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Sample records for artemisinin-based combination treatments

  1. Declining responsiveness of Plasmodium falciparum infections to artemisinin-based combination treatments on the Kenyan coast.

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    Steffen Borrmann

    Full Text Available BACKGROUND: The emergence of artemisinin-resistant P. falciparum malaria in South-East Asia highlights the need for continued global surveillance of the efficacy of artemisinin-based combination therapies. METHODS: On the Kenyan coast we studied the treatment responses in 474 children 6-59 months old with uncomplicated P. falciparum malaria in a randomized controlled trial of dihydroartemisinin-piperaquine vs. artemether-lumefantrine from 2005 to 2008. (ISRCTN88705995. RESULTS: The proportion of patients with residual parasitemia on day 1 rose from 55% in 2005-2006 to 87% in 2007-2008 (odds ratio, 5.4, 95%CI, 2.7-11.1; P37.5°C, 2.8, 1.9-4.1; P<0.001. Neither in vitro sensitivity of parasites to DHA nor levels of antibodies against parasite extract accounted for parasite clearance rates or changes thereof. CONCLUSIONS: The significant, albeit small, decline through time of parasitological response rates to treatment with ACTs may be due to the emergence of parasites with reduced drug sensitivity, to the coincident reduction in population-level clinical immunity, or both. Maintaining the efficacy of artemisinin-based therapy in Africa would benefit from a better understanding of the mechanisms underlying reduced parasite clearance rates. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN88705995.

  2. Increasing use of artemisinin-based combination therapy for treatment of malaria infection in Nigerian hospitals.

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    Igboeli, Nneka U; Ukwe, Chinwe V; Ekwunife, Obinna I

    2010-10-01

    This study aimed at describing the pattern of outpatient antimalarial drug prescribing in a secondary and a tertiary hospital, and to assess adherence to the National Antimalarial Treatment Guideline (ATG). An audit of antimalarial prescription files from the two health facilities for a period of six months in 2008 was conducted. Semi structured questionnaires were used to collect information from the doctors and pharmacists on their awareness and knowledge of the National Antimalarial Treatment Guideline. Artemisinin-based combination therapies (ACTs) were the most prescribed antimalarials. Overall, 81.4% of the total prescriptions contained ACTs, out of which 56.8% were artemetherlumefantrine. However, adherence to the drugs indicated by national guideline within the DU90% was 38.5% for the tertiary and 66.7 % for the secondary hospital. The standard practice of prescribing with generic name was still not adhered to as evidenced in the understudied hospitals. The percentage of health care providers that were aware of the ATG was 88.2% for doctors and 85.1% for pharmacists. However, 13.3% and 52.2% of doctors and pharmacists respectively could not properly list the drugs specified in the guideline. Amodiaquine was the most commonly preferred option for managing children aged 0 - 3 months with malaria infection against the indicated oral quinine. This study showed an increased use of artemisinin-based combination therapy for the treatment of uncomplicated malaria compared previous reports in Nigeria. This study also highlights the need for periodic in-service quality assurance among health professionals with monitoring of adherence to and assessment of knowledge of clinical guidelines to ensure the practice of evidence based medicine.

  3. Increasing use of artemisinin-based combination therapy for treatment of malaria infection in Nigerian hospitals

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    Igboeli NU

    2010-12-01

    Full Text Available Objectives: This study aimed at describing the pattern of outpatient antimalarial drug prescribing in a secondary and a tertiary hospital, and to assess adherence to the National Antimalarial Treatment Guideline (ATG. Methods: An audit of antimalarial prescription files from the two health facilities for a period of six months in 2008 was conducted. Semi structured questionnaires were used to collect information from the doctors and pharmacists on their awareness and knowledge of the National Antimalarial Treatment Guideline. Results: Artemisinin-based combination therapies (ACTs were the most prescribed antimalarials. Overall, 81.4% of the total prescriptions contained ACTs, out of which 56.8% were artemether-lumefantrine. However, adherence to the drugs indicated by national guideline within the DU90% was 38.5% for the tertiary and 66.7 % for the secondary hospital. The standard practice of prescribing with generic name was still not adhered to as evidenced in the understudied hospitals. The percentage of health care providers that were aware of the ATG was 88.2% for doctors and 85.1% for pharmacists. However, 13.3% and 52.2% of doctors and pharmacists respectively could not properly list the drugs specified in the guideline. Amodiaquine was the most commonly preferred option for managing children aged 0 – 3 months with malaria infection against the indicated oral quinine.Conclusion: This study showed an increased use of artemisinin-based combination therapy for the treatment of uncomplicated malaria compared previous reports in Nigeria. This study also highlights the need for periodic in-service quality assurance among health professionals with monitoring of adherence to and assessment of knowledge of clinical guidelines to ensure the practice of evidence based medicine.

  4. Artemisinin-based combination therapies (ACTs): best hope for malaria treatment but inaccessible to the needy!

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    Mutabingwa, T K

    2005-09-01

    Artemisinin-based combination therapies (ACTs) are the best anti-malarial drugs available now. Artemisinin enhances efficacy and has the potential of lowering the rate at which resistance emerges and spreads. Under low transmission intensity, ACTs have an additional public health benefit of reducing the overall malaria transmission and studies are urgently needed to investigate modalities of attaining similar benefits under high transmission. Despite being recommended by WHO since 2001, overall deployment of ACT has been slow. Limiting factors are high cost, limited knowledge and public awareness on the concept of combination therapy (CT) and ACT in particular, limited knowledge on safety of ACTs in pregnancy, operational issue such as inappropriate drug use, lack of suitable drug formulations, lack of post-marketing surveillance (PMS) systems, and the imbalance between demand and supply. Through concerted efforts of multilateral organizations, the local scientific community with involvement of policy-makers progress has been on several fonts leading to improved ACT uptake rates in the last 2 years. Of 43 countries that had adopted ACT by February 2005, 18 (42%) adopted the policy in 2004. Preference to co-formulated Coartem has led to a surge in its demand with consequent shortage. Alternative ways for increased production of ACTs are urgently needed otherwise most policies will remain adopted on paper. Despite limitations, opportunities are opening up for effective malaria control. Insecticides, insecticide-treated nets (ITNs) and ACTs are proven efficacious controls available that should be accessed by many. Substantial funding is now available for biomedical malaria research and for policy implementation. While the Global Fund is the financial engine behind the scaling up of ACT uptake, delays in cash flow after grant approval has led to many countries adopting ACT in 2004 but only few (nine) implementing it. Clear policies on granted funds and minimal politics

  5. Developing artemisinin based drug combinations for the treatment of drug resistant falciparum malaria: A review

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    Olliaro P

    2004-01-01

    clinical research that aims to bring artemisinin based combinations to those that need them most.

  6. Adherence and uptake of artemisinin-based combination treatments for uncomplicated malaria: a qualitative study in northern Ghana.

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    Samuel Chatio

    Full Text Available Based on the recommendations of the World Health Organization in 2004, Ghana changed her antimalarial drug policy from mono-therapy to Artemisinin-based Combination Therapy (ACTs. The country is currently using three first line drugs artesunate-amodiaquine, artemether-lumefantrine and dihydroartemisinin-piperaquine for the treatment of uncomplicated malaria. Despite this policy, little or no qualitative studies have been conducted to establish the factors influencing adherence to the new treatment for malaria. This study explored factors influencing adherence to the use of ACTs in northern Ghana.This was a qualitative study comprising forty (40 in-depth interviews with patients with malaria who visited selected public and private health facilities and received ACTs. Systematic sampling technique was used to select participants who were given ACTs for the interviews. Nvivo 9 software was used to code the data into themes for further analysis.The study revealed very important differences in knowledge about ACTs. As expected, the less or illiterates could not mention the type of ACT they would prefer to use for treating their malaria. The educated ones had a good knowledge on ACTs and preferred artemether-lumefantrinee in treating their malaria. The reason was that the drug was good and it had minimal or no side effects. Individual attitudes toward the use of medications and the side effects associated with the use of these ACTs were found to be the main factors affecting adherence to the use of ACTs. Perceived cure of illness after the initial dose greatly affected adherence. Other factors such as forgetfulness and lack of information also influenced patient adherence to ACTs use.Individual knowledge, attitudes and behaviors greatly influence patients' adherence to ACTs use. Since ACTs take a number of days to complete, continuous education by health professionals could improve on adherence to ACTs use by patients with malaria.

  7. Possible artemisinin-based combination therapy-resistant malaria in Nigeria: a report of three cases

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    Nnennaya Anthony Ajayi

    2013-07-01

    Full Text Available Artemisinin-based combination therapy-resistant malaria is rare in Sub-Saharan Africa. The World Health Organization identifies monitoring and surveillance using day-3 parasitaemia post-treatment as the standard test for identifying suspected artemisinin resistance. We report three cases of early treatment failure due to possible artemisinin-based combination therapy-resistant Plasmodium falciparum malaria. All cases showed adequate clinical and parasitological responses to quinine. This study reveals a need to re-evaluate the quality and efficacy of artemisinin-based combination therapy agents in Nigeria and Sub-Saharan Africa.

  8. Routine delivery of artemisinin-based combination treatment at fixed health facilities reduces malaria prevalence in Tanzania: an observational study

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    Khatib Rashid A

    2012-04-01

    Full Text Available Abstract Background Artemisinin-based combination therapy (ACT has been promoted as a means to reduce malaria transmission due to their ability to kill both asexual blood stages of malaria parasites, which sustain infections over long periods and the immature derived sexual stages responsible for infecting mosquitoes and onward transmission. Early studies reported a temporal association between ACT introduction and reduced malaria transmission in a number of ecological settings. However, these reports have come from areas with low to moderate malaria transmission, been confounded by the presence of other interventions or environmental changes that may have reduced malaria transmission, and have not included a comparison group without ACT. This report presents results from the first large-scale observational study to assess the impact of case management with ACT on population-level measures of malaria endemicity in an area with intense transmission where the benefits of effective infection clearance might be compromised by frequent and repeated re-infection. Methods A pre-post observational study with a non-randomized comparison group was conducted at two sites in Tanzania. Both sites used sulphadoxine-pyrimethamine (SP monotherapy as a first-line anti-malarial from mid-2001 through 2002. In 2003, the ACT, artesunate (AS co-administered with SP (AS + SP, was introduced in all fixed health facilities in the intervention site, including both public and registered non-governmental facilities. Population-level prevalence of Plasmodium falciparum asexual parasitaemia and gametocytaemia were assessed using light microscopy from samples collected during representative household surveys in 2001, 2002, 2004, 2005 and 2006. Findings Among 37,309 observations included in the analysis, annual asexual parasitaemia prevalence in persons of all ages ranged from 11% to 28% and gametocytaemia prevalence ranged from Interpretation The introduction of ACT at

  9. Efficacy of artemisinin-based combination therapy for treatment of persons with uncomplicated Plasmodium falciparum malaria in West Sumba District, East Nusa Tenggara Province, Indonesia, and genotypic profiles of the parasite.

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    Asih, P.B.; Dewi, R.M.; Tuti, S.; Sadikin, M.; Sumarto, W.; Sinaga, B.; Ven, A.J.A.M. van der; Sauerwein, R.W.; Syafruddin, D.

    2009-01-01

    Reports on treatment failures associated with the use of first-and second-line antimalarial drugs chloroquine and sulfadoxine-pyrimethamine have recently increased in many parts of Indonesia. The present study evaluated artemisinin-based combination therapy for treatment of persons with

  10. Efficacy of artemisinin-based combination therapy for treatment of persons with uncomplicated Plasmodium falciparum malaria in West Sumba District, East Nusa Tenggara Province, Indonesia, and genotypic profiles of the parasite.

    NARCIS (Netherlands)

    Asih, P.B.; Dewi, R.M.; Tuti, S.; Sadikin, M.; Sumarto, W.; Sinaga, B.; Ven, A.J.A.M. van der; Sauerwein, R.W.; Syafruddin, D.

    2009-01-01

    Reports on treatment failures associated with the use of first-and second-line antimalarial drugs chloroquine and sulfadoxine-pyrimethamine have recently increased in many parts of Indonesia. The present study evaluated artemisinin-based combination therapy for treatment of persons with uncomplicate

  11. Artemisinin-based combination therapies for uncomplicated malaria.

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    Davis, Timothy M E; Karunajeewa, Harin A; Ilett, Kenneth F

    2005-02-21

    There has been a relentless increase in resistance of malaria parasites to conventional antimalarial drugs, including chloroquine, sulfadoxine-pyrimethamine and mefloquine. In response to this situation, short-course artemisinin-based combination therapies (ACTs) have been developed. The World Health Organization has endorsed ACT as first-line treatment where the potentially life-threatening parasite Plasmodium falciparum is the predominant infecting species. ACTs combine the rapid schizontocidal activity of an artemisinin derivative (artesunate, artemether or dihydroartemisinin) with a longer-half-life partner drug. Although the use of chloroquine and sulfadoxine-pyrimethamine as partners in ACT improves their efficacy, this may only have value as a short-term measure in patients with a degree of immunity to malaria. Alternative currently available partner drugs include mefloquine, lumefantrine and piperaquine. Artesunate-mefloquine is highly effective but is expensive and side effects (mainly neurotoxicity) can be problematic. Artemether-lumefantrine, the only ACT available in Australia, appears less effective than artesunate-mefloquine and needs to be administered with food to ensure adequate bioavailability. Dihydroartemisinin-piperaquine is highly effective, well tolerated and relatively inexpensive. The goal of potent, safe, easy-to-administer and inexpensive ACTs may see trioxolanes in place of artemisinin derivatives, as well as novel partner drugs such as pyronaridine or naphthoquine, in the future.

  12. Different methodological approaches to the assessment of in vivo efficacy of three artemisinin-based combination antimalarial treatments for the treatment of uncomplicated falciparum malaria in African children

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    Zongo Issaka

    2008-08-01

    Full Text Available Abstract Background Use of different methods for assessing the efficacy of artemisinin-based combination antimalarial treatments (ACTs will result in different estimates being reported, with implications for changes in treatment policy. Methods Data from different in vivo studies of ACT treatment of uncomplicated falciparum malaria were combined in a single database. Efficacy at day 28 corrected by PCR genotyping was estimated using four methods. In the first two methods, failure rates were calculated as proportions with either (1a reinfections excluded from the analysis (standard WHO per-protocol analysis or (1b reinfections considered as treatment successes. In the second two methods, failure rates were estimated using the Kaplan-Meier product limit formula using either (2a WHO (2001 definitions of failure, or (2b failure defined using parasitological criteria only. Results Data analysed represented 2926 patients from 17 studies in nine African countries. Three ACTs were studied: artesunate-amodiaquine (AS+AQ, N = 1702, artesunate-sulphadoxine-pyrimethamine (AS+SP, N = 706 and artemether-lumefantrine (AL, N = 518. Using method (1a, the day 28 failure rates ranged from 0% to 39.3% for AS+AQ treatment, from 1.0% to 33.3% for AS+SP treatment and from 0% to 3.3% for AL treatment. The median [range] difference in point estimates between method 1a (reference and the others were: (i method 1b = 1.3% [0 to24.8], (ii method 2a = 1.1% [0 to21.5], and (iii method 2b = 0% [-38 to19.3]. The standard per-protocol method (1a tended to overestimate the risk of failure when compared to alternative methods using the same endpoint definitions (methods 1b and 2a. It either overestimated or underestimated the risk when endpoints based on parasitological rather than clinical criteria were applied. The standard method was also associated with a 34% reduction in the number of patients evaluated compared to the number of patients enrolled. Only 2% of the sample size

  13. Treatment of malaria from monotherapy to artemisinin-based combination therapy by health professionals in rural health facilities in southern Cameroon

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    Bley Daniel

    2009-07-01

    Full Text Available Abstract Background One year after the adoption of artesunate-amodiaquine (AS/AQ as first-line therapy for the treatment of uncomplicated malaria, this study was designed to assess the treatment practices regarding anti-malarial drugs at health facilities in four rural areas in southern Cameroon. Methods Between April and August 2005, information was collected by interviewing fifty-two health professionals from twelve rural health facilities, using a structured questionnaire. Results In 2005, only three anti-malarial drugs were used in rural health facilities, including: amodiaquine, quinine and sulphadoxine-pyrimethamine. Only 2.0% of the health professionals prescribed the recommended AS/AQ combination. After reading the treatment guidelines, 75.0% were in favour of the treatment protocol with the following limitations: lack of paediatric formulations, high cost and large number of tablets per day. Up to 21.0% of professionals did not prescribe AS/AQ because of the level of adverse events attributed to the use of amodiaquine as monotherapy. Conclusion The present study indicates that AS/AQ was not available in the public health facilities at the time of the study, and health practitioners were not informed about the new treatment guidelines. Results of qualitative analysis suggest that prescribers should be involved as soon as possible in projects related to the optimization of treatment guidelines and comply with new drugs. Adapted formulations should be made available at the international level and implemented locally before new drugs and treatments are proposed through a national control programme. This baseline information will be useful to monitor progresses in the implementation of artemisinin-based combination therapy in Cameroon.

