed with depression at least once in their lifetime.  Of these, almost one in three have been diagnosed more than once. The affected individual performs poorly in daily activities such as school, work and in social settings. Additionally, there is increased risk of suicide in depressed individuals. Accordingly, it is important to treat depression to reduce suffering. Depression in children was accepted as the same disease as in adults since 1980. Today, depression is treated primarily with first-line therapy SSRIs. The aim of this work was to examine the effect and safety of antidepressants in the treatment of major depresive disorder in chlidren and adolescents with special reference to suicidal activity and self-injury. To implement this study, scientific articles were obtained in Pubmed, and five articles were selected. Study 1 showed that the combination of fluoxetine and CBT, cognitive behavior therapy, had better effect than treatment with only flouxetin or with only CBT. Study 2 showed that suicidal events and ideation were least among the group treated with the combination of fluoxetine and CBT compared to the treatment with only fluoxetine or only CBT. Study 3 showed that more suicide-related events occurred among the group with previous non-suicidal self-injury, NSSI. Study 4 resulted in greater medical response and better remission in escitalopram patients compared to placebo. Study 5 showed that treatment with venlafaxine caused serious adverse events that led to many discontinuing treatment. Treatment with antidepressants, especially in combination with CBT, can reduce the severity of depression in children and adolescents and reduce suicidal ideation and suicide attempts in some patients. In cases of treatment failure a risk of suicide and self-injury remains. Previous self-injury increases the risk of future self-injury as well as the risk of future suicide attempts.

  • 9. Ahrenstedt, Örjan
    et al.
    Knutson, L
    Nilsson, B
    Nilsson Ekdahl, Kristina
    University Hospital, Uppsala.
    Odlind, B
    Hällgren, R
    Enhanced local production of the complement components in the small intestine in Crohn's disease1990In: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 322, p. 1345-1349Article in journal (Refereed)
    Abstract [en]

    There is evidence that complement components may be formed locally in inflammatory lesions containing monocytes and macrophages. To investigate the role of complement in Crohn's disease we measured jejunal-fluid concentrations of the complement components C4, C3, and factor B by perfusion of a closed segment of the jejunum in 22 patients with Crohn's disease thought to be limited to the terminal ileum.

    The mean (±SEM) jejunal-fluid C4 concentration was 2.0±0.3 mg per liter, significantly higher than the mean level in 35 healthy controls (0.7±0.1 mg per liter; P<0.001). The mean C3 concentration was 1.0±0.1 mg per liter in the patients and 0.7±0.1 mg per liter in the controls (P<0.05). The factor B levels were similar in the two groups. Calculated rates of intestinal secretion of these components showed differences of the same magnitude. Leakage of protein from plasma was not increased. The jejunal-fluid serum ratios of these complement proteins indicated that their appearance in the lumen of the jejunum was due at least in part to local mucosal synthesis. The increased jejunal secretion of C4, but not C3 or factor B, paralleled the clinical activity of Crohn's disease. Values were normal in first-degree relatives of the patients (n = 13), patients with celiac disease (n = 8), and patients with ulcerative colitis (n = 4).

    We conclude that increased secretion of complement by clinically unaffected jejunal tissue in patients with Crohn's disease reflects the systemic nature of this disorder and may be due to the stimulated synthesis of complement by activated intestinal monocytes and macrophages. 

  • 10.
    Alexandersson, Sandra
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Akutpreventivmedel: Hur skiljer sig effektivitet och säkerhet för de tre godkända metoderna levonorgestrel, ulipristal och kopparspiral?2014Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    I Sverige är abort en laglig rättighet och det finns flera godkända metoder för regelbunden antikonception. Ändå finns ett behov av akutmetoder för att förhindra oönskad graviditet.  Det finns tre godkända akutpreventivmedelsmetoder; levonorgestrel, ulipristal och kopparspiral. Detta arbetes syfte var att undersöka effektivitet och säkerhet för dessa tre godkända metoder. En litteratursökning gjordes i databasen PubMed,  7 artiklar valdes ut för analys. Artikel 1och 2 undersökte levonorgestrels effektivitet och säkerhet och kunde redovisa graviditetsfrekvenser på 0, 57%  och 0,67 % , samt en graviditetsförebyggande effektivitet på 68 %. Artikel 3 jämförde ulipristal och levonorgestrel och redovisade graviditetsfrekvenser på 1,8 % för ulipristal och 2,6 % för levonorgestrel. Även ”non-inferiority” konstaterades med OR på 0,68. Artikel 4 undersökte levonorgestrels effektivitet och redovisade graviditetsfrekvenser på 2,0 % (12 h- gruppen) och 1,9 % (24 h- gruppen), dessutom redovisades en graviditetsförebyggande effektivitet på 72 % (12 h- gruppen) och 75 % (24 h- gruppen). Artikel 5 jämförde ulipristal och levonorgestrel och fann att ulipristalbehandling  är ”non-inferiority” till levonorgestrelbehandling. Artikel 6 undersökte ulipristals effektivitet och redovisade en graviditetsfrekvens på 2, 1 % och en graviditetsförebyggande effektivitet på  62, 3%. Artikel 7 undersökte kopparspiralens effektivitet och kunde redovisa 100 % graviditetsförebyggande effektivitet. Akutpreventivmedel fungerar inte alltid, men förhindrar oönskade graviditeter. Slutsatsen är att resultaten ger stöd för gällande behandlingsrekommendationer.

  • 11.
    Alfredsson, Emma
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    The Manufacture of a Vegetarian Smoothie2010Independent thesis Advanced level (degree of Master (One Year)), 30 credits / 45 HE creditsStudent thesis
  • 12.
    Ali, Dholfoqar
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Vilken effekt har statiner vid primär- och sekundärprevention av hjärt- och kärlsjukdomar?2011Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Lipid-lowering drugs, mostly statines, were dispensed during 2011 to 815 000 people from the pharmacies in Sweden. High cholesterol is a major risk factor for development of coronary heart disease (myocardial infarction, angina, intermittent claudicatio intermittens and stroke). Coronary heart disease is the causes of more than 40% of all deaths in Sweden.Lifestyle changes, together with lipid-lowering drugs, statines, are effective treatments. Statines can be administered either to patients that have had a cardiac event i.e. heart attack, stroke (secondary care) or to persons with risk factors i.e. high levels of cholesterol, diabetes, primary care.

    Objective: with the help of published clinical trials and meta-analysis examine what effect statines have on morbidity / mortality in cardiovascular diseases in primary and secondary care.

    Results: The studies showed that statins reduce TC, LDL and TG and increase HDL. They also showed that statins reduce major coronary events, cerebrovascular events, mortality from coronary heart disease, unstable angina and revascularization. Statin therapy was associated with increased risk of moderate or severe liver failure, acute renal failure, moderate or severe myopathy and cataracts in both men and women. The risk was dose-dependent and greatest at the first year of treatment.

    Conclusion: The studies showed that statine treatment reduced the blood level of harmful cholesterol, prevented the atherosclerotic process and thus reduced the need for revascularization. Statin therapy is about two - three times as effective in secondary care as in primary care. One need to treat 60 people, who have had a coronary heart event, during about 5 years to prevent one death and 180 people to prevent a nonfatal cardiovascular event. The effect is similar for men and women and for older and middle aged people. Life expectancy increases by two years. For patients who not have had a coronary heart event but have risk factors i.e. high cholesterol levels, diabetes, one need to treat two - three times as many to achieve the same results (120 patients to prevent one death and 330 to prevent one nonfatal cardiovascular event). The effects of treating healthy individuals with statines are low.Statines are well-established and safe drugs. One noteworthy side effect is myopathy, (rhablomyelos) which is quite unusual as reported from studies.One problem that exists in all prescribed preventive treatments is poor adherence to prescriptions.

  • 13.
    Alimjanova, Aziza
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Hur vanligt är det med terapimisslyckande med SSRI-preparat?2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 14. Alksnis, M.
    et al.
    Lindberg, A Michael
    Department of Medical Genetics, Uppsala University.
    Stålhanske, POK
    Hultberg, H.
    Pettersson, U.
    Use of synthetic oligodeoxyribonucleotides for type-specific identification of coxsackie B viruses1989In: Molecular and Cellular Probes, ISSN 1044-7431, E-ISSN 1095-9327, Vol. 3, no 2, p. 103-108Article in journal (Refereed)
    Abstract [en]

    Synthetic oligodeoxyribonucleotides were used for type-specific identification of members of the coxsackie B virus group by nucleic acid hybridization. Two pairs of oligonucleotide chains were constructed based on nucleotide sequences in the VP1 regions of coxsackieviruses B3 and B4. Each labelled probe had a length of 24 nucleotides. The results showed that the oligonucleotide hybridized in a type-specific manner when assayed with extracts from cells infected with all different coxsackie B viruses. A method based on similar principles may thus be used for enterovirus typing.

  • 15.
    Almqvist, Sara
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Apotekskunders upplevelser av att tabletterna smular vid delning och vad de gör med smulorna2010Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    In Sweden, about 10 percent of the prescriptions have a dosage with split tablets. Many patients have problems with breaking tablets into two or more parts as the tablet may crumble or break into many small pieces. The aim with this work is to examine to which extent patients experience crumbled tablets when trying to split tablets and what the patient does with the crumbles.

