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När ett öra ser friskt ut men värker - projicerad öronvärk
No full textKorvakipu kuuluu yleisimpiin syihin hakeutua lääkärin vastaanotolle. Korvakivun voi jakaa korvaperäiseen ja heijasteiseen kipuun. Korvaperäinen kipu saa alkunsa korvan tautitilasta, esimerkiksi korvatulehduksesta. Heijasteinen korvakipu taas johtuu tautitilasta, joka ei ole korvaperäinen. Kliinisessä tutkimuksessa korva siis näyttää täysin terveeltä, vaikka potilas valittaa korvakipua. Heijasteinen korvakipu kattaa n. 50 % kaikesta korvakivusta, mutta sen syitä ei tunneta niin hyvin.
Teimme systemaattisen kirjallisuuskatsauksen selvittääksemme eri syitä heijasteisen korvakivun taustalla. Tarkoituksenamme oli myös kartoittaa eri diagnostisia keinoja kliinikkojen avuksi korvakivun syyn selvittelyssä. Katsauksemme perusteella yleisimmät heijasteisen korvakivun syyt ovat suu- ja leukaperäiset tautitilat, nielun ja kurkunpään sairaudet ja akuutti ja krooninen poskiontelon tulehdus. Harvinaisempiakin syitä heijasteisen korvakivun taustalla on, esimerkiksi rintaonteloperäiset syyt. Korvakivun taustaa selvittäessä on myös hyvä pitää mielessä potilaan muut perussairaudet ja huomioida niiden hoitotasapaino. Hyvä kliininen tutkimus auttaa korvakivun diagnostiikassa. Kirjallisuuskatsauksemme pohjalta kirjoitimme artikkelin Suomen Lääkärilehteen julkaistavaksi.Öronvärk är en av de vanligaste orsakerna för patienter att söka vård. Man kan klassificera öronvärk som direkt eller projicerad värk. Direkt öronvärk orsakas oftast av en öronsjukdom, exempelvis akut öroninflammation. Projicerad öronvärk orsakas däremot av en patologisk process eller sjukdom som inte är direkt förknippad med öronen. Vid klinisk undersökning ser örat då helt friskt ut även om patienten har ont i örat. Projicerad öronvärk står för ca. 50 % av all öronvärk, men dess orsaker är mindre kända.
Vi utförde en systematisk litteraturöversikt för att ta reda på orsaker bakom projicerad öronvärk. Vår avsikt var också att ta reda på diagnostiska medel för att hjälpa kliniker komma fram till en diagnos. De vanligaste orsakerna bakom projicerad öronvärk är mun- och käkrelaterade sjukdomar, sjukdomar i svalget och struphuvudet och akut och kronisk sinuit. Också sällsyntare orsaker kan ligga bakom projicerad öronvärk, exempelvis olika patologiska processer i bröstkorgen. Då man utreder orsaker bakom öronvärk bör man också beakta patientens andra sjukdomar och deras tillstånd. En god klinisk undersökning underlättar diagnostiken av öronvärk. Baserat på vår litteraturöversikt skrev vi en artikel som kommer publiceras i Finlands Läkartidning
HDR-brakyterapia uusiutuneen eturauhassyövän hoidossa HUS:issa 2015–2021
No full textKorkean annosnopeuden paikallinen sädehoito eli HDR-brakyterapia on osoittautunut tehokkaaksi ja hyvin siedetyksi hoitomuodoksi paikallisesti uusiutuneessa eturauhassyövässä. Tässä retrospektiivisessä tutkimuksessa tarkastellaan 100 HUS:issa uusiutuneeseen eturauhassyöpään brakyterapiaa saaneen potilaan sädehoitosuunnitelmien annoskattavuusparametrejä ja niihin vaikuttavia tekijöitä.
Tutkielman aineisto koostuu 100 potilaasta, jotka saivat HDR-brakyterapiaa paikallisesti uusiutuneen eturauhassyövän hoitona HUS:in Syöpäkeskuksessa vuosina 2015– 2020. Kaikki 100 potilasta saivat kolme 8 Gy fraktiota koko eturauhaseen kohdistettua korkean annosnopeuden sädehoitoa. Aineiston analyysissä tarkasteltiin brakyterapian kohdekudoksen eli eturauhasen laskennallisen tilavuuden (PTV) yhteyttä muihin sädehoitosuunnitelman annosparametrien tavoitteisiin. Lisäksi tarkasteltiin kolmen hoitoa antaneen toimenpidelääkärin kliinisen kokemuksen vaikutusta toteutuneisiin annosparametreihin.