  14. Comparative assessment of two Artemisinin based combination Therapies in the treatment of Uncomplicated Malaria among University students in Nigeria

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    Okonta Matthew J

    2013-06-01

    Full Text Available Background: In line with the recommendation of artemisininbased combination therapy (ACT by WHO in the effective treatment of uncomplicated malaria, African nations including Nigeria changed their malaria treatment policy to combination therapies. To date, about 15 African nations adopted artesunate /amodiaquine (AA as their first line agent while Nigeria adopted artemether /lumefantrine (AL. Objective: The objective of this study is to compare the treatment outcome among patients treated with AA to those treated with AL for acute uncomplicated malaria. Method: The study was conducted at Nnamdi Azikiwe University campuses using quantitative methods. Two hundered and ninety six patients were randomly allocated to one of two treatment group- AA and AL with 148 patients per group. All the patients were educated about the drugs and adherence. Adherence and treatment outcomes including parasite clearance and the drugs’ effects on biochemical parameters among others were assessed by follow up visits on third, seventh, fourteenth and twenty eighth-day post treatment. Data were analysed using Cox Regression model on SPSS 17.0. Result: Both drugs were well adhered to and tolerated. One case of Steven Johnson-like reaction was observed with AL. Fever resolution and parasite clearance was similar in both groups with adequate clinical and parasitological response (ACPR by day 28 for AL and AA being 70.3% and 85.1% respectively. Conclusion: Our findings is in favour of higher efficacy of AA with respect to their ACPR. More controlled studies will be needed to ascertain the adoption of AL as first line drug in malaria treatment in Nigeria.

  15. Clinical illness and outcomes in Nigerian children with late-appearing anaemia after artemisinin-based combination treatments of uncomplicated falciparum malaria.

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    Sowunmi, Akintunde; Akano, Kazeem; Ayede, Adejumoke I; Ntadom, Godwin; Aderoyeje, Temitope; Adewoye, Elsie O; Fatunmbi, Bayo

    2016-06-01

    Late-appearing anaemia (LAA) following treatment with artemisinins for severe malaria has been reported and well described, but there are limited clinical and parasitological data on LAA in African children with uncomplicated falciparum malaria following oral artemisinin-based combination therapies (ACTs). This was an open label study with the main objectives of evaluating the clinical features, the risk factors for, the temporal changes in haematocrit and the outcomes of a LAA in malarious children treated with artesunate-amodiaquine (AA), artemether-lumefantrine (AL) or dihydroartemisinin-piperaquine (DHP). The diagnosis of LAA was made using the criteria: clearance of parasitaemia, fever and other symptoms within 1 week of commencing treatment; adequate clinical and parasitological response at 4-6 weeks after treatment began; haematocrit ≥30 % 1 and/or 2 weeks after treatment began; and haematocrit 10(4) 2 days after treatment began (AOR = 2.1, 95 % CI 1.1-3.9, P = 0.03) and spleen enlargement at presentation (AOR = 2.0, 95 % CI 1.1-3.9, P anaemia occurred in 56 children [mean recovery time of 11.8 days (95 % CI 10.3-13.3)]. The only independent predictor of failure of recovery was LAA occurring 4 weeks after starting treatment (AOR = 7.5, 95 % CI 2.5-22.9, P anaemia and for anaemia control efforts in sub-Saharan Africa where ACTs have become first-line antimalarials. Pan African Clinical Trial Registry PACTR201508001188143, 3 July 2015; PACTR201510001189370, 3 July 2015; PACTR201508001191898, 7 July 2015 and PACTR201508001193368, 8 July 2015 http://www.pactr.org .

  16. Artemisinin-based combinations versus amodiaquine plus sulphadoxine-pyrimethamine for the treatment of uncomplicated malaria in Faladje, Mali

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    Traore Boubacar

    2009-01-01

    Full Text Available Abstract Background Because of the emergence of chloroquine resistance in Mali, artemether-lumefantrine (AL or artesunate-amodiaquine (AS+AQ are recommended as first-line therapy for uncomplicated malaria, but have not been available in Mali until recently because of high costs. Methods From July 2005 to January 2006, a randomized open-label trial of three oral antimalarial combinations, namely AS+AQ, artesunate plus sulphadoxine-pyrimethamine (AS+SP, and amodiaquine plus sulphadoxine-pyrimethamine (AQ+SP, was conducted in Faladje, Mali. Parasite genotyping by polymerase chain reaction (PCR was used to distinguish new from recrudescent Plasmodium falciparum infections. Results 397 children 6 to 59 months of age with uncomplicated Plasmodium falciparum malaria were enrolled, and followed for 28 days to assess treatment efficacy. Baseline characteristics were similar in all three treatment groups. The uncorrected rates of adequate clinical and parasitologic response (ACPR were 55.7%, 90.8%, and 97.7% in AS+AQ, AS+SP, and AQ+SP respectively (p Conclusion The combination of AQ+SP provides a potentially low cost alternative for treatment of uncomplicated P. falciparum infection in Mali and appears to have the added value of longer protective effect against new infection.

  17. Randomized comparison of the efficacies and tolerabilities of three artemisinin-based combination treatments for children with acute Plasmodium falciparum malaria in the Democratic Republic of the Congo.

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    Onyamboko, M A; Fanello, C I; Wongsaen, K; Tarning, J; Cheah, P Y; Tshefu, K A; Dondorp, A M; Nosten, F; White, N J; Day, N P J

    2014-09-01

    An open-label, randomized controlled trial was carried out in 2011-2012 in the Democratic Republic of the Congo to test the efficacy, safety, and tolerability of the artemisinin-based combination treatments dihydroartemisinin-piperaquine, amodiaquine-artesunate, and artemether-lumefantrine. Six hundred eighty-four children aged 3 to 59 months with uncomplicated Plasmodium falciparum malaria were randomly allocated to each study arm. Children were hospitalized for 3 days, given supervised treatment, and followed up weekly for 42 days. All regimens were well tolerated and rapidly effective. The median parasitemia clearance half-life was 2.2 h, and half-lives were similar between arms (P=0.19). The PCR-uncorrected cure rates by day 42 were 73.0% for amodiaquine-artesunate, 70.2% for artemether-lumefantrine, and 86.3% for dihydroartemisinin-piperaquine (P=0.001). Early treatment failure occurred in three patients (0.5%), one in each arm. The PCR-corrected cure rates were 93.4% for amodiaquine-artesunate, 92.7% for artemether-lumefantrine, and 94.3% for dihydroartemisinin-piperaquine (P=0.78). The last provided a longer posttreatment prophylactic effect than did the other two treatments. The day 7 plasma concentration of piperaquine was below 30 ng/ml in 47% of the children treated with dihydroartemisinin-piperaquine, and the day 7 lumefantrine concentration was below 280 ng/ml in 37.0% of children who received artemether-lumefantrine. Thus, although cure rates were all satisfactory, they could be improved by increasing the dose. (This study has been registered with the International Standard Randomized Controlled Trial Number Register [www.isrctn.org] under registration no. ISRCTN20984426.).

  18. PfHRP2 and PfLDH antigen detection for monitoring the efficacy of artemisinin-based combination therapy (ACT in the treatment of uncomplicated falciparum malaria

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    Deloron Philippe

    2009-09-01

    Full Text Available Abstract Background An assessment of the accuracy of two malaria rapid diagnostic tests (RDT for the detection of Plasmodium falciparum histidine-rich protein 2 (PfHRP2 or Pf lactate dehydrogenase (PfLDH was undertaken in children aged between six and 59 months included in an anti-malarial efficacy study in Benin. Methods In Allada (Benin, 205 children aged 6-59 months with falciparum malaria received either artesunate-amodiaquine (ASAQ, artemether-lumefantrine (AL, or sulphadoxine-pyrimethamine (SP. Children included in the study were simultaneously followed by both RDT and high-quality microscopy for up to 42 days. Results At the time of inclusion, PfHRP2-based tests were positive in 203 children (99% and PfLDH-based tests were positive in 204 (99.5%. During follow-up, independent of the treatment received, only 17.3% (28/162 of children effectively cured were negative with the PfHRP2 RDT at day 3, with a gradual increase in specificity until day 42. The specificity of antigen detection with the PfLDH test was 87% (141/162 on day 3, and between 92% and 100% on days 7 to 42. A statistical difference was observed between the persistence of PfHRP2 and PfLDH antigenaemia during follow-up in children treated with artemisinin-based combination therapy (ACT but not with SP. Conclusion Although both RDTs are as sensitive as microscopy in detecting true malaria cases, the PfHRP2 RDT had very low specificity during follow-up until day 28. On the other hand, the PfLDH test could be used to detect failures and, therefore, to assess anti-malarial efficacy.

  19. Efficacy of artemisinin-based combination treatments of uncomplicated falciparum malaria in under-five-year-old Nigerian children.

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    Oguche, Stephen; Okafor, Henrietta U; Watila, Ismaila; Meremikwu, Martin; Agomo, Philip; Ogala, William; Agomo, Chimere; Ntadom, Godwin; Banjo, Olajide; Okuboyejo, Titilope; Ogunrinde, Gboye; Odey, Friday; Aina, Olugbemiga; Sofola, Tolulope; Sowunmi, Akintunde

    2014-11-01

    The efficacy of 3-day regimens of artemether-lumefantrine and artesunate-amodiaquine were evaluated in 747 children artesunate-amodiaquine-compared with artemether-lumefantrine-treated children. Parasite clearance times were similar with both treatments. Overall efficacy was 96.3% (95% confidence interval [CI] 94.5-97.6%), and was similar for both regimens. Polymerase chain reaction-corrected parasitologic cure rates on Day 28 were 96.9% (95% CI 93.9-98.2%) and 98.3% (95% CI 96.1-99.3%) for artemether-lumefantrine and artesunate-amodiaquine, respectively. Gametocyte carriage post treatment was significantly lower than pretreatment (P < 0.0001). In anemic children, mean time to recovery from anemia was 10 days (95% CI 9.04-10.9) and was similar for both regimens. Both treatments were well tolerated and are safe and efficacious treatments of uncomplicated falciparum malaria in young Nigerian children.

  20. Intermittent preventive treatment using artemisinin-based combination therapy reduces malaria morbidity among school-aged children in Mali

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    Barger, Breanna; Maiga, Hamma; Traore, Oumar Bila; Tekete, Mamadou; Tembine, Intimbeye; Dara, Antoine; Traore, Zoumana Isaac; Gantt, Soren; Doumbo, Ogobara K.; Djimde, Abdoulaye A.

    2011-01-01

    Summary OBJECTIVE To assess the efficacy of intermittent preventive treatment (IPT) against malaria in school-aged children. METHODS This was an open randomized controlled trial of seasonal IPT among school children (IPTsc) aged 6–13 years in Kollé, Mali. The study began in September 2007 and completed follow-up in May 2008. Students were randomized to one of three study arms: Sulfadoxine–pyrimethamine plus artesunate (SP/AS), amodiaquine plus artesunate (AQ/AS) or vitamin C. All students received two full treatment doses, given 2 months apart during the season of high transmission from September to December. Groups were compared with respect to incidence of clinical malaria, asymptomatic parasitemia and haemoglobin concentration. RESULTS A total of 296 students were randomized, and retention in the study was 99.3%. Clinical malaria incidence in the SP/AS and AQ/AS arms was reduced by 66.6% and 46.5%, respectively, vs. vitamin C (P < 0.001). There were fewer clinic visits for any cause among the children receiving SP/AS or AQ/AS (P = 0.024). The prevalence of asymptomatic parasitemia was fivefold higher in the vitamin C arm than either SP/AS or AQ/AS at each post-treatment evaluation (P < 0.001). At the end of the transmission period, children treated with IPT had lower rates of anaemia (SP/AS, 17.7%; AQ/AS, 16.0%; vitamin C, 29.6%; P = 0.039). CONCLUSION IPT among school children reduced the rates of clinical malaria, all-cause acute clinic visits, asymptomatic parasitemia and anaemia among school-aged children. PMID:19497079

  1. Degradation of Artemisinin-Based Combination Therapies under Tropical Conditions

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    Hall, Zoe; Allan, Elizabeth Louise; van Schalkwyk, Donelly Andrew; van Wyk, Albert; Kaur, Harparkash

    2016-01-01

    Poor quality antimalarials, including falsified, substandard, and degraded drugs, are a serious health concern in malaria-endemic countries. Guidelines are lacking on how to distinguish between substandard and degraded drugs. “Forced degradation” in an oven was carried out on three common artemisinin-based combination therapy (ACT) brands to detect products of degradation using liquid chromatography mass spectrometry and help facilitate classification of degraded drugs. “Natural aging” of 2,880 tablets each of ACTs artemether/lumefantrine and artesunate/amodiaquine was undertaken to evaluate their long-term stability in tropical climates. Samples were aged in the presence and absence of light on-site in Ghana and in a stability chamber (London), removed at regular intervals, and analyzed to determine loss of the active pharmaceutical ingredients (APIs) over time and detect products of degradation. Loss of APIs in naturally aged tablets (both in Ghana and the pharmaceutical stability chamber) was 0–7% over 3 years (∼12 months beyond expiry) with low levels of degradation products detected. Using this developed methodology, it was found that a quarter of ACTs purchased in Enugu, Nigeria (concurrent study), that would have been classified as substandard, were in fact degraded. Presence of degradation products together with evidence of insufficient APIs can be used to classify drugs as degraded. PMID:26951346

  2. Moderate effect of artemisinin-based combination therapy on transmission of Plasmodium falciparum.

    NARCIS (Netherlands)

    Bousema, J.T.; Schneider, P.; Gouagna, L.C.; Drakeley, C.; Tostmann, A.; Houben, R.; Githure, J.I.; Ord, R.; Sutherland, C.J.; Omar, S.A.; Sauerwein, R.W.

    2006-01-01

    Background. Artemisinin-based combination therapy (ACT) reduces microscopically confirmed gametocytemia and mosquito infection. However, molecular techniques have recently revealed high prevalences of submicroscopic gametocytemia. Our objective here was to determine the effect of sulfadoxine-pyrimet

  3. Anaemia following Artemisinin-Based Combination Treatments of Uncomplicated Plasmodium falciparum Malaria in Children: Temporal Patterns of Haematocrit and the Use of Uncomplicated Hyperparasitaemia as a Model for Evaluating Late-Appearing Anaemia.

    Science.gov (United States)

    Sowunmi, Akin; Akano, Kazeem; Ntadom, Godwin; Ayede, Adejumoke; Oguche, Stephen; Agomo, Chimere; Okafor, Henrietta; Watila, Ismaila; Meremikwu, Martin; Ogala, William; Agomo, Philip; Adowoye, Elsie; Fatunmbi, Bayo; Aderoyeje, Temitope; Happi, Christian; Gbotosho, Grace; Folarin, Onikepe

    2017-01-01

    In severe malaria, intravenous artesunate may cause delayed haemolytic anaemia but there has been little evaluation of the propensity of oral artemisinin-based combination treatments (ACTs) to cause late-appearing anaemia. The frequency of anaemia (haematocrit anaemia decreased significantly following treatment. FIH/1,000 asexual parasites cpb, average haematocrit:total parasitaemia cleared, and mean haematocrit 5 weeks after treatment began were significantly lower in hyperparasitaemic children than in children without hyperparasitaemia, suggesting haematocrit conservation during treatment followed later by a loss of haematocrit. Asymptomatic late-appearing anaemia occurred in 6% of the children. Artesunate-amodiaquine and artemether-lumefantrine contribute to haematocrit conservation at high parasitaemias but may cause late-appearing anaemia. © 2017 S. Karger AG, Basel.

  4. Plasmodium falciparum gametocyte carriage, sex ratios and asexual parasite rates in Nigerian children before and after a treatment protocol policy change instituting the use of artemisinin-based combination therapies

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    Grace Olusola Gbotosho

    2011-09-01

    Full Text Available The effects of artemisinin-based combination therapies (ACTs on transmission of Plasmodium falciparum were evaluated after a policy change instituting the use of ACTs in an endemic area. P. falciparum gametocyte carriage, sex ratios and inbreeding rates were examined in 2,585 children at presentation with acute falciparum malaria during a 10-year period from 2001-2010. Asexual parasite rates were also evaluated from 2003-2010 in 10,615 children before and after the policy change. Gametocyte carriage declined significantly from 12.4% in 2001 to 3.6% in 2010 (@@χ2 for trend = 44.3, p < 0.0001, but sex ratios and inbreeding rates remained unchanged. Additionally, overall parasite rates remained unchanged before and after the policy change (47.2% vs. 45.4%, but these rates declined significantly from 2003-2010 (@@χ2 for trend 35.4, p < 0.0001. Chloroquine (CQ and artemether-lumefantrine (AL were used as prototype drugs before and after the policy change, respectively. AL significantly shortened the duration of male gametocyte carriage in individual patients after treatment began compared with CQ (log rank statistic = 7.92, p = 0.005. ACTs reduced the rate of gametocyte carriage in children with acute falciparum infections at presentation and shortened the duration of male gametocyte carriage after treatment. However, parasite population sex ratios, inbreeding rates and overall parasite rate were unaffected.

  5. School-based diagnosis and treatment of malaria by teachers using rapid diagnostic tests and artemisinin-based combination therapy: experiences and perceptions of users and implementers of the Learner Treatment Kit, southern Malawi.

