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  • 1.
    Abdelaal, Abdelrahman
    et al.
    Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    El Ansari, Walid
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar / College of Medicine, Qatar University, Doha, Qatar.
    Abusabeib, Abdelrahman
    Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    Farghaly, Hanan
    Department of Lab Medicine & Pathology, Hamad General Hospital, Doha, Qatar.
    Tabeb, Abdelhakem A. M.
    Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    Simultaneous occurrence of follicular and papillary thyroid carcinomas in same thyroid lobe: A case series of six patients from Qatar2020In: International Journal of Surgery Case Reports, E-ISSN 2210-2612, Vol. 73, p. 65-70Article in journal (Refereed)
    Abstract [en]

    Background: Papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC) are the first and second most common thyroid cancers comprising about 85% and 10% of all thyroid cancers. Simultaneous occurrence of medullary and papillary thyroid cancer has been reported with various presentations, but simultaneous occurrence of FTC in addition to PTC as differentiated cancers, is an unusual event that is rarely reported. Presentation of cases: We report our experience of six rare cases of synchronous coexistence of FTC and PTC with unique features. Case 1 is 31 old Egyptian female. Case 2 is a 61 year old Sudanese male. Case 3 is a 59 year old Sudanese male. Case 4 is a 56 years old Indian female. Case 5 is a 35 years old Filipina female. Case 6 is a 52 years old Qatari female. The six cases are special in their co-occurrence of two thyroid carcinoma, consisting of histologic features of follicular thyroid carcinomas, and classical papillary thyroid carcinoma, possibly the first case series of simultaneous occurrence of these two types of thyroid cancer in the Middle East and North Africa Region. Conclusions: We present rare cases of concurrent FTC and PTC. These six cases add more data highlighting the coincidental simultaneous coexistence of FTC and PTC. Endocrinologists and pathologists should be aware of and vigilant to this variety. © 2020 The Author(s)

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  • 2.
    Abdul-Hussein, Saba
    et al.
    Department of Pathology, University of Gothenburg, Gothenburg, Sweden.
    Rahl, Karin
    Department of Pathology, University of Gothenburg, Gothenburg, Sweden.
    Moslemi, Ali-Reza
    Department of Pathology, University of Gothenburg, Gothenburg, Sweden.
    Tajsharghi, Homa
    Department of Pathology, University of Gothenburg, Gothenburg, Sweden / Department of Clinical and Medical Genetics, University of Gothenburg, Gothenburg, Sweden.
    Phenotypes of myopathy-related beta-tropomyosin mutants in human and mouse tissue cultures2013In: PLOS ONE, E-ISSN 1932-6203, Vol. 8, no 9, article id e72396Article in journal (Refereed)
    Abstract [en]

    Mutations in TPM2 result in a variety of myopathies characterised by variable clinical and morphological features. We used human and mouse cultured cells to study the effects of β-TM mutants. The mutants induced a range of phenotypes in human myoblasts, which generally changed upon differentiation to myotubes. Human myotubes transfected with the E41K-β-TM(EGFP) mutant showed perinuclear aggregates. The G53ins-β-TM(EGFP) mutant tended to accumulate in myoblasts but was incorporated into filamentous structures of myotubes. The K49del-β-TM(EGFP) and E122K-β-TM(EGFP) mutants induced the formation of rod-like structures in human cells. The N202K-β-TM(EGFP) mutant failed to integrate into thin filaments and formed accumulations in myotubes. The accumulation of mutant β-TM(EGFP) in the perinuclear and peripheral areas of the cells was the striking feature in C2C12. We demonstrated that human tissue culture is a suitable system for studying the early stages of altered myofibrilogenesis and morphological changes linked to myopathy-related β-TM mutants. In addition, the histopathological phenotype associated with expression of the various mutant proteins depends on the cell type and varies with the maturation of the muscle cell. Further, the phenotype is a combinatorial effect of the specific amino acid change and the temporal expression of the mutant protein.

  • 3.
    Abdul-Hussein, Saba
    et al.
    Department of Pathology, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
    van der Ven, Peter F. M.
    Department of Molecular Cell Biology, Institute for Cell Biology, University of Bonn, Bonn, Germany.
    Tajsharghi, Homa
    Department of Pathology, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden / Department of Clinical and Medical Genetics, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Expression profiles of muscle disease-associated genes and their isoforms during differentiation of cultured human skeletal muscle cells2012In: BMC Musculoskeletal Disorders, E-ISSN 1471-2474, Vol. 13, article id 262Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The formation of contractile myofibrils requires the stepwise onset of expression of muscle specific proteins. It is likely that elucidation of the expression patterns of muscle-specific sarcomeric proteins is important to understand muscle disorders originating from defects in contractile sarcomeric proteins.

    METHODS: We investigated the expression profile of a panel of sarcomeric components with a focus on proteins associated with a group of congenital disorders. The analyses were performed in cultured human skeletal muscle cells during myoblast proliferation and myotube development.

    RESULTS: Our culture technique resulted in the development of striated myotubes and the expression of adult isoforms of the sarcomeric proteins, such as fast TnI, fast TnT, adult fast and slow MyHC isoforms and predominantly skeletal muscle rather than cardiac actin. Many proteins involved in muscle diseases, such as beta tropomyosin, slow TnI, slow MyBPC and cardiac TnI were readily detected in the initial stages of muscle cell differentiation, suggesting the possibility of an early role for these proteins as constituent of the developing contractile apparatus during myofibrillogenesis. This suggests that in disease conditions the mechanisms of pathogenesis for each of the mutated sarcomeric proteins might be reflected by altered expression patterns, and disturbed assembly of cytoskeletal, myofibrillar structures and muscle development.

    CONCLUSIONS: In conclusion, we here confirm that cell cultures of human skeletal muscle are an appropriate tool to study developmental stages of myofibrillogenesis. The expression of several disease-associated proteins indicates that they might be a useful model system for studying the pathogenesis of muscle diseases caused by defects in specific sarcomeric constituents.

  • 4.
    Abdulrazzaq, Sama
    et al.
    Department of Bariatric Surgery/Bariatric Medicine, Hamad General Hospital, Doha, Qatar.
    Elhag, Wahiba
    Department of Bariatric Surgery/Bariatric Medicine, Hamad General Hospital, Doha, Qatar.
    El Ansari, Walid
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad General Hospital, Doha, Qatar / College of Medicine, Qatar University, Doha, Qatar.
    Mohammad, Amjad Salah
    Departments of General Surgery, Hamad General Hospital, Doha, Qatar.
    Sargsyan, Davit
    Department of Metabolic and Bariatric Surgery, Hamad General Hospital, Doha, Qatar / Weill Cornell Medicine-Qatar, Doha, Qatar.
    Bashah, Moataz
    Department of Metabolic and Bariatric Surgery, Hamad General Hospital, Doha, Qatar / Weill Cornell Medicine-Qatar, Doha, Qatar.
    Is Revisional Gastric Bypass as Effective as Primary Gastric Bypass for Weight Loss and Improvement of Comorbidities?2020In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 30, p. 1219-1229Article in journal (Refereed)
    Abstract [en]

    Background: Revisional gastric bypass (R-RYGB) surgery is utilized for the management of inadequate weight loss or weight regain observed after some cases of bariatric surgeries. Data on the mid-term effectiveness of primary gastric bypass (P-RYGB) compared to R-RYGB (e.g., post sleeve gastrectomy or gastric banding) are controversial. Methods: Retrospective chart review of all patients who received P-RYGB and R-RYGB (January 2011 - June 2015) at our center. One hundred and twenty patients who underwent P-RYGB and 34 R-RYGB who completed 18 months follow-up were included. We compared the effectiveness of P-RYGB with R-RYGB by assessing four anthropometric, two glycemic, and four lipid parameters, as well as the control of type 2 diabetes (T2DM), hypertension and dyslipidemia in terms of remission, improvement, persistence, relapse and de novo. The current study also assessed mortality and complications rates. Results: There were no significant differences in the baseline characteristics of patients who received P-RYGB with those who received R-RYGB in terms of age, gender and preoperative BMI. However, at 18 months: a) Patients who received P-RYGB had lower mean weight (P = 0.001) and BMI (P <0.001), reflected by a higher mean delta BMI (P = 0.02), TWL%(P <0.0001) and EWL%(P < 0.0001); b) No differences were observed between the two patients groups in terms of glycemic parameters, lipid profiles, and control of T2DM, hypertension, and dyslipidemia; and, c) No deaths were reported among both patients groups, and complication rates were comparable. Conclusion: Although R-RYGB effectively addressed inadequate weight loss, weight regain and recurrence of comorbidities after restrictive bariatric surgery, R-RYGB resulted in inferior weight loss compared to P-RYGB. There were no significant differences between the two procedures in terms of their clinical control of T2DM, hypertension and dyslipidemia. Both procedures exhibited comparable complication rates. 

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  • 5.
    Abulafia, Carolina
    et al.
    FLENI Foundation Department of Psychiatry, Buenos Aires, Argentina / Applied Neuroscience Laboratory, Institute for Biomedical Research, School of Medical Sciences, Universidad Católica Argentina, Buenos Aires, Argentina / Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina.
    Duarte-Abritta, Bárbara
    FLENI Foundation Department of Psychiatry, Buenos Aires, Argentina.
    Villarreal, Mirta F.
    FLENI Foundation Department of Psychiatry, Buenos Aires, Argentina / Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina.
    Ladrón-de-Guevara, Maria S.
    FLENI Foundation Department of Psychiatry, Buenos Aires, Argentina / Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina.
    Garcia, Celeste
    FLENI Foundation Department of Psychiatry, Buenos Aires, Argentina.
    Sequeyra, Geraldine
    FLENI Foundation Department of Psychiatry, Buenos Aires, Argentina.
    Sevlever, Gustavo
    FLENI Foundation Department of Psychiatry, Buenos Aires, Argentina.
    Fiorentini, Leticia
    FLENI Foundation Department of Psychiatry, Buenos Aires, Argentina.
    Bär, Karl-Jürgen
    Department of Psychiatry and Psychotherapy, Universitätsklinikum Jena, Friedrich-Schiller-Universität, Jena, Germany.
    Gustafson, Deborah R.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Neurology, State University of New York, Downstate Medical Center, Brooklyn, NY, USA / Neuropsychiatric Epidemiology Unit, University of Gothenburg, Gothenburg, Sweden.
    Vigo, Daniel E.
    Applied Neuroscience Laboratory, Institute for Biomedical Research, School of Medical Sciences, Universidad Católica Argentina, Buenos Aires, Argentina / Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina.
    Guinjoan, Salvador M.
    FLENI Foundation Department of Psychiatry, Buenos Aires, Argentina / Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina / FLENI Teaching Unit, Department of Psychiatry and Mental Health, University of Buenos Aires School of Medicine, Buenos Aires, Argentina / Department of Neurophysiology, University of Buenos Aires School of Psychology, Buenos Aires, Argentina.
    Relationship between Cognitive and Sleep-wake Variables in Asymptomatic Offspring of Patients with Late-onset Alzheimer's Disease2017In: Frontiers in Aging Neuroscience, ISSN 1663-4365, E-ISSN 1663-4365, Vol. 9, article id 93Article in journal (Refereed)
    Abstract [en]

    Early neuropathological changes characteristic of late-onset Alzheimer's disease (LOAD) involve brain stem and limbic structures that regulate neurovegetative functions, including sleep-wake rhythm. Indeed, sleep pattern is an emerging biomarker and a potential pathophysiological mechanism in LOAD. We hypothesized that cognitively asymptomatic, middle-aged offspring of patients with LOAD (O-LOAD) would display a series of circadian rhythm abnormalities prior to the onset of objective cognitive alterations. We tested 31 children of patients with LOAD (O-LOAD) and 19 healthy individuals without family history of Alzheimer's disease (control subjects, CS) with basic tests of cognitive function, as well as actigraphy measures of sleep-wake rhythm, cardiac autonomic function, and bodily temperature. Unexpectedly, O-LOAD displayed subtle but significant deficits in verbal episodic memory (Rey Auditory Verbal Learning Test delayed recall 10.6 +/- 0.4 vs. 8.6 +/- 0.6, t = 4.97, df = 49, p < 0.01) and language (Weschler's vocabulary 51.4 +/- 1.3 vs. 44.3 +/- 1.5, t = 2.49, df = 49, p < 0.001) compared to CS, even though all participants had results within the clinically normal range. O-LOAD showed a phase-delayed rhythm of body temperature (2.56 +/- 0.47 h vs. 3.8 +/- 0.26 h, t = 2.48, df = 40, p = 0.031). Cognitive performance in O-LOAD was associated with a series of cardiac autonomic sleep-wake variables; specifically indicators of greater sympathetic activity at night were related to poorer cognition. The present results suggest sleep pattern deserves further study as a potential neurobiological signature in LOAD, even in middle-aged, at risk individuals.