    In order to examine patients experience with crumbled tablets, interviews with patients who collected a prescription with a dosage with divided tablets in one of twelve pharmacies, were done. Included patients had to be 18 years or older.

    Of the 416 included patients with experience of splitting tablets, 123 had problems with tablet splitting and out of these 29 found the issue with tablets crumbling to be a problem. Overall, 174 patients experienced crumbled tablets. Patients, who didn’t experience crumbled tablets, were less likely to split tablets with a tool than patients who did experience crumbled tablets. 93 of 380 patients collected crumbles equivalent to half a tablet and consumed the crumbles while 80 patients discarded the crumbles (threw them away).

    Many patients use the crumbles instead of throwing them away even though it is difficult to tell how much of the drug you obtain with the crumbles. It seems as if the way you choose to divide the tablet (with or with out a tool) is affecting whether you experience crumbling or not. Most people don’t experience crumbling and of those who do only one out of six considers it to be a problem. In Sweden in whole the interviews give a slight estimate for how many patients the problem is persistent. In rough numbers it is estimated that 37- 47.000 had experienced crumbled tablets whereas 4.500-10.500 found it be a problem.

  • 16.
    Alqaysi, Faeza
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Effekter av befintliga och eventuella framtida läkemedelsbehandlingar på morbiditet och mortalitet hos patienter med hjärtsvikt.2015Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background:  Heart failure is a multidimensional phenomenon with high mortality. Heart failure is treated with angiotensin converting enzyme (ACE) - inhibitors or angiotensin receptor blockers (ARBs) that counteract neurohormonal stimuli that occur in heart failure, as well as providing vessel dilatation, which reduces symptoms and the need for hospitalization and increases survival. Despite this, only about 50% of heart failure patients survive 6 years after diagnosis with drug therapy, and as heart failure is increasing globally, due to improved care and treatment and increasing life expectancy of the population, there is a great need for new drugs such as LCZ696 that acts by dual inhibition of the renin - angiotensin - aldosterone system and neprilysin inhibition.

    Objective: The aim of this literature study was to evaluate the efficacy of current treatment and possible future treatments on mortality and morbidity in heart failure patients.

    Results: The examined articles show that treatment with ACE inhibitors in patients with symptomatic heart failure reduces the risk of total mortality by 16% over 3.5 years, reduces all-cause mortality or hospitalization due to heart failure with NNT (number needed to treat) = 10.4 over 3.5 years and increases median survival by 9.2 months over 12.1 years in patients with asymptomatic heart failure. Treatments with high-dose ACE inhibitors reduce mortality and hospitalization because of cardiovascular causes and hospitalizations from any cause by NNT = 30 over 3 years. Beta-blockers reduce sudden death and total mortality and cardiac death or non - fatal myocardial infarction with NNT = 38 and NNT = 23, respectively, over 12 months. Treatment with the new drug LCZ696 reduces mortality due to cardiovascular causes with NNT = 21 over 27 months, reduces hospitalizations due to heart failure with NNT = 36 over 27 months and reduces deaths from any cause with NNT = 34 compared to treatment with ACE inhibitors.

    Conclusion: The studies show that both ACE inhibitors and beta-blockers have clear beneficial effects in the treatment of heart failure. Treatment with ACE inhibitors for 3.5 years compared to placebo reduces total mortality by a NNT value of about 22. Treatment with beta-blockers during 1 year compared with placebo reduces total mortality by a NNT value of 24. Treatment with the new drug LCZ 696 for 27 months compared with ACE inhibitors reduces total mortality with a NNT value of 36. One remaining problem is that 50% of patients with severe heart failure (NYHA class IV) die within a year.

  • 17. Alston-Smith, J
    et al.
    Boija, P O
    Ware, J
    Nilsson Ekdahl, Kristina
    Department of Clinical Immunology and Transfusion Medicine, University Hospital, Uppsala.
    Endotoxin, epinephrine, glucagon, insulin and calcium ionophore A23187 modulation of pyruvate kinase activity in cultured rat hepatocytes1990In: Acta chirurgica Scandinavica, Vol. 156, no 10, p. 677-681Article in journal (Refereed)
    Abstract [en]

    Altered glucose metabolism is one of the commonly observed sequelae of sepsis and septic shock. The present investigation was undertaken to determine the role of endotoxin (ET) upon hepatocyte glucoregulation, by measuring the activity of pyruvate kinase (PK), a key glycolytic enzyme. Hepatocytes were exposed to endotoxin concentrations known to occur in vivo during sepsis, i.e., from 1 X 10(-14) to 1 X 10(-8) g/ml. The alteration of the enzyme activities after addition of epinephrine, glucagon, insulin and calcium ionophore A23187 with and without ET preincubation were also examined. ET alone decreased the PK activity by 12% at all concentrations tested. The basal inhibition of the enzyme caused by epinephrine (-48%) was partially blocked by ET preincubation above 1 X 10(-10) g/ml. There were no ET-(glucagon, calcium ionophore, insulin) interaction. These in vitro results do not support pyruvate kinase as a site of hepatic enzyme regulation defect in endotoxaemia. 

  • 18. Alston-Smith, J
    et al.
    Ljungqvist, O
    Ware, J
    Nilsson Ekdahl, Kristina
    Department of Clinical Immunology and Transfusion Medicine, University Hospital, Uppsala.
    Regulation of rat hepatocyte fructose 1,6-diphosphatase activity during endotoxemia1991In: Surgical research communications, ISSN 0882-9233, Vol. 11, p. 67-75Article in journal (Refereed)
  • 19.
    Andersson, Evelyn
    et al.
    Karolinska Institutet, Sweden;Stockholm Countty Council, Sweden.
    Crowley, James J.
    Karolinska Institutet, Sweden;Univ N Carolina, USA;Univ N Carolina, USA.
    Lindefors, Nils
    Karolinska Institutet, Sweden;Stockholm County Council, Sweden.
    Ljotsson, Brjann
    Karolinska Institutet, Sweden.
    Hedman-Lagerlöf, Erik
    Karolinska Institutet, Sweden.
    Boberg, Julia
    Karolinska Institutet, Sweden;Stockholm County Council, Sweden.
    El Alaoui, Samir
    Karolinska Institutet, Sweden;Stockholm County Council, Sweden.
    Karlsson, Robert
    Karolinska Institutet, Sweden.
    Lu, Yi
    Karolinska Institutet, Sweden.
    Mattheisen, Manuel
    Karolinska Institutet, Sweden;Stockholm County Council, Sweden;Aarhus Univ, Denmark.
    Kahler, Anna K.
    Karolinska Institutet, Sweden.
    Svanborg, Cecilia
    Karolinska Institutet, Sweden;Stockholm County Council, Sweden.
    Mataix-Cols, David
    Karolinska Institutet, Sweden;Stockholm County Council, Sweden.
    Mattsson, Simon
    Karolinska Institutet, Sweden;Stockholm County Council, Sweden.
    Forsell, Erik
    Karolinska Institutet, Sweden;Stockholm County Council, Sweden.
    Kaldo, Viktor
    Linnaeus University, Faculty of Health and Life Sciences, Department of Psychology. Karolinska Institutet, Sweden;Stockholm County Council, Sweden.
    Schalling, Martin
    Karolinska Institutet, Sweden;Karolinska University Hospital, Sweden.
    Lavebratt, Catharina
    Karolinska Institutet, Sweden;Karolinska University Hosp, Sweden.
    Sullivan, Patrick F.
    Univ N Carolina, USA;Karolinska Institutet, Sweden.
    Ruck, Christian
    Karolinska Institutet, Sweden;Stockholm County Council, Sweden.
    Genetics of response to cognitive behavior therapy in adults with major depression: a preliminary report2019In: Molecular Psychiatry, ISSN 1359-4184, E-ISSN 1476-5578, Vol. 24, no 4, p. 484-490Article in journal (Refereed)
    Abstract [en]

    Major depressive disorder is heritable and a leading cause of disability. Cognitive behavior therapy is an effective treatment for major depression. By quantifying genetic risk scores based on common genetic variants, the aim of this report was to explore the utility of psychiatric and cognitive trait genetic risk scores, for predicting the response of 894 adults with major depressive disorder to cognitive behavior therapy. The participants were recruited in a psychiatric setting, and the primary outcome score was measured using the Montgomery Asberg Depression Rating Scale-Self Rated. Single-nucleotide polymorphism genotyping arrays were used to calculate the genomic risk scores based on large genetic studies of six phenotypes: major depressive disorder, bipolar disorder, attention-deficit/hyperactivity disorder, autism spectrum disorder, intelligence, and educational attainment. Linear mixed-effect models were used to test the relationships between the six genetic risk scores and cognitive behavior therapy outcome. Our analyses yielded one significant interaction effect (B = 0.09, p < 0.001): the autism spectrum disorder genetic risk score correlated with Montgomery Asberg Depression Rating Scale-Self Rated changes during treatment, and the higher the autism spectrum disorder genetic load, the less the depressive symptoms decreased over time. The genetic risk scores for the other psychiatric and cognitive traits were not related to depressive symptom severity or change over time. Our preliminary results indicated, as expected, that the genomics of the response of patients with major depression to cognitive behavior therapy were complex and that future efforts should aim to maximize sample size and limit subject heterogeneity in order to gain a better understanding of the use of genetic risk factors to predict treatment outcome.