    Science.gov (United States)

    Mphwatiwa, Treza; Witek-McManus, Stefan; Mtali, Austin; Okello, George; Nguluwe, Paul; Chatsika, Hard; Roschnik, Natalie; Halliday, Katherine E; Brooker, Simon J; Mathanga, Don P

    2017-08-07

    Training teachers to diagnose uncomplicated malaria using malaria rapid diagnostic tests and treat with artemisinin-based combination therapy has the potential to improve the access of primary school children (6-14 years) to prompt and efficient treatment for malaria, but little is known about the acceptability of such an intervention. This qualitative study explored experiences and perceptions of users and implementers of a programme of school-based malaria case management via a first-aid kit-the Learner Treatment Kit (LTK)-implemented as part of a cluster-randomized controlled trial in Zomba district, Malawi. From 29 primary schools where teachers were trained to test and treat school children for malaria using the LTK, six schools were purposively selected on the basis of relative intervention usage (low, medium or high); school size and geographical location. In total eight focus group discussions were held with school children, parents and guardians, and teachers; and 20 in-depth interviews were conducted with key stakeholders at the school, district and national levels. Interviews were recorded, transcribed, and analysed using a thematic analysis approach. The LTK was widely perceived by respondents to be a worthwhile intervention, with the opinion that trained teachers were trusted providers of malaria testing and treatment to school children. Benefits of the programme included a perception of improved access to malaria treatment for school children; decreased school absenteeism; and that the programme supported broader national health and education policies. Potential barriers to successful implementation expressed included increased teacher workloads, a feeling of inadequate supervision from health workers, lack of incentives and concerns for the sustainability of the programme regarding the supply of drugs and commodities. Training teachers to test for and treat uncomplicated malaria in schools was well received by both users and implementers alike, and

  6. Efficacy of non-artemisinin- and artemisinin-based combination therapies for uncomplicated falciparum malaria in Cameroon

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    Thalabard Jean-Christophe

    2010-02-01

    Full Text Available Abstract Background The use of drug combinations, including non-artemisinin-based and artemisinin-based combination therapy (ACT, is a novel strategy that enhances therapeutic efficacy and delays the emergence of multidrug-resistant Plasmodium falciparum. Its use is strongly recommended in most sub-Saharan African countries, namely Cameroon, where resistance to chloroquine is widespread and antifolate resistance is emerging. Methods Studies were conducted in Cameroonian children with acute uncomplicated P. falciparum malaria according to the standard World Health Organization protocol at four sentinel sites between 2003 and 2007. A total of 1,401 children were enrolled, of whom 1,337 were assigned to randomized studies and 64 were included in a single non-randomized study. The proportions of adequate clinical and parasitological response (PCR-uncorrected on day 14 and PCR-corrected on day 28 were the primary endpoints to evaluate treatment efficacy on day 14 and day 28. The relative effectiveness of drug combinations was compared by a multi-treatment Bayesian random-effect meta-analysis. Findings The results based on the meta-analysis suggested that artesunate-amodiaquine (AS-AQ is as effective as other drugs (artesunate-sulphadoxine-pyrimethamine [AS-SP], artesunate-chlorproguanil-dapsone [AS-CD], artesunate-mefloquine [AS-MQ], dihydroartemisinin-piperaquine [DH-PP], artemether-lumefantrine [AM-LM], amodiaquine, and amodiaquine-sulphadoxine-pyrimethamine [AQ-SP]. AM-LM appeared to be the most effective with no treatment failure due to recrudescence, closely followed by DH-PP. Conclusion Although AM-LM requires six doses, rather than three doses for other artemisinin-based combinations, it has potential advantages over other forms of ACT. Further studies are needed to evaluate the clinical efficacy and tolerance of these combinations in different epidemiological context.

  7. Treatment of malaria from monotherapy to artemisinin-based combination therapy by health professionals in urban health facilities in Yaoundé, central province, Cameroon

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    Bley Daniel

    2009-07-01

    Full Text Available Abstract Background After adoption of artesunate-amodiaquine (AS/AQ as first-line therapy for the treatment of uncomplicated malaria by the malaria control programme, this study was designed to assess the availability of anti-malarial drugs, treatment practices and acceptability of the new protocol by health professionals, in the urban health facilities and drugstores of Yaoundé city, Cameroon. Methods Between April and August 2005, retrospective and current information was collected by consulting registers and interviewing health practitioners in urban health facilities using a structured questionnaire. Results In 2005, twenty-seven trade-named drugs have been identified in drugstores; quinine tablets (300 mg were the most affordable anti-malarial drugs. Chloroquine was restricted to food market places and no generic artemisinin derivative was available in public health centres. In public health facilities, 13.6% of health professionals were informed about the new guidelines; 73.5% supported the use of AS-AQ as first-line therapy. However, 38.6% apprehended its use due to adverse events attributed to amodiaquine. Malaria treatment was mainly based on the diagnosis of fever. Quinine (300 mg tablets was the most commonly prescribed first-line anti-malarial drug in adults (44.5% and pregnant women (52.5%. Artequin® was the most cited artemsinin-based combination therapy (ACT (9.9%. Medical sales representatives were the main sources of information on anti-malarials. Conclusion The use of AS/AQ was not implemented in 2005 in Yaoundé, despite the wide range of anti-malarials and trade-named artemisinin derivatives available. Nevertheless, medical practitioners will support the use of this combination, when it is available in a paediatric formulation, at an affordable price. Training, information and participation of health professionals in decision-making is one of the key elements to improve adherence to new protocol guidelines. This baseline

  8. Efficacy of artemisinin-based combination therapies for the treatment of falciparum malaria in Pakistan (2007-2015): In vivo response and dhfr and dhps mutations.

    Science.gov (United States)

    Kakar, Qutbuddin; Sheikh, Salma; Ahmed, Imran; Khan, Munir Ahmed; Jamil, Muhammad; ElMohammady, Hanan; Warsame, Marian

    2016-12-01

    Artesunate+sulfadoxine-pyrimethamine (AS+SP) and artemether+lumefantrine (AL) are the first- and second line treatments, respectively, for the treatment of falciparum infections and dihydroartemsinin+piperaquine (DHA+PPQ) is a potential candidate in case AS+SP or AL fails in Pakistan. The therapeutic efficacies of AS+SP (5 sites in 2007, 2 sites in 2011 and 2 sites in 2012), AL (2 sites in 2012) and DHA+PPQ (2 sites in 2015) were evaluated in seven sentinel sites. Clinical and parasitological outcomes were evaluated among eligible patients. Mutations of the P. falciparum dihydrofolate reductase (dhfr) and dihydropteroate synthase (dhps) genes were investigated. After PCR correction, a 98.5-100% adequate clinical and parasitological response (ACPR) for AS+SP and a 98.8-100% ACPR for AL were observed by day 28, as well as a 100% ACPR by day 42 for DHA+PPQ. The prevalences of mutants dhfr S108N (100%) and C59R (98%-100%) reached or were near fixation. The double dhfr (C59R/S108N) mutant was dominant (96%-100%) at all sites. The triple dhfr (N51I/C59R/S108N) mutant was rare (1.1%-2.3%). The prevalence of dhps A437G varied between 38% and 70%. A combination of triple dhfr/dhps (C59R/S108N+A437G or N51I/S108N+A437G) mutants was observed (38%-69%). A quadruple dhfr/dhps (N51I/C59R/S108N+A437G) mutation was very rare and no quintuple (N51I/C59R/S108N+A437G/K540E) mutations were detected. AS+SP remains highly effective in Pakistan. However, molecular data indicate that SP resistance is being established, although mutations that confer a high risk of SP treatment failure are rare or non-existent. This underscores the need for close monitoring of both in vivo AS+SP efficacy and dhfr and dhps mutations to inform national treatment policy. Trial registration numbers: ISRCTN21926128 (2007), ACTRN12611001244998 (2011), ACTRN12612001090808 (2012), ACTRN12615001248550 (2015).

  9. Quality of Artemisinin-Based Combination Formulations for Malaria Treatment: Prevalence and Risk Factors for Poor Quality Medicines in Public Facilities and Private Sector Drug Outlets in Enugu, Nigeria

    Science.gov (United States)

    Kaur, Harparkash; Allan, Elizabeth Louise; Mamadu, Ibrahim; Hall, Zoe; Ibe, Ogochukwu; El Sherbiny, Mohamed; van Wyk, Albert; Yeung, Shunmay; Swamidoss, Isabel; Green, Michael D.; Dwivedi, Prabha; Culzoni, Maria Julia; Clarke, Siân; Schellenberg, David; Fernández, Facundo M.; Onwujekwe, Obinna

    2015-01-01

    Background Artemisinin-based combination therapies are recommended by the World Health Organisation (WHO) as first-line treatment for Plasmodium falciparum malaria, yet medication must be of good quality for efficacious treatment. A recent meta-analysis reported 35% (796/2,296) of antimalarial drug samples from 21 Sub-Saharan African countries, purchased from outlets predominantly using convenience sampling, failed chemical content analysis. We used three sampling strategies to purchase artemisinin-containing antimalarials (ACAs) in Enugu metropolis, Nigeria, and compared the resulting quality estimates. Methods ACAs were purchased using three sampling approaches - convenience, mystery clients and overt, within a defined area and sampling frame in Enugu metropolis. The active pharmaceutical ingredients were assessed using high-performance liquid chromatography and confirmed by mass spectrometry at three independent laboratories. Results were expressed as percentage of APIs stated on the packaging and used to categorise each sample as acceptable quality, substandard, degraded, or falsified. Results Content analysis of 3024 samples purchased from 421 outlets using convenience (n=200), mystery (n=1,919) and overt (n=905) approaches, showed overall 90.8% ACAs to be of acceptable quality, 6.8% substandard, 1.3% degraded and 1.2% falsified. Convenience sampling yielded a significantly higher prevalence of poor quality ACAs, but was not evident by the mystery and overt sampling strategies both of which yielded results that were comparable between each other. Artesunate (n=135; 4 falsified) and dihydroartemisinin (n=14) monotherapy tablets, not recommended by WHO, were also identified. Conclusion Randomised sampling identified fewer falsified ACAs than previously reported by convenience approaches. Our findings emphasise the need for specific consideration to be given to sampling frame and sampling approach if representative information on drug quality is to be obtained

  10. Quality of artemisinin-based combination formulations for malaria treatment: prevalence and risk factors for poor quality medicines in public facilities and private sector drug outlets in Enugu, Nigeria.

    Directory of Open Access Journals (Sweden)

    Harparkash Kaur

    Full Text Available Artemisinin-based combination therapies are recommended by the World Health Organisation (WHO as first-line treatment for Plasmodium falciparum malaria, yet medication must be of good quality for efficacious treatment. A recent meta-analysis reported 35% (796/2,296 of antimalarial drug samples from 21 Sub-Saharan African countries, purchased from outlets predominantly using convenience sampling, failed chemical content analysis. We used three sampling strategies to purchase artemisinin-containing antimalarials (ACAs in Enugu metropolis, Nigeria, and compared the resulting quality estimates.ACAs were purchased using three sampling approaches--convenience, mystery clients and overt, within a defined area and sampling frame in Enugu metropolis. The active pharmaceutical ingredients were assessed using high-performance liquid chromatography and confirmed by mass spectrometry at three independent laboratories. Results were expressed as percentage of APIs stated on the packaging and used to categorise each sample as acceptable quality, substandard, degraded, or falsified.Content analysis of 3024 samples purchased from 421 outlets using convenience (n=200, mystery (n=1,919 and overt (n=905 approaches, showed overall 90.8% ACAs to be of acceptable quality, 6.8% substandard, 1.3% degraded and 1.2% falsified. Convenience sampling yielded a significantly higher prevalence of poor quality ACAs, but was not evident by the mystery and overt sampling strategies both of which yielded results that were comparable between each other. Artesunate (n=135; 4 falsified and dihydroartemisinin (n=14 monotherapy tablets, not recommended by WHO, were also identified.Randomised sampling identified fewer falsified ACAs than previously reported by convenience approaches. Our findings emphasise the need for specific consideration to be given to sampling frame and sampling approach if representative information on drug quality is to be obtained.

  11. Subsidizing artemisinin-based combination therapies: a preliminary investigation of the Affordable Medicines Facility – malaria

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    Bate R

    2012-07-01

    Full Text Available Roger Bate,1,2 Kimberly Hess,2 Richard Tren,2 Lorraine Mooney,3 Franklin Cudjoe,4 Thompson Ayodele,5 Amir Attaran61American Enterprise Institute, Washington, DC, USA; 2Africa Fighting Malaria, Washington, DC, USA; 3Africa Fighting Malaria, Cambridge, United Kingdom; 4IMANI Center for Policy and Education, Accra, Ghana; 5Initiative for Public Policy Analysis, Lagos, Nigeria; 6University of Ottawa, Ottawa, ON, CanadaBackground: The Affordable Medicines Facility – malaria (AMFm is a subsidy mechanism to lower the price of, and hence increase access to, the best antimalarial medicines, artemisinin-based combination therapies (ACTs. While the AMFm stipulates that only quality-approved products are eligible for subsidy, it is not known whether those products, when actually supplied, are of good quality and comport with established pharmacopeial guidance on formulation and content of active ingredients. This study aimed to assess price and quality of AMFm ACTs, to compare AMFm ACTs with non-AMFm ACTs and artemisinin monotherapies, and to assess whether AMFm ACTs have been pilfered and diverted to a nearby country.Methods: In all, 140 artemisinin-based antimalarial drugs were acquired from 37 pharmacies in Lagos, Nigeria, and Accra, Ghana. An additional ten samples of AMFm ACTs were collected from Lomé, Togo (not participating in the AMFm. Samples were analyzed using high-performance liquid chromatography.Results: The AMFm ACTs were lower in price than many of the other drugs collected, but by less than anticipated or stipulated by the participating governments of Nigeria and Ghana. The quality of the AMFm ACTs was not universally good: overall, 7.7% had too little active pharmaceutical ingredient (API and none had too much – these results are not likely to be as a result of random chance. AMFm ACTs were also found to have been diverted, both to pharmacies in Lagos not participating in the AMFm and to a foreign city (Lomé where the AMFm is not

  12. Treatment of malaria from monotherapy to artemisinin-based combination therapy by health professionals in urban health facilities in Yaoundé, central province, Cameroon

    OpenAIRE

    Bley Daniel; Malvy Denis; Vernazza-Licht Nicole; Gausseres Mathieu; Sayang Collins; Millet Pascal

    2009-01-01

    Abstract Background After adoption of artesunate-amodiaquine (AS/AQ) as first-line therapy for the treatment of uncomplicated malaria by the malaria control programme, this study was designed to assess the availability of anti-malarial drugs, treatment practices and acceptability of the new protocol by health professionals, in the urban health facilities and drugstores of Yaoundé city, Cameroon. Methods Between April and August 2005, retrospective and current information was collected by cons...

  13. Estimating antimalarial drugs consumption in Africa before the switch to artemisinin-based combination therapies (ACTs

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    Vreeke Ed

    2007-07-01

    Full Text Available Abstract Background Having reliable forecasts is critical now for producers, malaria-endemic countries and agencies in order to adapt production and procurement of the artemisinin-based combination treatments (ACTs, the new first-line treatments of malaria. There is no ideal method to quantify drug requirements for malaria. Morbidity data give uncertain estimations. This study uses drug consumption to provide elements to help estimate quantities and financial requirements of ACTs. Methods The consumption of chloroquine, sulphadoxine/pyrimethamine and quinine both through the private and public sector was assessed in five sub-Saharan Africa countries with different epidemiological patterns (Senegal, Rwanda, Tanzania, Malawi, Zimbabwe. From these data the number of adult treatments per capita was calculated and the volumes and financial implications derived for the whole of Africa. Results Identifying and obtaining data from the private sector was difficult. The quality of information on drug supply and distribution in countries must be improved. The number of adult treatments per capita and per year in the five countries ranged from 0.18 to 0.50. Current adult treatment prices for ACTs range US$ 1–1.8. Taking the upper range for both volumes and costs, the highest number of adult treatments consumed for Africa was estimated at 314.5 million, corresponding to an overall maximum annual need for financing ACT procurement of US$ 566.1 million. In reality, both the number of cases treated and the cost of treatment are likely to be lower (projections for the lowest consumption estimate with the least expensive ACT would require US $ 113 million per annum. There were substantial variations in the market share between public and private sources among these countries (the public sector share ranging from 98% in Rwanda to 33% in Tanzania. Conclusion Additional studies are required to build a more robust methodology, and to assess current consumptions

  14. From chloroquine to artemisinin-based combination therapy: the Sudanese experience

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    Elhassan AH

    2006-07-01

    Full Text Available Abstract Background In Sudan, chloroquine (CQ remains the most frequently used drug for falciparum malaria for more than 40 years. The change to artemisinin-based combination therapy (ACT was initiated in 2004 using the co-blister of artesunate + sulfadoxine/pyrimethamine (AS+SP and artemether + lumefantrine (ART+LUM, as first- and second-line, respectively. This article describes the evidence-base, the process for policy change and it reflects the experience of one year implementation. Relevant published and unpublished documents were reviewed. Data and information obtained were compiled into a structured format. Case description Sudan has used evidence to update its malaria treatment to ACTs. The country moved without interim period and proceeded with country-wide implementation instead of a phased introduction of the new policy. The involvement of care providers and key stakeholders in a form of a technical advisory committee is considered the key issue in the process. Development and distribution of guidelines, training of care providers, communication to the public and provision of drugs were given great consideration. To ensure presence of high quality drugs, a system for post-marketing drugs surveillance was established. Currently, ACTs are chargeable and chiefly available in urban areas. With the input from the Global Fund to fight AIDs, Tuberculosis and Malaria, AS+SP is now available free of charge in 10 states. Conclusion Implementation of the new policy is affected by the limited availability of the drugs, their high cost and limited pre-qualified manufacturers. Substantial funding needs to be mobilized by all partners to increase patients' access for this life-saving intervention.

