Now showing items 1-20 of 100
Next Page| Abstract: | The GPCR CXCR4 is a chemokine receptor that by activation of its natural ligand SDF-1α is involved in the pathology of several diseases like cancer metastasis, leukemia cell progression and rheumatoid arthritis. The finding that CXCR4 plays a critical role for HIV-1 entry into T cells prompts additional motivation for the design of CXCR4 inhibitor. The establishment of the possible binding mode(s) for the cyclopentapeptide FC131 is decisive for the development of such inhibitor. Induced fit docking, which allowed flexibility for both the ligand and receptor structure, was used to generate ligand-receptor complexes. The resulting poses were compared based on their XP score and two ligand binding modes were suggested. In addition to this, mutational analysis on three CXCR4 residues which are believed to be important for HIV infection of T cells was performed. |
| URI: | http://hdl.handle.net/10037/2204 |
| Abstract: | Metridium senile, Halocynthia pyriformis and ParaParastichopus tremulus were subjected to organic and aqueous extraction. The aqueous extract was made with water, while the organic was made with dichloromethane and methanol in 1:1 ratio. The aqueous and organic extracts were fractionated on reversed-phase HPLC and tested for antiviral activity against Herpes simplex virus-1. All the three organisms displayed anti-viral activity in the primary screening, but when retested their activity were lost. During the work with the thesis Dendrodoa aggregata was included.Screening of D.aggregata had shown that deoxytubastrine had antiviral activity in pilot studies. Tubasterine has shown antiviral activity in earlier studies so it was decided to purify and test deoxytubastrine against HSV-1. Analysis on LC-MS ESI-TOF in positive mode indicated the active compound with m/z 178.0906 amu which gave us the elemental composition C9H11N30. The identity of deoxytubastrine was confirmed by LC-MS ESI-TOF in positive mode and 1H-NMR. However, pure deoxytubastrine did not show any pronounced anti-viral activity. |
| URI: | http://hdl.handle.net/10037/4390 |
| Abstract: | Calanus finmarchicus is a vast resource that until recently have been exploited to a minimal degree only. In the last few years harvesting and processing methods have been developed. There is a large market and great interest in products derived from marine oils. Most of the products today are derived from organisms at a high trophic level, i.e. products derived from cod liver oil. One disadvantage with these products is high levels of fat-soluble pollutants that require extensive purification before the products can be released to the market. As C. finmarchicus exists on the first trophic levels it is not polluted and is therefore very interesting as a substitution for cod liver oil, which is the main source for ω-3 fatty acids. In addition to this studies have shown that the oil extracted from the animal, Calanus oil, have beneficial properties and can reduce the risk for coronary heart disease, cancer and inflammation and this could be attributed to the contents of wax esters, high levels of a natural antioxidant, Astaxantine, and high levels of phytosterols. The aim of this thesis was to isolate and characterize the wax esters of the oil, and elucidate their structure. The wax esters were first separated from the Calanus oil with silica SPE and then transesterified to FAME and FAL. The two structures types were separated into two fractions with APS SPE. The FAME were analyzed as their picolinyl esters in GC-MS for structure elucidation and the FAL as their nicotinate esters and TMS ethers. The fractions from various SPE columns were tested by use of TLC and/or GC-MS to confirm that they contained the actual compounds. The FAME found were in a range of 14 to 22 carbon chain length, and there were saturated, monounsaturated and polyunsaturated FAME present. The PUFA were 18:4 (n-5, 7, 9, 11) and 22:5 (n-5, 7, 9, 11, 13). The FAL identified ranged from 16 to 22 carbon atoms in chain length, and were mostly monounsaturated, but one saturated compound was found. The next step would now be to analyze the wax esters in LC-MS to find the complete structure using the pieces of structure found in the FAME and FAL, as there are limited numbers of combinations of the FAME and FAL in a wax ester. |
| URI: | http://hdl.handle.net/10037/3526 |