  • 20.
    Andersson, Håkan S.
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Jacobsson, Erik
    Uppsala University.
    Eriksson, Camilla
    Uppsala University.
    Hedström, Martin
    Lund University.
    Seth, Henrik
    Gothenburg University.
    McEvoy, Eric G
    Sundberg, Per
    Gothenburg University.
    Strand, Malin
    Swedish agricultural university (SLU).
    Discovery of peptide toxins in the world’s longest animal (The bootlace worm; Lineus longissimus): challenging claims of tetrodotoxin production.2015Conference paper (Other academic)
  • 21.
    Andersson, Jeanette
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Finns det något värde i att mäta Peptide tyrosine tyrosine, Glucose-dependent insulinotropic polypeptide och Oxyntomodulin postprandialt vid måltidsstudier?2015Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Övervikt och fetma sprider sig likt en epidemi över världen. Omkring 1,9 miljarder vuxna varöverviktiga år 2014 och av dessa klassificerades 600 miljoner som feta. Forskning kring fetmas uppkomst och nya former av behandlingsalternativ pågår. En viktig faktor för uppkomst av övervikt är aptitreglering, där t.ex. Peptide tyrosine tyrosine (PYY), Oxyntomodulin (OXM) och Glucosedependent insulinotropic polypeptide (GIP) har betydelse. En litteraturstudie genomfördes där totalt nio originalartiklar från PubMed utvärderades. Syftet var att undersöka om det finns något värde i att mäta dessa hormon postprandialt. Finns det någon skillnad mellan normalviktiga, överviktiga och obesa och finns det någon skillnad mellan individer med typ 2-diabetes mellitus (T2DM) och friska individer? Finns det någon pålitlig analysmetod? Samtliga studier var måltidsstudier där olika näringsämnens påverkan på den postprandiala responsen undersöktes. Peptide tyrosine tyrosine ochGlucose-dependent insulinotropic polypeptide mättes i sex resp. fem av artiklarna och OXM mättes ien artikel. Protein, fett och kolhydrater ger en postprandial respons på PYY och GIP. Responsen av PYY var starkast efter stimuli från fett och protein. Fett tycks ge starkast respons på GIP. Fastevärden av PYY och GIP var inte olika hos normalviktiga och överviktiga i de studier som undersöktes. Det fanns en signifikant skillnad (p=0,01) mellan normalviktiga och överviktiga tonårsflickor av den postprandiala utsöndringen av PYY efter fettrik måltid, där de obesa flickorna hade lägre procentuell ändring jämfört med de normalviktiga. Pålitliga analysmetoder vid koncentrationsbestämning av dessa tre hormon i plasma är Radioimmunoassay (RIA) och Enzyme-linked immunosorbent assay (ELISA).

  • 22.
    Andersson, Louise
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Hur sker prioriteringar av resurser för att bekosta särläkemedel?: Cerezyme® – en fallstudie2013Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The choice of my thesis is based on orphan drugs, which individuals with rare diseases use as treatment, diagnostics or to prevent the progress of the disease. In order to get a classification as an orphan drug, the drug must be used for a condition that affects 5 or less of 10 000 individuals, based on the European classification. The clinical trials for this type of medicines are as every medical trial, expensive and orphan drugs have the smallest patient groups. Therefore there is no justification to the pharmaceutical companies in development in orphan drugs. This project is made by a case study and answer survey, and the literature research was based on articles written in English or Swedish, and articles older than 2000 were excluded.The purpose of this thesis is to evaluate how priorities of resources are made, to fund expensive drugs, in Sweden. Tandvårds- och läkemedelsförmånsverket (TLV) has the authority to decide whether different kind of medicines are subjects to the Swedish pharmaceutical benefits, which are funding a great amount of medicines. The thesis is based on evaluations from various stakeholder, Swedish laws and previous research in priority.Sweden is financing the orphan drugs in three ways. Orphan drugs included in Swedish pharmaceutical benefits are funded by customs fee to 2200 SEK, and the rest of the costs are financed by the state through the council counties. Orphan drugs in hospitalization are financed by the hospital, clinic or the county where the patient is registered. The orphan drugs which are prescribed but still excluded from the benefits are financed either by the patient, county or the hospital. The investigation of pricing and financial proposition of orphan drugs in Sweden is delayed but still in progress, and are expected to be presented in April, 2014.TLV make the decisions regarding pharmaceutical benefits through calculations of QALY’s and by three ethical grounds or principles. The principles stand for human dignity, cost-effectiveness, solidarity and needs. TLV could either approve the drug, which makes the drug included to pharmaceutical benefits, or disapprove the drug and makes it unavailable through state funding. TLV decided to exclude Cerezyme® from the Swedish pharmaceutical benefits. The decisions were made of calculations of QALY’s, which was calculated much higher costs than previously approved by TLV. The manufacturers of Cerezyme® did not agree with TLV’s decision, and went to higher courts. The recent decision of higher courts was to re-include Cerezyme® from pharmaceutical benefits, which makes the drug available to patients in desperate need again.Processes of different kinds of orphan drugs to include these to pharmaceutical benefits are not treated equally. Depending of the state of the disease, prevalence and geographic location, are patients treated variously. This is a major problem in management of orphan drugs, and should be prevented as soon as possible. All citizens should on equal terms, have access to same health care, this through Swedish Health Care laws.

  • 23.
    Andersson, Mari
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Har kost och statiner var för sig eller i kombination någon effekt på LDL och HDL?2019Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Cholesterol is an important part in our cells. Cholesterol stabilize cell membranes and is needed for the synthesis of estrogen, testosterone, cortisol, vitamin D and in the formation of bile acid. Cholesterol is synthesized in the liver but the body also absorbs cholesterol from the diet. The transport of cholesterol in the blood is taken care of by LDL and HDL. When the levels of LDL are increased and HDL are decreased there is an increased risk of developing atherosclerosis and cardiovascular diseases which are the main cause of death in the western countries. 

    Purpose: One of three different purposes of this presented study was to evaluate if the levels of low-density lipoprotein (LDL) and high-density lipoprotein (HDL) were changed when following different diets. The second purpose was to study the change in levels of LDL and HDL change after treatment with statins as monotherapy or in combination with ezetimibe. The third part of this study was to see how LDL and HDL were changed when different diets were combined with statins. 

    Method: This work was a literature study based on seven different randomized controlled trials that were found in the database PubMed. Three of the studies evaluated the role of the different diets when aiming at reducing the cholesterol levels. In two of the studies patients were either treated with atorvastatin as monotherapy or with atorvastatin plus ezetimib. The last two studies evaluated the use of simvastatin in combination with LCHF-diet as compared to the use of simvastatin plus ezetimib which were used in combination with a LCHF-diet.

    Results: The results showed that weight reduction and the choice of a specific diet are important factors when aiming at a decrease in levels of LDL and an increase in levels of HDL. Moreover, results obtained also suggested that statins, when used in combination with ezetimibe, gave the largest effect and was found to decrease levels of LDL and increase levels of  HDL. According to the results, it may be concluded that the controlled release of simvastatin has an equivalent effect on these levels regardless if administered in the morning or in the evening.

    Conclusion: The results obtained in this work suggest that weight reduction and eating according to a diet that consists of a low proportion of carbohydrates may be a good and safe approach to reduce the levels of  LDL and increase the levels of  HDL. Statins can be considered to be the first alternative to treat dyslipidemia and should be used at elevated levels of cholesterol. To achieve the best result, an analysis of the selected literature in this work, suggest that a low-carbohydrate diet should be combined with the use of statins and ezetimibe. 

  • 24.
    Andersson, Michaela
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    På vilket sätt är oxytocin intressant för behandling av autism?2012Independent thesis Basic level (university diploma), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Autism är ett medfött funktionshinder som innebär symtom inom tre huvudområden; bristande social förmåga,kommunikationssvårigheter och upprepade stereotypa rörelser. Idag saknas effektiv behandling för dessa komplexa symtom, något som förbryllar forskarna. Oxytocin är ett neurohormon i kroppen som påverkar våra relationer till andra människor på olika sätt, hur väl vi knyter an, litar på och förhåller oss till andra. Studier som testat oxytocinets effekter på olika sociala beteenden har väckt intresse för huruvida oxytocin kan vara användbart för behandling av autism.

    Syfte: att med hjälp av randomiserade kliniska studier undersöka på vilket sätt oxytocin kan vara användbart för behandling av autism.

    Resultat: Oxytocin hade goda effekter på de olika autistiska symtom som det i studierna testades förså som repetitiva beteendemönster, förmåga att läsa av känslor hos andra, förmåga att uppfatta känslomässigt innehåll i tal och påverkan på det sociala beteendet. Dessutom fann man i en studie att barn med autism generellt hade lägre halt oxytocin i blodet än friska barn i samma ålder och att det förekom avvikelser i hur halten oxytocin hängde samman med olika färdigheter.