Logit-muunnetulla lineaarisella sekamallilla analysoituna havaittiin, että eturauhasen tilavuudella (PTV) on tilastollisesti merkittävä yhteys täyden sädeannoksen saavan kohdekudoksen osuutta koko rauhasesta kuvaavaan V100:aan. Lisäksi havaittiin, että pienillä eturauhasen tilavuuksilla V100:n vaihtelu oli huomattavaa ja mallin ennustearvo heikompi. Operatöörien kokemuksella ei ollut merkittävää vaikutusta PTV:n ja V100:n väliseen yhteyteen. Eturauhasen pienemmillä tilavuuksilla virtsaputken saamat säteilyannokset olivat suurempia.
Tulokset osoittavat, että eturauhasen HDR-brakyterapian annossuunnittelussa rauhasen koko vaikuttaa annoskattavuuteen ja toisaalta ympäröivien muiden rakenteiden saamiin säteilyannoksiin. Tutkimuksen rajoituksina on huomioitava, että käytetty matemaattinen malli aliarvioi aineiston hajontaa etenkin pienillä PTV:n arvoilla. Pienillä eturauhasen tilavuuksilla anatomisen vaihtelun ja sattuman merkitys korostuu. Lisätutkimuksia tarvitaan löydösten vaikutuksista onkologisiin hoitotuloksiin ja potilaiden pitkäaikaisennusteeseen
Akut buk hos vuxna vid Helsingfors Universitets sjukhus område, Finland i 2023
No full textAcute abdomen is defined as a sudden onset severe abdominal pain that requires urgent diagnostic workup and care. Acute abdomen is a common reason for admissions to the emergency department (ED) in all age groups. The current distribution of acute abdomen causes in Finland is unknown. Studies from previous decades show that most cases of acute abdomen remain unspecified after diagnostic workup.
The aim of this study is to investigate the distribution of diseases causing acute abdomen in adults in Uusimaa in Finland in 2023. All adult patients admitted to the Meilahti, Jorvi, Peijas, Hyvinkää, Lohja, Porvoo and Malmi hospital EDs with symptoms of acute abdomen in 2023 were included. In total 34 695 ED patient visits were included.
Non-specific abdominal pain (NSAP) was the most common diagnosis code in our study population, with an incidence rate of 28.4%, followed by gastroenteritis (5.6%) and gallstone disease (5.2%). NSAP (40.1%) and acute appendicitis (6.8%) were most frequent in patients younger than 40 years. Males had a higher hospitalization rate in all age groups. The results of this study are similar to the previous studies on the incidence of acute abdomen in Finland and other European countries (Sweden, Germany, Italy).Akut buk definieras som plötslig buksmärta och kräver ofta brådskande diagnostik och vård. Akut buk är en vanlig ankomstorsak till akutmottagningen vid sjukhusjourerna i alla åldersgrupper. Den nuvarande fördelningen av orsakande sjukdomar till akut buk i Finland är okänd. Studier från tidigare årtionden visar att de flesta fall av akut buk förblir oklara efter diagnostiskt arbete.
Målet med denna studie är att undersöka fördelningen av sjukdomarna som orsakar akut buk hos vuxna i Nyland i Finland under år 2023. Alla vuxna patienter som uppsökte Mejlans, Jorv, Pejas, Hyvinge, Borgå och Malm sjukhus akutmottagning med symtom på akut buk under år 2023 inkluderades i studien. Totalt inkluderades 34 695 patientbesök.
