Pulmonary arterial hypertension (PAH) is an uncommon but serious disease that causes increased pressure in the pulmonary vessels and increased pulmonary vascular resistance (PVR), which in turn leads to right heart failure. At diagnosis, mean pulmonary artery pressure (mPAP) must be >20 mmHg, pulmonary artery wedge pressure (PAWP) ≤15 mmHg and PVR >2 Wood units (WU). Calculation of cardiac output (CO) is an important hemodynamic parameter to be measured and assessed in these patients during a right heart catheterization (RHC). Prevailing ESC guidelines recommend using direct Fick's principle (dFp), which is considered the gold standard, or thermodilution when calculating CO. The aim of this study was to compare these two methods to see if there is a significant difference in the calculation of CO in patients with PAH. The aim was also to see if calculated cardiac index (CI) and PVR differ significantly depending on which of the methods for calculating CO is used. A retrospective study was conducted in which 34 patients who underwent RHC at the University Hospital in Örebro were included. The result showed a significant difference between dFp and thermodilution (p<0,05), where dFp on average measures higher volumes compared to thermodilution. It also showed a low agreement between the two methods. A significant difference was seen between CI and PVR (p<0,05) depending on which of the methods is used. Therefore, dFp and thermodilution cannot be said to have a good agreement in this patient group. It is important to use the same method for follow-up examinations as the assessment of PVR and CI is used as a predictor of whether the disease progresses or remains stable.

Syfte: Syftet var att studera hur depression påverkar vuxna individers orala hälsa. Material och metod: Studien är en allmän litteraturstudie som grundar sig i kvantitativa och kvalitativa artiklar. Databaserna som användes var “Dentistry and Oral Sciences Source” och “Medline”. Resultat: Totalt analyserades 15 vetenskapliga artiklar som sammanställdes och delades in under två rubriker. Rubrikerna består av inre och yttre faktorer som påverkar och begränsar den orala hälsan. Faktorerna som beskrivs är oralhygien, orala sjukdomar och nedsatt tuggförmåga kopplat till depression samt låg socioekonomi och tandvårdspersonalens roll kopplat till depression. Slutsats: Depression påverkar den orala hälsan på ett negativt sätt. Påverkan beror på olika faktorer såsom låg socioekonomisk status, besvär med olika mun funktioner och orala sjukdomstillstånd som begränsar deprimerade patienters förmåga att upprätthålla en god oral hälsa samt försämrar livskvaliteten. Ytterligare forskning kring ämnet behöver tillämpas för bredare kunskap inom området. / Aim: The aim was to study how depression affects the oral health of adults. Material and method: The study is a general literature study based on quantitative and qualitative articles. The used databases were "Dentistry and Oral Sciences Source" and "Medline". Results: A total of 15 scientific articles were analyzed, compiled and divided under two headings. The headings consist of internal and external factors that affect and limit oral health. The factors described are oral hygiene, oral diseases and impaired chewing ability linked to depression, as well as low socioeconomic status and the role of the dental care staff linked to depression. Conclusion: Depression affects oral health in a negative way. The impact depends on various factors such as low socio-economic status, problems with various mouth functions and oral diseases that limit depressed patients' ability to maintain good oral health and impair the quality of life. Further research on the subject needs to be applied for broader knowledge in the area.

