Yes / Recent clinical trials of the hypoglycaemic sodium-glucose co-transporter-2 (SGLT2) inhibitors, which inhibit renal glucose reabsorption, have reported beneficial cardiovascular outcomes. Whether SGLT2 inhibitors directly affect cardiovascular tissues, however, remains unclear. We have previously reported that the SGLT2 inhibitor canagliflozin activates AMP-activated protein kinase (AMPK) in immortalised cell lines and murine hepatocytes. As AMPK has anti-inflammatory actions in vascular cells, we examined whether SGLT2 inhibitors attenuated inflammatory signalling in cultured human endothelial cells. Incubation with clinically-relevant concentrations of canagliflozin, but not empagliflozin or dapagliflozin activated AMPK and inhibited IL-1β-stimulated adhesion of pro-monocytic U937 cells and secretion of IL-6 and monocyte chemoattractant protein-1 (MCP-1). Inhibition of MCP-1 secretion was attenuated by expression of dominant-negative AMPK and was mimicked by the direct AMPK activator, A769662. Stimulation of cells with either canagliflozin or A769662 had no effect on IL-1β-stimulated cell surface levels of adhesion molecules or nuclear factor-κB signalling. Despite these identical effects of canagliflozin and A769662, IL-1β-stimulated IL-6/MCP-1 mRNA was inhibited by canagliflozin, but not A769662, whereas IL-1β-stimulated c-jun N-terminal kinase phosphorylation was inhibited by A769662, but not canagliflozin. These data indicate that clinically-relevant canagliflozin concentrations directly inhibit endothelial pro-inflammatory chemokine/cytokine secretion by AMPK-dependent and -independent mechanisms without affecting early IL-1β signalling. / Project Grant (PG/13/82/30483 to IPS and TMP) and PhD studentships (FS/16/55/32731 and FS/14/61/31284 to DB and AS) from the British Heart Foundation and an equipment grant (BDA11/0004309 to IPS and TMP) from Diabetes UK. OJK was supported by a Scholarship from the Iraqi Ministry of Higher Education and Scientific Research. TAA was supported by a Libyan Ministry of Education PhD Studentship.

Introduktion: Intensivvårdsavdelningen är en högteknologisk miljö, vilket ställer höga krav på intensivvårdssjuksköterskan som vårdar kritiskt sjuka patienter. Intensivvårdspatienter är i behov av att transporteras inom sjukhuset. Dessa transporter är riskfyllda och ställer krav på intensivvårdssjuksköterskan. Syfte: Att beskriva intensivvårdssjuksköterskors upplevelser av patientsäkerheten vid intrahospitala transporter. Metod: Studien genomfördes som en integrativ litteraturstudie enligt Whittemore & Knafl (2005) med induktiv ansats. Totalt inkluderades tre kvalitativa studier, tre mixade metoder och tre kvantitativa studier samt en observationsstudie. Resultat: Baserades på 10 artiklar som berör intensivvårdssjuksköterskans upplevelser av patientsäkerheten vid intrahospitala transporter. Utifrån studiernas resultat identifierades faktorer som hotar och främjar patientsäkerheten under intrahospitala transporter som presenteras i de tre teman: Att samarbeta i teamet, Att arbeta förebyggande och Ökad arbetsbelastning. Konklusion: Forskningsområdet inom intensivvårdssjuksköterskors upplevelser av patientsäkerhet under intrahospitala transporter var begränsat. Intensivvårdssjuksköterskor upplevde att intrahospitala transporter var riskfyllda och krävande, där patientsäkerheten var hotad. Intrahospitala transporter kräver kompetens och förberedelser för att kunna utföra intrahospitala transporterna på ett patientsäkert sätt. Där fungerande utrustning, samarbete inom teamet, patientens kliniska status och vårdmiljö hade en betydande roll för att kunna utföra säkra intrahospitala transporter. / Introduction: The intensive care unit is a high-tech environment, which places high demands on the intensive care nurse who cares for critically ill patients. Intensive care patients need to be transported within the hospital. These transports are fraught with risk and place demands on the intensive care nurse. Aim: To describe intensive care nurses' experiences of patient safety during intrahospital transport. Method: The study was conducted as an integrative literature study according to Whittemore & Knafl (2005) with an inductive approach. In total, three qualitative studies, three mixed methods and three quantitative studies and one observational study were included. Results: Was based on 10 articles concerning the intensive care nurse's experiences of patient safety during intrahospital transport. Based on the results of the studies, factors that threaten and promote patient safety during intrahospital transport were identified, which are presented in the three themes: Working together in the team, Working preventively and Increased workload. Conclusion: The research area within intensive care nurses' experiences of patient safety during intrahospital transport was limited. Intensive care nurses felt that intrahospital transport was risky and demanding, where patient safety was threatened. Intrahospital transports require competence and preparation to be able to carry out the transports in a patient-safe way. Functioning equipment, collaboration within the team, the patient's clinical status and care environment played a significant role in being able to carry out safe transports.

