Adjunct corticosteroid treatment in patients with pneumonia: A precision medicine approach

Pneumonia is the leading infectious cause of death worldwide. While inflammation is critically important in host response to microbial invasion, exaggerated inflammation can damage the lungs, contributing to respiratory failure and mortality. Corticosteroids are effective in reducing inflammation and can also cause immune suppression. Presently, clinicians are unable to reliably distinguish between exaggerated and appropriate immune response and thus cannot rapidly identify patients most likely to benefit from adjunctive corticosteroids. In this review, we propose a biomarker-guided, precision medicine approach to corticosteroid treatment, aimed to give these medications at appropriate dose and time and only to patients who have exaggerated inflammation

Psychological Co-morbidity in Functional Gastrointestinal Disorders: Epidemiology, Mechanisms and Management

Functional gastrointestinal disorder (FGID) is one of the commonest digestive diseases worldwide and leads to significant morbidity and burden on healthcare resource. The putative bio-psycho-social pathophysiological model for FGID underscores the importance of psychological distress in the pathogenesis of FGID. Concomitant psychological disorders, notably anxiety and depressive disorders, are strongly associated with FGID and these psychological co-morbidities correlate with severity of FGID symptoms. Early life adversity such as sexual and physical abuse is more commonly reported in patients with FGID. There is mounting evidence showing that psychological disorders are commonly associated with abnormal central processing of visceral noxious stimuli. The possible causal link between psychological disorders and FGID involves functional abnormalities in various components of the brain-gut axis, which include hypothalamic-pituitary-adrenal system, sympathetic and parasympathetic nervous system, serotonergic and endocannabinoid systems. Moreover, recent studies have also shown that psychological distress may alter the systemic and gut immunity, which is increasingly recognized as a pathophysiologic feature of FGID. Psychotropic agent, in particular antidepressant, and psychological intervention such as cognitive behavioral therapy and meditation have been reported to be effective for alleviation of gastrointestinal symptoms and quality of life in FGID patients. Further studies are needed to evaluate the impact of early detection and management of co-morbid psychological disorders on the long-term clinical outcome and disease course of FGID

T is associated with severe dyspepsia

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Etniska vänner - Politiska fiender

Arbetet ämnar förklara varför relationerna mellan bosniaker och kroater har sett utsom de har. Arbetet försöker med hjälp av instrumentalism, primordialism ochkonstruktivism förklara hur identiteten samt relationerna mellan kroater och bosniakerhar varierat under tidsperioden 1939-1994. Arbetet syftar även till att undersöka vilkenteori som bäst hjälper oss förstå varför identiteten och relationerna mellan kroater ochbosniaker har varierat. Arbetet analyserar relationerna mellan kroater och bosniakermed hjälp av idealtyper och kommer fram till att samtliga teorier behövs om man villförstå kroaters och bosniakers relationer åren 1939-1994. Arbetet kommer även framtill att instrumentalismens idealtyp kommer närmast händelseförloppet

Bosniska ungdomar i Sverige : en kvalitativ studie om bosniska ungdomars upplevelse och hantering av sin livssituation i Sverige

Syftet med denna uppsats var att studera bosniska ungdomars upplevelse och hantering av sin livssituation i Sverige. Studiens frågeställning var: Hur beskriver ett mindre urval bosniska ungdomar sin upplevelse och hantering av sin livssituation i Sverige i de två kulturella världar de lever i - den svenska och den bosniska? För att besvara frågeställningen tillämpades en kvalitativ metod där djupintervjuer genomfördes med fyra ungdomar – två flickor och två pojkar i åldern 15 – 19 år. Samtliga ungdomar är födda i Bosnien och kom till Sverige i början av 90-talet på grund av kriget i Bosnien. Ungdomarna befann sig i olika faser när det gäller deras etniska identitet. De beskrev att de anpassar sitt beteende beroende på vilken etnisk grupp de umgås med. Ungdomarna hade ett blandat umgänge, men tre ungdomar umgicks mer med invandrare än med svenskar. Ungdomarna uppgav få exempel på upplevd diskriminering och beskrev sig själva som ”integrerade”, men i deras utsagor fanns motsägelser. Studiens resultat analyserades utifrån en hermeneutisk forskningsansats med dialektisk genomgång av insamlat material. Analysverktygen var social konstruktivism och rollteori. Begrepp som användes som analysverktyg var etnisk identitet, ”vi och dom” och diskriminering. Resultatet ligger i linje med tidigare forskning

Genetic and psychological determinants of dyspepsia and implications for treatment

Dyspepsia is a very common condition in the population with a prevalence ranging from 25 to 40%. It refers to a complex of symptoms believed arising in the upper gastrointestinal tract and includes heartburn, acid regurgitation, excessive burping or belching, a feeling of slow digestion, early satiety, nausea and bloating. Dyspepsia is an important and costly health problem due to high medical costs for diagnostic investigations and for drug treatment and its impact on absenteeism from work. The aetiology of dyspepsia is very complex and still poorly understood. Several causal factors are suggested: Helicobacter pylori infection, excessive gastric acid, delayed gastric emptying, visceral hypersensitivity, psychosocial morbidity, use of NSAID's and post-infective mucosal damage. Recently also genetic predisposition has been suggested as a relevant factor in the genesis of dyspeptic complaints. In this thesis we report our studies on the influence of psychological state, major life events, coping style and genetic factors on dyspeptic symptom severity and the extend to which these factors affect the outcome of acid inhibiting treatment in primary care patients with dyspepsia