Stroke är den vanligaste orsaken till förvärvat neurologiskt funktionshinder hos vuxna och den tredje vanligaste dödsorsaken i Sverige. Antal symtom samt svårighetsgrad varierar beroende på skadans områdesbegränsning. Riskutsatt hjärnvävnad kan återhämta sig vid tidig behandling och kan minimera permanenta skador på hjärnan. Initialt genomförs en datortomografi (DT) av hjärnan, för att möjliggöra trombektomi behandling rekommenderas det att förutom DT-angiografi även diagnostik av räddningsbar hjärnvävnad göras med DT-perfusion (DTP).   Syftet med denna litteraturstudie är att ur ett radiografiskt perspektiv beskriva DTPs roll vid utredning och behandling av akut ischemisk stroke vid ocklusion av större cerebrala artärer. Metoden är en litteraturstudie med systematisk metod där 108 studier genomgått en urvalsprocess samt en kvalitetsgranskning. Totalt inkluderades 20 studier.   Resultatet visar på att urval för trombektomi baserad på avancerad bildbehandling fördubblar sannolikheten för goda funktionella resultat jämfört med standard DT metod. Urval baserad på standard DT-protokoll kan inkludera patienter som skulle ha uteslutits av DTP på grund av stor variation i DTP-corevolym.  Slutsats: Vår studie visar att DTP tillför ökad diagnostisk säkerhet vid akut ischemisk stroke och kan påverka efterföljande behandling. / Stroke is the most common cause of acquired neurological disability in adults and the third most common cause of death in Sweden. Symptoms and severity vary depends on the area limitation of the injury. Risk-prone brain tissue can recover with early treatment and can minimize permanent damage to the brain. Initially, a CT (Computed Tomography) scan of the brain is performed, but to enable thrombectomy treatment, it is recommended that in addition to CT angiography, diagnostics of salvageable brain tissue be done with CT-perfusion (CTP).   The aim of this literature review based on 20 quality reviewed studies is to elucidate, from a radiographic perspective, the role of CTP of the brain in the diagnosis and treatment of acute ischemic stroke (AIS) in occlusion of major cerebral arteries.   The results show that selection for thrombectomy based on advanced image processing doubles the probability of good functional results compared to the standard CT. Selection based on the CT method may include patients who would have been excluded by CTP due to large variation in CTP core volume.  Conclusion: Our study shows that CTP provides increased diagnostic safety in AIS and may affect subsequent treatment.

This review aimed to evaluate orthotic treatments for children and adolescents with pectus carinatum, primarily focusing on patient satisfaction with the treatment. Secondary outcomes of interest were adherence and psychological and social factors following the treatment period. A literature search was performed in the databases CINHAL, Medline, Web of Science and Scopus. Following predetermined eligibility criteria, articles were included and excluded. Next, criticala ppraisal was performed for the included articles. Following this, relevant data were extracted, analysed, and presented to aid in answering the research questions. Six articles with 402 patients were included in the final review. Patient satisfaction was good or improved following the treatment period, and the combined non-adherence rate for the included orthosis was 37.7 %. Patients adhering to the treatment protocol showed increased self-esteem and decreased interference with social activity following orthotic correction. Moreover, they displayed significantly higher patient satisfaction than patient's non-adherent to the treatment protocol. The findings were displayed and discussed in the Bio-Psycho-Social model. Due to their connection, patient satisfaction and adherence were placed together in the middle and surrounded bypsychological and social factors. The model displayed that a combination of many aspects determines patient satisfaction and adherence, demonstrating that treatment is complex and challenging. In conclusion, adherence was deemed one of the most important aspects to achieve high patient satisfaction. Moreover, due to psychological and social factors, a patient-centred approach with professional collaboration is necessary to achieve successful outcomes. To make reliable conclusions, research of higher quality with long follow-up periods including standardised patient satisfaction and adherence measures is needed.

The value proposition of Personalized Medicine is to deliver the “right drug, to the right patient, at the right time”. Companion diagnostics is the required tool for Personalized Medicine used to aid clinical decision making with the aim to identify patients who are most suitable for a given treatment approach and to avoid adverse effects. However, even 16 years after the first co-approval of a therapeutic drug and an associated diagnostic test (trastuzumab (Herceptin1) from Genentech and the HercepTest1 from Dako), the co-development and co-approval of drug-diagnostic pairs is a challenging task.This study has the aim to identify major challenges for diagnostics companies when developing and commercializing companion diagnostics. This is achieved by (1) a literature research and (2) an empirical case study in form of interviews with diagnostics companies. The collected data is analyzed and discussed with focus on current regulatory and reimbursement frameworks in the USA and European Union. The co-development strategies and business models of companion diagnostics developers are identified.The conclusion of this study is that the major hurdles for companion diagnostics development and commercialization are gaps in scientific evidence and lacking regulatory guidelines for co-development and clinical biomarker studies. Companion diagnostics commercialization is further challenged by poor reimbursement levels. The main strategy of diagnostics companies to address these challenges is the demonstration of a beneficial outcome for patients in form of clinical studies. Small companies with limited resources for clinical research receive funding from academic research grants, patient support groups, pharmaceutical industry, and governmental Innovation agencies.Finally the formation of a new “pharma-diagnostics” sectoral innovation system as a result of the emerging paradigm of stratified medicine has been proposed.