Doctor of Philosophy / In healthy individuals, the autoimmune system is the body's natural defense against foreign materials and organisms. The main tools utilized for this defense mechanism are immune cells. However, in patients suffering from autoimmune diseases, the autoimmune system is overactive resulting in its attack on healthy cells, which leads to reduced or eliminated function of the targeted organs. To suppress these overreactive immune responses, pharmaceutical intervention is needed. An integral part of autoimmune response is the lipid sphingosine-1-phosphate (S1P). Interactions of S1P with its response-inducing receptors prompts the release of immune cells, lymphocytes in particular, from lymph tissue to migrate and participate in the invoked immune response. The pharmaceutical industry has produced five FDA approved drugs that disrupt this S1P-receptor interaction by blocking the receptor to reduce the autoimmune response in patients suffering from autoimmune diseases such as multiple sclerosis and ulcerative colitis. However, these treatments had adverse side effects on the cardiovascular system due to the presence of S1P receptors in the heart. Due to this, there is attraction to target a different node of the S1P signaling pathway to avoid these side effects while still suppressing the immune response. A node that is a viable target for therapeutic target that has recently become the focus of medicinal chemistry campaigns is the transporter protein spinster homolog 2 (Spns2). This protein is responsible for the transport of S1P from intracellular space to extracellular space to interact with its receptors and induce the immune response. Recently, our group has developed several effective inhibitors of Spns2. In this dissertation, several improvements of previously reported inhibitors are revealed. The pinnacle of this work is the development of 4.22v that is optimized to have drug-like properties for testing in mice. Administration of 4.22v to mice resulted in reduced circulating lymphocytes and without showing signs of toxicity following chronic dosing for 14 days. These results suggest that 4.22v is a potential drug candidate and is currently undergoing further biological evaluation.

No description available.