| Abstract: | Background: Familial adenomatous polyposis (FAP) is a hereditary autosomal dominant condition characterized by the appearance of hundreds to thousands of adenomatous polyps throughout the colon and rectum. If the condition is left untreated it will ultimately develop into colorectal cancer. Most of the articles available today concerning FAP focus on the adenomatous polyposis coli gene as this gene appears to be the most frequent mutated gene in FAP patients. Recent studies suggest that certain modifier genes may play an important role in the development of colorectal cancer in the general population this may also be true for FAP. Aim of the study: The aim of this study was to examine 199 Australian APC mutation positive FAP patients with a molecular diagnosis of FAP for polymorphisms in five loci on chromosomes 10p14, 8q23.3, 8q24, 11q23, 18q21 and the gene ATP5a1. Methods: The genotypes were determined for each individual by finding the polymorphic combination for the candidate single nucleotide polymorphisms (SNPs). When a genotype was determined for a particular DNA sample, the nucleotide present at the polymorpic site was reported. The results were analysed using statistical programs. Results: The result of this study revealed that there is an increased risk of developing polyps if a patient harbours the heterozygote or variant genotype of the SNP rs10318 compared to patients with the wildtype genotype. This appears to be a protective effect against early polyp development in FAP individuals who harbours the variant genotype of SNP rs3802842 compared with those with a wildtype or heterozygote genotype. Patients harbouring the variant genotype of the SNP rs4779584 have an increased risk of developing polyps and CRC at an earlier stage than patients harbouring a wildtype or heterozygote genotype. Conclusion: In conclusions the findings from this study indicate that modifier genes have an effect on disease expression in FAP patients. These results warrant further investigation in larger FAP populations that harbour APC mutations to confirm the associations reported herein. |
| URI: | http://hdl.handle.net/10037/2205 |
| Abstract: | SAMMENDRAG CXCR4 er en kjemokinreseptor som er involvert i en rekke biologiske prosesser i kroppen, blant annet angiogenese, neurogenese og dannelse av blodceller i embryostadiet. I voksne er CXCR4 funnet å være involvert i sykdommer som HIV, reumatoid artritt og kreft. I litteraturen finnes det potente CXCR4 antagonister (AMD3100, KRH1636, FC131) som har vist effekt mot HIV-1, reumatoid artritt og kreft. Cyklopentapeptidet FC131 er av de mest potente og har vist høy anti-HIV-1 aktivitet. FC131 inneholder to aminosyrer (Arg3 og 2-Nal4) som er helt avgjørende for antagonistisk aktivitet. I denne oppgaven har det blitt syntetisert analoger av FC131, der 2-Nal4 har blitt byttet ut med andre aromatiske aminosyrer for å studere struktur-aktivitets-sammenhengen. Valg av nye aminosyrer har basert seg på egenskaper til den aromatiske naftylgruppen i KRH1636 og FC131. |
| URI: | http://hdl.handle.net/10037/2176 |
| Abstract: | Studies have shown that fatty acids from fish and fish oils, like eicosapentaenoic acid (EPA) and docosapentaenoic acid (DHA) may have a beneficial role in cancer by inhibiting proliferation or inducing apoptosis of the cancer cells. Several mechanisms involving different metabolites (eicosanoids) of the fatty acids have been suggested for the anti-cancer actions, but the detailed effects are still not known. One of the eicosanoid groups of the fatty acids are epoxy-EPAs. Little have been investigated about epoxy-EPAs’ effect on cancer cells. This experiment is based on previous studies from this laboratory that have shown an anti-proliferative effect of epoxy-EPA on murine endothelial cells (unpublished data). In this study the effect of 8,9-epoxy-EPA was tested on human breast cancer cell line MDA-MB-231. The epoxide was tested alone and in combination with an epoxide hydrolase inhibitor, N’N-dicycyclohexylurea (DCU). Different cell viability assays were assessed to investigate the effect of 8,9-epoxy-EPA on cancer cell proliferation. Cell cycle and immunoblotting were carried out to test if cell cycle regulatory proteins were affected. 8,9-epoxy-EPA was found to increase cell viability of MDA-MB-231. No change in cell cycle regulatory proteins was found. 8,9-epoxy-EPA was also tested on the MDA-MB-231 cells together with a well known anti-cancer drug, paclitaxel. Cell viability assay and cell cycle analysis were assessed. An increase in cell viability of cell treated with both 8,9-epoxy-EPA and paclitaxel compared to cell treated with paclitaxel alone was found. No effect of 8,9-epoxy-EPA on cell cycle was observed. Results from these experiments are not what we expected based on previous studies. Further studies on cell mechanism and apoptosis are required to investigate possible differences in cell response to epoxide n-3 fatty acids. |