    Slutsats: Det som är intressant för behandling av autism är oxytocinets förmåga att både stärka det sociala engagemanget och samtidigt dämpa de repetitiva beteendena. Dock verkar det inte vara så enkelt som att oxytocin ensamt ligger bakom hela orsaken och att låg halt oxytocin inte alltid är associerat med autism. En egen spekulation om möjlig orsak till autism är att det skulle kunna vara en form av oxytocinresistens inblandad som innebär att receptorerna inte fungerar normalt och således kan inte effekten medieras på ett adekvat sätt. Produktionen ökar därför som kompensation men utan att för den skull öka effekten. Det är viktigt att komma ihåg att oxytocin ingår i ett komplext system som arbetar tätt tillsammans med ett stort antal olika signalsubstanser. Resultat från forskningen visar dock att oxytocin onekligen verkar spela en viktig roll i etnologin bakom autism vilket gör den intressant för framtiden.

  • 25.
    Andersson, Sanna
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Hur har det påverkat apoteken att receptfria läkemedel får säljas i dagligvaruhandeln?2012Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Den 1 november 2009 infördes en ny lag med bestämmelser som säger att det är tillåtet att bedriva detaljhandel utanför öppenvårdsapotek med nikotinläkemedel och vissa andra receptfria läkemedel. Under 2010, som var det första hela året då receptfria läkemedel fick säljas utanför apotek, uppgick den totala försäljningen av dessa till ungefär 614 miljoner kronor. Det motsvarade ungefär 15 % av den totala försäljningen av receptfria läkemedel för egenvård. De läkemedel som säljs mest utanför apotek är smärtstillande läkemedel, nässprayer mot förkylningsnästäppa och nikotinläkemedel.      Att receptfria läkemedel får säljas i dagligvaruhandeln påverkar sannolikt apotekens omsättning. Hur mycket detta påverkat är dock svårt att säga, då även avregleringen av apoteksmarknaden skett inom samma tidsperiod. Syftet med denna uppsats var att därför ta reda på hur försäljningen av receptfria läkemedel i dagligvaruhandeln har påverkat apoteken.   För att besvara frågeställningen har en kvalitativ metod använts.  Intervjuer har genomförts med åtta apotekschefer i ett geografiskt område i västra Östergötland  inkluderandes orterna Mjölby, Motala och Skänninge.   Generellt sett har apotekscheferna varit positiva till den ökade tillgänglighet av läkemedel som uppstått då receptfria läkemedel får säljas i dagligvaruhandeln. De påpekar dock att det kan föreligga en risk för felanvändning av ett läkemedel som säljs utan rådgivning.   Sortimenten på apoteken har påverkats och de flesta apotekskedjorna har valt att ta fram egna märkesvaror, vilket ger en ytterligare skillnad i sortiment mellan de olika apoteken. En annan förändring som har skett på apoteken är att apoteksmedarbetarna inom de flesta kedjorna har fått säljutbildning.    De resultat som framkommit i denna studie visar att avregleringen av apoteksmarknaden och konkurrensen från andra apotekskedjor har påverkat apoteken mer än det faktum att receptfria läkemedel numera får säljas i dagligvaruhandeln. Det krävs dock en studie över ett större geografiskt område och därmed med ett större antal apotek involverade för att komma fram till om det är så och få ett mer rättvisande resultat.

  • 26.
    Andersson, Sofie
    University of Kalmar, School of Pure and Applied Natural Sciences.
    Lipashämmaren orlistats effekt på viktnedgång och typ 2-diabetes2009Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Fetma är ett växande hälsoproblem, såväl i Sverige som i övriga världen. Idag räknar man med att cirka 10 % av männen och 12 % av kvinnorna i Sverige lider av fetma (BMI≥30). Komplikationerna till följd av fetma är många, och inkluderar många allvarliga sjukdomar och tillstånd. Typ 2-diabetes är en av dessa sjukdomar och risken att insjukna ökar kraftigt med ett stigande BMI. Man räknar med att cirka 90 % av alla som diagnosticerats med sjukdomen också uppvisar fetma. Grunden i all fetmabehandling utgörs av livsstilsförändringar, som kost och fysisk aktivitet. En viktnedgång på 5-10 % är ofta tillräckligt för att man ska se en förbättring av kardiovaskulära och metabola riskfaktorer. När en tillfredsställande viktnedgång inte uppnås genom livsstilsförändringar kan farmakologisk behandling bli aktuell. Ett av de läkemedel som idag är godkänt för behandling av fetma är orlistat (Xenical®). Läkemedlet verkar genom att hämma gastro- och pankreaslipaser, vilket resulterar i en minskad fettabsorption på cirka 30 %.

    Syftet med detta arbete var att undersöka orlistats additiva effekt på viktnedgång hos personer med en samtidigt mild minskning av kaloriintaget. Förutom viktnedgång har även dess effekt vid typ 2-diabetes, med avseende på HbA1C, fasteglukos samt förändringar i diabetesmedicinering undersökts i vissa studier.

    Metoden som har använts i detta arbete är en litteraturstudie. De artiklar som användes hämtades från databasen PubMed, och sammanlagt var det fem studier som granskades. Två studier som fokuserade på orlistats effekt på viktnedgång, och tre studier som fokuserade på både dess effekt på viktnedgång och typ 2-diabetes.

    Samtliga studier visade på en signifikant större viktnedgång hos orlistatbehandlade individer jämfört med placebogruppen. I tre av studierna låg viktnedgången mellan 3,9-6,5 kg, och i de övriga två studierna mellan 5,0-8,5 %. När det gäller HbA1C så minskades det med mellan 0,6-1,1 procentenheter och fasteglukos mellan 1,3-1,9 mmol/l. Det var även fler orlistatbehandlade som kunde minska, eller till och med upphöra med, medicineringen mot sin diabetes. Slutsats blir därför att orlistat kan vara ett användbart läkemedel i kampen mot fetma och dess riskfaktorer, som i det här fallet typ 2-diabetes.

  • 27.
    Angviken, Åsa
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    SSRIs effekt och säkerhet hos barn och ungdomar2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Depression är den näst mest kostsamma sjukdomen för samhället efter hjärt-kärlsjukdom, främst på grund av långa sjukskrivningsperioder. Sjukdomen kan uppstå när som helst från sex månaders ålder, men prevalensen ökar med åldern. Det finns ett antal stressrelaterade faktorer som skulle kunna leda till depression, så som stor sorg, verbala eller fysiska övergrepp samt en svår barndom. Vad som orsakar sjukdomen är ännu inte helt känt, men det finns teorier att halterna av serotonin och noradrenalin är lägre hos deprimerade personer. Behandling som används är olika former av samtalsterapi, men även läkemedel så som selektiva serotoninåterupptagshämmare (SSRI). Det finns teorier som sammankopplar användandet av SSRI med självmord, framförallt hos personer ≤19 år. Syftet med detta litteraturarbete var att undersöka om SSRI preparat har någon effekt på depression hos barn och ungdomar och om de är säkra eller kan få allvarliga konsekvenser så som självmord. Sökningar i PubMed gjordes för att hitta relevanta artiklar. Fem av de åtta inkluderade studierna rapporterade olika effekter och säkerhet hos olika SSRI preparat bland barn och ungdomar, jämfört med placebo. Två andra studier undersökte förekomsten av suicidalitet till följd av läkemedlen. Den sista studien jämförde toxikologiska data från Rättsmedicinalverket med receptregistret på antidepressiva läkemedel från  Socialstyrelsen. Endast två av de fem studerade preparaten (fluoxetin och citalopram) hade en bättre effekt än placebo i hela populationen och ytterligare ett (sertralin) hade bättre effekt hos ungdomar. Det begicks inga självmord i studierna.    De studier som har granskats i detta arbete tyder på att olika SSRI preparat har olika bra effekt samt olika säkerhetsprofiler. Det sågs inget tydligt samband mellan behandlingen och självmord, men en något förhöjd risk för suicidalitet.     

  • 28.
    Ardiles-Villegas, Karen
    et al.
    Universidad de Concepción, Chile.
    González-Acuña, Daniel
    Universidad de Concepción, Chile.
    Waldenström, Jonas
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Olsen, Björn
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences. Uppsala University.
    Hernandez, Jorge
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences. Uppsala University.
    Antibiotic resistance patterns in fecal bacteria isolated from Christmas shearwater (Puffinus nativitatis) and masked booby (Sula dactylatra) at remote Easter Island2011In: Avian diseases, ISSN 0005-2086, E-ISSN 1938-4351, Vol. 55, no 3, p. 486-489Article in journal (Refereed)
    Abstract [en]

    Antibiotic use and its implications have been discussed extensively in the past decades. This situation has global consequences when antibiotic resistance becomes widespread in the intestinal bacterial flora of stationary and migratory birds. This study investigated the incidence of fecal bacteria and general antibiotic resistance, with special focus on extended spectrum beta-lactamase (ESBL) isolates, in two species of seabirds at remote Easter Island. We identified 11 species of bacteria from masked booby (Sula dactylatra) and Christmas shearwater (Puffinus nativitatis); five species of gram-negative bacilli, four species of Streptococcus (Enterococcus), and 2 species of Staphylococcus. In addition, 6 types of bacteria were determined barely to the genus level. General antibiotic susceptibility was measured in the 30 isolated Enterobacteriaceae to 11 antibiotics used in human and veterinary medicine. The 10 isolates that showed a phenotypic ESBL profile were verified by clavulanic acid inhibition in double mixture discs with cefpodoxime, and two ESBL strains were found, one strain in masked booby and one strain in Christmas shearwater. The two bacteria harboring the ESBL type were identified as Serratia odorifera biotype 1, which has zoonotic importance. Despite minimal human presence in the masked booby and Christmas shearwater habitats, and the extreme geographic isolation of Easter Island, we found several multiresistant bacteria and even two isolates with ESBL phenotypes. The finding of ESBLs has animal and public health significance and is of potential concern, especially because the investigation was limited in size and indicated that antibiotic-resistant bacteria now are distributed globally.