  15. Adherence to prescribed artemisinin-based combination therapy in Garissa and Bunyala districts, Kenya

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    Munga Stephen

    2011-09-01

    Full Text Available Abstract Background Following the development of resistance to anti-malarial mono-therapies, malaria endemic countries in Africa now use artemisinin-based combination therapy (ACT as recommended first-line treatment for uncomplicated malaria. Patients' adherence to ACT is an important factor to ensure treatment efficacy, as well as to reduce the likelihood of parasite resistance to these drugs. This study reports adherence to a specific ACT, artemether-lumefantrine (AL, under conditions of routine clinical practice in Kenya. Method The study was undertaken in Garissa and Bunyala districts among outpatients of five government health facilities. Patients treated with AL were visited at home four days after having been prescribed the drug. Respondents (patients ≥ 15 years and caregivers of patients Results Of the 918 patients included in the study, 588 (64.1% were 'probably adherent', 291 (31.7% were 'definitely non-adherent' and 39 (4.2% were 'probably non-adherent'. Six factors were found to be significant predictors of adherence: patient knowledge of the ACT dosing regimen (odds ratio (OR = 1.76; 95% CI = 1.32-2.35, patient age (OR = 1.65; 95% CI = 1.02-1.85, respondent age (OR = 1.37; 95% CI = 1.10-2.48, whether a respondent had seen AL before (OR = 1.46; 95% CI = 1.08-1.98, whether a patient had reported dislikes to AL (OR = 0.62 95% CI = 0.47-0.82 and whether a respondent had waited more than 24 hours to seek treatment (OR = 0.73; 95% CI = 0.54-0.99. Conclusion Overall, adherence to AL was found to be low in both Garissa and Bunyala districts, with patient knowledge of the AL dosing regimen found to be the strongest predictor of adherence. Interventions aimed at increasing community awareness of the AL dosing regimen, use of child friendly formulations and improving health workers' prescribing practices are likely to ensure higher adherence to AL and eventual treatment success.

  16. Increasing Access to Subsidized Artemisinin-based Combination Therapy through Accredited Drug Dispensing Outlets in Tanzania

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    Gabra Michael

    2011-06-01

    Full Text Available Abstract Background In Tanzania, many people seek malaria treatment from retail drug sellers. The National Malaria Control Program identified the accredited drug dispensing outlet (ADDO program as a private sector mechanism to supplement the distribution of subsidized artemisinin-based combination therapies (ACTs from public facilities and increase access to the first-line antimalarial in rural and underserved areas. The ADDO program strengthens private sector pharmaceutical services by improving regulatory and supervisory support, dispenser training, and record keeping practices. Methods The government's pilot program made subsidized ACTs available through ADDOs in 10 districts in the Morogoro and Ruvuma regions, covering about 2.9 million people. The program established a supply of subsidized ACTs, created a price system with a cost recovery plan, developed a plan to distribute the subsidized products to the ADDOs, trained dispensers, and strengthened the adverse drug reactions reporting system. As part of the evaluation, 448 ADDO dispensers brought their records to central locations for analysis, representing nearly 70% of ADDOs operating in the two regions. ADDO drug register data were available from July 2007-June 2008 for Morogoro and from July 2007-September 2008 for Ruvuma. This intervention was implemented from 2007-2008. Results During the pilot, over 300,000 people received treatment for malaria at the 448 ADDOs. The percentage of ADDOs that dispensed at least one course of ACT rose from 26.2% during July-September 2007 to 72.6% during April-June 2008. The number of malaria patients treated with ACTs gradually increased after the start of the pilot, while the use of non-ACT antimalarials declined; ACTs went from 3% of all antimalarials sold in July 2007 to 26% in June 2008. District-specific data showed substantial variation among the districts in ACT uptake through ADDOs, ranging from ACTs representing 10% of all antimalarial sales

  17. The challenges of changing national malaria drug policy to artemisinin-based combinations in Kenya

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    Otieno Dorothy N

    2007-05-01

    Full Text Available Abstract Backgound Sulphadoxine/sulphalene-pyrimethamine (SP was adopted in Kenya as first line therapeutic for uncomplicated malaria in 1998. By the second half of 2003, there was convincing evidence that SP was failing and had to be replaced. Despite several descriptive investigations of policy change and implementation when countries moved from chloroquine to SP, the different constraints of moving to artemisinin-based combination therapy (ACT in Africa are less well documented. Methods A narrative description of the process of anti-malarial drug policy change, financing and implementation in Kenya is assembled from discussions with stakeholders, reports, newspaper articles, minutes of meetings and email correspondence between actors in the policy change process. The narrative has been structured to capture the timing of events, the difficulties and hurdles faced and the resolutions reached to the final implementation of a new treatment policy. Results Following a recognition that SP was failing there was a rapid technical appraisal of available data and replacement options resulting in a decision to adopt artemether-lumefantrine (AL as the recommended first-line therapy in Kenya, announced in April 2004. Funding requirements were approved by the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM and over 60 million US$ were agreed in principle in July 2004 to procure AL and implement the policy change. AL arrived in Kenya in May 2006, distribution to health facilities began in July 2006 coincidental with cascade in-service training in the revised national guidelines. Both training and drug distribution were almost complete by the end of 2006. The article examines why it took over 32 months from announcing a drug policy change to completing early implementation. Reasons included: lack of clarity on sustainable financing of an expensive therapeutic for a common disease, a delay in release of funding, a lack of comparative efficacy data

  18. Artemisinin-based combination therapy for uncomplicated Plasmodium falciparum malaria in Colombia

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    Taylor Walter RJ

    2007-02-01

    Full Text Available Abstract Background Artemisinin-based combination therapy (ACT is being widely promoted as a strategy to counteract the increase in Plasmodium falciparum antimalarial drug resistance. Methods A randomized, double-blind, placebo-controlled, clinical trial of the efficacy, effect on gametocytes and safety of the addition of artesunate/placebo (4 mg/kg/day × 3 d to amodiaquine (10 mg/kg/day × 3 d was conducted in Choco department, a low intensity transmission area in northwest Colombia. Results From 2,137 screened subjects, 85 entered the study: 43 in the amodiaquine plus placebo and 42 in the amodiaquine plus artesunate groups. Potentially eligible cases failed to qualify mostly because they were not available for follow-up visits (73%. Based on a per protocol analysis, the therapeutic response to both treatments was high: amodiaquine/placebo 35/36, 97.2% (95% CI 85.5–99.9, and amodiaquine/artesunate 32/32, 100% (89.1–100 after PCR genotyping. The Kaplan-Meier survival estimates based on all eligible patients enrolled (amodiaquine/placebo: n = 42; amodiaquine/artesunate: n = 41 were similar in the two study groups (P = 0.3. The addition of artesunate significantly decreased gametocyte carriage on Day 4 (OR = 0.1 95% CI 0.02–0.6, Day 7 (OR = 0.2 95%CI 0.04–0.9, Day 14 (OR = 0.09 95% CI 0–0.8, and Day 21 (OR95%CI 0–0.9. Most subjects in both groups (81% in amodiaquine/placebo and 75.6% in amodiaquine/artesunate reported at least one drug related adverse event. Symptoms were generally mild and self-limiting and there was no serious adverse event. Two patients on amodiaquine/artesunate voluntarily withdrew from study because they could not tolerate the medication. Conclusion Both drug regimens were effective in this area of Colombia. The addition of artesunate reduced gametocyte carriage and did not adversely affect tolerability. In this set of patients, the rate of adverse events was higher than in other studies. Patients' follow-up is

  19. Subsidising artemisinin-based combination therapy in the private retail sector

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    Opiyo, Newton; Yamey, Gavin; Garner, Paul

    2016-01-01

    Background Malaria causes ill health and death in Africa. Treating illness promptly with artemisinin-based combination therapy (ACT) is likely to cure people and avoid the disease progressing to more severe forms and death. In many countries, ACT use remains low. Part of the problem is that most people seek treatment from the retail sector where ACTs are expensive; this expense is a barrier to their use. The Global Fund and other international organisations are subsidising the cost of ACTs for private retail providers to improve access to ACTs. The subsidy was initially organised through a stand-alone initiative, called the Affordable Medicines Facility-malaria (AMFm), but has since been integrated into the Global Fund core grant management and financial processes. Objectives To assess the effect of programmes that include ACT price subsidies for private retailers on ACT use, availability, price and market share. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 1, The Cochrane Library, including the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register); MEDLINE (OvidSP), EMBASE (OvidSP), CINAHL (EbscoHost), EconLit (ProQuest), Global Health (OvidSP), Regional Indexes (Global Health Library, WHO), LILACS (Global Health Library, WHO), Science Citation Index and Social Sciences Citation Index (ISI Web of Science) and Health Management (ProQuest). All databases were searched February 2015, except for Health Management which was searched November 2013, without any date, language or publication status restrictions. We also searched the International Clinical Trials Registry Platform (ICTRP; WHO), ClinicalTrials.gov (NIH) and various grey literature sources. We also conducted a cited reference search for all included studies in ISI Web of Knowledge, checked references of identified articles and contacted authors to identify additional studies. Selection criteria Randomised trials, non

  20. Stabilizing supply of artemisinin and artemisinin-based combination therapy in an era of wide-spread scale-up

    OpenAIRE

    Shretta Rima; Yadav Prashant

    2012-01-01

    Abstract The global demand for artemisinin-based combination therapy (ACT) has grown sharply since its recommendation by the World Health Organization in 2002. However, a combination of financing and programmatic uncertainties, limited suppliers of finished products, information opacity across the different tiers in the supply chain, and widespread fluctuations in raw material prices have together contributed to a market fraught with demand and supply uncertainties and price volatility. Vario...

  1. Predicting Global Fund grant disbursements for procurement of artemisinin-based combination therapies

    Directory of Open Access Journals (Sweden)

    O'Brien Megan E

    2008-10-01

    Full Text Available Abstract Background An accurate forecast of global demand is essential to stabilize the market for artemisinin-based combination therapy (ACT and to ensure access to high-quality, life-saving medications at the lowest sustainable prices by avoiding underproduction and excessive overproduction, each of which can have negative consequences for the availability of affordable drugs. A robust forecast requires an understanding of the resources available to support procurement of these relatively expensive antimalarials, in particular from the Global Fund, at present the single largest source of ACT funding. Methods Predictive regression models estimating the timing and rate of disbursements from the Global Fund to recipient countries for each malaria grant were derived using a repeated split-sample procedure intended to avoid over-fitting. Predictions were compared against actual disbursements in a group of validation grants, and forecasts of ACT procurement extrapolated from disbursement predictions were evaluated against actual procurement in two sub-Saharan countries. Results Quarterly forecasts were correlated highly with actual smoothed disbursement rates (r = 0.987, p Conclusion This analysis derived predictive regression models that successfully forecasted disbursement patterning for individual Global Fund malaria grants. These results indicate the utility of this approach for demand forecasting of ACT and, potentially, for other commodities procured using funding from the Global Fund. Further validation using data from other countries in different regions and environments will be necessary to confirm its generalizability.

  2. Access to artemisinin-based combination therapy (ACT) and quinine in malaria holoendemic regions of western Kenya.

    Science.gov (United States)

    Watsierah, Carren A; Ouma, Collins

    2014-07-28

    Artemisinin-based combination therapy (ACT) has been adopted as the most effective treatment against malaria in many endemic countries like Kenya while quinine has remained the second line. The objective of the current study was to assess access to Kenya's policy recommended anti-malarials, ACT and quinine in the public, private and not-for-profit drug outlets in western Kenya. A cross-sectional survey using purposive sampling of 288 outlets (126 public, 96 private, 66 not-for-profit) was conducted in western Kenya in two regions with varying Plasmodium falciparum endemicities. Information on access (availability, price, affordability) on ACT and quinine was collected using the WHO and Healthcare Associated Infection (HAI) standardized methodologies for availability, prices and affordability of drugs. From a Ministry of Health database, the following were included in the analyses: one (1) main public hospital, followed by random selection of five hospitals under this main facility. Eight other public outlets under each of the hospitals were selected, to a total of 96. Matching number of private outlets (n = 96), all (66) not-for-profit outlets and additional 30 public health facilities were sampled to get the required sample size of 288. More public 111 (88.1%) and not-for-profit 27 (40.9%) outlets stocked subsidized ACT (artemether-lumefantrine, AL). Other artemisinin-based combinations were widely available for both children 93 (96.9%) and adults 82 (85.0%) in private outlets. Frequent stock-outs were in public in 106 (84%), reporting three times or more stock-outs in three months. Subsidized ACT (AL) was sold at median price of USD 0.94 and 0.75 in private and not-for-profit outlets respectively. The costs was higher than recommended price of USD 0.5 and requiring up to 0.20-0.25 days of disposable income for households in lowest economic status. There is low availability of subsidized ACT (AL) and higher frequency of stock-outs in government facilities, while

  3. Subsidising artemisinin-based combination therapy in the private retail sector.

    Science.gov (United States)

    Opiyo, Newton; Yamey, Gavin; Garner, Paul

    2016-03-09

    Malaria causes ill health and death in Africa. Treating illness promptly with artemisinin-based combination therapy (ACT) is likely to cure people and avoid the disease progressing to more severe forms and death. In many countries, ACT use remains low. Part of the problem is that most people seek treatment from the retail sector where ACTs are expensive; this expense is a barrier to their use.The Global Fund and other international organisations are subsidising the cost of ACTs for private retail providers to improve access to ACTs. The subsidy was initially organised through a stand-alone initiative, called the Affordable Medicines Facility-malaria (AMFm), but has since been integrated into the Global Fund core grant management and financial processes. To assess the effect of programmes that include ACT price subsidies for private retailers on ACT use, availability, price and market share. We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 1, The Cochrane Library, including the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register); MEDLINE (OvidSP), EMBASE (OvidSP), CINAHL (EbscoHost), EconLit (ProQuest), Global Health (OvidSP), Regional Indexes (Global Health Library, WHO), LILACS (Global Health Library, WHO), Science Citation Index and Social Sciences Citation Index (ISI Web of Science) and Health Management (ProQuest). All databases were searched February 2015, except for Health Management which was searched November 2013, without any date, language or publication status restrictions. We also searched the International Clinical Trials Registry Platform (ICTRP; WHO), ClinicalTrials.gov (NIH) and various grey literature sources. We also conducted a cited reference search for all included studies in ISI Web of Knowledge, checked references of identified articles and contacted authors to identify additional studies. Randomised trials, non-randomised trials, controlled before-after studies and

  4. Plasmodium falciparum Polymorphisms associated with ex vivo drug susceptibility and clinical effectiveness of artemisinin-based combination therapies in Benin.

    Science.gov (United States)

    Dahlström, Sabina; Aubouy, Agnès; Maïga-Ascofaré, Oumou; Faucher, Jean-François; Wakpo, Abel; Ezinmègnon, Sèm; Massougbodji, Achille; Houzé, Pascal; Kendjo, Eric; Deloron, Philippe; Le Bras, Jacques; Houzé, Sandrine

    2014-01-01

    Artemisinin-based combination therapies (ACTs) are the main option to treat malaria, and their efficacy and susceptibility must be closely monitored to avoid resistance. We assessed the association of Plasmodium falciparum polymorphisms and ex vivo drug susceptibility with clinical effectiveness. Patients enrolled in an effectiveness trial comparing artemether-lumefantrine (n = 96), fixed-dose artesunate-amodiaquine (n = 96), and sulfadoxine-pyrimethamine (n = 48) for the treatment of uncomplicated malaria 2007 in Benin were assessed. pfcrt, pfmdr1, pfmrp1, pfdhfr, and pfdhps polymorphisms were analyzed pretreatment and in recurrent infections. Drug susceptibility was determined in fresh baseline isolates by Plasmodium lactate dehydrogenase enzyme-linked immunosorbent assay (ELISA). A majority had 50% inhibitory concentration (IC50) estimates (the concentration required for 50% growth inhibition) lower than those of the 3D7 reference clone for desethylamodiaquine, lumefantrine, mefloquine, and quinine and was considered to be susceptible, while dihydroartemisinin and pyrimethamine IC50s were higher. No association was found between susceptibility to the ACT compounds and treatment outcome. Selection was observed for the pfmdr1 N86 allele in artemether-lumefantrine recrudescences (recurring infections) (4/7 [57.1%] versus 36/195 [18.5%]), and of the opposite allele, 86Y, in artesunate-amodiaquine reinfections (new infections) (20/22 [90.9%] versus 137/195 [70.3%]) compared to baseline infections. The importance of pfmdr1 N86 in lumefantrine tolerance was emphasized by its association with elevated lumefantrine IC50s. Genetic linkage between N86 and Y184 was observed, which together with the low frequency of 1246Y may explain regional differences in selection of pfmdr1 loci. Selection of opposite alleles in artemether-lumefantrine and artesunate-amodiaquine recurrent infections supports the strategy of multiple first-line treatment. Surveillance based on clinical, ex

  5. Randomised controlled trial of two sequential artemisinin-based combination therapy regimens to treat uncomplicated falciparum malaria in African children: a protocol to investigate safety, efficacy and adherence

    DEFF Research Database (Denmark)

    Schallig, Henk D. F. H.; Tinto, Halidou; Sawa, Patrick

    2017-01-01

    Background Management of uncomplicated Plasmodium falciparum malaria relies on artemisinin-based combination therapies (ACTs). These highly effective regimens have contributed to reductions in malaria morbidity and mortality. However, artemisinin resistance in Asia and changing parasite...... whether prolonged ACT-based regimens using currently available formulations can eliminate potentially resistant parasites. The protocol investigates whether a sequential course of two licensed ACT in 1080 children aged 6–120 months exhibits superior efficacy against acute P. falciparum malaria and non...... gametocytaemia, occurrence of treatment-related adverse events in the double-ACT versus single-ACT arms, carriage of molecular markers of drug resistance, drug kinetics and patient adherence to treatment. Discussion This protocol addresses efficacy and safety of sequential ACT regimens in P. falciparum malaria...