| URI: | http://hdl.handle.net/10037/1572 |
| Abstract: | Hookworms are parasitic nematodes that reside in the intestines of their host, where they feed on host blood. The large number of infected individuals and the long survival time inside the host makes it interesting to study the immunomodulatory activities of the hookworms. The excretory/secretory (ES) products are suspected to be responsible for these effects. One aim of this project was to fractionate the low molecular weight part (< 10 kDa) of ES products from the dog hookworm Ancylostoma caninum and test their activity in a mouse colitis model that resembles human Crohn’s disease. The results were inconclusive, but trends could be seen and it seems that two fractions might show activity in the future if the tests are scaled up. The second aim was to use Fmoc-SPPS to synthesise two disulfide-rich peptides that were identified in the transcriptome of hookworms. These peptides possess the cysteine framework of the sea anemone toxin ShK, which is able to block voltage-gated potassium channels. One peptide, Name2, was synthesised successfully and as predicted folded into a ShK-like domain as confirmed by NMR spectroscopy. The three dimensional structure of the peptide was determined and it was revealed to contain two helical segments that were braced by the three disulfide bonds. Difficulties were encountered in the synthesis of Acan1 and the correct peptide was not obtained. |
| URI: | http://hdl.handle.net/10037/4321 |
| Abstract: | Introduction The Edinburgh IMPACT (Improved Anticipatory Care and Treatment) is aimed at people with long term conditions, and focuses on improving patients’ quality of life and reducing preventable hospital admissions. The service is nurse led, and recently primary care pharmacists have been added to the team to perform a medication review pilot. Patients would be referred to the pharmacist, who would go to their house and review their medicines. The aim for this project was to assess pharmaceutical care needs of patients with heart failure, design a clinical document for the use in the care of these patients, and to develop a questionnaire to evaluate the medication review service. Methods A model of pharmaceutical care was adapted from a previous project, and was modified in order to show the multidisciplinary care for patients with heart failure. A pharmaceutical care plan for heart failure was developed by using a pharmaceutical care plan from previous work done on diabetes. A patient questionnaire with closed-ended questions was designed in order to evaluate the existing anticipatory care service. The draft care plan was revised following feedback from pharmacists in NHS Lothian. The draft patient questionnaire was piloted in two patients that had been seen by the pharmacist. Results The output from the project was a tool kit for documentation of the anticipatory care service to heart failure patients. The toolkit comprises; a model of care for heart failure, a two page clinical document (patient profile and care plan) that can be used in the care of patients with heart failure, and a patient questionnaire that enables other to evaluate the anticipatory care service when it is up and running properly. Conclusion The researcher has developed a set of tools that after some redesign and modifications can be used to support the care of patients with heart failure, and to evaluate the medication review service. |
| URI: | http://hdl.handle.net/10037/2179 |
| Abstract: | Trauma to the skin in the form of severe wound, particularly burns, can facilitate colonization of potentially life threatening bacterial infections. To prevent infections of the wounded area, antimicrobial agents are recommended as standard treatment. Topical administration of antimicrobial agents, such as mupirocin, can provide local therapy, while avoiding the risks of systemic administration. Mupirocin-in-liposomes-in hydrogels were proposed as advanced delivery system for this purpose. Up to now, no liposomal mupirocin for topical administration has been reported. Chitosan was selected as hydrogel matrix due to its biodegradability and in-built antimicrobial and wound healing potentials. Phosphatidylcholine liposomes containing mupirocin, namely non-sonicated and sonicated liposomes, were characterized for vesicle size and size distributions. Non-sonicated vesicles entrapped in average 74 and sonicated 49 % of mupirocin calcium, respectively. Sonication reduced the original vesicle size from around 1 micron down to 135 nm. Liposomes (10 %, w/w) were incorporated in chitosan hydrogels and liposomal hydrogels evaluated for