Samsjuklighet i form utav psykisk ohälsa och substansbrukssyndrom är ett nationellt omfattandefolkhälsoproblem. Personer som lever med samsjuklighet söker sig ofta till vården vilket ställerkrav på den vård som erbjuds inom psykiatrisk vård. Patienten som lever med samsjuklighetanses ofta som komplexa och vårdkrävande i kontakt med sjukvården. Vårdpersonalensbemötande i kontakt med den patientgrupp kan uppfattas på olika sätt av patienter.Vårdpersonalens bemötande kan upplevas som värdefull respektive dålig erfarenhet beroende påhur patienter upplever det och vad det tillfört i deras lidande. Syftet: var att beskriva patientensupplevelse av psykiatrisk vård vid samsjuklighet i form av psykiatrisk ohälsa ochsubstansbrukssyndrom. Metod: Studien utfördes som en litteraturstudie med en metod förinnehållsanalys. Sexton vetenskapliga artiklar analyserades. Resultat: Analysen resulterade ifyra kategorier: Att mötas av okunskap och brist på förståelse, Att bli bemött utifrån enhelhetssyn, Att acceptera att man behöver hjälp och ha viljan att kämpa för att ett bättre liv, Attuppleva brist i uppföljnings och behandling. Resultatet visade att patienter upplevde brist avkunskap och kompetens hos vårdpersonalen som ska bidra till att minska / hindra uppkomst avfördomar, stigma i möte med vårdpersonal. Patientgruppen upplevde att en bemötande som ettpräglas av en helhetssyn från vårdpersonal är nyckeln till god vård som främjar derasåterhämtning. Patienter upplevde att egen acceptans och insikt på att de är i behov av hjälp var ien viktig del i behandlingen och brist på kontinuerlig uppföljning och deras behandling var en avde faktorer som försämrade och försvårade återhämtningsprocessen och beslut att sluta medsubstansbruk. Diskussion: Diskussion: Bemötande som speglar av helhetssyn, kontinuerliguppföljning under behandling, kunskap samt kompetensutveckling bör prioriteras inom denpsykiatrisk vården för att förbättra patientens upplevelse av vården som erbjöds.