  6. Feasibility and acceptability of artemisinin-based combination therapy for the home management of malaria in four African sites

    Directory of Open Access Journals (Sweden)

    Munguti Kaendi

    2008-01-01

    Full Text Available Abstract Background The Home Management of Malaria (HMM strategy was developed using chloroquine, a now obsolete drug, which has been replaced by artemisinin-based combination therapy (ACT in health facility settings. Incorporation of ACT in HMM would greatly expand access to effective antimalarial therapy by the populations living in underserved areas in malaria endemic countries. The feasibility and acceptability of incorporating ACT in HMM needs to be evaluated. Methods A multi-country study was performed in four district-size sites in Ghana (two sites, Nigeria and Uganda, with populations ranging between 38,000 and 60,000. Community medicine distributors (CMDs were trained in each village to dispense pre-packaged ACT to febrile children aged 6–59 months, after exclusion of danger signs. A community mobilization campaign accompanied the programme. Artesunate-amodiaquine (AA was used in Ghana and artemether-lumefantrine (AL in Nigeria and Uganda. Harmonized qualitative and quantitative data collection methods were used to evaluate CMD performance, caregiver adherence and treatment coverage of febrile children with ACTs obtained from CMDs. Results Some 20,000 fever episodes in young children were treated with ACT by CMDs across the four study sites. Cross-sectional surveys identified 2,190 children with fever in the two preceding weeks, of whom 1,289 (59% were reported to have received ACT from a CMD. Coverage varied from 52% in Nigeria to 75% in Ho District, Ghana. Coverage rates did not appear to vary greatly with the age of the child or with the educational level of the caregiver. A very high proportion of children were reported to have received the first dose on the day of onset or the next day in all four sites (range 86–97%, average 90%. The proportion of children correctly treated in terms of dose and duration was also high (range 74–97%, average 85%. Overall, the proportion of febrile children who received prompt treatment and the

  7. Stabilizing supply of artemisinin and artemisinin-based combination therapy in an era of wide-spread scale-up.

    Science.gov (United States)

    Shretta, Rima; Yadav, Prashant

    2012-12-02

    The global demand for artemisinin-based combination therapy (ACT) has grown sharply since its recommendation by the World Health Organization in 2002. However, a combination of financing and programmatic uncertainties, limited suppliers of finished products, information opacity across the different tiers in the supply chain, and widespread fluctuations in raw material prices have together contributed to a market fraught with demand and supply uncertainties and price volatility. Various short-term solutions have been deployed to alleviate supply shortages caused by these challenges; however, new mechanisms are required to build resilience into the supply chain. This review concludes that a mix of strategies is required to stabilize the artemisinin and ACT market. First, better and more effective pooling of demand and supply risks and better contracting to allow risk sharing among the stakeholders are needed. Physical and financial buffer stocks will enable better matching of demand and supply in the short and medium term. Secondly, physical buffers will allow stable supplies when there are procurement and supply management challenges while financial buffer funds will address issues around funding disruptions. Finally, in the medium to long term, significant investments in country level system strengthening will be required to minimize national level demand uncertainties. In addition a voluntary standard for extractors to ensure appropriate purchasing and sales practices as well as minimum quality and ethical standards could help stabilize the artemisinin market in the long term.

  8. Stabilizing supply of artemisinin and artemisinin-based combination therapy in an era of wide-spread scale-up

    Directory of Open Access Journals (Sweden)

    Shretta Rima

    2012-12-01

    Full Text Available Abstract The global demand for artemisinin-based combination therapy (ACT has grown sharply since its recommendation by the World Health Organization in 2002. However, a combination of financing and programmatic uncertainties, limited suppliers of finished products, information opacity across the different tiers in the supply chain, and widespread fluctuations in raw material prices have together contributed to a market fraught with demand and supply uncertainties and price volatility. Various short-term solutions have been deployed to alleviate supply shortages caused by these challenges; however, new mechanisms are required to build resilience into the supply chain. This review concludes that a mix of strategies is required to stabilize the artemisinin and ACT market. First, better and more effective pooling of demand and supply risks and better contracting to allow risk sharing among the stakeholders are needed. Physical and financial buffer stocks will enable better matching of demand and supply in the short and medium term. Secondly, physical buffers will allow stable supplies when there are procurement and supply management challenges while financial buffer funds will address issues around funding disruptions. Finally, in the medium to long term, significant investments in country level system strengthening will be required to minimize national level demand uncertainties. In addition a voluntary standard for extractors to ensure appropriate purchasing and sales practices as well as minimum quality and ethical standards could help stabilize the artemisinin market in the long term.

  9. Factors associated with non-adherence to Artemisinin-based combination therapy (ACT) to malaria in a rural population from holoendemic region of western Kenya.

    Science.gov (United States)

    Onyango, Elizabeth O; Ayodo, George; Watsierah, Carren A; Were, Tom; Okumu, Wilson; Anyona, Samuel B; Raballah, Evans; Okoth, John M; Gumo, Sussy; Orinda, George O; Ouma, Collins

    2012-06-24

    Over the years, reports implicate improper anti-malarial use as a major contributor of morbidity and mortality amongst millions of residents in malaria endemic areas, Kenya included. However, there are limited reports on improper use of Artemisinin-based Combination Therapy (ACT) which is a first-line drug in the treatment of malaria in Kenya. Knowing this is important for ensured sustainable cure rates and also protection against the emergence of resistant malarial parasites. We therefore investigated ACT adherence level, factors associated with non-adherence and accessibility in households (n = 297) in rural location of Southeast Alego location in Siaya County in western Kenya. ACT Adherence level was assessed with reference to the duration of treatment and number of tablets taken. Using systematic random sampling technique, a questionnaire was administered to a particular household member who had the most recent malaria episode ( 9000; OR, 0.340; 95% CI, 0.167-0.694; P = 0.003) were associated with ACT adherence. In addition, about 52.9% of the respondents reported that ACT was not always available at the source and that drug availability (P = 0.020) and distance to drug source (P < 0.01) significantly affected accessibility. This study demonstrates that more than half of those who get ACT prescription do not take recommended dose and that accessibility is of concern. The findings of this study suggest a potential need to improve accessibility and also initiate programmatic interventions to encourage patient-centred care.

  10. Towards subsidized malaria rapid diagnostic tests. Lessons learned from programmes to subsidise artemisinin-based combination therapies in the private sector: a review.

    Science.gov (United States)

    Lussiana, Cristina

    2016-09-01

    The idea of a private sector subsidy programme of artemisinin-based combination therapies (ACTs) was first proposed in 2004. Since then, several countries around the world have hosted pilot projects or programmes on subsidized ACTs and/or the Affordable Medicines Facility-malaria programme (AMFm). Overall the private sector subsidy programmes of ACTs have been effective in increasing availability of ACTs in the private sector and driving down average prices but struggled to crowd out antimalarial monotherapies. The results obtained from this ambitious strategy should inform policy makers in the designing of future interventions aimed to control malaria morbidity and mortality. Among the interventions recently proposed, a subsidy of rapid diagnostic tests (RDTs) in the private sector has been recommended by governments and international donors to cope with over-treatment with ACTs and to delay the emergence of resistance to artemisinin. In order to improve the cost-effectiveness of co-paid RDTs, we should build on the lessons we learned from almost 10 years of private sector subsidy programmes of ACTs in malaria-endemic countries.

  11. Lack of artemisinin resistance in Plasmodium falciparum in northwest Benin after 10 years of use of artemisinin-based combination therapy

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    Ogouyèmi-Hounto Aurore

    2016-01-01

    Full Text Available Aim: In Benin, artemisinin-based combination therapy (ACT has been recommended as the first-line treatment for uncomplicated Plasmodium falciparum malaria since 2004. The emergence in Southeast Asia of parasites that are resistant to artemisinins poses a serious threat to global control of this disease. The presence of artemisinin resistance genotypes in parasite populations in Benin is currently unknown. The present study investigated the prevalence of relevant K13-propeller gene polymorphisms in parasite isolates from the north-western region of Benin. Method: Plasmodium falciparum isolates were collected from children with a confirmed diagnosis of malaria aged 6 months to 5 years in two towns, Cobly and Djougou, in the north-western part of Benin. The study was conducted during the rainy season from July to November 2014 in local health facilities. The K13-propeller gene was amplified in parasite isolates using nested PCR and subsequently sequenced. Results: A total of 108 children were recruited into the study. The efficiency of amplification reactions was 72% (78/108. The propeller domain of the K13 gene was successfully sequenced in 78 P. falciparum isolates; all of them were wild type with no polymorphisms detectable. Conclusion: The absence of mutations in the K13 gene indicates that P. falciparum parasite populations in the study area are still fully susceptible to artemisinins.

  12. Impact of artemisinin-based combination therapy and insecticide-treated nets on malaria burden in Zanzibar.

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    Achuyt Bhattarai

    2007-11-01

    Full Text Available BACKGROUND: The Roll Back Malaria strategy recommends a combination of interventions for malaria control. Zanzibar implemented artemisinin-based combination therapy (ACT for uncomplicated malaria in late 2003 and long-lasting insecticidal nets (LLINs from early 2006. ACT is provided free of charge to all malaria patients, while LLINs are distributed free to children under age 5 y ("under five" and pregnant women. We investigated temporal trends in Plasmodium falciparum prevalence and malaria-related health parameters following the implementation of these two malaria control interventions in Zanzibar. METHODS AND FINDINGS: Cross-sectional clinical and parasitological surveys in children under the age of 14 y were conducted in North A District in May 2003, 2005, and 2006. Survey data were analyzed in a logistic regression model and adjusted for complex sampling design and potential confounders. Records from all 13 public health facilities in North A District were analyzed for malaria-related outpatient visits and admissions. Mortality and demographic data were obtained from District Commissioner's Office. P. falciparum prevalence decreased in children under five between 2003 and 2006; using 2003 as the reference year, odds ratios (ORs and 95% confidence intervals (CIs were, for 2005, 0.55 (0.28-1.08, and for 2006, 0.03 (0.00-0.27; p for trend < 0.001. Between 2002 and 2005 crude under-five, infant (under age 1 y, and child (aged 1-4 y mortality decreased by 52%, 33%, and 71%, respectively. Similarly, malaria-related admissions, blood transfusions, and malaria-attributed mortality decreased significantly by 77%, 67% and 75%, respectively, between 2002 and 2005 in children under five. Climatic conditions favorable for malaria transmission persisted throughout the observational period. CONCLUSIONS: Following deployment of ACT in Zanzibar 2003, malaria-associated morbidity and mortality decreased dramatically within two years. Additional distribution

  13. Understanding the impact of subsidizing artemisinin-based combination therapies (ACTs in the retail sector--results from focus group discussions in rural Kenya.

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    Sarah V Kedenge

    Full Text Available BACKGROUND: There is considerable interest in the potential of private sector subsidies to increase availability and affordability of artemisinin-based combination therapies (ACTs for malaria treatment. A cluster randomized trial of such subsidies was conducted in 3 districts in Kenya, comprising provision of subsidized packs of paediatric ACT to retail outlets, training of retail staff, and community awareness activities. The results demonstrated a substantial increase in ACT availability and coverage, though patient counselling and adherence were suboptimal. We conducted a qualitative study in order to understand why these successes and limitations occurred. METHODOLOGY/PRINCIPAL FINDINGS: Eighteen focus group discussions were conducted, 9 with retailers and 9 with caregivers, to document experiences with the intervention. Respondents were positive about intervention components, praising the focused retailer training, affordable pricing, strong promotional activities, dispensing job aids, and consumer friendly packaging, which are likely to have contributed to the positive access and coverage outcomes observed. However, many retailers still did not stock ACT, due to insufficient supplies, lack of capital and staff turnover. Advice to caregivers was poor due to insufficient time, and poor recall of instructions. Adherence by caregivers to dosing guidelines was sub-optimal, because of a wish to save tablets for other episodes, doses being required at night, stopping treatment when the child felt better, and the number and bitter taste of the tablets. Caregivers used a number of strategies to obtain paediatric ACT for older age groups. CONCLUSIONS/SIGNIFICANCE: This study has highlighted that important components of a successful ACT subsidy intervention are regular retailer training, affordable pricing, a reliable supply chain and community mobilization emphasizing patient adherence and when to seek further care.

  14. Willingness-to-pay for a rapid malaria diagnostic test and artemisinin-based combination therapy from private drug shops in Mukono District, Uganda.

    Science.gov (United States)

    Hansen, Kristian Schultz; Pedrazzoli, Debora; Mbonye, Anthony; Clarke, Sian; Cundill, Bonnie; Magnussen, Pascal; Yeung, Shunmay

    2013-03-01

    In Uganda, as in many parts of Africa, the majority of the population seek treatment for malaria in drug shops as their first point of care; however, parasitological diagnosis is not usually offered in these outlets. Rapid diagnostic tests (RDTs) for malaria have attracted interest in recent years as a tool to improve malaria diagnosis, since they have proved accurate and easy to perform with minimal training. Although RDTs could feasibly be performed by drug shop vendors, it is not known how much customers would be willing to pay for an RDT if offered in these settings. We conducted a contingent valuation survey among drug shop customers in Mukono District, Uganda. Exit interviews were undertaken with customers aged 15 years and above after leaving a drug shop having purchased an antimalarial and/or paracetamol. The bidding game technique was used to elicit the willingness-to-pay (WTP) for an RDT and a course of artemisinin-based combination therapy (ACT) with and without RDT confirmation. Factors associated with WTP were investigated using linear regression. The geometric mean WTP for an RDT was US$0.53, US$1.82 for a course of ACT and US$2.05 for a course of ACT after a positive RDT. Factors strongly associated with a higher WTP for these commodities included having a higher socio-economic status, no fever/malaria in the household in the past 2 weeks and if a malaria diagnosis had been obtained from a qualified health worker prior to visiting the drug shop. The findings further suggest that the WTP for an RDT and a course of ACT among drug shop customers is considerably lower than prevailing and estimated end-user prices for these commodities. Increasing the uptake of ACTs in drug shops and restricting the sale of ACTs to parasitologically confirmed malaria will therefore require additional measures.

  15. A pharmacy too far? Equity and spatial distribution of outcomes in the delivery of subsidized artemisinin-based combination therapies through private drug shops

    Directory of Open Access Journals (Sweden)

    Ward Lorrayne

    2010-07-01

    Full Text Available Abstract Background Millions of individuals with malaria-like fevers purchase drugs from private retailers, but artemisinin-based combination therapies (ACTs, the only effective treatment in regions with high levels of resistance to older drugs, are rarely obtained through these outlets due to their relatively high cost. To encourage scale up of ACTs, the Affordable Medicines Facility – malaria is being launched to subsidize their price. The Government of Tanzania and the Clinton Foundation piloted this subsidized distribution model in two Tanzanian districts to examine concerns about whether the intervention will successfully reach poor, rural communities. Methods Stocking of ACTs and other antimalarial drugs in all retail shops was observed at baseline and in four subsequent surveys over 15 months. Exit interviews were conducted with antimalarial drug customers during each survey period. All shops and facilities were georeferenced, and variables related to population density and proximity to distribution hubs, roads, and other facilities were calculated. To understand the equity of impact, shops stocking ACTs and consumers buying them were compared to those that did not, according to geographic and socioeconomic variables. Patterning in ACT stocking and sales was evaluated against that of other common antimalarials to identify factors that may have impacted access. Qualitative data were used to assess motivations underlying stocking, distribution, and buying disparities. Results Results indicated that although total ACT purchases rose from negligible levels to nearly half of total antimalarial sales over the course of the pilot, considerable geographic variation in stocking and sales persisted and was related to a variety of socio-spatial factors; ACTs were stocked more often in shops located closer to district towns (p Conclusions As this subsidy model is scaled up across multiple countries, these results confirm the potential for increased

  16. Malaria treatment failures after artemisinin-based therapy in three expatriates: could improved manufacturer information help to decrease the risk of treatment failure ?