their textural properties. Hydrogels were found to exhibit satisfactory adhesiveness and cohesiveness, with corresponding stability profile. Microbiological assessment confirmed antibacterial properties of liposomally entrapped mupirocin incorporated in hydrogels. In vitro and ex vivo (on pig skin) drug release profiles of various formulations containing mupirocin were performed on Franz diffusion cells. Liposomal hydrogels were compared with marketed mupirocin product, Bactroban® cream. The release studies showed that liposomal size affects the release of the incorporated drug. Liposomal hydrogels were shown to provide sustained release of incorporated mupirocin. In conclusion, liposomal hydrogels developed for mupirocin offer the potential to increase retention time and provide sustained release of a drug, which are important parameters for improved treatment of wounds, including burns. |
| URI: | http://hdl.handle.net/10037/3689 |
| Abstract: | Background Hereditary non-polyposis colorectal cancer(HNPCC) is an autosomal dominantly inherited predisposition to a variety of epithelial malignancies most notable colorectal and endometrial cancer. Unlike other genetic predispositions to colorectal cancer HNPCC does not present with a premalignant phenotype, which as such makes it difficult to predict when or if an affected person will present with disease. The genetic basis of HNPCC has been conclusively shown to be due to mutations in genes involved in DNA mismatch repair; hMLH1, hMSH2 hMSH6 and PMS2. Methods Several reports suggest that genetic modifiers of disease risk are capable of influencing the age of disease onset in HNPCC and it is likely that many of them have not yet been identified. Recently several genome-wide association studies have revealed a number of colorectal cancer susceptibility loci on chromosomes 10p14, 8q23.3, 8q24, 11q23 and 18q21. These loci are of particular importance as they are associated with an increased risk of colorectal cancer and may therefore act as modifiers of disease risk in individuals diagnosed with HNPCC. Materials and methods 373 Australian and 311 Polish HNPCC patients with a molecular diagnosis of HNPCC have been examined for nine polymorphisms in the five loci described above. All DNA samples were genotyped to determine the allele frequency in the nine polymorphisms investigated. A statistically evaluation of the exact nature of the effect on disease risk was assessed using the statistical software package SPSS Graduate Pack Version 12.0. Results In this study, hMLH1 mutation carriers harbouring the variant genotype for polymorphism rs3802842 were associated to development of colorectal cancer (CRC) at an earlier age than hMLH1 carriers harbouring the heterozygous or wild type genotype. This suggests that the particular polymorphism might act as a modifier for disease development in hMLH1 mutation carriers. |
| URI: | http://hdl.handle.net/10037/2206 |
| Abstract: | Bakgrunn: Antibiotikaresistens er i dag blitt et signifikant problem på grunn av vårt misbruk – både overforbruk, underforbruk, feilbruk, manglende compliance, inadekvat dosering og ikke minst en likegyldighet til bruk. For alvorlige infeksjonssykdommer som sepsis kan dette gi dramatiske konsekvenser, da man er avhengig av effektive terapimidler da sykdommen er forbundet med høy morbiditet og mortalitet. Selv om Norge enda er et av de landene hvor resistensproblemet er minst så er det viktig at det tas på alvor, og at terapi følger gitte retningslinjer - blant annet ved sepsis hvor en initial bredspektret empirisk terapi raskest mulig bør endres til mer smalspektret terapi for å redusere risikoen for resistensutvikling. Formål: Formålet med denne studien var å undersøke om diagnostisk informasjon i form av mikrobiologisk bakterieidentifikasjon og resistensbestemmelse førte til endringer av bredspektret empirisk terapi ved bakteriemi. Karakterisering av endringer gjort og behandlingsregimer, og vurdere disse i forhold til gitte retningslinjer utarbeidet ved UNN i 2005 var også et mål med studien. Studien ble utført ved Avdeling for Mikrobiologi og Smittevern ved UNN, og sammenlignet med tilsvarende studie utført ved UNN i 2005 og ved St. Olavs Hospital i 2003. Metode: Studien er en deskriptiv observasjonsstudie basert på retrospektive data. Studiepopulasjonen var pasienter innlagt på UNN og med positive blodkulturer i 2006. Pasientjournaler og mikrobiologiske arbeidsskjemaer ble gjennomgått, og det ble registrert antibiotikabehandling og mikrobiologiske besvarelser for gitte registreringsperioder. Resultater: Av 276 episoder med reell bakteriemi ble det registrert endringer i terapiregimene i 34,1 % av