  • 29.
    Arildsson, Mathilda
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Har ketamin effekt mot terapiresistent depression?2019Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Depression is a syndrome characterized by depressed mood, loss of interest and energy, feelings of guilt or worthlessness and thoughts of death and suicide. Over 300 million people suffer from depression and it is one of the leading causes of disability in the world.

    Today’s treatment for depression includes psychological treatment as well as pharmacological treatment. While there are many antidepressant drugs, it can take up to weeks or even months before a clinical effect in the severity of the depression can be noticed. In addition, one third of the patients do not achieve remission. These patients, after treatment with two antidepressant medications given at adequate doses for an adequate duration, are considered to have treatment-resistant depression (TRD).

    Ketamine is a drug long used for its anesthetic and analgesic effects, but it is also known as a party-drug that can cause out-of-body experience. However, it has also been found that a single-dose ketamine may give people with TRD a rapid antidepressant effect, within 24 hours. In contrast to current antidepressant medications which primarily acts on the monoaminergic system, ketamine instead acts on the glutamatergic system.

    The aim of this study was to evaluate if ketamine has an effect on people suffering from TRD.

    This study is a literature review where five randomized controlled trials on the effect of ketamine in patients with TRD have been analyzed. Four studies evaluated the effect of intravenous ketamine where one of them used a varied dose frequency and one of them used esketamine in various doses. The fifth study evaluated the effect of intranasal administration of ketamine. All studies were found in the database PubMed.

    The overall result shows that ketamine has an effect on TRD. After 24 hours all the studies showed a significant improvement in the severity of the depression with ketamine treatment compared to placebo (p <0.05). Ketamine treatment resulted in a 7-16 points larger reduction in depressive symptoms on the scales used compared to placebo. This represents on average a change from severe/moderately severe depression to mild depression. There was also a significant difference in response (at least 50 % reduction in points from baseline on the scale used) after 24 hours with ketamine treatment compared to placebo (p <0.05). The proportion of ketamine treated patients with response varied between 44-71 % compared to 0-6 % for placebo and 28 % for active placebo (midazolam).

    Even though ketamine seems to have an effect on patients with TRD there is still limited knowledge of how the antidepressant effect shall be maintained and the safety of long-term use. Further studies are needed to determine if ketamine will be an option in future antidepressant treatment against TRD.

  • 30.
    Aslani Asl, Ali
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Synthesis of new perchlorates from 4- nitropyridine 1-oxide by acylation and decarboxylation2011Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    4-Nitropyridine 1-oxide was reacted with bis(trichloromethyl) carbonate, carbonyl fluoride, methyland ethyl chloroformate. Of particular interest was to examine if denitrohalogenation occurs when 4-nitropyridine 1-oxide is treated with carbonyl fluoride which happens when 4-nitropyridine 1-oxidereacts with bis(trichloromethyl) carbonate. A reaction took place but what was formed is still amatter of question.

    Two new compounds, 1-(methyloxycarbonyloxy)- and 1-(ethyloxycarbonyloxy)-4-nitropyridiniumperchlorate were obtained when 4-nitropyridine 1-oxide and sodium perchlorate in acetonitrile werereacted with methyl and ethyl chloroformate, respectively.

    1-Ethyloxy-4-nitropyridinium perchlorate were formed when heating 1-(ethyloxy-carbonyloxy)-4-nitropyridinium perchlorate. The evolution of carbon dioxide ceased at 90 OC. The structuredetermination of the product was made by IR and1H-NMR spectroscopy. The methyl analogue onthe other hand was completely decarboxylated at 145 OC according to an IR spectrum. The finalstructure determination of the latter compound remains to be done. Both compounds are new.

    Experiments were also done in order to work out a simple method for synthesizing carbonyl fluoridefrom bis(trichloromethyl) carbonate and potassium fluoride using 18-crown-6 or tetrabutylammoniumbromide as phase transfer catalysts in several solvents, e.g. acetonitrile, nitromethane, propylenecarbonate. Carbonyl fluoride was formed but its purity remains to be settled.

  • 31.
    Atterby, Clara
    et al.
    Uppsala University.
    Börjesson, Stefan
    National Veterinary Institute.
    Ny, Sofia
    Public Health Agency of Sweden;Karolinska Institutet.
    Järhult, Josef D.
    Uppsala University.
    Byfors, Sara
    Public Health Agency of Sweden.
    Bonnedahl, Jonas
    Linnaeus University, Faculty of Health and Life Sciences, Department of Biology and Environmental Science. Kalmar County Council;Linköping University.
    ESBL-producing Escherichia coli in Swedish gulls: A case of environmental pollution from humans?2017In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 12, article id e0190380Article in journal (Refereed)
    Abstract [en]

    ESBL-producing bacteria are present in wildlife and the environment might serve as a resistance reservoir. Wild gulls have been described as frequent carriers of ESBL-producing E. coli strains with genotypic characteristics similar to strains found in humans. Therefore, potential dissemination of antibiotic resistance genes and bacteria between the human population and wildlife need to be further investigated. Occurrence and characterization of ESBL-producing E. coli in Swedish wild gulls were assessed and compared to isolates from humans, livestock and surface water collected in the same country and similar time-period. Occurrence of ESBL-producing E. coli in Swedish gulls is about three times higher in gulls compared to Swedish community carriers (17% versus 5%) and the genetic characteristics of the ESBL-producing E. coli population in Swedish wild gulls and Swedish human are similar. ESBL-plasmids IncF-and IncI1-type carrying ESBL-genes blaCTX-M-15 or blaCTX-M-14 were most common in isolates from both gulls and humans, but there was limited evidence of clonal transmission. Isolates from Swedish surface water harbored similar genetic characteristics, which highlights surface waters as potential dissemination routes between wildlife and the human population. Even in a low-prevalence country such as Sweden, the occurrence of ESBL producing E. coli in wild gulls and the human population appears to be connected and the occurrence of ESBL-producing E. coli in Swedish gulls is likely a case of environmental pollution.

  • 32.
    Au, Gough G
    et al.
    The University of Newcastle.
    Lindberg, A Michael
    University of Kalmar, School of Pure and Applied Natural Sciences.
    Barry, Richard D
    The University of Newcastle.
    Shafren, Darren R
    The University of Newcastle.
    Oncolysis of vascular malignant human melanoma tumors by Coxsackievirus A21.2005In: International Journal of Oncology, ISSN 1019-6439, Vol. 26, no 6, p. 1471-6Article in journal (Refereed)
    Abstract [en]

    Cultured melanoma cell lines despite exhibiting similar in vitro morphology, display significant phenotypic and growth rate differences when propagated as in vivo xenografts. Previously we have shown that Coxsackievirus A21 (CVA21) lytically infects in vitro cultures of malignant melanoma cells and is efficient at reducing the tumor burden of mice bearing slow-growing SK-Mel-28 melanoma xenografts. The oncolytic activity of CVA21 against in vivo melanoma xenografts, which possess rapid growth rates and more extensive vascular structure than SK-Mel-28 xenografts warrants further investigation. In the present study we evaluated the oncolytic action of CVA21 against rapidly growing melanoma xenografts (ME4405) which exhibit a highly vascular phenotype. Flow cytometric analysis indicated that in vitro cultures of ME4405 cells expressed comparable levels of the CVA21 cellular receptors, ICAM-1 (intercellular adhesion molecules-1) and DAF (decay accelerating factor) to SK-Mel-28 cells. Despite similar levels of CVA21 receptor expression, SK-Mel-28 cells appear to be more susceptible to viral lysis than ME4405 cells, even though the kinetics of virus replication in both lines was comparable. Intratumoral, intraperitoneal or intravenous administration of CVA21 were equally effective in reducing the tumor volume of ME4405 xenografts in immunodeficient mice, and provides further evidence for the use of CVA21 as a novel oncolytic agent against varying phenotypes of malignant melanoma.

  • 33.
    Ax, Fredrik
    et al.
    Apoteket AB.
    Ekedahl, Anders
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Electronic transmitted prescriptions not picked up at pharmacies in Sweden2010In: Research in Social and Administrative Pharmacy, ISSN 1551-7411, E-ISSN 1934-8150, Vol. 6, no 1, p. 70-77Article in journal (Refereed)
    Abstract [en]

    Background: Electronic transmitted prescriptions (ETPs) became common after 1995 in Sweden; however, it is accompanied by a substantial increase in the number of prescriptions not picked up at pharmacies.