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  • 6.
    Abusabeib, Abdelrahman
    et al.
    Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    Bhat, Harun
    Weill Cornell Medicine in Qatar, Doha, Qatar.
    El Ansari, Walid
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar / College of Medicine, Qatar University, Doha, Qatar.
    Al Hassan, Mohamed S.
    Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    Abdelaal, Abdelrahman
    Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    Right ectopic paraesophageal parathyroid adenoma with refractory hypercalcemia in pregnancy: A case report and review of the literature2020In: International Journal of Surgery Case Reports, E-ISSN 2210-2612, Vol. 77, p. 229-234Article, review/survey (Refereed)
    Abstract [en]

    Introduction: Ectopic parathyroid adenoma is rare during pregnancy but poses multiple challenges in treatment. It presents as primary hyperparathyroidism which leads to symptoms and complications of hypercalcemia in both the mother and fetus. Presentation of case: A 38-year-old Sudanese female presented with diffuse bone pain and polyuria. Laboratory investigations revealed elevated serum calcium and parathyroid hormone. Ultrasound of the neck did not show any abnormal lesion, however 99mTc-sestamibi scan showed a right sided parathyroid adenoma, and an earlier CT scan showed the adenoma to be in an ectopic paraesophageal position. Focused surgical neck exploration was done, and the ectopic parathyroid adenoma was excised. Discussion: Preoperative localization of the ectopic parathyroid adenoma allows for a focused surgical procedure. Ultrasound is the safest during pregnancy, but 99mTc-sestamibi and CT scan may be necessary if ultrasound or initial bilateral neck exploration do not detect any adenoma. Mild elevations in maternal serum calcium can have detrimental effects on the fetus which suggests that a surgical approach may be necessary in the majority of cases. Conclusions: Ectopic parathyroid adenoma is rare during pregnancy and is detrimental to both the mother and fetus. Preoperative localization allows for a focused surgery which is a definitive treatment and can safely be performed during the 2nd trimester of pregnancy. 

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  • 7.
    Abusabeib, Abdelrahman
    et al.
    Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    El Ansari, Walid
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar ; College of Medicine, Qatar University, Doha, Qatar.
    Al Hassan, Mohamed S.
    Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    Petkar, Mahir
    Department of Laboratory Medicine & Pathology, Hamad Medical Corporation, Doha, Qatar.
    Mohamed, Sugad
    Department of Laboratory Medicine & Pathology, Hamad Medical Corporation, Doha, Qatar.
    First case of huge classic papillary thyroid cancer rupturing spontaneously leading to ischemic necrosis, perforation and inflammation of overlying skin: Case report and review of the literature2021In: International Journal of Surgery Case Reports, E-ISSN 2210-2612, Vol. 85, article id 106136Article in journal (Refereed)
    Abstract [en]

    Introduction: Papillary thyroid cancer (PTC) is the commonest form of well-differentiated endocrine carcinoma. It is categorized into indolent and aggressive, where the indolent subtypes (classic, follicular) rarely demonstrate aggressive behavior. We present a classic PTC presenting with a rapidly growing huge anterior neck mass that subsequently spontaneously ruptured subcutaneously resulting in ischemia, necrosis, and perforation of overlying skin leading to inflammation. Presentation of case: A 37-year-old female with no comorbidities presented to our emergency department with a neck swelling of 2 years duration that rapidly enlarged one week prior to presentation. Though the mass initially appeared of inflammatory nature, the tumor was a PTC, and she underwent total thyroidectomy with selective right side neck dissection and debridement of necrotic skin. The gross specimen revealed a fragmented non-intact right thyroid lobe mass causing pressure ischemia, necrosis and perforation of the skin. Histopathology showed a 9 × 9 × 5 cm classic PTC staged as pT3b N1b. Postoperative course was uneventful, she was discharged by the eighth postoperative day, and then she received a high dose of radioactive iodine ablation (RAI). Discussion: Classic PTC is usually of a smaller size and a relatively benign course compared to other PTC subtypes and thyroid cancers. It is indolent with favorable prognosis. Although it is associated with increased risk of lymph node metastases at the time of diagnosis, it is slow growing with high survival rates approaching 95%. Conclusion: Despite that classic PTC progresses slowly, it should still be suspected in neck swellings presenting with rapid and aggressive behavior. Prompt and systematic assessment is required with surgical intervention and radioactive iodine ablation therapy. 

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  • 8.
    Abusabeib, Alyaa
    et al.
    Department of Bariatric Surgery/Bariatric Medicine, Hamad General Hospital, Doha, Qatar.
    El Ansari, Walid
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad General Hospital, Doha, Qatar / College of Medicine, Qatar University, Doha, Qatar.
    Alobaidan, Jassim
    Department of Bariatric Surgery/Bariatric Medicine, Hamad General Hospital, Doha, Qatar.
    Elhag, Wahiba
    Department of Bariatric Surgery/Bariatric Medicine, Hamad General Hospital, Doha, Qatar.
    First Case Report of Fulminant Hepatitis After Laparoscopic Sleeve Gastrectomy Associated with Concomitant Maximal Therapeutic Dose of Acetaminophen Use, Protein Calorie Malnutrition, and Vitamins A and D, Selenium, and Glutathione Deficiencies2021In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 31, no 2, p. 899-903Article in journal (Refereed)
    Abstract [en]

    Nonalcoholic fatty liver disease (NAFLD) is increasingly being linked to obesity. Although laparoscopic sleeve gastrectomy (LSG) is effective for weight loss that can ultimately resolve NAFLD, an initial transient deterioration of liver functions could be observed during the first few months post-operatively, after which a subsequent improvement of the liver functions might occur. Rapid weight loss, nutritional deficiencies, and protein malnutrition can all contribute to hepatic dysfunction and can affect the metabolism of medications such as acetaminophen leading to more insult to a compromised liver. We report acute liver failure after LSG associated with protein calorie malnutrition, multiple nutritional deficiencies in addition to concomitant use of therapeutic doses of acetaminophen. Treatment with N-acetylcysteine, and replacement of deficient multivitamins and trace elements resulted in significant improvement in liver functions. 

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  • 9.
    Abusabeib, Alyaa
    et al.
    Department of Bariatric Surgery/Bariatric Medicine, Hamad General Hospital, Doha, Qatar.
    El Ansari, Walid
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad General Hospital, Doha, Qatar / College of Medicine, Qatar University, Doha, Qatar.
    Elhag, Wahiba
    Department of Bariatric Surgery/Bariatric Medicine, Hamad General Hospital, Doha, Qatar.
    First Case Report of Acquired Copper Deficiency Following Revisional Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S) Leading to Severe Pancytopenia with Refractory Anemia2020In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 30, no 12, p. 5131-5134Article in journal (Refereed)
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  • 10.
    Adawi, Rahim
    University of Skövde, School of Engineering Science.
    Preventing fatal effects of overworking: Product design solution2018Independent thesis Basic level (university diploma), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    “Overworking to death” is a phenomenon that has been noticeable in developing countries. The cause of death is mainly through ischemic strokes. While the victims’ occupations differed, they all shared a common characteristic, being positioned in a sedentary work, ranging from IT workers to doctors. This project’s aim was to develop a product that prevented or decreased the strokes that derived from sedentary overwork. This was mainly tackled by preventing one of the three causes of developing blood props, slowed blood flow. In order to gather rich data of the phenomenon, a qualitative study was conducted in China, during two months. By doing an extensive structured sampling, information rich data could be gathered during a short period of time. Data were derived from observations, questionnaires and an interview, which then was interpreted to customer needs and the final product specification. The final product became a trouser with an in built dynamic compression mechanic, that can compress the veins mostly during sitting activities, in order to prevent blood stasis. The compression mechanic works like the Chinese finger trap; compressing the calves while sitting and stretching the legs forward. It is made only out of polysaccharides fibres; cotton and corn.

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    PREVENTING FATAL EFFECTS OF OVERWORKING – PRODUCT DESIGN SOLUTION / Rahim_Adawi
  • 11.
    Adewale, Lauryn
    University of Skövde, School of Health Sciences.
    GLP-1-secreting L-cell signalling in response to Bifidobacterium breve ncfb22582024Independent thesis Basic level (degree of Bachelor), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    The relationship between gut microbiota and intestinal epithelial cells, particularly specialized enteroendocrine cells, such as GLP-1-secreting L-cells, is a critical aspect of gastrointestinal homeostasis and the gut-brain axis. This study delves into the molecular signalling pathways activated by the interaction between Bifidobacterium breve ncfb2258, a putative probiotic, and GLP-1-secreting L-cells. Bifidobacterium breve ncfb2258 produces conjugated linoleic acids (CLAs), which activate peroxisome proliferator-activated receptors (PPARs) and free fatty acid receptors (FFARs). This study aims to shed light on whether L-cells function as crossbarrier signal transducers and the mechanisms with which they do. Significant findings emerged through immunofluorescent labelling and calcium imaging, revealing differential expression patterns of these molecules in response to exposure to Bifidobacterium breve ncfb2258 supernatants. A significant response was observed when the human colorectal cancer cell line, NCI-H716 cells, a model of human GLP-1-secreting L-cells, were exposed to Bifidobacterium breve ncfb2258 supernatants (p = 0.003). PPARα and FFAR4 were both detected on NCI-H716 cells and while exposure to Bifidobacterium breve ncfb2258 supernatants increased the intensity of their cellular expression (p = <0.001; 0.042), expressiononly decreased with the addition of PPARα antagonist (p < 0.001) and remained elevated after the addition of FFAR4 antagonist (p = 0.999). These findings suggest the NCI-H716 cell line is suitable for exploring human GLP-1-secreting L-cells as potential cross-barrier signal transducers for the putative probiotic, B. Breve ncfb2258, and identify PPARα as potentially being involved in the molecular mechanisms of this interaction.

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  • 12.
    Adolfsson, Annsofie
    et al.
    University of Skövde, School of Life Sciences. Department of Obstetrics and Gynecology, Central Hospital Skövde.
    Tullander-Tjörnstrand, Karin
    Department of Obstetrics and Gynecology, Central Hospital Skövde.
    Larsson, Per-Göran
    University of Skövde, School of Life Sciences. Department of Obstetrics and Gynecology, Central Hospital Skövde.
    Decreased need for emergency services after changing management for suspected miscarriage2011In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 90, no 8, p. 921-923Article in journal (Refereed)
    Abstract [en]

    We investigated the effect of a changed routine to identify women with a nonviable pregnancy, in order to utilize health care resources more efficiently during office hours rather than relying on emergency care services. From hospital register data about where and when women with miscarriages were treated, there was a significant trend during a nine-year period for miscarriages to be more rarely diagnosed (p-value<0.001) in the emergency ward after office hours. The proportion of miscarriages that were diagnosed and handled at the emergency ward decreased from 31% in 2001 to 17% in 2009. Furthermore, the number of women showing up with bleeding at the emergency ward, but who also had a normal viable pregnancy, declined during the same period (p-value<0.01). Women with suspected miscarriage benefit from structured information and standardized management and can effectively be scheduled for day-time assessment including ultrasound with a concomitant reduced need for emergency services.

  • 13.
    Agder, Terese
    et al.
    University of Skövde, School of Health Sciences.
    Bobeck, Sabina
    University of Skövde, School of Health Sciences.
    Kvinnors kunskap och förståelse om hemförlossning i Sverige: En kvalitativ hermeneutisk textanalys2021Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Research shows that the choice of place of birth is important for the woman's birth experience. Home birth in a low-risk pregnancy is a safe alternative to giving birth in a hospital, however, interest in home birth is low in Sweden. In order for women to be able to make an active choice, an awareness of the alternatives available is required. The authors ask themselves whether women in Sweden know that home birth exists. Aim: To shed light on women's knowledge and understanding of home birth in Sweden. Aim: To shed light on women's knowledge and understanding of home birth in Sweden. Method: Questionguide analyzed with a qualitative hermeneutic text analysis. Results: Knowledge about home birth has been shown to vary. The result shows 4 main themes and 8 sub-themes. The main themes consist of "Women's interest in home birth varies", "The importance of information for decision-making", "Obstacles to home birth in Sweden" and "Home birth as a right".Conclusion: The study shows that there is risk that women do not know that homebirth exists. It also shows greater obstacles to the possibility of making an active choice of place of birth and undergoing a homebirth. 

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  • 14.
    Ahmadi, Nasser S.
    et al.
    Department of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy at the University of Gothenburg, Göteborg, Sweden.
    Bennet, Louise
    Department of Clinical Sciences in Malmö, Family Medicine, Lund University, Malmö, Sweden.
    Larsson, Charlotte A.
    Department of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy at the University of Gothenburg, Göteborg, Sweden / Department of Clinical Sciences in Malmö, Social Medicine and Global Health, Lund University, Malmö, Sweden.
    Andersson, Susanne
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Månsson, Jörgen
    Department of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy at the University of Gothenburg, Göteborg, SwedenDepartment of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy at the University of Gothenburg, Göteborg, Sweden.
    Lindblad, Ulf
    Department of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy at the University of Gothenburg, Göteborg, Sweden.
    Clinical characteristics of asymptomatic left ventricular diastolic dysfunction and its association with self-rated health and N-terminal B-type natriuretic peptide: a cross-sectional study2016In: ESC Heart Failure, E-ISSN 2055-5822, Vol. 3, no 3, p. 205-211Article in journal (Refereed)
    Abstract [en]

    AimsLeft ventricular hypertrophy, obesity, hypertension, and N-terminal B-type natriuretic peptide (Nt-proBNP) predict left ventricular diastolic dysfunction with preserved systolic function (DD-PSF). Self-rated health (SRH) is shown to be associated with chronic diseases, but the association of SRH with DD-PSF is unclear. In light of the clinical implications of DD-PSF, the following goals are of considerable importance: (1) to determine the role of SRH in patients with DD-PSF in the general population and (2) to study the association between Nt-proBNP and DD-PSF.

    Methods and resultsThe current study is a cross-sectional study conducted on a random sampling of a rural population. Individuals 30–75 years of age were consecutively subjected to conventional echocardiography and tissue velocity imaging. Data were collected on 500 (48%) men and 538 (52%) women (n = 1038). DD-PSF was the main outcome, and SRH and Nt-proBNP were the primary indicators. Diabetes mellitus, hypertension, and obesity were accounted for as major confounders of the association with SRH. DD-PSF was identified in 137 individuals, namely, 79 men (15.8%) and 58 women (10.8%). In a multivariate regression model, SRH (OR 2.95; 95% CI 1.02–8.57) and Nt-proBNP (quartile 4 vs. quartile 1 OR 4.23; 95% CI 1.74–10.26) were both independently associated with DD-PSF.