besvarte episoder etter mikroskopifunn, 36,2 % etter preliminær resistensbestemmelse og 12,0 % etter definitiv resistensbestemmelse. Ved mistenkt bakteriemi var monoterapi med cefalosporiner eller kombinasjonsterapi med penicilliner og aminoglykosider mest fremtredende. Etter at mikrobiologiske data forelå bestod behandlingen av episoder med gram negative bakterier i hovedsak av monoterapi med cefalosporiner eller kombinasjonsterapi med enten penicilliner og aminoglykosider eller cefalosporiner og aminoglykosider. Behandlingen av episoder med gram positive bakterier bestod i hovedsak av monoterapi med penicilliner eller kombinasjonsterapi med penicilliner og aminoglykosider. Konklusjon: Resultatene tyder på at mikrobiologiske data hadde innvirkning på valg av antibiotikaregime ved bakteriemi. Det ble benyttet empirisk terapi anbefalt i antibiotikaveilederen i større grad ved UNN i 2006 enn ved UNN i 2002 og St. Olavs Hospital i 2002. Andelen monoterapi økte ved UNN fra 2002 til 2006. Resultatene av studien gir inntrykk av at terapien endret seg i henhold til bakterieidentifikasjon og resistensbestemmelse. |
| URI: | http://hdl.handle.net/10037/1583 |
| Abstract: | Iron homeostasis is regulated by the interaction between the hormone hepcidin and the iron exporter ferroportin. Hepcidin is a cysteine-rich peptide which is secreted by hepatocytes in response to inflammation, eryhropoietic demand and iron stores. Hepcidin binds to its receptor ferroportin, inducing its internalisation and degradation, thus regulating the export of iron from cells to plasma. One of the aims of this study was to determine the three-dimensional (3D) structure of hepcidin using nuclear magnetic resonance (NMR) spectroscopy. The structure calculated consisted of a β-sheet with a hairpin loop showing a flexible N-terminus. The overall aim of this study was to analyse the interaction between hepcidin and ferroportin. Recently, mutational analysis revealed that hepcidin binds to a 20 residue extracellular loop on ferroportin, called the hepcidin-binding domain (HBD). Techniques including NMR spectroscopy, isothermal titration calorimetry (ITC), circular dichroism (CD) spectroscopy and surface plasmon resonance (SPR) spectroscopy were used. The results from all the assays performed indicate, however, that hepcidin does not bind to the HBD peptide. Three hepcidin analogues was synthesised to elucidate which residues in hepcidin that are important for the binding to ferroportin. The N-terminus of hepcidin is essential for binding to hepcidin and serial deletion of the N-terminal amino acids showed to cause progressive loss of activity when all five residues were deleted. Gly 20 was shown to have a key role in the interaction between hepcidin and ferroportin. This is the first mutation outside the N-terminus region that has activity. |
| URI: | http://hdl.handle.net/10037/2178 |
| Abstract: | Background Pharmaceutical care as a health care service has already made its mark and been shown to make an important contribution to the health care system. However, there is still a demand from the NHS among others, that pharmacist to a greater extent must document their provision of pharmaceutical care. Tested out in this project, is the application of a Care Issue Categorisation System. Aims To compare two clinical settings in terms of the profile of pharmaceutical care delivered and the profile of medication use. The findings will be reported in a way which allows quantitative comparison of pharmaceutical care issues addressed by the clinical pharmacy service in a proposed reporting, and a modified categorisation system will be use to accomplish this. Method A literature review were performed on pharmaceutical care, medicines management, common chronic diseases etc. Process maps were produced to describe the delivery of pharmaceutical care at the General Medical Ward at Glasgow Royal Infirmary. An existing categorisation system was modified and a guideline developed and both used for the analysis of documentation made by the pharmacists. Inter rater agreement on the categorisation system was tested and pharmaceutical activity was compared between two wards. Result The existing categorisation system was modified in several parts and tested by four investigators. Process maps and analysis of the care issues documented reveal that there was a inconsistency between the pharmacist’s provision of care and documentation. The comparison between two wards showed that the pharmacists had different priorities and documentation. Conclusion The modified categorisation system is tool that has the potential to aid future documentation of pharmaceutical provision of patient care. Comparison of pharmaceutical care activity between two ward showed that pharmacists are contribution to pharmaceutical care but that there are differences in their priorities and documentation of care issues |