The main aim of the thesis was to measure antidepressant (AD) non-compliance, to determine which factors are closely associated with AD non-compliance and the consequences of prolonged AD non-compliance in the private health sector of South Africa. The empirical study followed an observational, prospective, cohort study using longitudinal medicine claims data provided by a nationally representative Pharmaceutical Benefit Management company (PBM) from 1 January 2006 to 31 December 2011. Failure to respond to AD treatment and achieving remission has severe neurobiological and clinical consequences. The clinical consequences include increased social and functional impairment, higher risk for recurrence and relapse of a depressive episode, a weak treatment outcome, significant increase in treatment cost, over-utilization of health care systems, and ultimately an increased suicide risk. However, the neurobiological consequences are much more far reaching. One of the more serious yet under-recognized neurobiological complications of AD non-compliance is the development of antidepressant discontinuation syndrome (ADS), which is the result of non-compliance or the abrupt discontinuation of AD treatment. Altered serotonergic dysfunction appears central to ADS so that how an antidepressant targets serotonin will determine its relative risk for inducing ADS and thereby affect later treatment outcome. Low ADS risk with agomelatine versus other antidepressants can be ascribed to its unique pharmacokinetic characteristics as well as its distinctive actions on serotonin, including melatonergic, monoaminergic and glutamatergic-nitrergic systems. After the first four months only 34% (n=12 397) of patients were compliant. What’s more a statistically significant association was found between active ingredient consumed and compliance (p < 0.0001). Only 26.2% of patients who received amitriptyline-containing products were complaint compared to 38.8% and 38.7% in the cases of venlafaxine and duloxetine, respectively. The current study found that females have a significantly higher prevalence of MDD and HIV/AIDS when compared to males. The co-morbidity between HIV/AIDS and major depressive disorder (MDD) had a significant effect on AD treatment compliance as patients diagnosed with both HIV/AIDS and MDD (74.43. ± 32.03, 95%Cl: 71.51-77.34) displayed a lower compliance vs. MDD patients (80.94% ± 29.44, 95%Cl: 80.56-81.33). Noteworthy, observations were that 75% (p < 0.0217; Cramer’s V = 0.0388) of venlafaxine and 28.6% (p < 0.0197; Cramer’s V = -0.0705) of the paroxetine items were compliant in patients diagnosed with both HIV/AIDS and MDD. The overall compliance (35.19% acceptable compliance; n = 42 869) of patients taking both ADs and GDs was weak. In the group receiving both AD and GDs, an increased AD treatment period was associated with a significant increase (p < 0.0001) in AD compliance (406.60 days; 95%Cl: 403.20 – 409.90 vs. 252.70 days; 95%Cl: 250.20 – 255.20). In this cohort amitriptyline (29.57%), mirtazapine (31.36%) and fluoxetine (32.29%) were associated with the lowest levels of compliance, while duloxetine (40.67%) was found to have the highest compliance. Lastly, ADs with highest non-compliance were associated with an increase use in GDs. Alprazolam (n = 10 201) and zolpidem (n = 9 312) were the most frequently dispensed GDs in combination with AD treatment. In conclusion the current study confirms that AD non-compliance is as big an obstacle in developing countries as it is in developed countries. Antidepressant treatment non-compliance has far reaching consequences especially with the development of ADS which further complicates MDD and might be a precursor for the development of TRD. Several factors were found to be closely associated with AD treatment non-compliance which include; pharmacological class of AD, gender, chronic co-morbid illnesses and a short treatment period. / PhD (Pharmacy Practice), North-West University, Potchefstroom Campus, 2015