    ConclusionsSRH, evaluated based on a descriptive question on general health, should be included in the diagnostic process of DD-PSF. In agreement with previous studies, our study confirms that Nt-proBNP is a major indicator of DD-PSF.

  • 15.
    Al Dhaheri, Mahmood
    et al.
    Department of Colorectal Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    Nada, Mohamed Abu
    Department of Colorectal Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    El Ansari, Walid
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar / College of Medicine, Qatar University, Doha, Qatar.
    Kurer, Mohamed
    Department of Colorectal Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    Ahmed, Ayman Abdelhafiz
    Department of Colorectal Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    Left iliac fossa mini-incision sigmoidectomy for treatment of sigmoid volvulus: Case series of six patients from Qatar2020In: International Journal of Surgery Case Reports, E-ISSN 2210-2612, Vol. 75, p. 534-538Article in journal (Refereed)
    Abstract [en]

    Background: Midline laparotomy is the definitive treatment for sigmoid volvulus after initial colonoscopic detorsion. We successfully adopted another technique at our center on 6 patients, treating sigmoid volvulus by left iliac fossa mini-incision. Presentation of cases: We report our experience of six non-consecutive cases of sigmoid volvulus treated by left iliac fossa mini-incision. The cases were a 33 year old Egyptian female, a 21 year old Bangladeshi male, a 58 year old Qatari male, a 30 year old Ethiopian male, a 36 year old Ugandan male, and a 58 year old Indian male. The six cases are unique in the surgical technique employed in their management. This is possibly the second case series of left iliac fossa mini-incision for sigmoid volvulus in the Middle East and North Africa Region. Discussion: All patients underwent initial colonoscopic detorsion followed by sigmoidectomy and anastomosis. The procedure was successful in treating the volvulus in five patients with no complication or recurrence over a mean follow up of 8 months (range: 1–36 months). One patient required further laparotomy and resection with anastomosis due to incompletely removed sigmoid colon. Conclusions: Left iliac fossa mini-incision for sigmoid volvulus is safe, feasible, cosmetically appealing and with low morbidity.

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  • 16.
    Al Hassan, Mohamed S.
    et al.
    Department of General Surgery, Hamad General Hospital, Doha, Qatar.
    El Ansari, Walid
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad General Hospital, Doha, Qatar ; College of Medicine, Qatar University, Doha, Qatar ; Weill Cornell Medicine – Qatar, Doha, Qatar.
    Alater, Ahmad
    Department of General Surgery, Hamad General Hospital, Doha, Qatar.
    Darweesh, Adham
    Department of Clinical Imaging, Hamad General Hospital, Doha, Qatar.
    Abdelaal, Abdelrahman
    Department of General Surgery, Hamad General Hospital, Doha, Qatar.
    Choroidal metastasis as initial presentation of aggressive medullary thyroid carcinoma with widespread mediastinal, brain, pituitary, bone, lung, and liver metastasis: Case report and literature review2021In: International Journal of Surgery Case Reports, E-ISSN 2210-2612, Vol. 87, no October 2021, article id 106419Article in journal (Refereed)
    Abstract [en]

    Introduction: Medullary thyroid carcinoma (MTC) is a neuroendocrine tumor that originates from the parafollicular C cells of the thyroid gland. MTC can be due to sporadic or hereditary causes due to gain of function germ line mutations in the RET proto-oncogene. MTC presenting as ocular symptoms due to choroidal mass is rare with bad prognosis. Presentation of case: A 38-year-old Sudanese male presented to Hamad General Hospital, complaining of sudden painless decrease of vision of the right eye of 3 weeks duration. After investigations using imaging methods, the patient was discovered to have metastatic MTC that presented as choroidal mass and metastasized to his lung, bone, brain, pituitary, liver and mediastinum. Discussion: In terms of investigations, serum levels of calcitonin have superior diagnostic accuracy. Our patient undertook diagnostic imaging including ultrasonography, fine needle aspiration and computerized tomography (CT) scan and/or MRI imaging. He undertook total thyroidectomy and left neck dissection followed by stereotactic radiosurgery for the right orbit and pituitary. He then received systemic anti-RET therapy (Selpercatinib). At 5 months follow up there was dramatic drop in CEA from 888 μg/L to 164 μg/L, and calcitonin from >585.2 pmol/L to 354 pmol/L. Conclusion: Choroidal metastasis as initial presentation of MTC is extremely rare and challenging to diagnose. Surgeons need a high index of suspicion when ocular symptoms accompany a neck mass or thyroid-related symptoms. MTC has a progressive course with involvement of blood vessels and neck lymph nodes. Choroidal metastasis of MTC is challenging to manage.

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  • 17.
    Al Hassan, Mohamed S.
    et al.
    Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    El Ansari, Walid
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar ; College of Medicine, Qatar University, Doha, Qatar ; Weill Cornell Medicine – Qatar, Doha, Qatar.
    El Baba, Hamzah
    Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    Petkar, Mahir
    Department of Laboratory Medicine and Pathology, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    Abdelaal, Abdelrahman
    Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    What you see might not be what you get: Analysis of 15 prospective cases of non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP)2022In: International Journal of Surgery Case Reports, E-ISSN 2210-2612, Vol. 91, article id 106751Article in journal (Refereed)
    Abstract [en]

    Introduction: Noninvasive follicular thyroid neoplasm with papillary-like nuclear (NIFTP) is a new entity. No previous study reported prospective cases, outlining using many quantitative and qualitative variables. Methods: Retrospective analysis of all (15) prospective NIFTP cases diagnosed between 2017 and 2021 at our institution. Statistical quantitative analysis outlined demographic, history, ultrasound, histopathology and treatment characteristics. Qualitative analysis examined the cases, with details provided on three cases to highlight the different possible presentations and configurations. Results: Mean age was 41.5 ± 9.91 years, 73.3% were females, and mean BMI was 29.49 ± 5.74 kg/m2. About 87% patients were symptomatic; 86.6% had neck swelling. Ultrasound (US) showed multiple nodules in 71.4% of cases. Fine-needle aspiration cytology (FNAC) showed that follicular lesion of undetermined significance (42.8%) was most common, followed by benign nodule (21.3%). Using the Bethesda System for Reporting Thyroid Cytopathology, 7 cases were category III, 3 category IV, 3 category II, and 1 category I. 60% of patients underwent total thyroidectomy. All cases were diagnosed postoperatively, 2 patients had additional papillary microcarcinoma. In 3 cases, the NIFTP site in the histopathology of resected specimen was different than the US-recommended site of the FNAC. Conclusion: We found discrepancies in the site and diagnosis of the preoperative US recommendation for the FNAC vs the postoperative histopathology of the specimen. These suggest that NIFTP might be incidentally and postoperatively diagnosed, irrespective of US or FNAC findings, hence its ‘true’ incidence might remain underestimated. As NIFTP cases higher BMI, Future research could predict preoperative diagnosis of NIFTP and explore associations with BMI. 

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  • 18.
    Al Hassan, Mohamed S.
    et al.
    Department of General Surgery, Hamad General Hospital, Doha, Qatar.
    El Ansari, Walid
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad General Hospital, Doha, Qatar / College of Medicine, Qatar University, Doha, Qatar.
    Elshafeey, Abdallah
    Weill Cornell Medicine – Qatar, Doha, Qatar.
    Petkar, Mahir
    Department of Laboratory Medicine & Pathology, Hamad General Hospital, Doha, Qatar.
    Abdelaal, Abdelrahman
    Department of General Surgery, Hamad General Hospital, Doha, Qatar.
    First bilateral non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) co-occurring with bilateral papillary thyroid microcarcinoma: Case report and literature review2021In: International Journal of Surgery Case Reports, E-ISSN 2210-2612, Vol. 78, p. 411-416Article in journal (Refereed)
    Abstract [en]

    Introduction: Non-invasive follicular thyroid neoplasm with papillary-like features (NIFTP) is a recently characterized lesion with very low malignant potential. This has allowed for less aggressive management of this tumor subtype. Papillary thyroid carcinoma (PTC) has malignant potential and requires different considerations in management. Presentation of case: A 33-year-old woman presented to our Thyroid Surgery Clinic with a left neck swelling slowly enlarging over 4 years, and recent right-sided neck pain. Neck ultrasound and fine needle aspiration for cytology found bilateral thyroid nodules, labelled as ‘follicular lesion of undetermined significance’ (FLUS). Final pathology report after total thyroidectomy identified four distinct tumors: bilateral NIFTP lesions and bilateral papillary microcarcinomas. Discussion: Management of NIFTP comprises partial or total thyroidectomy without further intervention. Management of PTC is the same but with the possible addition of radioactive ablation due to the increased malignant potential. This is the first report of bilateral NIFTP lesions and bilateral papillary microcarcinomas co-occurring together in the same patient, so management was challenging. The decision was made to give the patient low dose radioactive iodine ablation and continue monitoring. Ultrasound of the neck follow up 6 months later showed no residual thyroid tissue or local recurrence. Conclusion: Although rare, NIFTP can co-occur with PTC. Bilateral NIFTP with bilateral PTC is extremely rare. Surgeons and pathologists need to be aware of this rare entity that can co-occur in both thyroid lobes. Total thyroidectomy is the definitive treatment. Post-surgery surveillance is important and follow up needs to be watchful for any recurrence or metastasis. © 2020 The Author(s)

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  • 19.
    Al Zoubi, Mohammad
    et al.
    Department of General Surgery, Hamad Medical Corporation, Doha, Qatar.
    El Ansari, Walid
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar / College of Medicine, Qatar University, Doha, Qatar.
    Al Moudaris, Ahmed A.
    Department of General Surgery, Hamad Medical Corporation, Doha, Qatar.
    Abdelaal, Abdelrahman
    Department of General Surgery, Hamad Medical Corporation, Doha, Qatar.
    Largest case series of giant gallstones ever reported, and review of the literature2020In: International Journal of Surgery Case Reports, E-ISSN 2210-2612, Vol. 72, p. 454-459Article in journal (Refereed)
    Abstract [en]

    Introduction: Giant/large gallstones have high risk of complications, and technical difficulties during surgery. This case series is the largest ever reported. Presentation of cases: Case 1: Female (44 years), with one year intermittent right upper quadrant colicky pain. Ultrasound: large gallstone (normal gallbladder). Elective laparoscopic cholecystectomy (LC): 6 × 4 × 3.3 cm gallstone. Case 2: Female (41 years), presented to emergency room with 3 days right upper quadrant pain/tenderness, vomiting, and positive murphy's sign. Ultrasound: large gallstone, calculus cholecystitis. Emergency LC: 4.5 × 3.1 × 3.5 cm gallstone. Case 3: Male (38 years), with history of gallstones and acute cholecystitis presented with intermittent right upper quadrant pain (2 months) and vomiting. Normal abdominal examination. Ultrasound: large gallstone. Elective LC: 4.1 × 4 × 3.6 cm gallstone. Conclusions: Gallstones >5 cm are very rare, with higher risk of complications. Gallbladder should be removed even if asymptomatic. Gallstones >3 cm have increased risk for gallbladder cancer, biliary enteric fistula and ileus. LC has challenges that include grasping the gallbladder wall, exposure of Calot's triangle, and retrieval of gallbladder out of the abdomen. LC appears to be procedure of choice and should be performed by an experienced surgeon, considering the possibility of conversion to open cholecystectomy in case of inability to expose the anatomy or intraoperative difficulties. © 2020 The Author(s)

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  • 20.
    Aldosaky, Khatoon Salim Eshaq
    University of Skövde, School of Bioscience.
    MANUAL VS MACHINERY SMALL RNA EXTRACTION BY USING A QIACUBE® MACHINE: Two methods. Two volumes.2020Independent thesis Basic level (degree of Bachelor), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Sepsis is a serious condition caused by a dysregulated immune response of the host triggered by an infection that can potentially lead to malfunction of various organs or even death in severe cases. Some studies have shown that the use of biomarkers could aid in early diagnosis as well as early treatment of sepsis patients. Furthermore, various studies have investigated the idea of using extracellular microRNAs as biomarkers for sepsis diagnosis. This study aimed to see if there were any differences in the quantity and purity of small RNA -which includes microRNA- by performing two different RNA extraction methods (manual and machinery by using a QIAcube) as well as two different volumes by using the ExoRNeasy Serum/Plasma Midi Kit. Blood samples were collected solely from the same self-assessed healthy donor. The plasma samples were frozen and then thawed before the RNA extraction, whether manually or machinery by the QIAcube. The extracted small RNA was then measured for quantity and purity. The quantitative results were analysed by ANOVA followed by post-hoc Tukey test to show the statistically significant difference in the concentration of small RNA. The QIAcube showed higher concentration values compared to the manual method as well as larger initial plasma volume in comparison to the lower initial plasma volume. Meanwhile, the Kruskal-Wallis test showed no statistically significant difference in the purity values among the different methods and volumes. In conclusion, based on this study, the QIAcube could do what human hands do.

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  • 21.
    Aleter, Ammar
    et al.
    Department of General Surgery, Hamad General Hospital, Doha, Qatar.
    El Ansari, Walid
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad General Hospital, Doha, Qatar / College of Medicine, Qatar University, Doha, Qatar.
    Incidental appendiceal mucinous neoplasm mimicking a left adnexal mass: A case report2020In: International Journal of Surgery Case Reports, E-ISSN 2210-2612, Vol. 74, p. 132-135Article in journal (Refereed)
    Abstract [en]

    Introduction: Appendiceal mucinous neoplasm is a rare type of appendiceal tumors which can present in a variety of symptoms and is difficult to diagnose. Preoperative diagnosis depends mainly on diagnostic imaging such as ultrasonography and computerized tomography (CT) scan. This uncommon case report discusses an appendiceal mucinous neoplasm mimicking a left adnexal mass on presentation, physical examination and diagnostic imaging findings. Presentation of case: This is a 61-year-old female found to have a large left adnexal mass during follow up ultrasonography. The patient refused further imaging, and during laparotomy, she was found to have an appendicular mucocele with normal left and right ovaries. Discussion: Appendectomy was done and the final pathology came as appendiceal mucinous neoplasm. Her post-operative course and 3 years follow up were uneventful. Conclusions: The equivocal signs and symptoms along with the anatomical position of appendiceal mucocele makes it difficult to diagnose and can mimic other types of tumors. Therefore, it should be considered in the deferential diagnosis of lower abdominal and pelvic masses. 