| URI: | http://hdl.handle.net/10037/1573 |
| Abstract: | ABSTRACT Epidemiologic studies have indicated that n-3 polyunsaturated fatty acids (PUFAs) supplementation may reduce the incidence of breast cancer, also in vivo and in vitro studies have shown that n-3 PUFAs have an inhibitory effect on breast cancer cells. One important n-3 PUFA are eiocosapentaenoic acid (EPA), which are metabolized to five regioisomeric epoxyeicosatetraenoic acids (epoxy-EPAs) by the cytochromes P450 system. Further, these epoxides are metabolized by epoxide hydrolase (EH), which can be inhibited by N, N`-dicyclohexylurea (DCU), an epoxide hydrolase inhibitor (EHI). The effect of these five epoxy-EPAs and the combination of epoxy-EPAs and EHI on breast cancer cells is not known. In this study the effect of 8, 9-epoxy-EPA on the human estrogen responsive breast cancer cell line MCF-7 was tested. MCF-7 cells were treated with 8, 9-epoxy-EPA, DCU and a combination of 8, 9-epoxy-EPA + DCU. Both the treatment with 8, 9-epoxy-EPA and the combination of 8, 9-epoxy-EPA + DCU inhibited the growth of MCF-7 cells in the presence of FBS. Treatment with 8, 9-epoxy-EPA in the absence of FBS did not result in a change in cell viability, which indicates that the growth inhibition on MCF-7 cells by 8, 9-epoxy-EPA requires an additional proliferative stimulus. To examine the effects of 8, 9-epoxy-EPA on MCF-7 cell growth flow cytometry was used to monitor cell cycle progression. Cells treated with 8, 9-epoxy-EPA and the combination of 8, 9-epoxy-EPA + DCU for 16 and 24 hours were found to be arrested in G0/G1-phase, and did not progress through the cell cycle at the same rate as control cells. 8, 9-epoxy-EPA treatment for 24 hours also resulted in a corresponding decrease in G2/M-phase. The adding of DCU did not enhance the effect of the 8, 9-epoxy-EPA treatment on cell cycle progression significantly. Treatment in the absence of FBS showed no alteration in the progression of the cell cycle. The growth inhibition effect on MCF-7 cells of 8, 9-epoxy-EPA was further studied by examining changes in expression of different cell cycle regulatory proteins. The protein levels were found to be unaltered after 8, 9-epoxy-EPA treatment. The growth inhibition effect may be due to increased cell apoptosis as an alternative to decreased proliferation in MCF-7 cells. This possibility should be evaluated in further studies. |
| URI: | http://hdl.handle.net/10037/1574 |
| Abstract: | In the last decade, the investigation of marine natural products has resulted in a remarkable number of compounds with promising biological activities. Marine natural products have been shown to display antibacterial, antifungal, anticancer, antiviral, antiparasitic, anti-inflammatory activity and several other pharmacological activities of benefit to humankind. In this project, an investigation of the anti-inflammatory and immunostimulatory activities of extracts from two Arctic marine invertebrate species; a bryozoan, Eucratea loricata, and a sea urchin, Echinus esculentus, is presented. Anti-inflammatory activity was analyzed by using the monocyte/macrophage cell lines: THP-1 (accurate monocytic leukemia) and U937 (leukemic monocyte lymphoma). Immunostimulatory activity was analyzed by using THP-1 cell line. Effects on cell culture were monitored as reduced NFκB reporter activity in transfected cell line, and as reduced or increased production of the cytokines TNF-α and IL-1β. Bioassay-guided fractionation of the extracts revealed the presence of anti-inflammatory activity in the Echinus esculentus extracts. The structure of the target compound was partly elucidated using high resolution mass spectrometry, mass spectrometric fragmentation, and nuclear magnetic resonance spectroscopy. In addition, this present project provides background information about natural product research and current anti-inflammatory investigations of marine invertebrate species. |
| URI: | http://hdl.handle.net/10037/4323 |