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    Loutan Louis

    2006-10-01

    Full Text Available Abstract Background Artemisinin-containing therapies are highly effective against Plasmodium falciparum malaria. Insufficient numbers of tablets and inadequate package inserts result in sub-optimal dosing and possible treatment failure. This study reports the case of three, non-immune, expatriate workers with P. falciparum acquired in Africa, who failed to respond to artemisinin-based therapy. Sub-therapeutic dosing in accordance with the manufacturers' recommendations was the probable cause. Method Manufacturers information and drug content included in twenty-five artemisinin-containing specialities were reviewed. Results A substantial number of manufacturers do not follow current WHO recommendations regarding treatment duration and doses. Conclusion This study shows that drug packaging and their inserts should be improved.

  17. Assessment of global reporting of adverse drug reactions for anti-malarials, including artemisinin-based combination therapy, to the WHO Programme for International Drug Monitoring

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    Van Erps Jan

    2011-03-01

    Full Text Available Abstract Background In spite of enhanced control efforts, malaria remains a major public health problem causing close to a million deaths annually. With support from several donors, large amounts of artemisinin-based combination therapy (ACT are being deployed in endemic countries raising safety concerns as little is known about the use of ACT in several of the settings where they are deployed. This project was undertaken to profile the provenance of the pharmacovigilance reporting of all anti-malarials, including ACT to the WHO adverse drug reaction (ADR database (Vigibase™ over the past 40 years. Methods The WHO Programme for International Drug Monitoring, the Uppsala Monitoring Centre (UMC provided anonymized extracts of Vigibase™ covering the period 1968-2008. All countries in the programme were clustered according to their malaria control phase and income status. The number of individual case safety reports (ICSRs of anti-malarials was analyzed according to those clusters. Results From 1968 to 2008, 21,312 ICSRs suspecting anti-malarials were received from 64 countries. Low-income countries, that are also malaria-endemic (categorized as priority 1 countries submitted only 1.2% of the ICSRs. Only 60 out of 21,312 ICSRs were related to ACT, 51 of which were coming from four sub-Saharan African countries. Although very few ICSRs involved artemisinin-based compounds, many of the adverse events reported were potentially serious. Conclusions This paper illustrates the low reporting of ADRs to anti-malarials in general and ACT in particular. Most reports were submitted by non-endemic and/or high-income countries. Given the current mix of large donor funding, the insufficient information on safety of these drugs, increasing availability of ACT and artemisinin-based monotherapies in public and private sector channels, associated potential for inappropriate use and finally a pipeline of more than 10 new novel anti-malarials in various stages of

  18. Feasibility and acceptability of home-based management of malaria strategy adapted to Sudan's conditions using artemisinin-based combination therapy and rapid diagnostic test

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    Mudather Mahmoud A

    2009-03-01

    Full Text Available Abstract Background Malaria remains a major public health problem especially in sub-Saharan Africa. Despite the efforts exerted to provide effective anti-malarial drugs, still some communities suffer from getting access to these services due to many barriers. This research aimed to assess the feasibility and acceptability of home-based management of malaria (HMM strategy using artemisinin-based combination therapy (ACT for treatment and rapid diagnostic test (RDT for diagnosis. Methods This is a study conducted in 20 villages in Um Adara area, South Kordofan state, Sudan. Two-thirds (66% of the study community were seeking treatment from heath facilities, which were more than 5 km far from their villages with marked inaccessibility during rainy season. Volunteers (one per village were trained on using RDTs for diagnosis and artesunate plus sulphadoxine-pyrimethamine for treating malaria patients, as well as referral of severe and non-malaria cases. A system for supply and monitoring was established based on the rural health centre, which acted as a link between the volunteers and the health system. Advocacy for the policy was done through different tools. Volunteers worked on non-monetary incentives but only a consultation fee of One Sudanese Pound (equivalent to US$0.5. Pre- and post-intervention assessment was done using household survey, focus group discussion with the community leaders, structured interview with the volunteers, and records and reports analysis. Results and discussion The overall adherence of volunteers to the project protocol in treating and referring cases was accepted that was only one of the 20 volunteers did not comply with the study guidelines. Although the use of RDTs seemed to have improved the level of accuracy and trust in the diagnosis, 30% of volunteers did not rely on the negative RDT results when treating fever cases. Almost all (94.7% the volunteers felt that they were satisfied with the spiritual outcome of

  19. Feasibility and acceptability of home-based management of malaria strategy adapted to Sudan's conditions using artemisinin-based combination therapy and rapid diagnostic test.

    Science.gov (United States)

    Elmardi, Khalid A; Malik, Elfatih M; Abdelgadir, Tarig; Ali, Salah H; Elsyed, Abdalla H; Mudather, Mahmoud A; Elhassan, Asma H; Adam, Ishag

    2009-03-09

    Malaria remains a major public health problem especially in sub-Saharan Africa. Despite the efforts exerted to provide effective anti-malarial drugs, still some communities suffer from getting access to these services due to many barriers. This research aimed to assess the feasibility and acceptability of home-based management of malaria (HMM) strategy using artemisinin-based combination therapy (ACT) for treatment and rapid diagnostic test (RDT) for diagnosis. This is a study conducted in 20 villages in Um Adara area, South Kordofan state, Sudan. Two-thirds (66%) of the study community were seeking treatment from heath facilities, which were more than 5 km far from their villages with marked inaccessibility during rainy season. Volunteers (one per village) were trained on using RDTs for diagnosis and artesunate plus sulphadoxine-pyrimethamine for treating malaria patients, as well as referral of severe and non-malaria cases. A system for supply and monitoring was established based on the rural health centre, which acted as a link between the volunteers and the health system. Advocacy for the policy was done through different tools. Volunteers worked on non-monetary incentives but only a consultation fee of One Sudanese Pound (equivalent to US$0.5).Pre- and post-intervention assessment was done using household survey, focus group discussion with the community leaders, structured interview with the volunteers, and records and reports analysis. The overall adherence of volunteers to the project protocol in treating and referring cases was accepted that was only one of the 20 volunteers did not comply with the study guidelines. Although the use of RDTs seemed to have improved the level of accuracy and trust in the diagnosis, 30% of volunteers did not rely on the negative RDT results when treating fever cases. Almost all (94.7%) the volunteers felt that they were satisfied with the spiritual outcome of their new tasks. As well, volunteers have initiated advocacy

  20. Effectiveness of artemisinin-based combination therapy used in the context of home management of malaria: A report from three study sites in sub-Saharan Africa

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    Mugittu Kefas

    2008-09-01

    Full Text Available Abstract Background The use of artemisinin-based combination therapy (ACT at the community level has been advocated as a means to increase access to effective antimalarial medicines by high risk groups living in underserved areas, mainly in sub-Saharan Africa. This strategy has been shown to be feasible and acceptable to the community. However, the parasitological effectiveness of ACT when dispensed by community medicine distributors (CMDs within the context of home management of malaria (HMM and used unsupervised by caregivers at home has not been evaluated. Methods In a sub-set of villages participating in a large-scale study on feasibility and acceptability of ACT use in areas of high malaria transmission in Ghana, Nigeria and Uganda, thick blood smears and blood spotted filter paper were prepared from finger prick blood samples collected from febrile children between six and 59 months of age reporting to trained CMDs for microscopy and PCR analysis. Presumptive antimalarial treatment with ACT (artesunate-amodiaquine in Ghana, artemether-lumefantrine in Nigeria and Uganda was then initiated. Repeat finger prick blood samples were obtained 28 days later for children who were parasitaemic at baseline. For children who were parasitaemic at follow-up, PCR analyses were undertaken to distinguish recrudescence from re-infection. The extent to which ACTs had been correctly administered was assessed through separate household interviews with caregivers having had a child with fever in the previous two weeks. Results Over a period of 12 months, a total of 1,740 children presenting with fever were enrolled across the study sites. Patent parasitaemia at baseline was present in 1,189 children (68.3% and varied from 60.1% in Uganda to 71.1% in Ghana. A total of 606 children (51% of infected children reported for a repeat test 28 days after treatment. The crude parasitological failure rate varied from 3.7% in Uganda (C.I. 1.2%–6.2% to 41.8% in Nigeria (C

  1. Prevalence of malaria parasitemia and purchase of artemisinin-based combination therapies (ACTs among drug shop clients in two regions in Tanzania with ACT subsidies.

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    Melissa A Briggs

    Full Text Available BACKGROUND: Throughout Africa, many people seek care for malaria in private-sector drug shops where diagnostic testing is often unavailable. Recently, subsidized artemisinin-based combination therapies (ACTs, a first-line medication for uncomplicated malaria, were made available in these drug shops in Tanzania. This study assessed the prevalence of malaria among and purchase of ACTs by drug shop clients in the setting of a national ACT subsidy program and sub-national drug shop accreditation program. METHOD AND FINDINGS: A cross-sectional survey of drug shop clients was performed in two regions in Tanzania, one with a government drug shop accreditation program and one without, from March-May, 2012. Drug shops were randomly sampled from non-urban districts. Shop attendants were interviewed about their education, training, and accreditation status. Clients were interviewed about their symptoms and medication purchases, then underwent a limited physical examination and laboratory testing for malaria. Malaria prevalence and predictors of ACT purchase were assessed using univariate analysis and multiple logistic regression. Amongst 777 clients from 73 drug shops, the prevalence of laboratory-confirmed malaria was 12% (95% CI: 6-18%. Less than a third of clients with malaria had purchased ACTs, and less than a quarter of clients who purchased ACTs tested positive for malaria. Clients were more likely to have purchased ACTs if the participant was 5 years, experience (aOR: 2.8; 95% CI: 1.2-6.3. Having malaria was only a predictor of ACT purchase in the region with a drug shop accreditation program (aOR: 3.4; 95% CI: 1.5-7.4. CONCLUSION: Malaria is common amongst persons presenting to drug shops with a complaint of fever. The low proportion of persons with malaria purchasing ACTs, and the high proportion of ACTs going to persons without malaria demonstrates a need to better target who receives ACTs in these drug shops.

  2. Appropriate targeting of artemisinin-based combination therapy by community health workers using malaria rapid diagnostic tests

    DEFF Research Database (Denmark)

    Ndyomugyenyi, Richard; Magnussen, Pascal; Lal, Sham;

    2016-01-01

    OBJECTIVE: To compare the impact of malaria rapid diagnostic tests (mRDTs), used by community health workers (CHWs), on the proportion of children ... sensitivity of current mRDTs in patients with low parasite density are a concern. For community-based treatment in areas of low transmission and/or non-immune populations, presumptive treatment of all fevers as malaria may be advisable, until more sensitive diagnostic assays, suitable for routine use by CHWs...

  3. Artemisinin-based combination therapy availability and use in the private sector of five AMFm phase 1 countries

    Science.gov (United States)

    2013-01-01

    Background In 2009, the Global Fund to Fight AIDS, Tuberculosis and Malaria established the Affordable Medicines Facility-malaria (AMFm) in order to increase access to quality-assured artemisinin combination therapy (QAACT). AMFm Phase 1, which includes nine pilot programmes in eight countries, was launched in 2009. The objective of this study was to assess anti-malarial stock and purchase patterns at private outlets in five AMFm Phase 1 countries in regard to three of the core AMFm goals: increase the affordability of QAACT, increase the availability of QAACT, and crowd out artemisinin monotherapies and other substandard therapies. Methods The study was conducted between April and May 2012 and included interviews with personnel in 598 private pharmaceutical outlets in Ghana, Kenya, Nigeria, Tanzania, and Uganda. Questionnaires were administered at private retail outlets and the data were analyzed to assess within- and between-country differences in QAACT price, availability, and popularity. Results AMFm medications were less expensive than their non-AMFm counterparts, yet prices for both types were above country-specific suggested retail prices. Market penetration of AMFm QAACT in both urban and rural areas was high, although stock-outs of both AMFm and non-AMFm products were more common in rural compared with urban outlets in Ghana and Kenya (p = 0.0013). Government recommendation was the most significant factor influencing anti-malarial stock choices in urban (41.5%) and rural (31.9%) outlets. The three top-selling anti-malarials reported for both urban and rural areas in each country were, with the exception of rural Uganda and urban Nigeria, combination therapies. Conclusions Results from this study indicate that the AMFm has not fully achieved its affordability and crowd-out objectives. Still, the final purchase price of AMFm QAACT was substantially lower than non-AMFm equivalents. Moreover, for both urban and rural areas, AMFm QAACT availability was

  4. Community response to artemisinin-based combination therapy for childhood malaria: a case study from Dar es Salaam, Tanzania

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    Nyato Daniel J

    2010-02-01

    Full Text Available Abstract Background New malaria treatment guidelines in Tanzania have led to the large-scale deployment of artemether-lumefantrine (Coartem®, popularly known as ALu or dawa mseto. Very little is known about how people in malaria endemic areas interpret policy makers' decision to replace existing anti-malarials, such as sulphadoxine-pyrimethamine (SP with "new" treatment regimens, such as ALu or other formulations of ACT. This study was conducted to examine community level understandings and interpretations of ALu's efficacy and side-effects. The paper specifically examines the perceived efficacy of ALu as articulated by the mothers of young children diagnosed with malaria and prescribed ALu. Methods Participant observation, six focus group discussions in two large villages, followed by interviews with a random sample of 110 mothers of children less than five years of age, who were diagnosed with malaria and prescribed ALu. Additionally, observations were conducted in two village dispensaries involving interactions between mothers/caretakers and health care providers. Results While more than two-thirds of the mothers had an overall negative disposition toward SP, 97.5% of them spoke favourably about ALu, emphasizing it's ability to help their children to rapidly recover from malaria, without undesirable side-effects. 62.5% of the mothers reported that they were spending less money dealing with malaria than previously when their child was treated with SP. 88% of the mothers had waited for 48 hours or more after the onset of fever before taking their child to the dispensary. Mothers' knowledge and reporting of ALu's dosage was, in many cases, inconsistent with the recommended dosage schedule for children. Conclusion Deployment of ALu has significantly changed community level perceptions of anti-malarial treatment. However, mothers continue to delay seeking care before accessing ALu, limiting the impact of highly subsidized rollout of the drug

  5. Appropriate targeting of artemisinin-based combination therapy by community health workers using malaria rapid diagnostic tests

    DEFF Research Database (Denmark)

    Ndyomugyenyi, Richard; Magnussen, Pascal; Lal, Sham

    2016-01-01

    -randomized trials were conducted in two contrasting areas of moderate-to-high and low malaria transmission in rural Uganda. Each trial examined the effectiveness of mRDTs in the management of malaria and targeting of ACTs by CHWs comparing two diagnostic approaches: (i) presumptive clinical diagnosis of malaria...... the proportion of children microscopically-confirmed presence of parasites in a peripheral blood smear receiving artemether-lumefantrine or rectal artesunate, and patients with no malaria parasites not given ACT. RESULTS...... delivered by CHWs are more accurately targeted to children with malaria parasites. mRDT use could play an important role in reducing overdiagnosis of malaria and improving fever case management within iCCM, in both moderate-to-high and low transmission areas. Nonetheless, missed treatments due to the low...

  6. Molecular monitoring of plasmodium falciparum drug susceptibility at the time of the introduction of artemisinin-based combination therapy in Yaoundé, Cameroon: Implications for the future

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    Menard Sandie

    2012-04-01

    Full Text Available Abstract Background Regular monitoring of the levels of anti-malarial resistance of Plasmodium falciparum is an essential policy to adapt therapy and improve malaria control. This monitoring can be facilitated by using molecular tools, which are easier to implement than the classical determination of the resistance phenotype. In Cameroon, chloroquine (CQ, previously the first-line therapy for uncomplicated malaria was officially withdrawn in 2002 and replaced initially by amodiaquine (AQ monotherapy. Then, artemisinin-based combination therapy (ACT, notably artesunate-amodiaquine (AS-AQ or artemether-lumefantrine (AL, was gradually introduced in 2004. This situation raised the question of the evolution of P. falciparum resistance molecular markers in Yaoundé, a highly urbanized Cameroonian city. Methods The genotype of pfcrt 72 and 76 and pfmdr1 86 alleles and pfmdr1 copy number were determined using real-time PCR in 447 P. falciparum samples collected between 2005 and 2009. Results This study showed a high prevalence of parasites with mutant pfcrt 76 (83% and pfmdr1 86 (93% codons. On the contrary, no mutations in the pfcrt 72 codon and no samples with duplication of the pfmdr1 gene were observed. Conclusion The high prevalence of mutant pfcrt 76T and pfmdr1 86Y alleles might be due to the choice of alternative drugs (AQ and AS-AQ known to select such genotypes. Mutant pfcrt 72 codon was not detected despite the prolonged use of AQ either as monotherapy or combined with artesunate. The absence of pfmdr1 multicopies suggests that AL would still remain efficient. The limited use of mefloquine or the predominance of mutant pfmdr1 86Y codon could explain the lack of pfmdr1 amplification. Indeed, this mutant codon is rarely associated with duplication of pfmdr1 gene. In Cameroon, the changes of therapeutic strategies and the simultaneous use of several formulations of ACT or other anti-malarials that are not officially recommended result in a

  7. Appropriate targeting of artemisinin-based combination therapy by community health workers using malaria rapid diagnostic tests: findings from randomized trials in two contrasting areas of high and low malaria transmission in south-western Uganda.