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  • 22.
    Aleter, Ammar
    et al.
    Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    El Ansari, Walid
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar ; College of Medicine, Qatar University, Doha, Qatar.
    Toffaha, Ali
    Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    Ammar, Adham
    Department of Laboratory Medicine and Pathology, Hamad General Hospital, Doha, Qatar.
    Shahid, Fakhar
    Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    Abdelaal, Abdelrahman
    Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    Epidemiology, histopathology, clinical outcomes and survival of 50 cases of appendiceal mucinous neoplasms: Retrospective cross-sectional single academic tertiary care hospital experience2021In: Annals of Medicine and Surgery, E-ISSN 2049-0801, Vol. 64, article id 102199Article in journal (Refereed)
    Abstract [en]

    Background: Appendicular neoplasms are rare, most commonly as carcinoids followed by appendicular mucinous neoplasms (AMN). To date, there remains controversy regarding the best treatment of AMN and factors affecting its prognosis. Method: Retrospective chart review of patients operated for appendicular pathology (January 2011–December 2018, follow up to December 2020) at our institution. For all AMN patients, data included pre-operative clinical presentation, and operative/post-operative findings. Results: 12454 patients underwent appendectomy, of whom 50 (0.4%) had AMN histopathologically (mean age = 47.2). Most patients had laparoscopic appendectomy as primary surgery. Low grade AMN was the most common subtype (n = 41, 82%), and pseudomyxoma peritonei (PMP) was found in 8 (16%) patients. Based on histopathology and margin involvement, the 50 patients were categorized into 3 prognostic categories of recurrence risk (no risk, 24 patients; low risk, 8; high recurrence risk, 18 patients). Disease-free survival (DFS) was lowest for high recurrence risk group (P < 0.001). Eleven (22%) patients had AMN involving resection margin, of whom 3 had no completion surgery and had no recurrence. Higher tumor markers were associated with lower DFS, however it was not statistically significant. Conclusion: AMNs are rare but serious due to the risk of PMP. Laparoscopic approach for AMN may be feasible. Prognostic categories were significantly inversely correlated with recurrence risk; hence useful in predicting prognosis. Contrary to previous proposals, AMNs with acellular mucin at margin or local acellular mucin spillage may not require secondary surgery, especially if the patient is in low recurrence risk group. Tumor markers may predict risk of recurrence. 

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  • 23.
    Al-Ghamdi, Yasser
    University of Skövde, School of Health and Education.
    The Effects of Probiotics on High Sugar-Induced Type 2 Diabetes Mellitus Symptoms in Drosophila melanogaster2019Independent thesis Basic level (degree of Bachelor), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Background: Type 2 diabetes mellitus is a metabolic disorder characterized by the rise of fasting plasma glucose from its normal range (≥125mg/dl). It is marked by insufficient production of insulin from pancreatic β-cells as a result of failed compensation due to insulin resistance. Several treatments are available for the disorder, which mainly focus on improving the sensitivity of insulin in different body tissues. Recently, probiotics were suggested as candidate treatments for type 2 diabetes and for extending lifespan as well. This experiment aims to investigate such claims using Drosophila melanogaster as a disease model.

     

    Results: Other than the observed low average weights in treated larva samples, probiotics did not show any other significant results in affecting the length, glucose, glycogen, and trehalose levels (One-Way ANOVA and Kruskal-Wallis, p>0.05). Real-time PCR was only carried out once. Thus, no statistical tests were reliable enough to analyse the data obtained. The longevity study, on the other hand, did show significance (Log-rank (Mantel-Cox) test and Gehan-Breslow-Wilcoxon test, p<0.0001), as the probiotic Bifidobacterium lactis extended the lifespan of adult flies feeding on a high sugar diet significantly when compared to the control ones feeding on only high sugar diet without probiotics.

     

    Conclusion: Except for weight measurements, none of the other results was reliable enough to make a concrete conclusion on whether the treatments indeed worked in reversing type 2 diabetes symptoms or not. Real-time PCR results did show some effects of some of the treatments at different developmental stages. However, unless Real-time PCR is repeated at least once using the same protocol, no deduction can be made. Additionally, the data obtained hint that the dosage used (0.025 g) was too high for larvae and adult flies and might have caused malnutrition by blocking their midgut and decreasing food absorption. Hence, false significant or non-significant results were acquired instead.

     

    Further studies are required using a much lower probiotic dosage if Drosophila is used as a disease model. Although, other models such as mice or rats are recommended in this case, in order to reach a solid conclusion about the effectiveness of probiotics in treating type 2 diabetes mellitus. Baring these thoughts in mind and based on the results of this experiment, the null hypothesis indicating that there is no significant relationship between the use of probiotics and reversing type 2 diabetes mellitus symptoms is therefore accepted.

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  • 24.
    Alhardallo, Mutaz
    et al.
    Department of Orthopedic Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    El Ansari, Walid
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad General Hospital, Doha, Qatar ; College of Medicine, Qatar University, Doha, Qatar.
    Baco, Abdul M.
    Department of Orthopedic Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    Second ever reported case of central cause of unilateral foot drop due to cervical disc herniation: Case report and review of literature2021In: International Journal of Surgery Case Reports, E-ISSN 2210-2612, Vol. 83, article id 105928Article in journal (Refereed)
    Abstract [en]

    Background: Foot drop is defined as a weakness in the ankle and foot dorsiflexors. A disruption of the neural pathway starting from the motor prefrontal cortex and ending in the peroneal nerve can lead to foot drop. Foot drop due to lower motor neuron injury is well documented. However, foot drop due to a central cause of cervical disc prolapse is very rare. Case presentation: A 55-year-old male presenting with neck pain, right and left arms radicular pain and numbness, and unilateral right foot drop following cervical disc prolapse. The patient presented with upper motor neuron lesion signs. MRI showed cervical disc prolapse at two levels, confirming central cause of foot drop. The patient underwent anterior cervical decompression and fusion surgery. Discussion: Following decompression and fusion of involved cervical spine disc pathology, the patient had complete recovery of his right foot drop. Conclusions: Central causes, although rare, should be considered in the differential diagnosis of foot drop. Causes could be due to the compression effect of the cortico-spinal tract of the cervical spinal cord. Satisfactory results can be achieved upon correcting the causative lesion. 

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  • 25.
    Al-Hassan, Mohamed S.
    et al.
    Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    Mekhaimar, Menatalla
    Weill Cornell Medicine-Qatar, Doha, Qatar.
    El Ansari, Walid
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar ; College of Medicine, Qatar University, Doha, Qatar.
    Darweesh, Adham
    Department of Medical Imaging, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    Abdelaal, Abdelrahman
    Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    Giant parathyroid adenoma: a case report and review of the literature2019In: Journal of Medical Case Reports, E-ISSN 1752-1947, Vol. 13, no 1, article id 332Article in journal (Refereed)
    Abstract [en]

    Background: Giant parathyroid adenoma is a rare type of parathyroid adenoma defined as weighing > 3.5 g. They present as primary hyperparathyroidism but with more elevated laboratory findings and more severe clinical presentations due to the larger tissue mass. This is the first reported case of giant parathyroid adenoma from the Middle East.

    Case presentation: A 52-year-old Indian woman presented with a palpable right-sided neck mass and generalized fatigue. Investigations revealed hypercalcemia with elevated parathyroid hormone and an asymptomatic kidney stone. Ultrasound showed a complex nodule with solid and cystic components, and Sestamibi nuclear scan confirmed a giant parathyroid adenoma. Focused surgical neck exploration was done and a giant parathyroid adenoma weighing 7.7 gm was excised.

    Conclusions: Giant parathyroid adenoma is a rare cause of primary hyperparathyroidism and usually presents symptomatically with high calcium and parathyroid hormone levels. Giant parathyroid adenoma is diagnosed by imaging and laboratory studies. Management is typically surgical, aiming at complete resection. Patients usually recover with no long-term complications or recurrence.

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  • 26.
    Ali, Abukar
    University of Skövde, School of Life Sciences.
    Time window of TNF-a in innate immunity against staphylococcal infection2010Independent thesis Basic level (degree of Bachelor), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Staphylococcus aureus (S. aureus) is responsible for many human diseases including septic arthritis and sepsis shock. Tumor necrosis factor alpha (TNF-α) is a pro-inflammatory cytokine involved in inflammation and produced mainly by macrophages and monocytes. It is believed to be involved in pathogenesis of septic arthritis. Time window of TNF-a in innate immunity against staphylococcal infection was studied in this project.

    Two experiments were carried out: In the first experiment mice were infected with a low dose (8x106cfu/mouse) of S. aureus to induce septic arthritis whereas in the second experiment the mice were infected with a higher dose (8x107cfu/mouse) of S. aureus to induce sepsis shock. All mice were divided into three groups. The first group was treated with anti-TNF-α 20 minutes after infection. The second group was treated with the anti-TNF-α three days after infection. The third group served as control and was injected with PBS instead of anti-TNF-α. The mice were regularly weighed and signs of arthritis and mortality were recorded. Two weeks after inoculation bacteria viable counts in different organs was done, as well as histopathological assessment of joints and measurement of cytokines in blood.

    We have observed that mice treated with anti-TNF-α had less severe arthritis and also less mortality. However, they had more bacteria accumulated in the kidneys and lost more weight compared to the control group. The results were mostly seen in the group early treated with TNF-α, compared to the late treated group.

    We conclude that anti-TNF-α might be potentially used as a therapy against septic arthritis and sepsis shock. This should be combined with antibiotics to eliminate the bacteria while the anti-TNF-α reduces the severity of the inflammation and thus reduce the risk of permanent joint destruction and mortality. We can conclude that blocking TNF-α early on is essential in order to get the best results.

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  • 27.
    Allgulin, Marcus
    University of Skövde, School of Bioscience.
    Psilocybin and LSD in the Treatment of Depression and Anxiety2020Independent thesis Basic level (degree of Bachelor), 15 credits / 22,5 HE creditsStudent thesis
    Abstract [en]

    Psychiatry is in a crisis. Mental health disorders are on the rise worldwide and there are currently not enough efficient treatment methods that would meet the patients’ needs. Hence, the societal and economic costs of mental health problems are enormous, as well as the suffering of individuals afflicted by mental health problems. Lysergic acid diethylamide (LSD) and psilocybin are substances that create an altered state of consciousness characterized by altered sensory perception and on some occasions, ego-dissolution, and mystical experiences. In recent studies, LSD and psilocybin have been shown to carry significant therapeutic potential in the treatment of depression and anxiety disorders in conjunction with psychotherapy. The therapeutic effects of LSD and psilocybin have also been shown to persist for between 3-12 months post-treatment. LSD and psilocybin, like other classical hallucinogens, increase serotonin availability, which has been suggested to attenuate symptoms of anxiety and depression. In addition, LSD and psilocybin alter the activity of the default mode network, which has been suggested to be overly active in depressed and anxious patients. This essay is a literature review of the neural mechanisms of LSD and psilocybin, their potential therapeutic effects in the treatment of depressive and anxiety disorders, and how insights about said neural mechanisms may be useful in understanding the possible application of psychedelics in the treatment of depressive and anxiety disorders. In sum, recent studies have provided converging and convincing evidence on therapeutic potential of LSD and psilocybin. Yet, few conclusions on the exact neural mechanisms of how LSD and psilocybin alleviate depressive and anxiety symptoms can be made. Although the future of this research field looks promising, archaic national- and international regulations continue to be a hindrance to research into psychedelic drugs. Yet, due to the psychiatric crisis and the promising results so far, more studies in this field are warranted.

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  • 28.
    Almirón Santa-Bárbara, Rafael
    et al.
    Department of Orthopaedic Surgery and Traumatology, Hospital de Antequera, Malaga, Spain ; School of Medicine, Universidad de Málaga, Spain.
    García Rivera, Francisco
    University of Skövde, School of Engineering Science. University of Skövde, Virtual Engineering Research Environment.
    Lamb, Maurice
    University of Skövde, School of Informatics. University of Skövde, Informatics Research Environment. University of Skövde, School of Engineering Science. University of Skövde, Virtual Engineering Research Environment.
    Víquez Da-Silva, Rodrigo
    Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Virgen de la Victoria, Málaga, Spain.
    Gutiérrez Bedmar, Mario
    Preventive Medicine and Public Health Department, School of Medicine, University of Málaga, Spain ; Biomedical Research Institute of Malaga-IBIMA, Spain ; CIBERCV Cardiovascular Diseases, Carlos III Health Institute, Madrid, Spain.
    New technologies for the classification of proximal humeral fractures: Comparison between Virtual Reality and 3D printed models—a randomised controlled trial2023In: Virtual Reality, ISSN 1359-4338, E-ISSN 1434-9957, Vol. 27, no 3, p. 1623-1634Article in journal (Refereed)
    Abstract [en]

    Correct classification of fractures according to their patterns is critical for developing a treatment plan in orthopaedic surgery. Unfortunately, for proximal humeral fractures (PHF), methods for proper classification have remained a jigsaw puzzle that has not yet been fully solved despite numerous proposed classifications and diagnostic methods. Recently, many studies have suggested that three-dimensional printed models (3DPM) can improve the interobserver agreement on PHF classifications. Moreover, Virtual Reality (VR) has not been properly studied for classification of shoulder injuries. The current study investigates the PHF classification accuracy relative to an expert committee when using either 3DPM or equivalent models displayed in VR among 36 orthopaedic surgery residents from different hospitals. We designed a multicentric randomised controlled trial in which we created two groups: a group exposed to a total of 34 3DPM and another exposed to VR equivalents. Association between classification accuracy and group assignment (VR/3DPM) was assessed using mixed effects logistic regression models. The results showed VR can be considered a non-inferior technology for classifying PHF when compared to 3DPM. Moreover, VR may be preferable when considering possible time and resource savings along with potential uses of VR for presurgical planning in orthopaedics. 