Bakgrund: Diabetes mellitus typ 2 (DMT2) är ett globalt växande kronisk sjukdom. Cirka 500 000 personer i Sverige lider av diabetes, varav 90 procent har diabetes typ 2. Förekomsten av DMT2 ökar bland personer som har immigrerat till Sverige, vilket bedöms orsakas av en kombination av genetiska faktorer, livsstilsfaktorer och socioekonomiska omständigheter. För att effektivt hantera sjukdomen är det avgörande med noggrann egenvård, som inkluderar regelbunden självkontroll av blodsockernivåer, anpassad kost och fysisk aktivitet. Syfte: Syftet var att beskriva erfarenheter av egenvård hos immigrerade patienter som har diabetes typ 2. Metod: Kvalitativ litteraturöversikt baserad på 13 utvalda vetenskapliga artiklar som publicerades mellan 2003–2023. Litteratur söktes i databaserna CINAHL och Medline.  Artiklarna analyserades enligt Fribergs femstegsmodell. Resultat: En rad olika faktorer påverkade patienternas upplevelse av egenvård. Bristande kommunikation och språkfärdigheter samt otillräcklig kunskap om diabetes utgjorde stora utmaningar för patienterna när det gällde att förstå sin sjukdom. Patienterna hade olika uppfattningar om varför de drabbats av sjukdomen, ofta kopplade till kulturella och religiösa orsaker. Dessutom beskrivs frustration över vårdgivarnas bemötande och svårigheter för patienterna att bibehålla livsstilsförändringar. Slutsats: Patienternas uppfattning av DMT2 och egenvård spelar en avgörande roll. Det finns ett behov av ökad kunskap om kost, motion och medicinering för att möjliggöra kontinuerlig egenvård och förbättra hälsa. Socialt stöd underlättar acceptans av förändringar i livsstilen och främjar därmed egenvården. / Background: Diabetes mellitus type 2 (DMT2) is a globally growing chronic disease. Approximately 500 000 people in Sweden suffer from diabetes, of which 90 percent have DMT2. The prevalence of DMT2 is increasing among individuals who have immigrated to Sweden, which is assessed to be caused by a combination of genetic factors, lifestyle choices and social economic circumstances. To effectively manage DMT2, self-care is crucial, including regular monitoring of blood sugar levels, a tailored diet and physical activity. Aim: Describe self-care experiences among immigrant patients with diabetes type 2. Method: Qualitative literature review based on 13 selected articles published between 2003 and 2023. Literature was searched in the CINAHL and Medline databases. The articles were analysed using Friberg’s five-step model. Results: Several factors influenced a patient’s experience in managing their self-care. Lack of communication and language skills and insufficient knowledge about diabetes posed significant challenges for patients in understanding their illness. Patients held diverse perceptions regarding the causes for their diabetes, often linked to cultural and religious reasons. Furthermore, there was frustration regarding the healthcare providers’ attitudes and difficulties for patients in maintaining lifestyle changes. Conclusions: The patients’ perception of DMT2 and self-care plays a crucial role. There’s a need for increased knowledge about diet, exercise, and medication to enable continuous self-care and improve health. Social support facilitates the acceptance of lifestyle changes, thereby promoting self-care.

About 12 to 17 percent of all breast cancers are triple-negative breast cancer (TNBC). In TNBC, estrogen, progesterone, and human epidermal growth factor receptor two are not expressed, or copies of the HER2 gene are decreased (or both). This makes TNBC hard to treat in comparison with other kinds of breast cancers. New studies have made some interesting observations on how some monoclonal antibodies can help to treat TNBC. One of the monoclonal antibodies that can be useful for treating TNBC is pembrolizumab. Pembrolizumab inhibits programmed death ligand 1 (PD-1), which is located on the surface of T cells from connecting to immune checkpoint proteins such as programmed death ligand 1 (PD-L1) and programmed death ligand 2 (PD-L2) located on the surface of the cancer cell. Breaking this connection enables continued activation of T cells and attack of the cancer cells. This thesis aimed to evaluate if pembrolizumab was safe and effective as monotherapy or as a combination therapy with chemotherapy for patients with different stages of TNBC. This study was based on scientific articles identified from the database PubMed. Five randomized controlled trial studies were selected for further study in this project. Two publications were chosen from keynote-355, which studied the effect and safety of Pembrolizumab in combination with chemotherapy and compared it to chemotherapy monotherapy in patients with metastatic TNBC. The first study included patients from different countries as it was a multi-center study, and the second one focused only on patients who enrolled in Japan. One study was chosen from keynote-119 studies, which compared health-related quality of life for patients who were treated with pembrolizumab monotherapy or with monotherapy of chemotherapy. The last two articles which were chosen were about keynote-522. The first article about keynote-522 compared was a multicenter study enrolled in 21 countries. In this study, patients had early-stage TNBC and received neoadjuvant placebo chemotherapy or pembrolizumab chemotherapy. After the breast operation, either adjuvant pembrolizumab or placebo was received. The other study looked at Asian patients who enrolled in keynote-522. Results showed that monotherapy with pembrolizumab did not make a massive difference in overall survival compared to chemotherapy. Still, it led to better health- related quality of life for patients (Combined Positive Score (CPS) ≥ 10) treated with pembrolizumab. Results from keynote-355 showed that combination therapy with pembrolizumab and chemotherapy led to better and longer progression-free survival and overall survival in patients with CPS ≥ 10 treated with pembrolizumab. The analysis of Japanese patients showed even better progression-free survival and overall survival results than the global population. The study from keynote-522 showed that neoadjuvant pembrolizumab and chemotherapy followed by adjuvant pembrolizumab had a better effect than only neoadjuvant chemotherapy. The second keynote-522 study showed the same results as the global study and better results at event-free survival for the Asian population than the overall population. After reviewing the articles, it was found that pembrolizumab proves to be a safe and effective treatment for TNBC. To enhance understanding of the drug's effects, measures such as extending follow-up periods, conducting further studies to assess its effectiveness, and exploring new research methodologies are proposed.