    Science.gov (United States)

    Ndyomugyenyi, Richard; Magnussen, Pascal; Lal, Sham; Hansen, Kristian; Clarke, Siân E

    2016-09-01

    To compare the impact of malaria rapid diagnostic tests (mRDTs), used by community health workers (CHWs), on the proportion of children <5 years of age receiving appropriately targeted treatment with artemisinin-based combination therapy (ACT), vs. presumptive treatment. Cluster-randomized trials were conducted in two contrasting areas of moderate-to-high and low malaria transmission in rural Uganda. Each trial examined the effectiveness of mRDTs in the management of malaria and targeting of ACTs by CHWs comparing two diagnostic approaches: (i) presumptive clinical diagnosis of malaria [control arm] and (ii) confirmatory diagnosis with mRDTs followed by ACT treatment for positive patients [intervention arm], with village as the unit of randomisation. Treatment decisions by CHWs were validated by microscopy on a reference blood slide collected at the time of consultation, to compare the proportion of children <5 years receiving appropriately targeted ACT treatment, defined as patients with microscopically-confirmed presence of parasites in a peripheral blood smear receiving artemether-lumefantrine or rectal artesunate, and patients with no malaria parasites not given ACT. In the moderate-to-high transmission area, ACT treatment was appropriately targeted in 79.3% (520/656) of children seen by CHWs using mRDTs to diagnose malaria, vs. 30.8% (215/699) of children seen by CHWs using presumptive diagnosis (P < 0.001). In the low transmission area, 90.1% (363/403) children seen by CHWs using mRDTs received appropriately targeted ACT treatment vs. 7.8% (64/817) seen by CHWs using presumptive diagnosis (P < 0.001). Low mRDT sensitivity in children with low-density parasitaemia (<200 parasites/μl) was identified as a potential concern. When equipped with mRDTs, ACT treatments delivered by CHWs are more accurately targeted to children with malaria parasites. mRDT use could play an important role in reducing overdiagnosis of malaria and improving fever case management within

  8. Who gets prompt access to artemisinin-based combination therapy? A prospective community-based study in children from rural Kilosa, Tanzania.

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    Daudi O Simba

    Full Text Available BACKGROUND: Effective and timely case management remains one of the fundamental pillars for control of malaria. Tanzania introduced artemisinin-combination therapy [ACT] for uncomplicated malaria; however, the policy change is challenged by limited availability of ACTs due to high cost. This study aimed to determine factors influencing prompt access to ACTs among febrile children in rural Kilosa, Tanzania. METHODS AND FINDINGS: In a community-based study, 1,235 randomly selected children under five were followed up weekly for six months, in 2008. Using a structured questionnaire, children's caretakers were asked about the child's febrile history in the last seven days, and treatment actions including timing, medicines used and source of care. Caretakers' knowledge about malaria and socioeconomic and demographic data were also obtained. About half of followed-up children had at least one episode of fever. Less than half (44.8% of febrile children were taken to government facilities. Almost one-third (37.6%; 95% CI 33.1-42.1 of febrile children had prompt access to ACT. Care-seeking from a government facility was the overriding factor, increasing the likelihood of prompt access to an ACT 18 times (OR 17.7; 95% CI 10.55-29.54; adjusted OR 16.9; 95% CI 10.06-28.28. Caretakers from the better-off household (3rd-5th quintiles were more likely to seek care from government facilities (OR 3.66; 95% CI 2.56-5.24; adjusted OR 1.80; 95% CI 1.18-2.76. The majority of antimalarials accessed by the poor were ineffective [86.0%; 295/343], however, they paid more for them (median Tsh 500 compared to the better-offs (median Tsh 0. CONCLUSIONS: Prompt access to ACT among febrile children was unacceptably low, due mainly to limited availability of subsidised ACT at the location where most caretakers sought care. There is urgent need to accelerate implementation of strategies that will ensure availability of ACT at an affordable price in remote rural areas, where

  9. Malaria Case-Management following Change of Policy to Universal Parasitological Diagnosis and Targeted Artemisinin-Based Combination Therapy in Kenya

    Science.gov (United States)

    Nyandigisi, Andrew; Memusi, Dorothy; Mbithi, Agneta; Ang'wa, Newton; Shieshia, Mildred; Muturi, Alex; Sudoi, Raymond; Githinji, Sophie; Juma, Elizabeth; Zurovac, Dejan

    2011-01-01

    Background The change of malaria case-management policy in Kenya to recommend universal parasitological diagnosis and targeted treatment with artemether-lumefantrine (AL) is supported with activities aiming by 2013 at universal coverage and adherence to the recommendations. We evaluated changes in health systems and case-management indicators between the baseline survey undertaken before implementation of the policy and the follow-up survey following the first year of the implementation activities. Methods/Findings National, cross-sectional surveys using quality-of-care methods were undertaken at public facilities. Baseline and follow-up surveys respectively included 174 and 176 facilities, 224 and 237 health workers, and 2,405 and 1,456 febrile patients. Health systems indicators showed variable changes between surveys: AL stock-out (27% to 21%; p = 0.152); availability of diagnostics (55% to 58%; p = 0.600); training on the new policy (0 to 22%; p = 0.001); exposure to supervision (18% to 13%; p = 0.156) and access to guidelines (0 to 6%; p = 0.001). At all facilities, there was an increase among patients tested for malaria (24% vs 31%; p = 0.090) and those who were both tested and treated according to test result (16% to 22%; p = 0.048). At facilities with AL and malaria diagnostics, testing increased from 43% to 50% (p = 0.196) while patients who were both, tested and treated according to test result, increased from 28% to 36% (p = 0.114). Treatment adherence improved for test positive patients from 83% to 90% (p = 0.150) and for test negative patients from 47% to 56% (p = 0.227). No association was found between testing and exposure to training, supervision and guidelines, however, testing was significantly associated with facility ownership, type of testing, and patients' caseload, age and clinical presentation. Conclusions Most of the case-management indicators have shown some improvement trends; however

  10. Pyronaridine-Artesunate combination for the treatment of acute uncomplicated Plasmodium falciparum malaria in paediatric patients in Gabon

    OpenAIRE

    Schreier, Annette

    2010-01-01

    Artemisinin-based combination therapies (ACTs) are now the recommended first-line drugs for the treatment of acute uncomplicated Plasmodium falciparum malaria in many endemic regions and the development of novel therapy options, especially for the use in children, is a major aim in malaria research. This Phase II study intended to provide first clinical data about the new combination of pyronaridine and artesunate for the use in paediatric patients. 60 children were assigned to the four s...

  11. CRISPR-Cas9-modified pfmdr1 protects Plasmodium falciparum asexual blood stages and gametocytes against a class of piperazine-containing compounds but potentiates artemisinin-based combination therapy partner drugs.

    Science.gov (United States)

    Ng, Caroline L; Siciliano, Giulia; Lee, Marcus C S; de Almeida, Mariana J; Corey, Victoria C; Bopp, Selina E; Bertuccini, Lucia; Wittlin, Sergio; Kasdin, Rachel G; Le Bihan, Amélie; Clozel, Martine; Winzeler, Elizabeth A; Alano, Pietro; Fidock, David A

    2016-08-01

    Emerging resistance to first-line antimalarial combination therapies threatens malaria treatment and the global elimination campaign. Improved therapeutic strategies are required to protect existing drugs and enhance treatment efficacy. We report that the piperazine-containing compound ACT-451840 exhibits single-digit nanomolar inhibition of the Plasmodium falciparum asexual blood stages and transmissible gametocyte forms. Genome sequence analyses of in vitro-derived ACT-451840-resistant parasites revealed single nucleotide polymorphisms in pfmdr1, which encodes a digestive vacuole membrane-bound ATP-binding cassette transporter known to alter P. falciparum susceptibility to multiple first-line antimalarials. CRISPR-Cas9 based gene editing confirmed that PfMDR1 point mutations mediated ACT-451840 resistance. Resistant parasites demonstrated increased susceptibility to the clinical drugs lumefantrine, mefloquine, quinine and amodiaquine. Stage V gametocytes harboring Cas9-introduced pfmdr1 mutations also acquired ACT-451840 resistance. These findings reveal that PfMDR1 mutations can impart resistance to compounds active against asexual blood stages and mature gametocytes. Exploiting PfMDR1 resistance mechanisms provides new opportunities for developing disease-relieving and transmission-blocking antimalarials.

  12. Prevalence of Single Nucleotide Polymorphisms in the Plasmodium falciparum Multidrug Resistance Gene (Pfmdr-1) in Korogwe District in Tanzania Before and After Introduction of Artemisinin-Based Combination Therapy

    DEFF Research Database (Denmark)

    Thomsen, Thomas T; Ishengoma, Deus S; Mmbando, Bruno P;

    2011-01-01

    Abstract. Tanzania implemented artemether-lumefantrine (AL) as the first-line treatment for uncomplicated malaria in November of 2006 because of resistance to sulfadoxine-pyrimethamine. AL remains highly efficacious, but widespread use may soon facilitate emergence of artemisinin tolerance/resist.......9). The observed changes may be because of introduction of AL, and if so, this finding gives cause for concern and argues for continued surveillance of these molecular markers....

  13. A Survey of the Rational use of Artemisinin Based Combination ...

    African Journals Online (AJOL)

    Eighty six (86) (79.6%) doctors and 82 (89.1%) pharmacists agreed that the ACTs were more ... never documented adverse effect of ACTs experienced by the patients. ... of pregnancy because of their safety during these periods of pregnancy. ... a pivotal role in providing these drug information in literatures distributed to the ...

  14. Genetic loci associated with delayed clearance of Plasmodium falciparum following artemisinin treatment in Southeast Asia

    Science.gov (United States)

    2013-01-02

    Genetic loci associated with delayed clearance of Plasmodium falciparum following artemisinin treatment in Southeast Asia Shannon Takala-Harrisona...resistant Plasmodium falcipa- rum malaria in western Cambodia could threaten prospects for malaria elimination. Identification of the genetic basis of...molecular markers Artemisinin-based combination therapies (ACTs) are the lead-ing treatment for Plasmodium falciparum malaria (1), and their use with

  15. Substandard artemisinin-based antimalarial medicines in licensed retail pharmaceutical outlets in Ghana

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    M. El-Duah & K. Ofori-Kwakye

    2012-09-01

    Full Text Available Background & objectives: The artemisinin-based antimalarial medicines are first line medicines in the treatmentof severe and uncomplicated falciparum malaria. Numerous brands of these medicines manufactured in variouscountries are available in the Ghanaian market. The study was aimed at evaluating the authenticity and qualityof selected brands of artemisinin-based antimalarial medicines marketed in Ghana.Methods: In all, 14 artemisinin-based antimalarial medicines were purchased from pharmacies (P and licensedchemical shops (LCSs in the Kumasi metropolis, Ghana. Simple field tests based on colorimetry and thin layerchromatography were employed in determining the authenticity of the samples. Important quality assessmenttests, namely uniformity of mass, crushing strength, disintegration time, and the percentage content of activepharmaceutical ingredients (APIs were determined.Results: All the brands tested contained the stipulated APIs. Artesunate tablet AT2 failed the uniformity of masstest while artesunate tablets AT3 & AT4 as well as amodiaquine tablets AM4 & AM6 failed the crushing strengthtest. All the six artemether-lumefantrine tablet brands passed the uniformity of mass, crushing strength anddisintegration tests. Only artemether-lumefantrine tablet brand AL1 contained the correct amount of the drugs.The other 13 artemisinin products contained either a lower (underdose or higher (overdose amount of thespecified drug. Artesunate monotherapy tablets were readily available in pharmacies and licensed chemicalshops.Interpretation & conclusion: All the artemisinin-based medicines tested (except AL1 were of substandardquality. The results demonstrate the need for continuous monitoring and evaluation of the quality of artemisininbased antimalarials in the Ghanaian market. Also, the practice of artemisinin antimalarial monotherapy is prevalentin Ghana. Determined efforts should, therefore, be made to eradicate the practice to prevent the development

  16. A New Handheld Device for the Detection of Falsified Medicines: Demonstration on Falsified Artemisinin-Based Therapies from the Field.

    Science.gov (United States)

    Wilson, Benjamin K; Kaur, Harparkash; Allan, Elizabeth Louise; Lozama, Anthony; Bell, David

    2017-02-20

    Poor-quality medicines are a major problem for health-care systems in resource-poor settings as identifying falsified medicines requires a complex laboratory infrastructure such as a Medicines Quality Control Laboratory. We report here an evaluation of a low-cost, handheld near-infrared spectrometer (NIRS) device by analyzing a library of artemisinin-based combination therapy (ACT) medicines to determine its usefulness as a drug-screening tool. The "SCiO" research prototype device was used to collect NIR spectra of a library of ACT and artesunate monotherapy medicine samples previously collected in Bioko Island and Equatorial Guinea and Kintampo, Ghana. The quality of these samples had been categorized as falsified, substandard, and quality assured based on the amount of stated active pharmaceutical ingredients detected using high-performance liquid chromatography photodiode array. Numerical analyses were performed on the NIR spectra to assess the usefulness of NIR to identify falsified and substandard medicines. The NIRS device was successful at detecting falsified medicines in all cases where the library contained both quality assured and falsified medicines of the same stated brand of medicines. The NIRS device was successful at identifying substandard amounts of artesunate but not amodiaquine in the ACT samples (N = 15) of artesunate-amodiaquine. This work reveals that this low-cost, portable NIRS device is promising for screening ACTs for falsified samples and could enable widespread drug screening at all points of the health system.

  17. Evaluation of the Quality of Artemisinin-Based Antimalarial Medicines Distributed in Ghana and Togo

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    Dorcas Osei-Safo

    2014-01-01

    Full Text Available This study, conducted as part of our overall goal of regular pharmacovigilance of antimalarial medicines, reports on the quality of 132 artemisinin-based antimalarial medicines distributed in Ghana and Togo. Three methods were employed in the quality evaluation—basic (colorimetric tests for establishing the identity of the requisite active pharmaceutical ingredients (APIs, semi-quantitative TLC assay for the identification and estimation of API content, and HPLC assay for a more accurate quantification of API content. From the basic tests, only one sample totally lacked API. The HPLC assay, however, showed that 83.7% of the ACTs and 57.9% of the artemisinin-based monotherapies failed to comply with international pharmacopoeia requirements due to insufficient API content. In most of the ACTs, the artemisinin component was usually the insufficient API. Generally, there was a good correlation between the HPLC and SQ-TLC assays. The overall failure rates for both locally manufactured (77.3% and imported medicines (77.5% were comparable. Similarly the unregistered medicines recorded a slightly higher overall failure rate (84.7% than registered medicines (70.8%. Only two instances of possible cross-border exchange of medicines were observed and there was little difference between the medicine quality of collections from border towns and those from inland parts of both countries.

  18. Combination treatment for hypertension

    African Journals Online (AJOL)

    On average, one in four adults has hypertension.1 This figure is higher in certain regions of the world, .... doses favours the development of diabetes and should be ... New and old evidence strongly supports combination treatment .... cardiovascular death, stroke and myocardial infarction, cognitive function and dementia.

  19. Optimal Antihypertensive Combination Treatments

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    Massimo Volpe

    2012-03-01

    Full Text Available Over the past three decades it has been consistently shown that optimal blood pressure (BP control significantly reduced cardiovascular (CV morbidity and mortality [1]. Despite solid evidence in favour of benefits derived from BP reductions, however, hypertension control in treated hypertensive patients remains suboptimal worldwide [2, 3]. In addition, proportions of diagnosed and treated hypertensive patients remain largely unchanged over the last two decades[4]. Multiple factors may be advocated to explain this observation, including variation in healthcare access and availability [5, 6], attitudes amongst clinicians towards hypertension [7, 8], inaccuracy in BP measurements [9] and underuse or under dosage of antihypertensive drugs in both monotherapy and in combination therapy [10, 11].On the basis of these considerations, it is beyond the aim of this article to discuss the socioeconomic impact on healthcare and BP measurement techniques. Instead it will seek to explain the importance of attaining early optimal BP control and the use of combination therapy as a new paradigm for the modern clinical management of hypertension.