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  • 29.
    Alnadhari, Ibrahim
    et al.
    Department of Urology, Al Wakra Hospital, Hamad Medical Corporation, Doha, Qatar.
    Sampige, Venkata Ramana Pai
    Department of Urology, Al Wakra Hospital, Hamad Medical Corporation, Doha, Qatar.
    Abdeljaleel, Osama
    Department of Urology, Al Wakra Hospital, Hamad Medical Corporation, Doha, Qatar.
    El Ansari, Walid
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar / College of Medicine, Qatar University, Doha, Qatar.
    Ali, Omar
    Department of Urology, Al Wakra Hospital, Hamad Medical Corporation, Doha, Qatar.
    Salah, Morshed
    Department of Urology, Al Wakra Hospital, Hamad Medical Corporation, Doha, Qatar.
    Shamsodini, Ahmad
    Department of Urology, Al Wakra Hospital, Hamad Medical Corporation, Doha, Qatar.
    Presentation, diagnosis, management, and outcomes of prostatic abscess: comparison of three treatment modalities2020In: Therapeutic advances in urology, ISSN 1756-2872, Vol. 12, p. 1-8, article id 1756287220930627Article in journal (Refereed)
    Abstract [en]

    Purpose:

    The lack of available guidelines for the management of prostatic abscess (PA) results in inconsistencies in its management. The most commonly used management modalities were conservative treatment with parenteral antibiotics alone, transrectal ultrasound-guided (TRUS) needle aspiration, or transurethral deroofing (TUD).

    The current study is a retrospective study and examines prostatic abscess cases treated by either one or more of the different modalities. We assess and compare presentation, diagnosis, management, and outcomes of prostatic abscess and we compare the outcomes of the three management modalities.

    Methods:

    We retrieved the records of all patients (n = 23) admitted to the Urology department at Al Wakra hospital with the computed tomography (CT) diagnosis of prostatic abscess from January 2013 to March 2018. Data collected included demographic, clinical, laboratory, and imaging findings, as well as management modality, duration of hospital stay, duration of follow up, outcome, and recurrence.

    Results:

    A total of nine (39.1%) patients had conservative treatment only; eight (34.8%) had TUD, and six (26.1%) had TRUS needle aspiration. The mean age was 52.7 years. Lower urinary tract symptoms and fever were the most common presentations (95.7% and 82.6%, respectively). CT scan of the abdomen and pelvis with contrast was undertaken for all patients and it showed that multiple abscesses were observed in 14 (60.9%) cases.

    The overall mean hospital stay was 8.45 days (range 2–21 days). We observed no recurrences for patients treated conservatively or those who undertook TUD, but three patient (50%) recurrences were noted in TRUS aspiration patients. There was no mortality across the sample.

    Conclusion:

    Early diagnosis of prostatic abscess and prompt management may have decreased the morbidity and mortality. Conservative management can succeed in subcentimeter abscesses but TUD is the definite therapy for large and multiloculated abscess. TRUS aspiration does have a role in treatment, but it has higher recurrence and longer hospital stay.

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  • 30.
    Alobaidy, Abdulqadir
    et al.
    Department of Surgery, Urology Section, Hamad Medical Corporation, Doha, Qatar.
    Ibrahim, Tarek
    Department of Surgery, Urology Section, Hamad Medical Corporation, Doha, Qatar.
    El Ansari, Walid
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad General Corporation, Doha ; College of Medicine, Qatar University, Doha, Qatar.
    Tawfik, Hosam
    Department of Surgery, Urology Section, Hamad Medical Corporation, Doha, Qatar.
    Al-Naimi, Abdulla
    Department of Surgery, Urology Section, Hamad Medical Corporation, Doha, Qatar.
    Hussain, Salam
    Department of Surgery, Urology Section, Hamad Medical Corporation, Doha, Qatar.
    Al-Ansari, Abdulla
    Department of Surgery, Urology Section, Hamad Medical Corporation, Doha, Qatar.
    Grooved vs smooth ureteric stent before extracorporeal shockwave lithotripsy: Single-blind randomised clinical trial2022In: Arab Journal of Urology, ISSN 2090-598X, Vol. 20, no 1, p. 41-48Article in journal (Refereed)
    Abstract [en]

    Objective: No study compared the grooved stent to the widely used standard smooth (nongrooved) stent in humans. We compared stone clearance, complications, and patient tolerance of the grooved stent vs standard JJ stent. Patients and Methods: Single-blinded randomised trial among patients planned for pre-extracorporeal shockwave lithotripsy (ESWL) stenting. Adult patients with unilateral ureteric/ renal stones planned for ESWL were randomly assigned to receive (Percuflex) smooth ureteric stent or (Visiostar) grooved lithotripsy stent and blinded to the stent type. We collected and compared the baseline data and outcomes (stone-free rate, complications, and stent-related symptoms) of both patient groups. Results: A total of 96 adults were included (48 per arm). There were no significant differences between the groups at baseline in terms of demographics, body mass index, comorbidities, renal function, number of ESWL sessions, and stone characteristics, including pre-ESWL stone volume (mean [SD] smooth 310.2 [301.6] vs grooved 270.7 [278.6] mm3, P = 0.5). Stone clearance was statistically insignificant between the groups, although clinically relevant (smooth stent 70.8% vs grooved stent 81.2%, P = 0.2). Grooved-stent patients reported comparable urinary symptoms score (P = 0.05) and operative complications (P = 0.6), but significantly more urinary tract infections (UTIs) not requiring hospitalisation (P = 0.003). Conclusions: Although statistically insignificant, the grooved stent exhibited higher stone clearance compared to the smooth stent, with similar complication rates excpet that patients with grooved stents reported more UTIs. A re-visit to the size of the outer diameter of the grooved stent could enhance its stone clearance properties, and further development of its coating material could lead to better patient satisfaction.

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  • 31.
    Al-Yahri, Omer
    et al.
    Department of General Surgery, Hamad General Hospital, Doha, Qatar.
    Abdelaal, Abdelrahman
    Department of General Surgery, Hamad General Hospital, Doha, Qatar.
    El Ansari, Walid
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad General Hospital, Doha, Qatar / College of Medicine, Qatar University, Doha, Qatar.
    Farghaly, Hanan
    Department of Lab Medicine & Pathology, Hamad General Hospital, Doha, Qatar.
    Murshed, Khaled
    Department of Lab Medicine & Pathology, Hamad General Hospital, Doha, Qatar.
    Zirie, Mahmoud A.
    Department of Endocrinology, Hamad General Hospital, Doha, Qatar.
    Al Hassan, Mohamed S.
    Department of General Surgery, Hamad General Hospital, Doha, Qatar.
    First ever case report of co-occurrence of hobnail variant of papillary thyroid carcinoma and intrathyroid parathyroid adenoma in the same thyroid lobe2020In: International Journal of Surgery Case Reports, E-ISSN 2210-2612, Vol. 70, p. 40-52Article in journal (Refereed)
    Abstract [en]

    Introduction: The hobnail variant of papillary thyroid cancer (PTC) is rare. Intrathyroid parathyroid adenoma (ITPA) is also rare. Co-ocurrence of PTC and ITPA in the same thyroid lobe is extremely rare. Likewise, primary hyperparathyroidism with such non-medullary thyroid carcinoma is rare. The specific molecular profile of hobnail PTC (HPTC) is different from the classic, poorly differentiated and anaplastic variants and may contribute to its aggressive behavior. HPTC's genetic profile remains unclear. Presentation of case: A 61-year-old woman presented to our endocrine clinic with generalized aches, bone pain, polyuria, and right neck swelling of a few months’ duration. Laboratory findings revealed hypercalcemia and hyperparathyroidism. Ultrasound of the neck showed 4.6 cm complex nodule within the right thyroid lobe. Sestamibi scan suggested parathyroid adenoma in the right thyroid lobe. Fine-needle aspiration (FNA) revealed atypical follicular lesion of undetermined significance. She underwent right lobectomy, which normalized the intraoperative intact parathyroid hormone levels. Final pathology with immunohistochemical stains demonstrated HPTC and IPTA (2 cm each). Next-generation sequencing investigated the mutation spectrum of HPTC and detected BRAFV600E mutation. Conclusions: A parathyroid adenoma should not exclude the diagnosis of thyroid carcinoma. Thyroid evaluation is needed for patients with primary hyperparathyroidism to prevent missing concurrent thyroid cancers. Cytomorphologic features to distinguish thyroid from parathyroid cells on FNA cytology must be considered. Immunohistochemical stains are important. BRAFV600E is the most common mutation in HPTC. This is possibly the first reported case of HPTC and ITPA co-occurring within the same thyroid lobe. Studies that define other molecular abnormalities may be useful as therapeutic targets. © 2020 The Author(s)

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  • 32.
    Anderberg, Peter
    et al.
    Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden.
    Barnestein-Fonseca, Pilar
    Research Unit, La Unidad de Gestión Clínica de Mental Health, Instituto de Investigación Biomédica de Málaga, Hospital Regional Universitario Málaga, Malaga, Spain.
    Guzman-Parra, Jose
    Research Unit, La Unidad de Gestión Clínica de Mental Health, Instituto de Investigación Biomédica de Málaga, Hospital Regional Universitario Málaga, Malaga, Spain.
    Garolera, Maite
    Brain, Cognition and Behavior - Clinical Research, Consorci Sanitari de Terrassa, Barcelona, Spain.
    Quintana, Maria
    Brain, Cognition and Behavior - Clinical Research, Consorci Sanitari de Terrassa, Barcelona, Spain.
    Mayoral-Cleries, Fermin
    Research Unit, La Unidad de Gestión Clínica de Mental Health, Instituto de Investigación Biomédica de Málaga, Hospital Regional Universitario Málaga, Malaga, Spain.
    Lemmens, Evi
    University Colleges Leuven-Limburg, Genk, Belgium.
    Sanmartin Berglund, Johan
    Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden.
    The Effects of the Digital Platform Support Monitoring and Reminder Technology for Mild Dementia (SMART4MD) for People With Mild Cognitive Impairment and Their Informal Carers: Protocol for a Pilot Randomized Controlled Trial2019In: JMIR Research Protocols, E-ISSN 1929-0748, Vol. 8, no 6, article id e13711Article in journal (Refereed)
    Abstract [en]

    Background: Many countries are witnessing a trend of growth in the number and proportion of older adults within the total population. In Europe, population aging has had and will continue to have major social and economic consequences. This is a fundamentally positive development where the added life span is of great benefit for both the individual and the society. Yet, the risk for the individual to contract noncommunicable diseases and disability increases with age. This may adversely affect the individual's ability to live his or her life in the way that is desired. Cognitive conditions constitute a group of chronic diseases that predominantly affects older people. Recent technology advancements can help support the day-to-day living activities at home for people with cognitive impairments. Objective: A digital platform (Support Monitoring and Reminder for Mild Dementia; SMART4MD) is created to improve or maintain the quality of life for people with mild cognitive impairment (PwMCI) and their carers. The platform will provide reminders, information, and memory support in everyday life, with the purpose of giving structure and lowering stress. In the trial, we will include participants with a diagnosed neurocognitive disorder as well as persons with an undiagnosed subjective memory problem and cognitive impairment, that is, 20 to 28 points on the Mini-Mental State Examination. Methods: A pragmatic, multicenter RCT is being conducted in Spain, Sweden, and Belgium. The targets for recruitment are 1200 dyads-split into an intervention group and a control group that are in usual care. Intervention group participants will be provided with a data-enabled computer tablet with the SMART4MD app. Its core functionalities, intended to be used daily at home, are based on reminders, cognitive supporting activities, and sharing health information. Results: Inclusion of participants started in December 2017, and recruitment is expected to end in February 2019. Furthermore, there will be 3 follow-up visits at 6, 12, and 18 months after the baseline visit. Conclusions: This RCT is expected to offer benefits at several levels including in-depth knowledge of the possibilities of introducing a holistic multilayered information and communication technology solution for this group. SMART4MD has been developed in a process involving the structured participation of PwMCI, their informal carers, and clinicians. The adoption of SMART4MD faces the challenge of this age group's relative unfamiliarity with digital devices and services. However, this challenge can also be an opportunity for developing a digital device tailored to a group at risk of digital exclusion. This research responds to the wider call for the development of digital devices which are accessible and affordable to older people and this full scale RCT can hopefully serve as a model for further studies in this field.

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  • 33.
    Andersson, Annica
    et al.
    University of Skövde, School of Health Sciences.
    Stolt, Zarah
    University of Skövde, School of Health Sciences.
    Möjligheter och hinder för amningsrådgivning på BVC-mottagning: BVC-sjuksköterskors perspektiv2021Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Breastfeeding has many health-, economical and ecological benefits for child, parents and society, but statistics of breastfeeding are declining and are often due to insufficient breastfeeding support. Aim of the study: to examine child health care nurses’ possibilities and hindrance for breastfeeding counselling. Method: This study was conducted using Critical Incident as a method. Six child healthcare nurses in Sweden were interviewed about their experiences of providing breastfeeding advice. Results: The result was divided into two main incidents based on the aim, - possibilities and hindrance, with several behaviours that could affect the incidents. Under Possiblities a sensitivity for the woman’s needs, to be able to give simple breastfeeding advice, having time to give it and look for support when needed was seen. Behaviours that was a hindrance for breastfeeding counselling was a lack of sensitivity for the woman’s and child’s needs, to not have deeper knowledge or time, to not cooperate with others or not provide preparatory courses for parents. Conclusion: To create possibilities for individual breastfeeding counselling a sensitivity for the woman’s and child’s needs is essential, to have an understanding of the expectations the woman has and to have enough knowledge and time. Hindrance for breastfeeding counselling is a lack of sensitivity for the woman’s needs, difficulties to give evidence based information and not enough time. Cooperation between the different facilities and to follow the recommendations are potentials for improvement to strengthen the breastfeeding counselling. 