Overweight and obesity are enormous problems, causing both reduced life expectancy as well as socioeconomic consequences. In 2016, almost 40 % of the global population was classified as obese. Obesity is a major risk factor to numerous serious health issues, including high blood pressure, stroke, diabetes and it is connected to an increased risk of certain types of cancer.    Semaglutide is a glucagon-like peptide-1 receptor agonist (GLP-1RA) approved by the European Union in 2022 for treatment of obesity and some types of overweight. Semaglutide supports the regulation of blood sugar, hunger and satiety, similar to the hormone glucagon-like peptid-1 (GLP-1).   This review examined research related to expected length of treatment for weight loss with semaglutide. Specifically, it considered whether it is an option to end treatment with semaglutide once the patient reached the target weight and improved health, or if continuous treatment with semaglutide is necessary to prevent weight regain.    The studies reviewed were connected to the clinical trials “Semaglutide Treatment Effect in People with obesity” (STEP), that studied change of weight. The basic design of these trials combined once weekly injections of Semaglutide 2.4 mg or placebo with 150 minutes weekly exercise, 500 calories reduction in daily intake and ongoing supportive counselling. The trial objective, length and population varied, still all trials resulted in about 15 % mean weight loss with semaglutide treatment compared to 2-6 % with placebo treatment.    Investigation in changes in weight and cardiometabolic endpoints up to one year after discontinued 68 weeks of treatment, found that only -5% weight loss from base line remained, even with on-going lifestyle changes. Neither intensive behavioural therapy and 8 weeks of initial low-carb diet nor a prolonged 104 weeks study showed additional weight loss.    A questionnaire regarding the control of food cravings, hunger and satiety found that the semaglutide group had in average less cravings for savoury food and an increased control of general food craving than placebo.    It is not possible, based on examined trials of subcutaneous semaglutide 2.4 mg, to conclude that ending treatment will result in a permanent stable weight loss, even with continued lifestyle changes and supportive follow ups. Additional research, especially on long-term treatment with semaglutide 2.4 mg, is needed to investigate results as weight loss, other improved parameters and reported side effects. Still the reported side effects have not raised any alarm and parameters connected to some of the serious risk factors that are increased when obese or over-weight were indicated as improved compared to placebo.    Despite the need for more research, the absence of severe adverse effects, above positive indications related to reduced risk factors, and the fact that nearly 70 % of participants in average lost at least -10 % of their weight at base line, and closer to 35 % lost at least 20 %, all support a positive view of semaglutide 2.4 mg as a potential lifelong treatment option. / Fetma är ett globalt hälsoproblem, med flera allvarliga följdsjukdomar som kan leda till både förkortad förväntad livslängd och socioekonomiska konsekvenser. Semaglutid är en glukagonliknande peptid-1 receptoragonist (GLP-1RA) som godkändes för behandling av fetma och viss övervikt av Europeiska unionen år 2022. Precis som kroppsegen glukagonliknande peptid-1 (GLP-1) stödjer semaglutid glukoshomeostas genom att både stimulera insulinproduktionen och hämma glukagonutsöndring. Semaglutid bidrar även till minskade hungerkänslor och ökad mättnadskänsla. Denna litteraturstudie har undersökt forskningsresultat gällande förväntad behandlingstid vid behandling av övervikt och fetma med veckovis subkutan semaglutid 2,4 mg; en kortare kur med semaglutid som följs av fortsatta livsstilsförändringar för att bibehålla önskad vikt, eller livslång farmakologisk behandling. Utvalda studier har varit kopplade till de randomiserade, dubbelblinda kliniska studierna ”Semaglutide Treatment Effect in People with obesity” (STEP) som undersökte procentuell viktnedgång och där livsstilsförändring i form av 150 min rörelse per vecka, 500 kalorier minskat dagligt kaloriintag samt uppföljningssamtal kombinerades med behandling med veckovis subkutan 2,4 mg semaglutid.  