The main aim of the thesis was to measure antidepressant (AD) non-compliance, to determine which factors are closely associated with AD non-compliance and the consequences of prolonged AD non-compliance in the private health sector of South Africa. The empirical study followed an observational, prospective, cohort study using longitudinal medicine claims data provided by a nationally representative Pharmaceutical Benefit Management company (PBM) from 1 January 2006 to 31 December 2011. Failure to respond to AD treatment and achieving remission has severe neurobiological and clinical consequences. The clinical consequences include increased social and functional impairment, higher risk for recurrence and relapse of a depressive episode, a weak treatment outcome, significant increase in treatment cost, over-utilization of health care systems, and ultimately an increased suicide risk. However, the neurobiological consequences are much more far reaching. One of the more serious yet under-recognized neurobiological complications of AD non-compliance is the development of antidepressant discontinuation syndrome (ADS), which is the result of non-compliance or the abrupt discontinuation of AD treatment. Altered serotonergic dysfunction appears central to ADS so that how an antidepressant targets serotonin will determine its relative risk for inducing ADS and thereby affect later treatment outcome. Low ADS risk with agomelatine versus other antidepressants can be ascribed to its unique pharmacokinetic characteristics as well as its distinctive actions on serotonin, including melatonergic, monoaminergic and glutamatergic-nitrergic systems. After the first four months only 34% (n=12 397) of patients were compliant. What’s more a statistically significant association was found between active ingredient consumed and compliance (p < 0.0001). Only 26.2% of patients who received amitriptyline-containing products were complaint compared to 38.8% and 38.7% in the cases of venlafaxine and duloxetine, respectively. The current study found that females have a significantly higher prevalence of MDD and HIV/AIDS when compared to males. The co-morbidity between HIV/AIDS and major depressive disorder (MDD) had a significant effect on AD treatment compliance as patients diagnosed with both HIV/AIDS and MDD (74.43. ± 32.03, 95%Cl: 71.51-77.34) displayed a lower compliance vs. MDD patients (80.94% ± 29.44, 95%Cl: 80.56-81.33). Noteworthy, observations were that 75% (p < 0.0217; Cramer’s V = 0.0388) of venlafaxine and 28.6% (p < 0.0197; Cramer’s V = -0.0705) of the paroxetine items were compliant in patients diagnosed with both HIV/AIDS and MDD. The overall compliance (35.19% acceptable compliance; n = 42 869) of patients taking both ADs and GDs was weak. In the group receiving both AD and GDs, an increased AD treatment period was associated with a significant increase (p < 0.0001) in AD compliance (406.60 days; 95%Cl: 403.20 – 409.90 vs. 252.70 days; 95%Cl: 250.20 – 255.20). In this cohort amitriptyline (29.57%), mirtazapine (31.36%) and fluoxetine (32.29%) were associated with the lowest levels of compliance, while duloxetine (40.67%) was found to have the highest compliance. Lastly, ADs with highest non-compliance were associated with an increase use in GDs. Alprazolam (n = 10 201) and zolpidem (n = 9 312) were the most frequently dispensed GDs in combination with AD treatment. In conclusion the current study confirms that AD non-compliance is as big an obstacle in developing countries as it is in developed countries. Antidepressant treatment non-compliance has far reaching consequences especially with the development of ADS which further complicates MDD and might be a precursor for the development of TRD. Several factors were found to be closely associated with AD treatment non-compliance which include; pharmacological class of AD, gender, chronic co-morbid illnesses and a short treatment period. / PhD (Pharmacy Practice), North-West University, Potchefstroom Campus, 2015

No description available.

Att arbeta som nyutbildad intensivvårdssjuksköterska kan upplevas som väldigt krävande. Det krävs både specificerad kunskap om olika komplexa sjukdomstillstånd och att intensivvårdssjuksköterskan ska kunna hantera den högteknologiska miljön som en intensivvårdsavdelning utgör. När patienter vårdas på intensivvårdsavdelning förekommer olika intrahospitala transporter under vårdtiden, vilket medför ökade risker för patienterna. Tidigare studier visar att det förekommer ett högre antal oväntade händelser och en större otrygghet bland intensivvårdssjuksköterskor med kort arbetserfarenhet av intensivvård i samband med intrahospitala transporter. Syftet med detta examensarbete var att beskriva behov hos intensivvårdssjuksköterskor med mindre än fem års arbetserfarenhet för att känna sig trygga i samband med intrahospitala transporter av kritiskt sjuka patienter. Nio intensivvårdssjuksköterskor med &lt;5 års arbetserfarenhet av intensivvård deltog i studien. Datainsamlingen genomfördes med semistrukturerade intervjuer, vilka sedan analyserades med en kvalitativ innehållsanalys. Analysen resulterade i tre kategorier: behov av att ha kompetent vårdpersonal med god samarbetsförmåga, behov av att ha en miljö som är anpassad för transporter och behov av att genomföra en omsorgsfull planering för att känna sig förberedd, vilka sedan resulterade i ett tema: behov av att känna kontroll över situationen med stöd från vårdteamet. Resultatet av denna studie visar vikten av att det implementeras en rutin vid intensivvårdsavdelningar för nyutbildade intensivvårdssjuksköterskor som tar anställning vid arbetsplatserna. Största vikten bör läggas på att intensivvårdssjuksköterskor ska omges av ett kompetent vårdteam med en tillåtande miljö, där det finns tid och möjlighet för god och individanpassad handledning.