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  • 34.
    Andersson, Henrik
    et al.
    University of Borås, PreHospen Centre for Prehospital Researc Borås, Sweden ; University of Borås, Faculty of Caring Science, Work Life and Social Welfare, Borås, Sweden.
    Axelsson, Christer
    University of Borås, PreHospen Centre for Prehospital Researc Borås, Sweden ; University of Borås, Faculty of Caring Science, Work Life and Social Welfare, Borås, Sweden.
    Larsson, Anna
    Ambulance Department, South Älvsborg's Hospital, Borås, Sweden.
    Bremer, Anders
    University of Borås, PreHospen Centre for Prehospital Researc Borås, Sweden ; Linnaeus University, Faculty of Health and Life Sciences, Växjö, Sweden.
    Gellerstedt, Martin
    University West, School of Business, Economy and IT, Trollhättan, Sweden.
    Bång, Angela
    University of Borås, PreHospen Centre for Prehospital Researc Borås, Sweden ; University of Gothenburg, The Sahlgrenska Academy, Institute of Health and Care Sciences, Gothenburg, Sweden.
    Herlitz, Johan
    University of Borås, PreHospen Centre for Prehospital Researc Borås, Sweden ; University of Borås, Faculty of Caring Science, Work Life and Social Welfare, Borås, Sweden.
    Ljungström, Lars
    Skaraborg Hospital, Infection Disease Department, Skövde, Sweden.
    The early chain of care in bacteraemia patients: Early suspicion, treatment and survival in prehospital emergency care2018In: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 36, no 12, p. 2211-2218Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Bacteraemia is a first stage for patients risking conditions such as septic shock. The primary aim of this study is to describe factors in the early chain of care in bacteraemia, factors associated with increased chance of survival during the subsequent 28days after admission to hospital. Furthermore, the long-term outcome was assessed.

    METHODS: This study has a quantitative design based on data from Emergency Medical Services (EMS) and hospital records.

    RESULTS: In all, 961 patients were included in the study. Of these patients, 13.5% died during the first 28days. The EMS was more frequently used by non-survivors. Among patients who used the EMS, the suspicion of sepsis already on scene was more frequent in survivors. Similarly, EMS personnel noted the ESS code "fever, infection" more frequently for survivors upon arriving on scene. The delay time from call to the EMS and admission to hospital until start of antibiotics was similar in survivors and non-survivors. The five-year mortality rate was 50.8%. Five-year mortality was 62.6% among those who used the EMS and 29.5% among those who did not (p<0.0001).

    CONCLUSION: This study shows that among patients with bacteraemia who used the EMS, an early suspicion of sepsis or fever/infection was associated with improved early survival whereas the delay time from call to the EMS and admission to hospital until start of treatment with antibiotics was not. 50.8% of all patients were dead after five years.

  • 35.
    Andersson, Ida-Maria
    et al.
    University of Skövde.
    Nilsson, Sandra
    University of Skövde.
    Adolfsson, Annsofie
    University of Skövde, School of Life Sciences.
    How women who have experienced one or more miscarriages manage their feelings and emotions when they become pregnant again: a qualitative interview study2012In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 26, no 2, p. 262-270Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to investigate how women who have experienced one or more miscarriages manage their feelings when they become pregnant again.

    Method:  Individual qualitative interviews were conducted with 16 women who were pregnant again after experiencing one or more miscarriages. The interviews were analysed using qualitative content analysis with an inductive approach.

    Results: The analysis of the material ended up in five categories: distancing herself from her pregnancy, focusing on her pregnancy symptoms, searching for confirming information, asking for ultrasound examination and asking for professional and social support. Because of their past experience with miscarriage, it could be painful to have another pregnancy terminate in disappointment. Therefore, the women manage their feelings by distancing themselves from their pregnancies. Simultaneously, they are managing their emotions by seeking affirmation that their current pregnancy is normal.

    Conclusion: Generally speaking, women manage their emotions by themselves. They feel isolated with their worries and concerns, and they are in need of the support provided from their intimate circle of friends and family as well as from the staff of the maternity health care ward. Unfortunately, the women do not feel that they get the support they need from the staff, instead they have to rely on their friends, family and partners to help them manage their emotions.

  • 36.
    Andersson, John
    et al.
    Scandinavian Surgical Outcomes Research Group, Department of Surgery, Sahlgrenska University Hospital/Östra, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden ; Department of Surgery, Alingsås Hospital, Alingsås, Sweden.
    Abis, G
    Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands.
    Gellerstedt, Martin
    Scandinavian Surgical Outcomes Research Group, Department of Surgery, Sahlgrenska University Hospital/Östra, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
    Angenete, Eva
    Scandinavian Surgical Outcomes Research Group, Department of Surgery, Sahlgrenska University Hospital/Östra, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
    Angerås, Ulf
    Scandinavian Surgical Outcomes Research Group, Department of Surgery, Sahlgrenska University Hospital/Östra, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
    Cuesta, M. A.
    Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands.
    Jess, P
    Roskilde Hospital, Roskilde, Denmark.
    Rosenberg, Jakob
    Herlev Hospital, Copenhagen University, Copenhagen, Denmark.
    Bonjer, H. J.
    Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands.
    Haglind, Eva
    Scandinavian Surgical Outcomes Research Group, Department of Surgery, Sahlgrenska University Hospital/Östra, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
    Patient-reported genitourinary dysfunction after laparoscopic and open rectal cancer surgery in a randomized trial (COLOR II)2014In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 101, no 10, p. 1272-1279Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: This article reports on patient-reported sexual dysfunction and micturition symptoms following a randomized trial of laparoscopic and open surgery for rectal cancer.

    METHODS: Patients in the COLOR II randomized trial, comparing laparoscopic and open surgery for rectal cancer, completed the European Organization for Research and Treatment of Cancer (EORTC) QLQ-CR38 questionnaire before surgery, and after 4 weeks, 6, 12 and 24 months. Adjusted mean differences on a 100-point scale were calculated using changes from baseline value at the various time points in the domains of sexual functioning, sexual enjoyment, male and female sexual problems, and micturition symptoms.

    RESULTS: Of 617 randomized patients, 385 completed this phase of the trial. Their mean age was 67·1 years. Surgery caused an anticipated reduction in genitourinary function after 4 weeks, with no significant differences between laparoscopic and open approaches. An improvement in sexual dysfunction was seen in the first year, but some male sexual problems persisted. Before operation 64·5 per cent of men in the laparoscopic group and 55·6 per cent in the open group reported some degree of erectile dysfunction. This increased to 81·1 and 80·5 per cent respectively 4 weeks after surgery, and 76·3 versus 75·5 per cent at 12 months, with no significant differences between groups. Micturition symptoms were less affected than sexual function and gradually improved to preoperative levels by 6 months. Adjusting for confounders, including radiotherapy, did not change these results.

    CONCLUSION: Sexual dysfunction is common in patients with rectal cancer, and treatment (including surgery) increases the proportion of patients affected. A laparoscopic approach does not change this.

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  • 37.
    Andersson, John
    et al.
    Department of General and Orthopaedic Surgery, Alingsås Hospital, Sweden ; Department of Surgery, SSORG - Scandinavian Surgical Outcomes Research Group, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.
    Angenete, Eva
    Department of Surgery, SSORG - Scandinavian Surgical Outcomes Research Group, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden ; Department of Surgery, Region Västra Götaland, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
    Gellerstedt, Martin
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Haglind, Eva
    Department of Surgery, SSORG - Scandinavian Surgical Outcomes Research Group, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden ; Department of Surgery, Region Västra Götaland, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
    Developing a multivariable prediction model of global health-related quality of life in patients treated for rectal cancer: a prospective study in five countries2024In: International Journal of Colorectal Disease, ISSN 0179-1958, E-ISSN 1432-1262, Vol. 39, article id 35Article in journal (Refereed)
    Abstract [en]

    Purpose Rectal cancer and its treatment have a negative impact on health-related quality of life (HRQoL). If risk factors for sustained low HRQoL could be identified early, ideally before the start of treatment, individualised interventions could be identified and implemented to maintain or improve HRQoL. The study aimed to develop a multivariable prediction model for global HRQoL 12 months after rectal cancer treatment.

    Methods Within COLOR II, a randomised, multicentre, international trial of laparoscopic and open surgery for rectal cancer, a sub-study on HRQoL included 385 patients in 12 hospitals and five countries. The HRQoL study was optional for hospitals in the COLOR II trial. EORTC QLQ-C30 and EORTC QLQ-CR38 were analysed preoperatively and at 1 and 12 months postoperatively. In exploratory analyses, correlations between age, sex, fatigue, pain, ASA classification, complications, and symptoms after surgery to HRQoL were studied. Bivariate initial analyses were followed by multivariate regression models.

    Results Patient characteristics and clinical factors explained 4–10% of the variation in global HRQoL. The patient-reported outcomes from EORTC QLQ-C30 explained 55–65% of the variation in global HRQoL. The predominant predictors were fatigue and pain, which significantly impacted global HRQoL at all time points measured.

    Conclusion We found that fatigue and pain were two significant factors associated with posttreatment global HRQoL in patients treated for rectal cancer T1-T3 Nx. Interventions to reduce fatigue and pain could enhance global HRQoL after rectal cancer treatment.

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  • 38.
    Andersson, Susanne
    et al.
    University of Skövde, School of Life Sciences. Institute of Health and Care Sciences, The Sahlgrenska Academy of the University of Gothenburg, Gothenburg, Sweden.
    Ekman, Inger
    Institute of Health and Care Sciences, The Sahlgrenska Academy of the University of Gothenburg, Gothenburg, Sweden / Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.
    Friberg, Febe
    Institute of Health and Care Sciences, The Sahlgrenska Academy of the University of Gothenburg, Gothenburg, Sweden / Faculty of Social Sciences, Department of Health, University of Stavanger, Stavanger, Norway.
    Bøg-Hansen, Erik
    Institute of Medicine, Department of Primary Health Care, The Sahlgrenska Academy of the University of Gothenburg, Gothenburg, Sweden.
    Lindblad, Ulf
    Institute of Medicine, Department of Primary Health Care, The Sahlgrenska Academy of the University of Gothenburg, Gothenburg, Sweden / The Department of primary health care, University of Gothenburg, Gothenburg, Sweden.
    The association between self-reported lack of sleep, low vitality and impaired glucose tolerance: A Swedish cross-sectional study2013In: BMC Public Health, E-ISSN 1471-2458, Vol. 13, no 1, article id 700Article in journal (Refereed)
    Abstract [en]

    Background: The increased incidence of impaired glucose tolerance (IGT), are serious public health issues, and several studies link sleeping disorders with increased risk of developing type 2 diabetes, impaired glucose tolerance and insulin resistance (IR). This study explore how self-reported lack of sleep and low vitality, are associated with IGT in a representative Swedish population. Methods. A cross-sectional survey conducted in two municipalities in South-western Sweden. Participants aged 30-75 were randomly selected from the population in strata by sex and age. Altogether, 2,816 participants were surveyed with a participation rates at 76%. Participants with normal glucose tolerance (n=2,314), and those with IGT (n=213) were retained for analyses. The participants answered a questionnaire before the oral glucose tolerance test (OGTT). Associations for questions concerning sleeping disorders, vitality and IGT were analysed using logistic regression and were expressed as odds ratios (OR) with 95% CI. Results: In men a statistically significant age-adjusted association was found between self-reported lack of sleep and IGT: OR 2.4 (95% CI: 1.1-5.4). It did not weaken after further adjustment for body mass index (BMI), smoking, education, and leisure time physical activity 2.3 (1.0-5.5, p=0.044). No such associations were found in females. Corresponding age-adjusted associations between low vitality and IGT in both men 2.8 (1.3-5.8), and women 2.0 (1.2-3.4) were successively lost with increasing adjustment. Conclusions: Insufficient sleep seems independently associated with IGT in men, while low vitality was not independently associated with IGT neither in men nor women, when multiple confounders are considered. IGT should be considered in patients presenting these symptoms, and underlying mechanisms further explored. © 2013 Andersson et al.; licensee BioMed Central Ltd.