Samtliga studier, som undersökte förändring av vikt, gav trots skillnader i studiernas längd och andra parametrar likvärdiga effektkurvor som planade ut runt 15 % jämfört med omkring 2-6 % genomsnittlig viktreduktion för placebo. Efter 20 veckor sågs 10,6 % genomsnittlig viktnedgång, efter 68 veckor cirka 15 % och 104 veckors behandling med semaglutid gav inte ytterligare procentuell viktnedgång. Inte heller intensiv beteendeterapi eller inledande lågkalorikost bidrog till ökad viktnedgång. Däremot visade en av studierna en statistiskt signifikant förbättrad upplevd kontroll av begär efter mat och begär efter salta livsmedel för den grupp som behandlades med semaglutid.  Vid avbruten behandling återgick vikten till ungefär – 5% av ursprungsvikten efter 48-52 veckor utan semaglutid, oavsett om livsstilsförändringar bibehölls eller ej. Utifrån undersökta studier av subkutan semaglutid 2,4 mg går det inte att dra slutsatsen att en kortare behandlingskur åtföljs av en bestående viktminskning, inte ens i de fall där semaglutid ersätts med fortsatt icke-farmakologisk behandling i form av ökad rörelse, minskat kaloriintag samt kontinuerliga stödsamtal.  Fler långtidsstudier kring effekt och biverkan behövs, men rapporterad biverkan är framför allt lindrig och övergående, kardiometabola parametrar indikerar en förbättring jämfört med placebo men försämring vid avbruten behandling. Detta och en bibehållen viktnedgång där det för nästan 70 % leder det till minst 10 % viktminskning och närmare 35 % får minst 20 % bestående viktminskning är en anledning till att se positivt till möjlig livslång behandling med subkutan semaglutid 2.4 mg.

The increased incidence of diabetes mellitus has underscored the importance of effective management strategies, particularly in preventing complications such as diabetic foot ulcers (DFU). Chronic infections associated with DFU pose significant health risks, including lower limb amputations, highlighting the urgent need for non-invasive methods to assess skin microbiota changes. This study aimed to evaluate simple methods of sampling and quantifying skin bacteria, comparing techniques such as Gram staining, DAPI staining, fluorescence in situ hybridization (FISH), and polymerase chain reaction (PCR). Furthermore, the study investigated bacterial abundance variations across different sampling sites on the foot. Skin bacteria were sampled from healthy human volunteers using tape stripping (TPS) and swabbing. Gram-staining of the samples showed that most bacteria were found on the heel of the foot, and only Gram-positive bacteria were found on the skin of healthy study participants. However, Gram-staining showed artifacts in the form of bubbles under the microscope, which interfered with bacteria counting. PCR provided results indicating the presence of Staphylococcal species on the skin of healthy feet. DAPI staining showed images of bacteria like the ones stained with Gram staining. After using FISH-probe it was found that only a few bacteria hybridized with the probe and further optimization of the protocol is required. The study evaluated various techniques for sampling and quantifying skin bacteria and compared the number of bacteria present on the foot of healthy individuals, which may be used to identify infections before they develop into more serious conditions.