    Objective: To investigate the ‘‘no pick-up’’ rates of ETPs at pharmacies across type of drug and patient age and gender and the reasons patients’ report for no pick-up.

    Methods: A cross-sectional study examining no pick-up of ETPs transmitted during 3 months in 2002, and a mail survey of patients to determine the reasons for failure to pick-up in the county of Sormland, Sweden, with a population of 261,000, and 21 pharmacies. Chi-square tests were used for calculations of frequency differences among groups.

    Results: The overall no pick-up rate of ETPs was 2.5%; men had consistently higher rates than women. The highest rates were seen for adolescents and young adults. Rates were higher than average for antibiotics. About 60% of the answers indicated that prescriptions not picked up were duplicate prescriptions or not needed. ‘‘Unintentional nonadherence’’ was reported by one-fifth of patients.

    Conclusions: No pick-up rate in general was low (2.5%), but there were differences across patient age and sex, the rates being higher among adolescents and young adults. Duplicate prescriptions may explain a significant share of the abandoned prescriptions.

  • 34. Babiker, Adil A
    et al.
    Magnusson, Peetra U
    Ronquist, Gunnar
    Nilsson, Bo
    Nilsson Ekdahl, Kristina
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Mapping Pro- and Antiangiogenic Factors on the Surface of Prostasomes of Normal and Malignant Cell Origin2010In: The Prostate, ISSN 0270-4137, E-ISSN 1097-0045, Vol. 70, no 8, p. 834-847Article in journal (Refereed)
    Abstract [en]

    BACKGROUND. Angiogenesis is the formation of new blood vessels by capillary sprouting from pre-existing vessels. Tumor growth is angiogenesis-dependent and the formation of new blood vessels is associated with the increased expression of angiogenic factors. Prostasomes are secretory granules produced, stored and released by the glandular epithelial cells of the prostate. We investigated the expression of selected angiogenic and anti-angiogenic factors on the surface of prostasomes of different origins as well as the direct effect of prostasomes on angiogenesis.

    METHODS. VEGF, endothelin-1, endostatin, and thrombospondin-1 were determined on prostasomes from seminal fluid and human prostate cancer cell lines (DU145,PC-3,LNCaP) using different immunochemical techniques. Human dermal microvascular endothelial cells were incubated with seminal and DU145 cell-prostasomes and with radioactive thymidine. The effect of prostasomes on angiogenesis was judged by measuring the uptake of labeled thymidine. The presence of any deleterious effects of prostasomes on the endothelial cells was investigated using thymidine assay and confocal laser microscopy.

    RESULTS. VEGF and endothelin-1 were determined on malignant cell-prostasomes (no difference between cell lines) but not determined on seminal prostasomes. The same applies for the expression of endostatin but with much higher expression on malignant cell-prostasomes with obvious differences between them. Seminal and DU145 cell-prostasomes were found to have anti-angiogenic effect which was more expressed by DU145 cell-prostasomes. No deleterious effect of prostasomes on endothelial function was detected using either thymidine assay or microscopy.

    CONCLUSIONS. Prostasomes contain pro- and anti-angiogenic factors that function to counteract each other unless the impact from one side exceeds the other to bring about dysequilibrium.

  • 35. Babiker, Adil A
    et al.
    Ronquist, Gunnar
    Nilsson, Bo
    Nilsson Ekdahl, Kristina
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Prostasome Involvement in the Development and of Prostate Cancer2010In: Open Prostate Cancer Journal, ISSN 1876-8229, Vol. 3, p. 1-13Article, review/survey (Refereed)
    Abstract [en]

    Prostasomes are extracellularly occurring submicron, membrane-surrounded organelles produced by the epithelial cells of the prostate and present in semen after secretion. Even dedifferentiated prostate cancer cells have preserved their ability to produce and export prostasomes to the extracellular space. The precise physiological role of prostasomes is not known, although some of their properties assign them to important physiological and patho-physiological functions that could be exploited in prostate cancer growth and development. In this review, some new properties of seminal and malignant cell line (DU145, PC-3 and LNCaP) prostasomes will be discussed.There are typical differences in the expressions and activities of prostasomal CD59, ATPase, protein kinases and tissue factor (TF) as well as in the transfer of prostasomal CD59 to CD59-deficient erythrocytes (rabbit and human PNH erythrocytes). CD59, protein kinases and TF exhibit characteristic patterns of overexpression by malignant cell prostasomes. A high ATPase activity is recognized on seminal prostasomes with minimal activity on malignant cell prostasomes resulting in more residual ATP available for phosphorylation reactions. Several proteins are phosphorylated by prostasomal protein kinases, namely, complement component C3, fibrinogen, vitronectin and E-cadherin. Furthermore, TF is identified as the main endogenous phosphorylation substrate on prostasomes. In addition, prothrombotic effects of prostasomes are demonstrated. DU145 and PC-3 cell-derived prostasomes exert a higher clotting effect on whole blood and plasma compared to LNCaP cell-derived and seminal prostasomes.In conclusion, malignant cell prostasomes show an increased ability to interact with the biological system in favor of prostate cancer cell promotion and survival. The roles played by prostasomes in this context may improve the understanding of the mechanisms that help the prostate cancer cells to avoid the complement attack (CD59 transfer and phosphorylation and inactivation of C3), to promote angiogenesis (TF) and to metastasize. It may also provide a better understanding of some of the complications usually seen in some terminal prostate cancer patients like thrombotic events and tendency to develop disseminated intravascular coagulation.

  • 36.
    Baftijaj, Jehon
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Etniska skillnader i läkemedelsrespons för substanser relevanta vid hjärt-kärlsjukdomar2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    There are many factors that play a role in the response of a drug. An interesting factor that is often discussed in the academia is the role of ethnicity. Differences in the expression of CYP enzyme, protein transporters and receptors between different ethnic groups believed to affect the outcome of many drugs relevant to cardiovascular disease. Polymorphism is believed to play an important role in this regard. Genetic alleles that differ through ethnicity-based polymorphism causes CYP enzymes and protein transporters to respond differently to different drugs. It is nevertheless not always fully explored if these ethnic differences are always due to genetic or non-genetic causes.

    There are however important changes toward the notion of recognizing ethnicity as a key role in pharmaceutical development. The Food and Drug Administration in the US have for example released guidance on how to define and work towards categorizing ethnicity in clinical research. There are also several western countries creating guidelines for drug therapy specific to ethnic groups.

    The purpose of this literary work was to study the differences between ethnic groups in terms of dosing, efficacy and pharmacokinetics of drugs used in cardiovascular disease.

    Five studies were used in the literary work. The first study examined the differences in dosing for warfarin therapy between different ethnicities. The second trial studied the plasma exposure of rosuvastatin between Caucasian and Asian people. The third study examined the effect of the ACE inhibitor enalapril in black and white patients with left ventricular dysfunction. The fourth study investigated the effect of beta blocker atenolol in white and black participants. The last study was done to compare the effect of the thiazide diuretic chlorthalidone against calcium channel inhibitors and ACE inhibitors in black and non-black patients.

     

    The results showed that warfarin dosage differs between ethnicities. Plasma exposure of rosuvastatin is different between Caucasian and Asian people. ACE inhibitors work better with white patients, atenolol is more effective for white patients and chlorthalidone works better in black patients with certain cardiovascular diseases.

     

    The studies presented indicate that there are differences in drug response in various ethnicities and these distinctions are different in extent and significance. It can be argued for genetic and non-genetic causes of differences depending on the drug being studied. 

  • 37.
    Bagert, Bodil
    University of Kalmar, School of Pure and Applied Natural Sciences.
    Borrelia burgdorferi: metodutveckling och tillämpning avseende odling och resistensstudier mot komplement, särskilt interaktion med faktor H2008Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    The genus Borrelia is a widespread, pathogenic pest and the causative of among others borreliosis or Lyme disease. The vector for the bacteria is the hard tick, Ixodes ricinus and the infection is transferred through a bite. Untreated, Borrelia may cause arthritis, heart damage or neuroborreliosis. Infection is made possible through different strategies for avoiding the body’s complement system. One such strategy involves the binding of factor H to specific bacterial membrane proteins and, thus, no complement activation and lysis. Another defence mechanism, phagocytosis, acts in cooperation with the complement and is subsequently retarded. The present study includes optimizing of Borrelia culturing, characterisation of different Borrelia strains in regard to sensitivity against the complement including culture counting and the analysis of free C3a and the Terminal Complement Complex (TCC). Further, tagging with FITC in order to study morphology as well as phagocytosis with the aid of microscopy and FACS was performed. The culturing experiments showed Borrelia to be rather easy to culture, although a strict sterile technique has to be applied. Concerning sensitivity to complement, the B.afzelii strains showed to be resistant to complement action, while most of the B. garninii are sensitive. Analysis of C3a and TCC after incubation with normal human blood serum as well as human whole blood, showed that complement activation demands rather or very high cell densities. Tagging with FITC followed by microscopic analysis resulted in good illustrations of the bacterial morphology. The FACS analysis resulted in findings of phagocytosis in both monocytes and granulocytes and, further, the different stages of phagocytosis were visualised through nuclear staining followed by microscopy. The genus Borrelia is a widespread, pathogenic pest and the causative of among others borreliosis or Lyme disease. The vector for the bacteria is the hard tick, Ixodes ricinus and the infection is transferred through a bite. Untreated, Borrelia may cause arthritis, heart damage or neuroborreliosis. Infection is made possible through different strategies for avoiding the body’s complement system. One such strategy involves the binding of factor H to specific bacterial membrane proteins and, thus, no complement activation and lysis. Another defence mechanism, phagocytosis, acts in cooperation with the complement and is subsequently retarded. The present study includes optimizing of Borrelia culturing, characterisation of different Borrelia strains in regard to sensitivity against the complement including culture counting and the analysis of free C3a and the Terminal Complement Complex (TCC). Further, tagging with FITC in order to study morphology as well as phagocytosis with the aid of microscopy and FACS was performed. The culturing experiments showed Borrelia to be rather easy to culture, although a strict sterile technique has to be applied. Concerning sensitivity to complement, the B.afzelii strains showed to be resistant to complement action, while most of the B. garninii