  • 39.
    Andersson, Susanne
    et al.
    University of Skövde, School of Life Sciences. Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Sweden.
    Ekman, Inger
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden / University of Gothenburg, Centre for Person-Centred Care (GPCC), Sweden.
    Friberg, Febe
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden / Faculty of Social Sciences, Department of Health, University of Stavanger, Norway.
    Daka, Bledar
    Insitute of Medicine, Department of Primary Health Care, University of Gothenburg, Sahlgrenska Academy, Sweden.
    Lindblad, Ulf
    Insitute of Medicine, Department of Primary Health Care, University of Gothenburg, Sahlgrenska Academy, Sweden.
    Larsson, Charlotte A.
    Insitute of Medicine, Department of Primary Health Care, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden / University of Lund, Department of Clinical Sciences, Malmö, Social Medicine and Global Health, Sweden.
    The association between self-rated health and impaired glucose tolerance in Swedish adults: A cross-sectional study2013In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 31, no 2, p. 111-118Article in journal (Refereed)
    Abstract [en]

    Objective. To investigate gender differences in the association between self-rated health (SRH) and impaired glucose tolerance (IGT) in subjects unaware of their glucose tolerance. Design. A cross-sectional population-based study. Setting. The two municipalities of Vara and Skovde in south-western Sweden. Subjects. A total of 2502 participants (1301 women and 1201 men), aged 30-75, were randomly selected from the population. Main outcome measures. IGT was regarded as the outcome measure and SRH as the main risk factor. Results. The prevalence of IGT was significantly higher in women (11.9%) than in men (10.1%), (p = 0.029), as was the prevalence of low SRH (women: 35.4%; men: 22.1%, p = 0.006). Both men and women with low SRH had a poorer risk factor profile than those with high SRH, and a statistically significant crude association between SRH and IGT was found in both men (OR = 2.8, 95% CI 1.8-4.4) and women (OR = 1.5, 95% CI 1.0-2.2, p = 0.033). However, after controlling for several lifestyle factors and biomedical variables, the association was attenuated and remained statistically significant solely in men (OR = 2.3, 95% CI 1.2-4.3). Conclusion. The gender-specific associations found between SRH and IGT suggest that SRH may be a better indicator of IGT in men than in women. Future studies should evaluate the utility of SRH in comparison with objective health measures as a potential aid to health practitioners when deciding whether to screen for IGT and T2DM.

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  • 40.
    Andersson, Susanne
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Karlsson, Veronika
    Department of Health Sciences, University West, Trollhättan, Sweden.
    Bennet, Louise
    Center for Primary Health Care Research, Family Medicine, Department of Clinical Sciences, Lund University, Malmö, Sweden.
    Fellbrant, Klas
    Family Medicine, Department of Primary Health Care, Skövde, Sweden.
    Hellgren, Margareta
    Institute of Medicine, Department of Primary Health Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Attitudes Regarding Participation in a Diabetes Screening Test among an Assyrian Immigrant Population in Sweden2016In: Nursing Research and Practice, ISSN 2090-1429, E-ISSN 2090-1437, article id 1504530Article in journal (Refereed)
    Abstract [en]

    Immigrants from the Middle East have higher prevalence and incidence of type 2 diabetes (T2D) compared with native Swedes. The aim of the study was to describe and understand health beliefs in relation to T2D as well as attitudes regarding participation in a screening process in a local group of Assyrian immigrants living in Sweden. A qualitative and quantitative method was chosen in which 43 individuals participated in a health check-up and 13 agreed to be interviewed. Interviews were conducted, anthropometric measurements and blood tests were collected, and an oral glucose tolerance test was performed. In total, 13 of the 43 participants were diagnosed with impaired glucose metabolism, 4 of these 13 had TD2. The interviewed participants perceived that screening was an opportunity to discover more about their health and to care for themselves and their families. Nevertheless, they were not necessarily committed to taking action as a consequence of the screening. Instead, they professed that their health was not solely in their own hands and that they felt safe that God would provide for them. Assyrians' background and religion affect their health beliefs and willingness to participate in screening for TD2.

  • 41.
    Angenete, Eva
    et al.
    Scandinavian Surgical Outcomes Research Group, Department of Surgery, Sahlgrenska University Hospital/Östra, University of Gothenburg, Gothenburg, Sweden.
    Jacobsson, Anders
    Swedish National Board of Health and Welfare, Stockholm, Sweden.
    Gellerstedt, Martin
    Scandinavian Surgical Outcomes Research Group, Department of Surgery, Sahlgrenska University Hospital/Östra, University of Gothenburg, Gothenburg, Sweden.
    Haglind, Eva
    Scandinavian Surgical Outcomes Research Group, Department of Surgery, Sahlgrenska University Hospital/Östra, University of Gothenburg, Gothenburg, Sweden.
    Effect of Laparoscopy on the Risk of Small-Bowel Obstruction: A Population-Based Register Study2012In: Archives of surgery (Chicago. 1960), ISSN 0004-0010, E-ISSN 1538-3644, Vol. 147, no 4, p. 359-365Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate the incidence and risk factors for small-bowel obstruction (SBO) after certain surgical procedures.

    Design: A population-based retrospective register study.

    Setting: Small-bowel obstruction causes considerable patient suffering. Risk factors for SBO have been identified, but the effect of surgical technique (open vs laparoscopic) on the incidence of SBO has not been fully elucidated.

    Patients: The Inpatient Register held by the Swedish National Board of Health and Welfare was used. The hospital discharge diagnoses and registered performed surgical procedures identified data for cholecystectomy, hysterectomy, salpingo-oophorectomy, bowel resection, anterior resection, abdominoperineal resection, rectopexy, appendectomy, and bariatric surgery performed from January 1, 2002, through December 31, 2004. Data on demographic characteristics, comorbidity, previous abdominal surgery, and death were collected.

    Main Outcome Measures: Episodes of hospital stay and surgery for SBO within 5 years after the index surgery.

    Results: A total of 108 141 patients were included. The incidence of SBO ranged from 0.4% to 13.9%. Multivariate analysis revealed age, previous surgery, comorbidity, and surgical technique to be risk factors for SBO. Laparoscopy exceeded other risk factors in reduction of the risk of SBO for most of the surgical procedures.

    Conclusions: Open surgery seems to increase the risk of SBO at least 4 times compared with laparoscopy for most of the abdominal surgical procedures studied. Other factors such as age, previous abdominal surgery, and comorbidity are also of importance

  • 42.
    Arnoldussen, Ilse A. C.
    et al.
    Department of Anatomy, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands / Radboud Alzheimer Center, Radboud University Medical Center, Nijmegen, the Netherlands.
    Gustafson, Deborah R.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Neurology, The State University of New York Downstate Health Sciences University, Brooklyn, USA.
    Leijsen, Esther M. C.
    Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands.
    de Leeuw, Frank-Erik
    Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands.
    Kiliaan, Amanda J.
    Department of Anatomy, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands / Radboud Alzheimer Center, Radboud University Medical Center, Nijmegen, the Netherlands.
    Adiposity is related to cerebrovascular and brain volumetry outcomes in the RUN DMC study2019In: Neurology, ISSN 0028-3878, E-ISSN 1526-632X, Vol. 93, no 9, p. e864-e878Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Adiposity predictors, body mass index (BMI), waist circumference (WC), and blood leptin and total adiponectin levels were associated with components of cerebral small vessel disease (CSVD) and brain volumetry in 503 adults with CSVD who were ≥50 years of age and enrolled in the Radboud University Nijmegen Diffusion Tensor and Magnetic Resonance Imaging Cohort (RUN DMC).

    METHODS: RUN DMC participants were followed up for 9 years (2006-2015). BMI, WC, brain imaging, and dementia diagnoses were evaluated at baseline and follow-up. Adipokines were measured at baseline. Brain imaging outcomes included CSVD components, white matter hyperintensities, lacunes, microbleeds, gray and white matter, hippocampal, total brain, and intracranial volumes.

    RESULTS: Cross-sectionally among men at baseline, higher BMI, WC, and leptin were associated with lower gray matter and total brain volumes, and higher BMI and WC were associated with lower hippocampal volume. At follow-up 9 years later, higher BMI was cross-sectionally associated with lower gray matter volume, and an obese WC (>102 cm) was protective for ≥1 lacune or ≥1 microbleed in men. In women, increasing BMI and overweight or obesity (BMI ≥25 kg/m2 or WC >88 cm) were associated with ≥1 lacune. Longitudinally, over 9 years, a baseline obese WC was associated with decreasing hippocampal volume, particularly in men, and increasing white matter hyperintensity volume in women and men.

    CONCLUSIONS: Anthropometric and metabolic adiposity predictors were differentially associated with CSVD components and brain volumetry outcomes by sex. Higher adiposity is associated with a vascular-neurodegenerative spectrum among adults at risk for vascular forms of cognitive impairment and dementias.

  • 43.
    Arnoldussen, Ilse A. C.
    et al.
    Department of Anatomy, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands.
    Sundh, Valter
    Neuropsychiatric Epidemiology Unit, Sahlgrenska Academy at University of Gothenburg, Institute for Neuroscience and Physiology, Gothenburg, Sweden.
    Bäckman, Kristoffer
    Neuropsychiatric Epidemiology Unit, Sahlgrenska Academy at University of Gothenburg, Institute for Neuroscience and Physiology, Gothenburg, Sweden.
    Kern, Silke
    Neuropsychiatric Epidemiology Unit, Sahlgrenska Academy at University of Gothenburg, Institute for Neuroscience and Physiology, Gothenburg, Sweden.
    Östling, Svante
    Neuropsychiatric Epidemiology Unit, Sahlgrenska Academy at University of Gothenburg, Institute for Neuroscience and Physiology, Gothenburg, Sweden.
    Blennow, Kaj
    Neuropsychiatric Epidemiology Unit, Sahlgrenska Academy at University of Gothenburg, Institute for Neuroscience and Physiology, Gothenburg, Sweden.
    Zetterberg, Henrik
    Neuropsychiatric Epidemiology Unit, Sahlgrenska Academy at University of Gothenburg, Institute for Neuroscience and Physiology, Gothenburg, Sweden.
    Skoog, Ingmar
    Neuropsychiatric Epidemiology Unit, Sahlgrenska Academy at University of Gothenburg, Institute for Neuroscience and Physiology, Gothenburg, Sweden.
    Kiliaan, Amanda J.
    Department of Anatomy, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands.
    Gustafson, Deborah R.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Neurology, State University of New York, Downstate Medical Center, Brooklyn, NY, USA / Neuropsychiatric Epidemiology Unit, Sahlgrenska Academy at University of Gothenburg, Institute for Neuroscience and Physiology, Gothenburg, Sweden.
    A 10-Year Follow-Up of Adiposity and Dementia in Swedish Adults Aged 70 Years and Older2018In: Journal of Alzheimer's Disease, ISSN 1387-2877, E-ISSN 1875-8908, Vol. 63, no 4, p. 1325-1335Article in journal (Refereed)
    Abstract [en]

    Background: Adiposity measured in mid-or late-life and estimated using anthropometric measures such as body mass index (BMI) and waist-to-hip ratio (WHR), or metabolic markers such as blood leptin and adiponectin levels, is associated with late-onset dementia risk. However, during later life, this association may reverse and aging- and dementia-related processes may differentially affect adiposity measures.

    Objective: We explored associations of concurrent BMI, WHR, and blood leptin and high molecular weight adiponectin levels with dementia occurrence.

    Methods: 924 Swedish community-dwelling elderly without dementia, aged 70 years and older, systematically-sampled by birth day and birth year population-based in the Gothenburg city region of Sweden. The Gothenburg Birth Cohort Studies are designed for evaluating risk and protective factors for dementia. All dementias diagnosed after age 70 for 10 years were identified. Multivariable logistic regression models were used to predict dementia occurrence between 2000-2005, 2005-2010, and 2000-2010 after excluding prevalent baseline (year 2000) dementias. Baseline levels of BMI, WHR, leptin, and adiponectin were used.

    Results: Within 5 years of baseline, low BMI (<20 kg/m(2)) was associated with higher odds of dementia compared to those in the healthy BMI category (>= 20-24.9 kg/m(2)). Compared to the lowest quartile, leptin levels in the second quartile were associated with lower odds of dementia in women (p < 0.05).

    Conclusion: In late-life, anthropometric and metabolic adiposity measures appear to be differentially associated with dementia risk. While BMI and leptin levels are highly positively correlated, our results show that their association with dementia at age >= 70 years, is asynchronous. These data suggest that with aging, the complexity of the adiposity exposure may increase and suggests metabolic dysregulation. Additional studies are needed to better understand this complexity.

  • 44.
    Asp, Julia
    et al.
    Department of Clinical Chemistry and Transfusion Medicine, Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg, Sweden.
    Synnergren, Jane
    University of Skövde, School of Life Sciences. University of Skövde, The Systems Biology Research Centre.
    Jonsson, Marianne
    Department of Clinical Chemistry and Transfusion Medicine, Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg, Sweden.
    Dellgren, Goran
    Department of Molecular and Clinical Medicine, the Sahlgrenska Academy, University of Gothenburg, Sweden ; Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Jeppsson, Anders
    Department of Molecular and Clinical Medicine, the Sahlgrenska Academy, University of Gothenburg, Sweden ; Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Comparison of human cardiac gene expression profiles in paired samples of right atrium and left ventricle collected in vivo2012In: Physiological Genomics, ISSN 1094-8341, E-ISSN 1531-2267, Vol. 44, no 1, p. 89-98Article in journal (Refereed)
    Abstract [en]

    Studies of expressed genes in human heart provide insight into both physiological and pathophysiological mechanisms. This is of importance for extended understanding of cardiac function as well as development of new therapeutic drugs. Heart tissue for gene expression studies is generally hard to obtain, particularly from the ventricles. Since different parts of the heart have different functions, expression profiles should likely differ between these parts. The aim of the study was therefore to compare the global gene expression in cardiac tissue from the more accessible auricula of the right atrium to expression in tissue from the left ventricle. Tissue samples were collected from five men undergoing aortic valve replacement or coronary artery bypass grafting. Global gene expression analysis identified 542 genes as differentially expressed between the samples extracted from these two locations, corresponding to similar to 2% of the genes covered by the microarray; 416 genes were identified as abundantly expressed in right atrium, and 126 genes were abundantly expressed in left ventricle. Further analysis of the differentially expressed genes according to available annotations, information from curated pathways and known protein interactions, showed that genes with higher expression in the ventricle were mainly associated with contractile work of the heart. Transcription in biopsies from the auricula of the right atrium on the other hand indicated a wider area of functions, including immunity and defense. In conclusion, our results suggest that biopsies from the auricula of the right atrium may be suitable for various genetic studies, but not studies directly related to muscle work.