Ospecifik buksmärta var den vanligaste diagnoskoden i vår studiepopulation, med en incidens om 28,4 %, följd av gastroenterit (5,6 %) och gallstenssjukdom (5,2 %). Ospecifik buksmärta (40,1 %) och akut appendicit (6,8 %) förekom mest frekvent bland patienter yngre än 40 år. Män blev i en högre grad inlagda på sjukhus i alla åldersgrupper. Resultaten i denna studie motsvarar resultat från tidigare incidensstudier av akut buk i Finland och våra andra europeiska länder (Sverige, Tyskland, Italien)
Genotypic and Phenotypic Characterization of a Novel Gut Bacterial Strain
No full textHuman gut microbiota is a complex ecosystem that plays a crucial role in maintaining metabolic balance, immune regulation, and gut homeostasis. Recent advances in microbiome research have shown its importance in various health conditions, particularly metabolic disorders such as obesity. Studies indicate that individuals with obesity have a significant decrease in beneficial bacterial species compared to lean individuals and a disrupted gut barrier function. The discovery of novel gut bacterial strains with functional properties relevant to host metabolism can provide insights into potential therapeutic applications for restoring microbial balance.
The study aimed to characterize a novel gut bacterial strain, Strain-182, isolated from a healthy individual, and investigate its genomic and phenotypic properties to evaluate its adaptation to the gut environment and interactions with the human host. Whole genome sequencing and phylogenetic analysis were performed to determine the taxonomic placement and genetic features of Strain-182. A preliminary pangenome analysis identified unique genes related to metabolic activity, stress adaptation, and host interactions. In vitro assays were used to validate genomic analysis and further evaluate Strain-182 immunomodulation properties, short- chain fatty acid production, bile salts resistance and antimicrobial resistance, among other phenotypic traits.
The results demonstrated that Strain-182 belonged to a recently discovered species, Luoshenia tenuis, which has previously been studied for its anti-obesity potential. The strain showed susceptibility to a wide range of antibiotics, was able to survive in high bile salt concentrations and showed potential for sporulation. In terms of its potential beneficial metabolic activity, it produced acetate as a major SCFA and exhibited lipolytic activity. However, Strain-182 did not show any bile salt hydrolase activity and did not induce or attenuate LPS-induced IL-8 production in enterocytes.
The findings highlight the safety and survivability profile of Strain-182 and its potential for gut health-promoting effects, warranting further exploration of its therapeutic applications. Future studies will focus on validating these effects in vivo and in vitro potentially in combination with other strains, for assessing the role of Strain-182 in host health
Sairaalalääkkeiden saatavuushäiriöt Suomessa: Fimean saatavuushäiriöilmoitusten ja HUS Helsingin yliopistollisen sairaalan peruslääkevalikoiman vertailu vuosina 2022–2023
No full textDrug shortages have been a global concern for years, gradually worsening in the last decade. Drug shortages can severely impact healthcare facilities, patient care and healthcare providers’ work and efficiency, increasing costs, and sometimes leading to severe outcomes, such as delayed or cancelled care, medication errors, increased morbidities, and even mortality. Their causes are complex and multifactorial, making them difficult to address effectively.
Hospital drug shortages in Finland remain a relatively understudied area. The objective of this Master's thesis was to describe the prevalence and distribution of hospital drug shortage notifications within five ATC groups used at HUS Helsinki University Hospital. This was investigated comparing Fimea’s drug shortage notification data with the HUS Medicines Selection during 2022 - 2023. The critical ATC groups chosen for this study were Blood and Blood Forming Organs (B), Cardiovascular System (C), Anti-infectives for Systemic Use (J), Antineoplastic and Immunomodulating Agents (L), and Nervous System (N). The obligatory storage status of the products with shortage notifications was also considered. Two ATC groups, J and L, were further examined for available alternative products, using the national drug register.
In the final dataset, 1746 products were investigated, of which 26% (n=448) received one or more drug shortage notification during 2022 – 2023. A total of 722 shortage notifications were recorded, with the number of notifications per product ranging from one to six. Most of the products with drug shortage notifications were in ATC group C with 34% (n=67) of the investigated products receiving drug shortage notifications. 32% (n=200) of the products received shortage notifications in ATC group N, 23% (n=59) in ATC group J, 19% (n=59) in ATC group B, and 18% (n=63) in ATC group L. The duration of all the notified shortages varied from 1 to 545 days. The mean duration of the shortages was 53 days, with a median duration of 32 days (n=722, Std. Dev. 64.89). In total, 22% (n=97) of the investigated products receiving drug shortage notifications were subject to obligatory storage by HUS Pharmacy. For the 63 products with notified shortages in the ATC group L, 71% (n=45) had an alternative product in the national drug register, and out of 59 products with notified shortages in the ATC group J, the percentage was 61% (n=36).