| Abstract: | Abstract Background– All solid organ transplanted patients are treated with immuno suppression medications to keep the immune system from rejecting the transplanted organ. Unfortunately the suppressed immune system makes the body more exposed for cancer and opportunistic infections. Among the most important viruses that causes one of these opportunistic infections is cytomegalovirus (CMV). A local project showed that not all transplanted patients on CMV prophylaxis get the right dose according to creatinine clearance (CrCl), and that the patients who had not been prescribed the recommended dose according to CrCl had a higher incident of CMV disease than those adjusted as recommended. The Quality improvement team for the transplant unit therefore suggested that a project could further investigate these issues. Aim and objectives – The aim of this project was to critically review and evaluate the processes in the prescribing and administration of valganciclovir for cytomegalovirus prophylaxis in liver, kidney or pancreas transplantation. Methods – Semi-structured one-to-one interviews with 2 nurses and 6 prescribers were conducted to establish current practice in prescribing, administration and monitoring of valganciclovir. A review of the local protocols at the transplant unit was conducted. To assess the harm a database analysis on the incident reporting system and a retrospective review of clinical records of 4 patients was undertaken. A questionnaire was developed for staff to self-assess the risk of harm of the whole process of CMV prophylaxis treatment. Pharmaceutical care issues relevant to CMV prophylaxis were recorded prospectively by clinical pharmacists over a two month period. Results – The semi-structured interviews with prescribers indicated that: 1) Prescribers often fail to recognise that the valganciclovir dose should be adjusted with changing CrCl. 2) That the laboratory test results taken at the clinic do not come back until the evening and are therefore not available at the time of prescribing, 3) There are gaps of knowledge, especially in the junior doctors. Reviews of local protocols suggested a need for update of the protocols and inclusion of detailed dosing guidance. The one incident reported in the database in terms of valganciclovir involved a missed dose. Case note reviews of four patients identified that dose adjustments are appropriate in 2 cases, 1 case was borderline and the other was a complex case but was judged to be appropriate. The questionnaire identified that there was agreement among healthcare professionals that there is a risk of errors that might lead to harm associated with all stages of valganciclovir use. Two clinical pharmacists recommended adjustment of valganciclovir 12 times in 7 patients in a time period of approximately two months. Conclusion – the outcomes from the interviews and pharmaceutical care issues analysis confirm the previous observation that the dose of valganciclovir is not always adjusted according to CrCl. Recommendations for improvement are to ensure modified guidelines are implemented to ensure all prescribers are aware of need for dose adjustment. Further work can be undertaken to measure the benefit after implement of the recommendations to assess improvement. |
| URI: | http://hdl.handle.net/10037/3420 |
| Abstract: | The relaxin family of peptides consists of seven structurally related peptides, with a wide variety of biological functions, ranging from involvement in reproductive processes to functions as neuroendocrine modulators. Because of the complex, two-chained structure of the relaxins, and their lack of specificity for the various relaxin family receptors (RXFPs), design of simpler, more selective analogues is important for further investigation of their biological functions and as potential drug leads. The aim of this project was to introduce a helical structure around the receptor-binding region of single-chain relaxin analogues. This was approached by utilising helix capping sequences on truncated relaxin B-chains and by grafting of residues important for binding onto a stable peptide scaffold. Helix capping enhanced the helical properties compared to previous single- chain analogues, but was unable to introduce a sufficiently stable helix. Despite the increased helical tendencies, no high-affinity analogues were found. As a result, the importance of Arg8 was investigated, and we have demonstrated that this residue might be more involved in binding than previously thought. We successfully synthesised a relaxin-3/chlorotoxin analogue, which appeared to fold correctly. However, the yield following oxidation was poor, and no bioactivity data or structural data confirming the correct fold was obtained within the time limits of the project. A secondary aim was to probe for favourable mutations around the receptor- binding region by synthesising a combinational library. We were able to successfully synthesise a library of peptides with mutations in one position by inserting a mixture of amino acids at this coupling step in the solid phase peptide synthesis (SPPS) procedure. Although no significant improvement in binding was seen for the analogues generated, important methodological advances were made that will be used to scan different positions for new contact points with the receptor. |