  • 45.
    Awe, Julius Adebayo
    et al.
    University of Skövde, School of Health and Education. Manitoba Institute of Cell Biology, University of Manitoba, CancerCare Manitoba, Winnipeg, Manitoba, Canada / Department of Clinical Genetics, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Saranchuk, Jeff
    Department of Surgery, Manitoba Prostate Center, University of Manitoba, Winnipeg, Manitoba, Canada.
    Drachenberg, Darrel
    Department of Surgery, Manitoba Prostate Center, University of Manitoba, Winnipeg, Manitoba, Canada.
    Mai, Sabine
    Manitoba Institute of Cell Biology, University of Manitoba, CancerCare Manitoba, Winnipeg, Manitoba, Canada.
    Filtration-based enrichment of circulating tumor cells from all prostate cancer risk groups2017In: Urologic Oncology, ISSN 1078-1439, E-ISSN 1873-2496, Vol. 35, no 5, p. 300-309Article in journal (Refereed)
    Abstract [en]

    Objective: To combine circulating tumor cell (CTC) isolation by filtration and immunohistochemistry to investigate the presence of CTCs in low, intermediate, and high-risk prostate cancer (PCa). CTCs isolated from these risk groups stained positive for both cytokeratin and androgen receptors, but negative for CD45.

    Patients and methods: Blood samples from 41 biopsy confirmed patients with PCa at different clinical stages such as low, intermediate, and high risk were analyzed. The samples were processed with the ScreenCell filtration device and PCa CTCs were captured for all patients. The isolated CTCs were confirmed PCa CTCs by the presence of androgen receptors and cytokeratins 8, 18, and 19 that occurred in the absence of CD45 positivity. PCa CTC nuclear sizes were measured using the TeloView program.

    Results: The filtration-based isolation method used permitted the measurement of the average nuclear size of the captured CTCs. CTCs were identified by immunohistochemistry in low, intermediate, and high-risk groups of patients with PCa.

    Conclusion: CTCs may be found in all stages of PCa. These CTCs can be used to determine the level of genomic instability at any stage of PCa; this will, in the future, enable personalized patient management. 

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  • 46.
    Awe, Julius Adebayo
    et al.
    University of Skövde, School of Life Sciences. University of Skövde, The Systems Biology Research Centre. University of Manitoba, CancerCare Manitoba, Canada ; Sahlgrenska Academy, University of Gothenburg, Sweden.
    Xu, Mark Chu
    University of Manitoba, CancerCare Manitoba, Canada.
    Wechsler, Janine
    ScreenCell, Paris, France ; Hôpital Henri Mondor, Créteil, France.
    Benali-Furet, Naoual
    ScreenCell, Paris, France.
    Cayre, Yvon E
    ScreenCell, Paris, France ; Hôpital Robert Debré and Pierre, Marie Curie University, Paris, France.
    Saranchuk, Jeff
    University of Manitoba, Canada.
    Drachenberg, Darrel
    University of Manitoba, Canada.
    Mai, Sabine
    University of Manitoba, CancerCare Manitoba, Canada.
    Three-Dimensional Telomeric Analysis of Isolated Circulating Tumor Cells (CTCs) Defines CTC Subpopulations2013In: Translational Oncology, ISSN 1944-7124, E-ISSN 1936-5233, Vol. 6, no 1, p. 51-65Article in journal (Refereed)
    Abstract [en]

    Circulating tumor cells (CTCs) have been identified with the potential to serve as suitable biomarkers for tumor stage and progression, but the availability of effective isolation technique(s) coupled with detailed molecular characterization have been the challenges encountered in making CTCs clinically relevant. For the first time, we combined isolation of CTCs using the ScreenCell filtration technique with quantitative analysis of CTC telomeres by TeloView. This resulted in the identification and molecular characterization of different subpopulations of CTCs in the same patient. Three-dimensional (3D) telomeric analysis was carried out on isolated CTCs of 19 patients that consisted of four different tumor types, namely, prostate, colon, breast, melanoma, and one lung cancer cell line. With telomeric analysis of the filter-isolated CTCs, the level of chromosomal instability (CIN) of the CTCs can be determined. Our study shows that subpopulations of CTCs can be identified on the basis of their 3D telomeric properties.

  • 47.
    Axelsson, K. F.
    et al.
    Department of Orthopaedic Surgery, Skaraborg Hospital, Skövde, Sweden / Geriatric Medicine, Institute of Medicine, University of Gothenburg, Sahlgrenska University Hospital, Mölndal, Sweden / Center for Bone Research at the Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Jacobsson, R.
    Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
    Lundh, Dan
    University of Skövde, School of Bioscience. University of Skövde, Health and Education.
    Lorentzon, M.
    Geriatric Medicine, Institute of Medicine, University of Gothenburg, Sahlgrenska University Hospital, Mölndal, Sweden / Center for Bone Research at the Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Effectiveness of a minimal resource fracture liaison service2016In: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 27, no 11, p. 3165-3175Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The purpose of this study was to investigate if a 2-year intervention with a minimal resource fracture liaison service (FLS) was associated with increased investigation and medical treatment and if treatment was related to reduced re-fracture risk.

    METHODS: The FLS started in 2013 using existing secretaries (without an FLS coordinator) at the emergency department and orthopaedic wards to identify risk patients. All patients older than 50 years of age with a fractured hip, vertebra, shoulder, wrist or pelvis were followed during 2013-2014 (n = 2713) and compared with their historic counterparts in 2011-2012 (n = 2616) at the same hospital. Re-fractures were X-ray verified. A time-dependent adjusted (for age, sex, previous fracture, index fracture type, prevalent treatment, comorbidity and secondary osteoporosis) Cox model was used.

    RESULTS: The minimal resource FLS increased the proportion of DXA-investigated patients after fracture from 7.6 to 39.6 % (p < 0.001) and the treatment rate after fracture from 12.6 to 31.8 %, which is well in line with FLS types using the conventional coordinator model. Treated patients had a 51 % lower risk of any re-fracture than untreated patients (HR 0.49, 95 % CI 0.37-0.65 p < 0.001).

    CONCLUSIONS: We found that our minimal resource FLS was effective in increasing investigation and treatment, in line with conventional coordinator-based services, and that treated patients had a 51 % reduced risk of new fractures, indicating that also non-coordinator based fracture liaison services can improve secondary prevention of fractures.

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  • 48.
    Axelsson, K. F.
    et al.
    Department of Orthopaedic Surgery, Skaraborg Hospital, Skövde, Sweden / Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Wallander, M.
    Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden / Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden.
    Johansson, H.
    Institute for Health and Ageing, Catholic University of Australia, Melbourne, Vic., Australia.
    Lundh, Dan
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Lorentzon, M.
    Geriatric Medicine, Department of Internal Medicine and ClinicalNutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden / Geriatric Medicine, Sahlgrenska University Hospital, Mölndal, Sweden.
    Hip fracture risk and safety with alendronate treatment in the oldest-old2017In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 282, no 6, p. 546-559Article in journal (Refereed)
    Abstract [en]

    Background. There is high evidence for secondary prevention of fractures, including hip fracture, with alendronate treatment, but alendronate's efficacy to prevent hip fractures in the oldest-old (80 years old), the population with the highest fracture risk, has not been studied. Objective. To investigate whether alendronate treatment amongst the oldest-old with prior fracture was related to decreased hip fracture rate and sustained safety. Methods. Using a national database of men and women undergoing a fall risk assessment at a Swedish healthcare facility, we identified 90 795 patients who were 80 years or older and had a prior fracture. Propensity score matching (four to one) was then used to identify 7844 controls to 1961 alendronate-treated patients. The risk of incident hip fracture was investigated with Cox models and the interaction between age and treatment was investigated using an interaction term. Results. The case and control groups were well balanced in regard to age, sex, anthropometrics and comorbidity. Alendronate treatment was associated with a decreased risk of hip fracture in crude (hazard ratio (HR) 0.62 (0.49-0.79), P < 0.001) and multivariable models (HR 0.66 (0.51-0.86), P < 0.01). Alendronate was related to reduced mortality risk (HR 0.88 (0.82-0.95) but increased risk of mild upper gastrointestinal symptoms (UGI) (HR 1.58 (1.12-2.24). The alendronate association did not change with age for hip fractures or mild UGI. Conclusion. In old patients with prior fracture, alendronate treatment reduces the risk of hip fracture with sustained safety, indicating that this treatment should be considered in these high-risk patients.

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  • 49.
    Axelsson, Kristian F.
    et al.
    Department of Orthopaedic Surgery, Skaraborg Hospital, Skövde, Sweden / Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Sweden.
    Nilsson, Anna G.
    Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Sweden / Department of Endocrinology, Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Wedel, Hans
    Health Metrics, Sahlgrenska Academy, University of Gothenburg, Sweden.
    Lundh, Dan
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Lorentzon, Mattias
    Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Sweden / Geriatric Medicine, Sahlgrenska University Hospital, Mölndal, Sweden.
    Association between alendronate use and hip fracture risk in older patients using oral prednisolone2017In: Journal of the American Medical Association (JAMA), ISSN 0098-7484, E-ISSN 1538-3598, Vol. 318, no 2, p. 146-155Article in journal (Refereed)
    Abstract [en]

    Importance  Oral glucocorticoid treatment increases fracture risk, and evidence is lacking regarding the efficacy of alendronate to protect against hip fracture in older patients using glucocorticoids.Objective  To investigate whether alendronate treatment in older patients using oral prednisolone is associated with decreased hip fracture risk and adverse effects.Design, Setting, and Participants  Retrospective cohort study using a national database (N = 433 195) of patients aged 65 years or older undergoing a health evaluation (baseline) at Swedish health care facilities; 1802 patients who were prescribed alendronate after at least 3 months of oral prednisolone treatment (≥5 mg/d) were identified. Propensity score matching was used to select 1802 patients without alendronate use from 6076 patients taking prednisolone with the same dose and treatment time criteria. Follow-up occurred between January 2008 and December 2014.Exposures  Alendronate vs no alendronate use; no patients had previously taken alendronate at the time of prednisolone initiation.Main Outcomes and Measures  The primary outcome was incident hip fracture.Results  Of the 3604 included patients, the mean age was 79.9 (SD, 7.5) years, and 2524 (70%) were women. After a median follow-up of 1.32 years (interquartile range, 0.57-2.34 years), there were 27 hip fractures in the alendronate group and 73 in the no-alendronate group, corresponding to incidence rates of 9.5 (95% CI, 6.5-13.9) and 27.2 (95% CI, 21.6-34.2) fractures per 1000 person-years, with an absolute rate difference of −17.6 (95% CI, −24.8 to −10.4). The use of alendronate was associated with a lower risk of hip fracture in a multivariable-adjusted Cox model (hazard ratio, 0.35; 95% CI, 0.22-0.54). Alendronate treatment was not associated with increased risk of mild upper gastrointestinal tract symptoms (alendronate vs no alendronate, 15.6 [95% CI, 11.6-21.0] vs 12.9 [95% CI, 9.3-18.0] per 1000 person-years; P = .40) or peptic ulcers (10.9 [95% CI, 7.7-15.5] vs 11.4 [95% CI, 8.0-16.2] per 1000 person-years; P = .86). There were no cases of incident drug-induced osteonecrosis and only 1 case of femoral shaft fracture in each group.Conclusions and Relevance  Among older patients using medium to high doses of prednisolone, alendronate treatment was associated with a significantly lower risk of hip fracture over a median of 1.32 years. Although the findings are limited by the observational study design and the small number of events, these results support the use of alendronate in this patient group.

  • 50.
    Axelsson, Kristian F.
    et al.
    Skaraborg Hospital, Skövde, Sweden / University of Gothenburg, Sweden.
    Werling, Malin
    Sahlgrenska Academy, University of Gothenburg, Sweden.
    Eliasson, Björn
    Sahlgrenska Academy, University of Gothenburg, Sweden.
    Szabo, Eva
    Örebro University, Sweden.
    Näslund, Ingmar
    Örebro University, Sweden.
    Wedel, Hans
    Sahlgrenska Academy, University of Gothenburg, Sweden.
    Lundh, Dan
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Lorentzon, Mattias
    University of Gothenburg, Sweden / Sahlgrenska University Hospital, Mölndal, Sweden.
    Fracture risk after gastric bypass surgery – a retrospective cohort study2018In: Journal of Bone and Mineral Research, ISSN 0884-0431, E-ISSN 1523-4681, Vol. 33, no 12, p. 2122-2131Article in journal (Refereed)
    Abstract [en]

    Gastric bypass surgery constitutes the most common and effective bariatric surgery to treat obesity. Gastric bypass leads to bone loss, but fracture risk following surgery has been insufficiently studied. Furthermore, the association between gastric bypass and fracture risk has not been studied in patients with diabetes, which is a risk factor for fracture and affected by surgery. In this retrospective cohort study using Swedish national databases, 38 971 obese patients undergoing gastric bypass were identified, 7758 with diabetes and 31 213 without. An equal amount of well-balanced controls were identified through multivariable 1:1 propensity score matching. The risk of fracture and fall injury was investigated using Cox proportional hazards and flexible parameter models. Fracture risk according to weight loss and degree of calcium and vitamin D supplementation one-year post- surgery was investigated. During a median follow-up time of 3.1 (IQR 1.7-4.6) years, gastric bypass was associated with increased risk of any fracture, in patients with and without diabetes using a multivariable Cox model (HR 1.26, 95% CI 1.05- 1.53 and HR 1.32, 95% CI 1.18-1.47, respectively). Using flexible parameter models, the fracture risk appeared to increase with time. The risk of fall injury without fracture was also increased after gastric bypass. Larger weight loss or poor calcium and vitamin D supplementation after surgery were not associated with increased fracture risk. In conclusion, gastric bypass surgery is associated with an increased fracture risk, which appears to be increasing with time and not associated with degree of weight loss or calcium and vitamin D supplementation following surgery. An increased risk of fall injury was seen after surgery, which could contribute to the increased fracture risk. This article is protected by copyright. All rights reserved.

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