The results of this study reflect global trends in drug shortages, particularly for oncology medicines, antimicrobials, and critical care drugs. Finland and HUS have an efficient obligatory storage system, which mitigates the impact of shortages at the hospital level, but it cannot fully prevent delays or supply disruptions. Continued and more efficient strategies at national and EU level are crucial to ensuring that particularly all essential medicines are always available at Finnish hospitals and other healthcare units.Lääkkeiden saatavuushäiriöt ovat olleet maailmanlaajuinen ongelma jo vuosien ajan, ja ne ovat vain pahentuneet viimeisen vuosikymmenen aikana. Niillä voi olla vakavia vaikutuksia terveydenhuollon yksiköihin, potilashoitoon sekä terveydenhuollon ammattilaisten työhön, lisäten kustannuksia ja monenlaisia potilasturvallisuusriskejä. Syyt lääkkeiden saatavuushäiriöiden taustalla ovat usein monimutkaisia ja ne johtuvat useista tekijöistä, mikä vaikeuttaa niiden ennaltaehkäisyä ja hallintaa.
Sairaalalääkkeiden saatavuushäiriöt Suomessa on suhteellisen vähän tutkittu aihe. Tämän maisterintutkielman tavoitteena oli kuvata sairaalalääkkeiden saatavuushäiriöilmoitusten yleisyyttä ja jakautumista viidessä ATC-ryhmässä, joita käytetään HUS Helsingin yliopistollisessa sairaalassa. Tutkimus toteutettiin vertaamalla Fimean keräämiä lääkkeiden saatavuushäiriöilmoituksia HUSin peruslääkevalikoimaan tuotteisiin vuosina 2022–2023. Tutkittaviksi ATC-ryhmiksi valittiin sairaalanäkökulmasta kriittiset ryhmät: veritautien lääkkeet (B), sydän- ja verisuonisairauksien lääkkeet (C), systeemisesti vaikuttavat infektiolääkkeet (J), syöpälääkkeet ja immuunivasteen muuntajat (L) sekä hermostoon vaikuttavat lääkkeet (N). Lisäksi tarkasteltiin, oliko saatavuushäiriöilmoituksia saaneilla valmisteilla velvoitevarastointipakkoa. Kahden ATC-ryhmän (J ja L) kohdalta selvitettiin, onko saatavilla vaihtoehtoisia valmisteita käyttämällä kansallista lääkerekisteriä.
Lopullisessa tutkimusaineistossa oli 1746 lääkevalmistetta, joista 26 % (n=448) sai yhden tai useamman saatavuushäiriöilmoituksen vuosina 2022–2023. Saatavuushäiriöilmoituksia oli yhteensä 722 kpl, ja ilmoitusten määrä per tuote vaihteli yhdestä kuuteen. Eniten saatavuushäiriöilmoituksia saaneita valmisteita oli ATC-ryhmässä C, jossa 34 % (n=67) tutkituista lääkkeistä sai saatavuushäiriöilmoituksen. ATC-ryhmässä N osuus oli 32 % (n=200), ATC-ryhmässä J 23 % (n=59), ATC-ryhmässä B 19 % (n=59) ja ATC-ryhmässä L 18 % (n=63). Kaikkien arvioitujen saatavuushäiriöiden kesto vaihteli 1–545 päivän välillä. Saatavuushäiriöiden keskimääräinen arvioitu kesto oli 53 päivää ja mediaani 32 päivää (n=722, keskihajonta 64,89). Yhteensä 22 % (n=97) saatavuushäiriötiedotteita saaneista valmisteista kuului HUS Apteekin velvoitevarastoinnin piiriin. ATC-ryhmässä L saatavuushäiriötiedotteen saaneista 63 valmisteesta 71 %:lle (n=45) löytyi vaihtoehtoinen valmiste kansallisesta lääkerekisteristä tutkimusajanjaksolla, ja ATC-ryhmässä J vastaava osuus oli 61 % (n=36).