    are sensitive. Analysis of C3a and TCC after incubation with normal human blood serum as well as human whole blood, showed that complement activation demands rather or very high cell densities. Tagging with FITC followed by microscopic analysis resulted in good illustrations of the bacterial morphology. The FACS analysis resulted in findings of phagocytosis in both monocytes and granulocytes and, further, the different stages of phagocytosis were visualised through nuclear staining followed by microscopy.

  • 38.
    Bardage, Carola
    et al.
    Uppsala University, Sweden.
    Ekedahl, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Ring, Lena
    Uppsala University, Sweden.
    Health care professionals’ perspectives on automated multi-dose drug dispensing2014In: Pharmacy Practice, ISSN 1885-642X, E-ISSN 1886-3655, Vol. 12, no 4, article id 470Article in journal (Refereed)
    Abstract [en]

    Background: During the 1980s, manual repackaging of multi-dose medications from pharmacies in Sweden was successively substituted with automated multi-dose drug dispensing (MDD). There are few studies evaluating the consequences of automated MDD with regard to patient safety, and those that investigate this issue are not very extensive.

    Objectives: To investigate Swedish health care professionals’ perceived experience of automated MDD and its effects on patient adherence and patient safety.

    Methods: Three questionnaire forms, one for physicians, nurses, and assistant nurses/nursing assistants, were developed based on reviews of the literature and pilot testing of the questions in the intended target groups. The target groups were health professionals prescribing or administrating MDD to patients. A sample (every sixth municipality) was drawn from the sampling frame of Swedish municipalities, resulting in 40 municipalities, about 14% of all municipalities in Sweden. Email addresses of general practitioners were obtained from county councils, while the municipalities assisted in getting contact details for nurses, assistant nurses and nursing assistants. A total of 915 questionnaires were distributed electronically to physicians, 515 to nurses, and 4,118 to assistant nurses/nursing assistants. The data were collected in September and October 2012.

    Results: The response rate among physicians, nurses and assistant nurses/nursing assistants was 31%, 43% and 23%, respectively. The professionals reported that automated MDD reduces duplication of medication, contributes to correct dosages, helps patients take their medication at the right time, and reduces confusion among patients. Fifteen per cent of the physicians and about onethird of the nurses and assistant nurses/nursing assistants reported that generic substitution makes it more difficult for the patient to identify the various medicines available in the sachets. The physicians did, however, note that prescribing medicine to patients with automated MDD is complicated and can be a risk for patient safety. Both physicians and nurses requested more information on and training in automated MDD. They also asked for more medication reviews.

    Conclusions: The professionals generally had a positive attitude to automated MDD with regard to improved medication adherence, but said they believed that the electronic prescribing system posed a safety risk for patients.

  • 39.
    Bardage, Carola
    et al.
    Med Prod Agcy, Uppsala / Uppsala Univ.
    Ekedahl, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences. Med Prod Agcy, Uppsala.
    Ring, Lena
    Med Prod Agcy, Uppsala / Uppsala Univ.
    Health-Care Professionals' Perspectives on Multi-Dose Dispensed Medicines2013In: Pharmacoepidemiology and Drug Safety, ISSN 1053-8569, E-ISSN 1099-1557, Vol. 22, p. 251-251Article in journal (Other academic)
  • 40.
    Barratt-Due, Andreas
    et al.
    Oslo University Hospital, Norway ; University of Oslo, Norway.
    Pischke, Søren Erik
    Oslo University Hospital, Norway ; University of Oslo, Norway.
    Nilsson, Per H.
    Oslo University Hospital, Norway ; University of Oslo, Norway.
    Espevik, Terje
    Norwegian University of Science and Technology, Norway.
    Mollnes, Tom Eirik
    Norwegian University of Science and Technology, Norway ; Nordland Hospital, Norway ; University of Tromsø, Norway.
    Dual inhibition of complement and Toll-like receptors as a novel approach to treat inflammatory diseases-C3 or C5 emerge together with CD14 as promising targets.2017In: Journal of Leukocyte Biology, ISSN 0741-5400, E-ISSN 1938-3673, Vol. 101, no 1, p. 193-204Article in journal (Refereed)
    Abstract [en]

    The host is protected by pattern recognition systems, including complement and TLRs, which are closely cross-talking. If improperly activated, these systems might induce tissue damage and disease. Inhibition of single downstream proinflammatory cytokines, such as TNF, IL-1β, and IL-6, have failed in clinical sepsis trials, which might not be unexpected, given the substantial amounts of mediators involved in the pathogenesis of this condition. Instead, we have put forward a hypothesis of inhibition at the recognition phase by "dual blockade" of bottleneck molecules of complement and TLRs. By acting upstream and broadly, the dual blockade could be beneficial in conditions with improper or uncontrolled innate immune activation threatening the host. Key bottleneck molecules in these systems that could be targets for inhibition are the central complement molecules C3 and C5 and the important CD14 molecule, which is a coreceptor for several TLRs, including TLR4 and TLR2. This review summarizes current knowledge of inhibition of complement and TLRs alone and in combination, in both sterile and nonsterile inflammatory processes, where activation of these systems is of crucial importance for tissue damage and disease. Thus, dual blockade might provide a general, broad-acting therapeutic regimen against a number of diseases where innate immunity is improperly activated.

  • 41.
    Barzanji, Tara
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Kan användning av paracetamol under graviditeten medföra risk för barnet och leda till beteendeproblem?2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Introduction: Paracetamol is the most common medicine used as painkiller in the world. Since it has been on the market for a very long time it has been thought to be one of the safest medicines to use during pregnancy. Many women use this medicine for different indications during pregnancy thinking it is safe for the fetus. However, the mechanism of action for paracetamol is still unknown and therefore there is no information about how it could affect the fetus.

    Objective: To study paracetamol safety during pregnancy and its effect on the fetus and behaviour in childhood.

    Method: The information search for this literature study has been done through searching for different articles in the database pubmed. In these articles, pregnant women who used paracetamol during pregnancy have been analysed to see the effect on their children.

    Result: Different articles used in this literature study have shown an association between prenatal paracetamol exposure and behavioural problems in children. One study shows that if paracetamol is used during pregnancy the risk increases to get a Hyperkinetic disorder, HKD diagnosis (Hazard ratio (HR)= 1,37; 95% confidence interval (CI), 1,19-1,59), similarly the risk to get an ADHD-diagnosis increases (HR=1,29: 95% CI, 1,15-1,44).

    Discussion: The association between prenatal paracetamol exposure and behavioural problems has been shown in different studies made om pregnant women even though the exact mechanism is still unknown. Changes in children’s epigenetics seem to be associated with prenatal paracetamol exposure. Changes in DNA-methylation of genes previously linked to ADHD have been detected.  

    Conclusion: Prenatal paracetamol exposure seems to be associated with child behavioural problems. Therefore, paracetamol may not be a completely safe medicine in pregnancy and all pregnant women should have this information available to avoid unnecessary use especially during the second and third trimester.

  • 42.
    Behailu Bekele, Haimanot
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Atypisk aktivering av komplementprotein C52019Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 43.
    Berg, Aase
    et al.
    Stavanger University Hospital, Norway ; University of Bergen, Norway.
    Otterdal, Kari
    Oslo University Hospital Rikshospitalet, Norway.
    Patel, Sam
    Central Hospital of Maputo, Mozambique.
    Gonca, Miguel
    Central Hospital of Maputo, Mozambique.
    David, Catarina
    Central Hospital of Maputo, Mozambique.
    Dalen, Ingvild
    Stavanger University Hospital, Norway.
    Nymo, Stig
    Oslo University Hospital Rikshospitalet, Norway.
    Nilsson, Margareta
    Oslo University Hospital Rikshospitalet, Norway.
    Nordling, Sofia
    Uppsala University.
    Magnusson, Peetra U
    Uppsala University.
    Ueland, Thor
    Oslo University Hospital Rikshospitalet, Norway.
    Prato, Mauro
    University of Torino, Italy.
    Giribaldi, Giuliana
    University of Torino, Italy.
    Mollnes, Tom Eirik
    Oslo University Hospital Rikshospitalet, Norway.
    Aukrust, Pål
    Oslo University Hospital Rikshospitalet, Norway.
    Langeland, Nina
    University of Bergen, Norway.
    Nilsson, Per H.
    Oslo University Hospital Rikshospitalet, Norway.
    Complement Activation Correlates With Disease Severity and Contributes to Cytokine Responses in Plasmodium falciparum Malaria.2015In: Journal of Infectious Diseases, ISSN 0022-1899, E-ISSN 1537-6613, Vol. 212, no 11, p. 1835-1840Article in journal (Refereed)
    Abstract [en]

    The impact of complement activation and its possible relation to cytokine responses during malaria pathology was investigated in plasma samples from patients with confirmed Plasmodium falciparum malaria and in human whole-blood specimens stimulated with malaria-relevant agents ex vivo. Complement was significantly activated in the malaria cohort, compared with healthy controls, and was positively correlated with disease severity and with certain cytokines, in particular interleukin 8 (IL-8)/CXCL8. This was confirmed in ex vivo-stimulated blood specimens, in which complement inhibition significantly reduced IL-8/CXCL8 release. P. falciparum malaria is associated with systemic complement activation and complement-dependent release of inflammatory cytokines, of which IL-8/CXCL8 is particularly prominent.