| URI: | http://hdl.handle.net/10037/3428 |
| Abstract: | Hydrogels made of chitosan has a well-established place in drug delivery for the skin. Our particular interest were hydrogels for wound healing. Hydrogels from low, medium and high molecular weight were prepared in different concentrations for texture and release characterization incorporating liposomes and chloramphenicol as a model drug. A method for comparing viscosity between gels was established with a Texture analyser and back-extrusion method. The method proved to be able to distinguish differences between gels with standard deviations varying with less than 2%. Different liposomal chitosan hydrogels were prepared with or release studies with the model drug chloramphenicol. The release study proved that liposomal hydrogels could act as vehicles for antibiotics in depot formulations. Chitosan preparations were also tested under both accelerated stability testing and freeze-thaw test. Stability was improved with glycerine in the hydrogels. Stability seemed to be dependant on molecular weight and concentration of chitosan. The low molecular weight chitosan gels were the least stable, and higher concentrations can give more stable gels. |
| URI: | http://hdl.handle.net/10037/2750 |
| Abstract: | Innledning: Apotekloven slår fast at legemidler skal utleveres nøyaktig etter resept og rekvisisjon. Studier viser imidlertid at feil og mangler forekommer ved 2,0 % av reseptene som blir levert inn ved vanlige apotek i Norge, og forskrivningsavvik forekommer ved 8,5 % av ordinasjonene på resepter utskrevet av leger ved Haukeland Universitetssykehus. Forskrivningsavvik kan medføre fare for klinisk signifikante effekter på pasientens legemiddelbehandling og uønskede legemiddelhendelser. Hensikten med studien var å undersøke hvor stor andel av forskrivningsavvikene som hadde en klinisk relevans for pasientens legemiddelbehandling, og hvor alvorlig den kliniske relevansen var. Metode: Det ble i en studie fra 2007 registrert 867 forskrivningsavvik ved Haukeland Sykehusapotek, Vitusapotek Nordstjernen Bergen og Tønsberg Sykehusapotek. Et ekspertpanel med åtte deltakere, hvorav fire farmasøyter og fire leger, klassifiserte 119 potensielt klinisk relevante avvik i henhold til en modifisert versjon av Safety Assessment Code (SAC)-score med fire kategorier av klinisk relevans. Klassifiseringen ble gjennomført individuelt. Inter-rater reliabilitet ble vurdert i forhold til grad av enighet beregnet ved kappa-statistikk. Resultater: Ekspertpanelet viste svært lav enighet, κ=0,115-0,093, noe som henspeiler lav inter-rater reliabilitet. Dette må tas hensyn til ved tolkning av resultatene. Det er tendenser til at ekspertpanelet vurderte interaksjoner og avvik i forbindelse med dosering, samt legemidler i ATC-gruppe N 02 Analgetika, som mest klinisk relevant. Forskrivningsavvik men klinisk relevans forekom ved 1,29 % av resepter skrevet ut av sykehusleger, og ved 0,33 % av resepter skrevet ut av leger utenfor sykehus. Konklusjon: Klinisk relevante forskrivningsavvik forekommer hyppgere ved resepter skrevet ut av sykehusleger enn resepter utskrevet av leger utenfor sykehus. Metoden som ble benyttet for klassifisering av klinisk relevans av forskrivningsavvik hadde ikke tilfredsstillende reliabilitet og validitet. |
| URI: | http://hdl.handle.net/10037/1575 |
| Abstract: | Verdens helseorganisasjon (WHO) anbefaler primærforebyggende behandling med acetylsalisylsyre (ASA) hos pasienter med forhøyet risiko for utvikling av hjerte- og karsykdom. Per i dag ytes det ikke generell refusjon til forebyggende behandling med lavdosert ASA. Det var behov for å kartlegge hvorvidt primærforebygging av kardiovaskulære sykdommer med ASA viste seg å være en god utnyttelse av samfunnets begrensede ressurser. Hensikten med oppgaven var å belyse hvorvidt Albyl-E® oppfylte de faglige kriteriene for refusjon ved primærforebygging av hjerte- og karsykdommer. For å belyse det fjerde faglige kriteriet i Legemiddelforskriftens § 14-13, ble det utført tre legemiddeløkonomiske analyser. Den overordnede konklusjonen fra denne oppgaven er at ASA er et refusjonsverdig behandlingsalternativ for primærforebyggende behandling av pasienter med forhøyet risiko for hjerte- og karsykdommer. |
| URI: | http://hdl.handle.net/10037/2214 |
Now showing items 1-20 of 100
Next Page
Munin is powered by DSpace 1.8.2
The University Library of Tromsø, N-9037 Tromsø
Tel: +47 77 64 40 00, E-mail: munin@ub.uit.no