Tutkimuksen tulokset heijastavat maailmanlaajuisia lääkkeiden saatavuushäiriötrendejä, erityisesti onkologisten lääkkeiden, mikrobilääkkeiden ja tehohoidossa käytettävien lääkkeiden osalta. Suomessa ja HUSilla on käytössä tehokas velvoitevarastointijärjestelmä, joka lievittää lääkepuutosten vaikutuksia sairaalatasolla, mutta sekään ei täysin voi estää lääkkeiden saatavuuskatkoksia tai -viiveitä. Tarvitaan tehokkaampia toimia sekä kansallisesti että EU-tasolla, jotta erityisesti kaikkia välttämättömiä lääkkeitä olisi aina saatavilla Suomen sairaaloissa ja muissa terveydenhuollon yksiköissä
Harnessing Neuroplasticity of Brain Tumors : TrkB signaling modulation to modify glioblastoma phenotypic state dynamics
No full textBackground and purpose: Glioblastoma is an aggressive brain cancer that does not leave survivors. Tumor cells dynamically transition between invasive and proliferative phenotypes, allowing them to evade surgery and chemoradiotherapy. However, tumor plasticity may be coordinated by neurotrophic receptors such as tropomyosin receptor kinase B (TrkB). Targeting TrkB using therapeutic molecules could manipulate glioblastoma plasticity. Moreover, current neuroimaging fails to identify plastic features of glioblastoma, such as tumor cell invasion and integration with the brain. This incomplete tumor detection further challenges complete surgical removal. Functional ultrasound (fUS) is a non-invasive imaging method that assesses brain connectivity and could be repurposed to longitudinally monitor glioblastoma invasion.
Objective: To investigate the role of TrkB-driven changes in glioblastoma plasticity and evaluate the implementation of fUS as a tool for monitoring intracranial tumor progression.
Methods and materials: Methods are threefold. First, TrkB expression patterns were analyzed by data mining publicly available human total-, single-cell, and spatial transcriptomic data, with bioinformatics tools including Chipster and Loupe. Second, a library of TrkB-modulating compounds was applied to patient-derived glioblastoma cells, and changes in morphology, viability, and metabolic activity were assessed. This included a TrkB antagonist (ANA-12) and positive allosteric modulators of TrkB, such as antidepressants (fluoxetine, imipramine) and non-hallucinogenic psychedelics (lisuride). Third, immunocompromised mice were xenografted with human glioblastoma cells and longitudinally monitored with fUS over 50 days to assess changes in connectivity.
Results: Transcriptomic analysis revealed TrkB upregulation in invasive tumor populations, particularly at the tumor-brain interface. Low doses (0.1-5 μM) of positive allosteric TrkB modulators tended to increase viability in invasive cell lines. High doses (>25 μM), however, induced a neuron-like phenotypic shift with reduced NAD(P)H-dependent cellular oxidoreductase activity. In parallel, preliminary fUS data detected a gradual increase in brain connectivity in tumor-bearing mice, particularly in the corpus callosum and hippocampus. Pathological analysis of these affected brain areas confirmed tumor infiltration.
Conclusion: This exploratory project demonstrated that TrkB upregulation and associated phenotypic shifts might be linked to glioblastoma progression.
Modulating TrkB signaling with clinically approved drugs could potentially affect tumor progression and/or improve sensitivity to conventional chemoradiotherapy. Also, brain fUS shows promise as a real-time and non-invasive tool to detect and monitor tumor progression in preclinical models
Evaluation of drug-drug interactions between acute and prophylactic migraine drugs using multiple drug-drug interaction databases
No full textThe concomitant use of acute and prophylactic migraine drugs proposes a risk of drug-drug interactions (DDIs) in migraine treatment which is associated with a higher likelihood of adverse drug reactions. Drug-drug interaction databases (DIDs) are essential tools for managing DDIs, as new DDIs are identified and existing DDI information is continuously updated based on the latest research. Despite the benefits of DIDs, they have inherent limitations, e.g. in information content, data sources, update frequency, clinical relevance and severity. The aim of this study was to investigate the current DDI information between acute and prophylactic migraine medications across four different DIDs and to compare the consistency of the information between them.