  • 44.
    Berg, Christer
    et al.
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Ekedahl, Anders
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Dosages involving split tablets - common but unnecessary?2010In: Journal of Pharmaceutical Health Services Research, ISSN 1759-8885, Vol. 1, no 3, p. 137-141Article in journal (Refereed)
  • 45.
    Berg, Christer
    et al.
    University of Kalmar, School of Pure and Applied Natural Sciences.
    Haupt, Dan
    Department of Health Sciences, Lulea University of Technology, Lulea.
    Ekedahl, Anders
    University of Kalmar, School of Pure and Applied Natural Sciences.
    Prescriptions on split tablets: a common drug related problem - but unnecessary?2007In: ESCP 7th Spring Conference on Clinical Pharmacy 16-19 May 2007, Edinburgh: Tackling Inequalities in the Delivery of Pharmaceutical Care, 2007, p. 1-16Conference paper (Refereed)
  • 46.
    Bergdahl, Maria
    University of Kalmar, School of Pure and Applied Natural Sciences.
    Using the counterselectable marker pheS* to study the excision rate and excision patterns of the pathogenicity island of Enterococcus faecalis V583 2009Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    The Enterococcus genus consists of natural members of the gastrointestinal tract but they are also opportunistic pathogens. They are a common cause of urinary tract infections but can also cause sepsis and other infections. Enterococcus faecalis and Enterococcus faecium are the most abundant in clinical specimens. Enterococci are a leading cause of nosocomial infections and they have developed resistance against a number of antibiotics e.g. vancomycin. E. faecalis V583 was the first vancomycin resistant isolate reported in the U.S. Movable genetic elements such as pathogenicity islands, PAI, are important for bacterial evolution. PAI:s are large chromosomal fragments mostly seen in pathogenic strains and carry regions such as transposons and insertion elements along with virulence factors and transfer genes. A PAI has been detected in the chromosome of E. faecalis. Excision of PAI:s has been studied for uropathogenic E. coli and frequencies of 10-5 and 10-6 have been reported. In this study the excision rate and excision patterns of E. faecalis V583 was studied using the counterselectable marker pheS*, causing p-Cl-phe sensitivity, and a chloramphenicol resistance gene, cat, inserted at two different positions of the PAI and selecting for excisions by growth on p-Cl-phe. Excision rates of 10-6 and 10-8 were seen based on the p-Cl-phe resistance and chloramphenicol sensitivity. Mutation rate in the pheS* gene was high compared to excision rate which made the method difficult to work with. No obvious excision patterns were detected but the excisions seemed to be limited to the close surroundings of the pheS*/cat insertion.

  • 47.
    Bergman, Anna
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Har förskrivningen av antibiotika till våra vanligaste husdjur, hund och katt förändrats från 2009 till 2014 och i så fall, hur?2015Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Baserat på en rapport från e-hälsomyndigheten tillsammans med allmänt tillgänglig material från Statens Veterinärmedicinska Anstalt och Statens Jordbruksverk fastslås att expedieringen av antimikrobiella medel till hund och katt i Sverige har minskat med c:a 27 % mellan 2009 och 2014. Största delen av de antimikrobiellamedlen förskrivs till hund (70 %). Den mesta använda gruppen av antimikrobiella medel till båda djurslagenär penicilliner. Därefter vanligast använda grupper av antimikrobiella medel till hund är linkosamider,övriga antibakteriella betalaktamer och antibakteriella kinolonderivat. Till katt används näst penicillinerfrämst antibakteriella kinolonderivat och linkosamider. Samma grupper dominerar år efter år men förskrivningenav de enskilda medlen varierar inom respektive grupp. Minskningen är mer framträdande gällandehund och ses främst för cefalexin, enrofloxacin och klindamycin. De senaste åren ses, för bådadjurslagen enviss ökning i användningen av kombinationer med sulfametoxazol och trimetoprim. Mellan 6 och 7 % av dentotala mängden läkemedel till hund och katt utgörs av humanläkemedel. Baserat på de dokument som sammanställtsi detta arbete tycks det som att svenska veterinärer tar sitt ansvar och bidrar till den minskandeanvändningen av antimikrobiella medel i samhället. Med fortsatt medveten och kontrollerad användning av antimikrobiella medel till djur kommer Sverige att kunna fortsätta att föregå som gott exempel och som en förebild för övriga Europa och kanske även för resten av världen.

  • 48.
    Bergqvist, Petronella
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Towards novel therapies and diagnostics: Studies of a novel polymer system2010Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 49.
    Bergseth, Grethe
    et al.
    Nordland Hospital, Bodø, Norway.
    Nilsson, Per H.
    University of Oslo, Rikshospitalet, Norway.
    Thomas, Anub Mathew
    Radboud University Medical Center, The Netherlands.
    Gustavsen, Alice
    University of Oslo, Rikshospitalet, Norway.
    Volokhina, Elena B
    Radboud University Medical Center, The Netherlands.
    van den Heuvel, Lambertus P
    Radboud University Medical Center, The Netherlands.
    Barratt-Due, Andreas
    University of Oslo, Rikshospitalet, Norway.
    Mollnes, Tom E
    University of Oslo, Rikshospitalet, Norway;Nordland Hospital, Norway;University of Tromsø, Norway.
    Neoepitope based assays to detect C5a – Pitfalls and interpretations2017In: Molecular Immunology, ISSN 0161-5890, E-ISSN 1872-9142, Vol. 89, no SI: EMCHD2017, p. 201-201Article in journal (Refereed)
  • 50.
    Bernestrå, Isadora
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Ebolaviruset - nu och då: varför har utbrottet 2013-2015 blivit så stort?2015Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Ebola upptäcktes för första gången 1976 i ett dubbelt utbrott i Sudan och Zaire i Afrika. Det pågående utbrottet av ebola virus sjukdom (EVD) startade i Guinea 2013 och har sedan dess spridits vidare till Liberia, Sierra Leone, Nigeria, Mali och Senegal. T.o.m. 4 mars 2015 har nästan 24 000 smittats och 10 000 avlidit vilket är mer än 50 gånger fler än i det tidigare största utbrottet i Uganda 2000. Viruset består av fem arter: Bundibugyo, Reston, Sudan, Tai Forest och Zaire. Vektorn för viruset är fortfarande okänd men förmodas vara flygande hundar (fruit bats) som själva är resistenta. Symtomen innefattar bl.a. feber, trötthet, kräkning, diarré, ledsmärtor och mukosala blödningar. Behandlingen består vanligen av vätskeersättning. Det finns varken godkänt vaccin eller läkemedel i dagsläget men flertalet studier pågår för att utveckla bl.a. antikropparna ZMapp och antiviral behandling med Brincidofovir.

    Syfte: Redogöra för tidigare och pågående utbrott av ebola och undersöka vilka faktorer som bidragit till att epidemin 2013-2015 inträffat och fått stora proportioner i Västafrika.

    Metod: Till det aktuella ämnet har den senaste informationen inhämtats via WHO och CDCs respektive hemsidor mellan 23/2-9/3 2015.

    Resultat: En kombination av faktorer har bidragit till att det pågående utbrottet blivit större än tidigare. Länderna som drabbats har inte varit förberedda, virusarten ebola Zaire har hög dödlighet, sjukvård och infrastruktur är svag och kulturen är djupt grundad i ett samhälle där utbildningen är låg. Befolkningen behöver respekteras och utbildas för att de aktivt ska kunna vara delaktiga i att stoppa smittspridningen av viruset. Ju mindre geografisk yta viruset är fördelat på desto lättare blir det att kontrollera och bekämpa det.

    Diskussion: Guinea, Liberia och Sierra Leone har alla drabbats extra hårt av pågående EVD utbrott och behöver nu få hjälp med återuppbyggnad av ett fungerande sjukvårdssystem som befolkningen kan lita på och med personal som kan arbeta under säkra förhållanden. Stort fokus bör också läggas på att implementera kulturen i de skyddsåtgärder som behövs för att förhindra ytterligare spridning och framtida utbrott. Ytterligare forskning krävs för att kunna erbjuda bättre behandling och profylax.

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