Il est rapporté que la biodisponibilité orale de l’amoxicilline chez le porc est environ trois fois moindre que chez l’homme. Pour élucider les raisons de cette différence, la pharmacocinétique artérielle, veineuse porte et urinaire de cet antibiotique a été caractérisée à des doses intragastriques de 4 à 30 mg/kg et différents modèles compartimentaux physiologiques ont été conçus pour l’analyse des données. La biodisponibilité orale de l’amoxicilline est maximale à 4 mg/kg, avec une valeur moyenne de 52%. Les différences porto-systémiques de concentrations plasmatiques d’amoxicilline et la clairance urinaire ont permis de démontrer une augmentation de la clairance hépatique jusqu’à la dose de 30 mg/kg. Un modèle compartimental comprenant deux voies parallèles d’absorption (de type Michaelis- Menten d’accessibilité limitée dans le temps et d’ordre 1), deux compartiments de distribution (central et périphérique) deux voies d’élimination (excrétions urinaire et biliaire) est celui qui prédit le mieux les données observées. Ces résultats mettent en évidence le rôle prépondérant du transporteur saturable PepT1 dans l’absorption orale de l’amoxicilline administrée à faible dose, ainsi que l’importance croissante de l’absorption passive lors d’administration à forte dose. / It was reported that the oral bioavailability of amoxicillin in swine is about three times lower than in human beings. To elucidate the reasons for this difference, arterial, portal venous and urinary pharmacokinetics was documented at intragastric dose amounts ranging between 4 and 30 mg/kg, and several physiologic compartmental models were developed for data analysis. The maximum oral bioavailability of amoxicillin was recorded at 4mg/kg with a mean value of 52%. The portal-systemic plasma concentration differences of amoxicillin and its urinary clearance revealed an increase in hepatic clearance up to the 30 mg/kg dose. A compartmental model with two parallel absorption route (time-constrained Michaelis- Menten and first-order processes), two distribution compartments (central and peripheral) two elimination pathways (urinary and biliary excretions) best fitted the experimental data. These results highlight the paramount role of the PepT1 carriermediated, saturable absorption at low oral amoxicillin doses, as well as the increasing role of passive absorption at high doses.

Numerous natural products are widely used as first-line/alternative therapeutics and dietary supplements in both western and eastern society. However, the safety and efficacy profiles for herbal products are still limited. Organic anion transporters (OATs; SLC22 family) are expressed in many barrier organs and mediate in vivo body disposition of a broad array of endogenous substances and clinically important drugs. As some dietary flavonoids and phenolic acids were previously demonstrated to interact with OATs, it is necessary to explore the potential interaction of such components found in natural products in order to avoid potential OAT-mediated drug-drug interactions (DDIs). The inhibitory effects of 23 natural products were assessed on the function of human (h) OATs, hOAT1 (SLC22A6), hOAT3 (SLC22A7), and hOAT4 (SLC22A11) and/or the murine (m) orthologs mOat1 and mOat3. For compounds exhibiting marked inhibition at initial screening, dose-response curves (IC50 values) and DDI indices were determined. At the initial screening concentrations, 14, 19, and 2 test compounds exhibited significant inhibition on hOAT1, hOAT3, and hOAT4, respectively. Additionally, all test Danshen (a Chinese herbal medicine) hydrophilic components significantly reduced mOat1- and mOat3-mediated substrate uptake at 1 mM. For selected compounds, the IC50 and Ki values were estimated to be in the micromolar or even nanomolar range. Considering the clinical plasma concentration and unbound fraction in plasma, DDI indices for gallic acid, gentisic acid, lithospermic acid, protocatechuic acid, rosmarinic acid, salvianolic acid B, and tanshinol indicated DDIs may occur in vivo in situations of co-administration of these compounds and clinical therapeutics known to be OAT substrates. Finally, a new, rapid, and sensitive liquid chromatography-tandem mass spectrometry (LC-MS/MS) method was developed and validated to quantify gallic acid and gentisic acid in cell lysates in order to measure cellular uptake of these compounds in mOat1- or mOat3-expressing cells. Significant cellular uptake of gallic acid was observed in mOat1-expressing cells, compared with background control cells. The absorptive uptake was completely blocked by probenecid (known OAT inhibitor) at 1 mM. These results indicate that gallic acid is a substrate for mOat1 and suggest that human OAT1 might be involved in the active renal secretion of gallic acid.