This study’s material consisted of acute (n=14) and prophylactic (n=14) migraine drugs that were selected based on the Finnish Current Care Guidelines for migraine. Four different drug-drug interaction databases were selected for the study: Inxbase, MerativeTM Micromedex® Drug Interaction, Drugs.com Drug Interaction Checker and Medscape Drug Interaction Checker. A total of 195 drug pairs were formed (e.g. sumatriptan-rimegepant) and identical drug pair searches were made in each DID. The first search was conducted in January 2025 and the second search in March 2025. Results from the searches were collected in Microsoft Excel spreadsheets for quantitative and qualitative analysis.
A total of 198 potential DDIs were identified across the four DIDs. Of the interactions found, only 28 were found in all four databases. Three databases contained unique DDIs that were not found in the other databases, but those were mainly clinically non-significant. As expected, the findings of this study shows that new calcitonin gene-related peptide (CGRP) antagonists do not interact or have clinically significant DDIs with existing migraine treatments. No absolutely contraindicated combinations were found when assessing the results from all four databases. Majority of the acute and prophylactic drugs can be used together if e.g. patient is monitored, or minor dosage adjustments are made.
Significant differences in the classification of interaction severity were found across the DIDs. When comparing interaction details, all DIDs described the DDIs in similar manner. The most notable differences between DIDs were observed in the description how the DDIs should be managed. Inxbase, Micromedex and Drugs.com, seemed to generally offer more comprehensive guidelines for managing interactions compared to Medscape. There is a clear need for the harmonization of databases. In the future, databases should aim to display only clinically relevant interactions and provide explicit recommendations to HCPs on how to manage them
Orthopoxvirus i europeiska gnagare
No full textOrthopoxviruses are a group of zoonotic pathogens that are able to infect a broad range of mammals, including many species of rodents. In European rodents, the most prevalent orthopoxvirus is the Cowpox virus, which is also known to be able to cause disease in humans. The aim of this study was to understand what viruses of the genus Orthopoxvirus are present in European rodents, as well as to see if there is a higher risk of transmission in urban areas with low biodiversity, versus rural areas with high biodiversity. For the study serological data from 2791 rodents, from Belgium, France, Germany and Finland, captured during spring and autumn 2020-2022 and autumn 2024, was analyzed in silico. The serological data revealed a higher total seropositivity in rodents captured in rural areas, with Myodes glareolus having the highest seropositivity in combination with a large sample size. To understand which Orthopoxviruses are circulating in the rodents, 222 tissue samples from Myodes glareolus were analyzed using conventional PCR targeting the hemagglutinin gene of Orthopoxviruses. The PCR analysis did not reveal any viral DNA in the tissues, due to either low or non-existent viremia during the time of sampling, or the use of the wrong tissue type. The results of the study show that there is a higher risk of transmission in rural areas compared to urban areas, but the exact viral species circulating is unclear.Orthopoxvirus är en grupp av zoonotiska virus som är kapabla att infektera en bred grupp av däggdjur, inklusive ett flertal olika gnagare. I europeiska gnagare är Kokoppsviruset det mest prevalenta orthopoxviruset och viruset kan även orsaka sjukdom hos människor. Målet med denna studie var att få förståelse för vilka orthopoxvirus som finns hos europeiska gnagare samt att se ifall det finns en större risk för överföring i urbana områden med lägre biodiversitet, jämfört med rurala områden med högre biodiversitet. För studien analyserades serologiska data från 2791 gnagare, fångade i Frankrike, Tyskland, Belgien och Finland under våren och hösten 2020–2022 samt hösten 2024, in silico. Den serologiska datan visade en högre total seropositivitet hos gnagare fångade i rurala områden och att Myodes glareolus hade den högsta seropositiviteten i kombination med ett stort urval. För att få förståelse över vilka arter av Orthopoxvirus cirkulerar i gnagarna analyserades 222 vävnadsprover med hjälp av konventionell PCR där orthopoxvirusets hemagglutinin-gen fungerade som mål. PCR-analysen uppvisade inget viralt DNA i vävnaderna, vilket kan bero på endera låg eller icke-existerande viremi vid provtagningstidpunkten eller användningen av fel typ av vävnad. Resultaten av studien visar att det finns en högre risk för överföring i rurala områden jämfört med urbana områden, men den exakta arten av virus som cirkulerar i populationerna är fortfarande oklar
Feasibility of Electrochemical Formic Acid Detection for Point-of-Care Diagnosis of Methanol Poisoning
No full textMethanol poisoning is a global health concern, particularly in low-resource settings where access to regulated
alcohol and advanced diagnostics is limited. Clinical symptoms are often delayed due to the co-ingestion of
ethanol, which makes timely diagnosis and treatment challenging. The toxicity of methanol arises primarily
from its metabolite, formic acid (present as formate ion), which causes severe metabolic acidosis and cellular
injury. Since methanol concentrations do not reliably correlate with toxicity, formate provides a more specific
and clinically relevant diagnostic target. Currently, diagnostic confirmation relies on gas chromatography,
which is time-consuming, costly, and rarely available in decentralized healthcare settings. These challenges
highlight the urgent need for a rapid, accessible point-of-care (POC) testing method.
This thesis investigates the feasibility and clinical value of an electrochemical sensor for formic acid detection
as a POC diagnostic tool for methanol poisoning. More specifically the study evaluates the clinical rationale
for formate detection, explores assay development and assesses its performance in both buffer and blood. It
further defines requirements such a sensor must meet, based on clinical demands and theoretical constraints.
These include criteria for analytical performance, fast turnaround time, portability and ease of use. The
developed sensor system uses chronoamperometric detection of NADH, produced via enzymatic oxidation of
formate by formate dehydrogenase. A commercially available colorimetric assay kit was adapted for
electrochemical use while phenanthroline-modified screen-printed electrodes and a portable potentiostat
were employed for measurement. Assay conditions were optimized for incubation time, temperature, and
signal acquisition to meet point-of-care needs. The system reliably detected clinically relevant formate
concentrations (1-20 mM) with a 15-minute incubation at room temperature. Chronoamperometry showed a
strong correlation between formate concentration and current response, confirming the assay’s technical
feasibility. However, the whole blood test revealed significant variability due to matrix effects, significantly
impacting the performance and raising the need for improved electrode materials.
These results establish the technical feasibility, analytical foundation and the design criteria necessary for a
clinically viable POC sensor. Future work should focus on improving assay robustness in complex matrices,
simplifying the workflow, and validating performance in clinical settings. This work lays the foundation for
the future development of electrochemical formate detection as a clinically relevant, rapid, portable and cost effective tool for methanol poisoning diagnosis, particularly in resource-limited or emergency settings
Effects of pharmacist prescribing on health-related outcomes in secondary care compared with medical prescribing or no treatment: A systematic review.
No full textPharmacist prescribing has gained momentum over the years and is currently utilised in Brazil, Canada, New Zealand, Poland, South Africa, United Kingdom (UK), and the United States of America (USA). Pharmacist prescribing has been associated with symptom improvement, reduced prescribing error rates, medication omissions, and improved medication access. The effects of pharmacist prescribing in secondary care has not been previously evaluated. This systematic review aimed to assess the effects of pharmacist prescribing on health-related outcomes in secondary care. MEDLINE, Cochrane , CINAHL, Scopus, and Web of Science Core Collection databases were searched for studies published in English from database inception to 03 October 2024. Studies were included if the intervention was pharmacist prescribing and the outcomes were health-related and measurable. Narrative synthesis of the outcomes from included studies was conducted. A total of 21 studies published from five countries (Australia, Egypt, Hong Kong, UK, USA) were included. The findings of this study demonstrated that pharmacist prescribing significantly improved disease management, reduced the number of hospital revisits, improved blood pressure control, international normalised ratio control and decreased the number of adverse events when compared to medical prescribing. The evidence further suggests that the healthcare costs per patient per month, median cost of treatment, inpatient hospitalisations and emergency department admissions were significantly lower when the pharmacist prescribed. This systematic review provides low to moderate quality evidence that pharmacist prescribing has a positive effect on therapeutic outcomes, and that pharmacist prescribing is comparable or better than medical prescribing in secondary care