  20. Artesunate-amodiaquine fixed dose combination for the treatment of Plasmodium falciparum malaria in India

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    Anvikar Anupkumar R

    2012-03-01

    Full Text Available Abstract Background Artemisinin-based combination therapy (ACT has been recommended for the treatment of falciparum malaria by the World Health Organization. Though India has already switched to ACT for treating falciparum malaria, there is need to have multiple options of alternative forms of ACT. A randomized trial was conducted to assess the safety and efficacy of the fixed dose combination of artesunate-amodiaquine (ASAQ and amodiaquine (AQ for the treatment of uncomplicated falciparum malaria for the first time in India. The study sites are located in malaria-endemic, chloroquine-resistant areas. Methods This was an open label, randomized trial conducted at two sites in India from January 2007 to January 2008. Patients between six months and 60 years of age having Plasmodium falciparum mono-infection were randomly allocated to ASAQ and AQ arms. The primary endpoint was 28-day PCR-corrected parasitological cure rate. Results Three hundred patients were enrolled at two participating centres, Ranchi, Jharkhand and Rourkela, Odisha. Two patients in AQ arm had early treatment failure while there was no early treatment failure in ASAQ arm. Late treatment failures were seen in 13 and 12 patients in ASAQ and AQ arms, respectively. The PCR-corrected cure rates in intent-to-treat population were 97.51% (94.6-99.1% in ASAQ and 88.65% (81.3-93.9% in AQ arms. In per-protocol population, they were 97.47% (94.2-99.2% and 88.30% (80-94% in ASAQ and AQ arms respectively. Seven serious adverse events (SAEs were reported in five patients, of which two were reported as related to the treatment. All SAEs resolved without sequel. Conclusion The fixed dose combination of ASAQ was found to be efficacious and safe treatment for P. falciparum malaria. Amodiaquine also showed acceptable efficacy, making it a suitable partner of artesunate. The combination could prove to be a viable option in case India opts for fixed dose combination ACT. Clinical trial registry

  1. Artemisinin-Naphthoquine Combination (ARCO®: An Overview of the Progress

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    Qingyun Huang

    2010-12-01

    Full Text Available With the rapidly spreading resistance of Plasmodium falciparum to available non-artemisinin antimalarial drugs, new and novel pharmaceuticals are needed. ARCO® is a new generation ACT, one of several artemisinin-based combinations developed in China to counter antimalarial drug resistance. ARCO® is a derivative of two independently developed antimalarials, artemisinin and naphthoquine phosphate, which were combined to form the artemisinin-naphthoquine combination. Both artemisinin and naphthoquine drugs have proven to be efficacious, safe and well tolerated as monotherapies. The artemisinin-naphthoquine combination offers a novel advantage over existing ACTs: it can be administered as a single oral dose (or a 1-day treatment. Several therapeutic studies conducted recently indicate that a single oral dose administration of artemisinin-naphthoquine combination is equally effective and safe as the 3-day treatment with artemether-lumefantrine combination and other existing ACTs. This would make ARCO® the next generation ACT for the treatment of uncomplicated falciparum malaria.

  2. Efficacy of monotherapies and artesunate-based combination therapies in children with uncomplicated malaria in Somalia.

    Science.gov (United States)

    Warsame, Marian; Atta, Hoda; Klena, John D; Waqar, Butt Ahmed; Elmi, Hussein Haji; Jibril, Ali Mohamed; Hassan, Hassan Mohamed; Hassan, Abdullahi Mohamed

    2009-02-01

    In order to guide the antimalarial treatment policy of Somalia, we conducted therapeutic efficacy studies of routinely used antimalarial monotherapies as well as artemisinin-based combination therapies (ACTs) for uncomplicated malaria in three sentinel sites during 2003-2006. Therapeutic efficacy of chloroquine (CQ), amodiaquine (AQ) and sulfadoxine/pyrimetahmine (SP) monotherapies, and artesunate plus SP (AS+SP) or AQ (AS+AQ) were evaluated in children 6 months to 10 years old with uncomplicated malaria. For the assessment of the monotherapies, 2003 WHO protocol with 14-day follow-up was used while the 2005 WHO protocol with 28-day follow-up was used for testing the ACTs. Of the monotherapies, CQ performed very poorly with treatment failures varying from 76.5% to 88% between the sites. AQ treatment failure was low except for Janale site with treatment failure of 23.4% compared to 2.8% and 8% in Jamame and Jowhar, respectively. For SP, treatment failures from 7.8% to 12.2% were observed. A 28-day test of artemisinin-based combinations, AS+SP and AS+AQ, proved to be highly efficacious with cure rates of 98-100% supporting the choice of AS+SP combination as first line treatment for uncomplicated malaria for Somalia.

  3. Safety, efficacy and population pharmacokinetics of fixed-dose combination of artesunate-mefloquine in the treatment of acute uncomplicated Plasmodium falciparum malaria in India.

    Science.gov (United States)

    Valecha, Neena; Srivastava, Bina; Dubhashi, N G; Rao, B H Krishnamoorthy; Kumar, Ashwani; Ghosh, S K; Singh, Jai Prakash Narayan; Kiechel, J R; Sharma, Bhawna; Jullien, V; Dash, A P; Taylor, W R J; Anvikar, Anupkumar R

    2013-12-01

    India has switched over to artemisinin-based combination therapy (ACT) for the treatment of acute uncomplicated Plasmodium falciparum malaria and the ACT used in the national programme is artesunate + sulphadoxine-pyrimethamine. Since the efficacy of ACT is dependent also on the partner drug, there is a need to evaluate and deploy multiple ACTs. This multicentre, single-arm, open-label clinical trial was carried out to assess the efficacy, safety and population pharmacokinetics of a fixed dose combination (FDC) artesunate mefloquine (ASMQ) in P. falciparum infected, Indian adults at Panjim, Goa, and Mangalore, Karnataka between December 2007 and November 2008. A total of 77 patients (males 74) were screened and enrolled: 42 at Goa and 35 at Mangalore with a median age of 25 yr (range 18-55 yr). One patient failed in treatment on D53, a PCR proven new infection, seven developed recurrent vivax parasitaemia and 11 did not have a parasitological endpoint. By per protocol analysis, the D63 cure rate was 58/59 (98.3; 95% C.I. 90.9-99.9%), and 58/58, with PCR correction. ASMQ was well-tolerated and no serious adverse events were reported. The study showed that the ASMQ FDC was efficacious and well-tolerated for the treatment of acute, uncomplicated P. falciparum malaria in highly endemic, chloroquine resistant areas of Goa and Mangalore. It is a viable option for India.

  4. Brazilian Plasmodium falciparum isolates: investigation of candidate polymorphisms for artemisinin resistance before introduction of artemisinin-based combination therapy

    Directory of Open Access Journals (Sweden)

    Rosenthal Philip J

    2010-12-01

    Full Text Available Abstract Background This study was performed to better understand the genetic diversity of known polymorphisms in pfatpase6 and pfmdr1 genes before the introduction of ACT in Brazil, in order to get a genotypic snapshot of Plasmodium falciparum parasites that may be used as baseline reference for future studies. Methods Parasites from P. falciparum samples collected in 2002, 2004 and 2006-2007 were genotyped using PCR and DNA sequencing at codons 86, 130, 184, 1034, 1042, 1109 and 1246 for pfmdr1 gene, and 243, 263, 402, 431, 623, 630, 639, 683, 716, 776, 769 and 771 for pfatpase6 gene. Results A pfmdr1 haplotype NEF/CDVY was found in 97% of the samples. In the case of pfatpase6, four haplotypes, wild-type (37%, 630 S (35%, 402 V (5% and double-mutant 630 S + 402 V (23%, were detected. Conclusion Although some polymorphism in pfmdr1 and pfatpase6 were verified, no reported haplotypes in both genes that may mediate altered response to ACT was detected before the introduction of this therapy in Brazil. Thus, the haplotypes herein described can be very useful as a baseline reference of P. falciparum populations without ACT drug pressure.

  5. Acquired resistance of malarial parasites against artemisinin-based drugs: social and economic impacts.

    Science.gov (United States)

    Porter-Kelley, Johanna M; Cofie, Joann; Jean, Sophonie; Brooks, Mark E; Lassiter, Mia; Mayer, Dc Ghislaine

    2010-01-01

    Malaria, a disease of poverty and high morbidity and mortality in the tropical world, has led to a worldwide search for control measures. To that end, good antimalarial chemotherapies have been difficult to find in the global market and those that seem to be most effective are rapidly becoming ineffective due to the emergence and spread of drug resistance. Artemisinin, a very effective yet expensive antimalarial, has quickly become the recommended drug of choice when all other possibilities fail. However, for all its promise as the next great antimalarial, the outlook is bleak. Resistance is developing to artemisinin while another effective antimalarial is not in sight. Malaria endemic areas which are mostly in developing countries must deal with the multifaceted process of changing and implementing new national malaria treatment guidelines. This requires complex interactions between several sectors of the affected society which in some cases take place within the context of political instability. Moreover, the cost associated with preventing and containing the spread of antimalarial resistance is detrimental to economic progress. This review addresses the impact of artemisinin resistance on the socioeconomic structure of malaria endemic countries.

  6. Hemolysis after Oral Artemisinin Combination Therapy for Uncomplicated Plasmodium falciparum Malaria

    Science.gov (United States)

    Lingscheid, Tilman; Steiner, Florian; Stegemann, Miriam S.; Bélard, Sabine; Menner, Nikolai; Pongratz, Peter; Kim, Johanna; von Bernuth, Horst; Mayer, Beate; Damm, Georg; Seehofer, Daniel; Salama, Abdulgabar; Suttorp, Norbert; Zoller, Thomas

    2016-01-01

    Episodes of delayed hemolysis 2–6 weeks after treatment of severe malaria with intravenous artesunate have been described. We performed a prospective observational study of patients with uncomplicated malaria to investigate whether posttreatment hemolysis also occurs after oral artemisinin-based combination therapy. Eight of 20 patients with uncomplicated malaria who were given oral artemisinin-based combination therapy met the definition of posttreatment hemolysis (low haptoglobin level and increased lactate dehydrogenase level on day 14). Five patients had hemolysis persisting for 1 month. Patients with posttreatment hemolysis had a median decrease in hemoglobin level of 1.3 g/dL (interquartile range 0.3–2.0 g/dL) in the posttreatment period, and patients without posttreatment hemolysis had a median increase of 0.3 g/dL (IQR −0.1 to 0.7 g/dL; p = 0.002). These findings indicate a need for increased vigilance for hemolytic events in malaria patients, particularly those with predisposing factors for anemia. PMID:27434054

  7. Combined treatment for complex intracranial aneurysm

    OpenAIRE

    Chiriac A.; Ion Georgiana; Dobrin N.; Iencean St.M.; Poeata I.

    2015-01-01

    Complex aneurysms often cannot be completely excluded by a single approaches. Today successful treatment of these lesions requires a combination between microsurgical and endovascular techniques. Planning of combined treatment require a very good understanding of aneurysm anatomy and a close collaboration between neurosurgeon and neuroendovascular interventionist. Endovascular coiling can usually be used as early treatment for a partially aneurysm occlusion including the ruptured area and fol...

  8. Pattern of drug utilization for treatment of uncomplicated malaria in urban Ghana following national treatment policy change to artemisinin-combination therapy

    Directory of Open Access Journals (Sweden)

    Tenkorang Ofori

    2009-01-01

    Full Text Available Abstract Background Change of first-line treatment of uncomplicated malaria to artemisinin-combination therapy (ACT is widespread in Africa. To expand knowledge of safety profiles of ACT, pharmacovigilance activities are included in the implementation process of therapy changes. Ghana implemented first-line therapy of artesunate-amodiaquine in 2005. Drug utilization data is an important component of determining drug safety, and this paper describes how anti-malarials were prescribed within a prospective pharmacovigilance study in Ghana following anti-malarial treatment policy change. Methods Patients with diagnosis of uncomplicated malaria were recruited from pharmacies of health facilities throughout Accra in a cohort-event monitoring study. The main drug utilization outcomes were the relation of patient age, gender, type of facility attended, mode of diagnosis and concomitant treatments to the anti-malarial regimen prescribed. Logistic regression was used to predict prescription of nationally recommended first-line therapy and concomitant prescription of antibiotics. Results The cohort comprised 2,831 patients. Curative regimens containing an artemisinin derivative were given to 90.8% (n = 2,574 of patients, although 33% (n = 936 of patients received an artemisinin-based monotherapy. Predictors of first-line therapy were laboratory-confirmed diagnosis, age >5 years, and attending a government facility. Analgesics and antibiotics were the most commonly prescribed concomitant medications, with a median of two co-prescriptions per patient (range 1–9. Patients above 12 years were significantly less likely to have antibiotics co-prescribed than patients under five years; those prescribed non-artemisinin monotherapies were more likely to receive antibiotics. A dihydroartemisinin-amodiaquine combination was the most used therapy for children under five years of age (29.0%, n = 177. Conclusion This study shows that though first-line therapy

  9. Pattern of drug utilization for treatment of uncomplicated malaria in urban Ghana following national treatment policy change to artemisinin-combination therapy.

    Science.gov (United States)

    Dodoo, Alexander N O; Fogg, Carole; Asiimwe, Alex; Nartey, Edmund T; Kodua, Augustina; Tenkorang, Ofori; Ofori-Adjei, David

    2009-01-05

    Change of first-line treatment of uncomplicated malaria to artemisinin-combination therapy (ACT) is widespread in Africa. To expand knowledge of safety profiles of ACT, pharmacovigilance activities are included in the implementation process of therapy changes. Ghana implemented first-line therapy of artesunate-amodiaquine in 2005. Drug utilization data is an important component of determining drug safety, and this paper describes how anti-malarials were prescribed within a prospective pharmacovigilance study in Ghana following anti-malarial treatment policy change. Patients with diagnosis of uncomplicated malaria were recruited from pharmacies of health facilities throughout Accra in a cohort-event monitoring study. The main drug utilization outcomes were the relation of patient age, gender, type of facility attended, mode of diagnosis and concomitant treatments to the anti-malarial regimen prescribed. Logistic regression was used to predict prescription of nationally recommended first-line therapy and concomitant prescription of antibiotics. The cohort comprised 2,831 patients. Curative regimens containing an artemisinin derivative were given to 90.8% (n = 2,574) of patients, although 33% (n = 936) of patients received an artemisinin-based monotherapy. Predictors of first-line therapy were laboratory-confirmed diagnosis, age >5 years, and attending a government facility. Analgesics and antibiotics were the most commonly prescribed concomitant medications, with a median of two co-prescriptions per patient (range 1-9). Patients above 12 years were significantly less likely to have antibiotics co-prescribed than patients under five years; those prescribed non-artemisinin monotherapies were more likely to receive antibiotics. A dihydroartemisinin-amodiaquine combination was the most used therapy for children under five years of age (29.0%, n = 177). This study shows that though first-line therapy recommendations may change, clinical practice may still be affected by

  10. Combined treatment for complex intracranial aneurysm

    Directory of Open Access Journals (Sweden)

    Chiriac A.

    2015-06-01

    Full Text Available Complex aneurysms often cannot be completely excluded by a single approaches. Today successful treatment of these lesions requires a combination between microsurgical and endovascular techniques. Planning of combined treatment require a very good understanding of aneurysm anatomy and a close collaboration between neurosurgeon and neuroendovascular interventionist. Endovascular coiling can usually be used as early treatment for a partially aneurysm occlusion including the ruptured area and followed by definitive clipping. On the other hand microsurgical clipping also can be used as first treatment for complex aneurysm neck reconstruction, allowing successful secondary placement of coils inside the remnant aneurysm sac

  11. Optimal price subsidies for appropriate malaria testing and treatment behaviour

    DEFF Research Database (Denmark)

    Hansen, K. S.; Lesner, T. H.; Østerdal, L. P.

    2016-01-01

    of presumptive diagnosis. A global subsidy on artemisinin-based combination therapy (ACT) has recently been suggested to increase access to the most effective malaria treatment. Methods: Following the recommendation by World Health Organization that parasitological testing should be performed before treatment......, ACT medicines, and cheap, less effective anti-malarials are sold. Assuming that the individual has certain beliefs of the accuracy of the RDT and the probability that the fever is malaria, the model predicts the diagnosis-treatment behaviour of the individual. Subsidies on RDTs and ACT are introduced...... to incentivize appropriate behaviour: choose an RDT before treatment and purchase ACT only if the test is positive. Results: Solving the model numerically suggests that a combined subsidy on both RDT and ACT is cost minimizing and improves diagnosis-treatment behaviour of individuals. For certain beliefs...

  12. [Age peculiarities of combined maxillofacial injuries treatment].

    Science.gov (United States)

    Kharitonov, D Iu

    2008-01-01

    Experience of help to 399 patients with combined craniofacial traumas of different age groups was shown. Some algorithm of help to such patients was suggested, interaction of craniofacial trauma components were demonstrated. Some scheme of pathogenetic based treatment of patients with combined craniofacial injuries was grounded upon it.

  13. Oxidative stress in malaria and artemisinin combination therapy

    DEFF Research Database (Denmark)

    Kavishe, Reginald A.; Koenderink, Jan B.; Alifrangis, Michael

    2017-01-01

    Artemisinin-based combination therapy (ACT) has been adopted as a strategy to mitigate multidrug resistance to antimalarial monotherapies. ACT combines the rapid and effective but rather short plasma half-life antimalarial action of an artemisinin derivative with a longer acting partner drug...

  14. Combined photoultrasonic treatment of infected wounds

    Science.gov (United States)

    Zharov, Vladimir P.; Menyaev, Yulian A.; Kalinin, Konstantin L.; Zmievskoy, Gregory N.; Velsher, Leonid Z.; Podkolzin, Alexander A.; Stakhanov, Mikhail L.; Gorchak, Yury Y.; Sarantsev, V. P.

    2001-05-01

    A new combined photoultrasonic (CPUS) technology for the treatment of infected wounds is suggested. The CPUS principal operation is based on the topical application of a photosensitizer followed by light irradiation in combination with low frequency ultrasonic (US) treatment of wounds. In CPUS, two methods - photodynamic (PDT) and ultrasonic therapies supplement each other beneficially and in conjunction provide a significant effect of deep suppurative inflammatory wounds treatment. The main advantages of the new technology are the combined application of an antibiotic solution and photodynamic therapy to destroy antibiotic- resistant microorganisms, an effective mixing of a photosensitizer in the wound, the US enhancement of photosensitizer impregnation into the membranes of bacteria, the US clearing of wound surface from necrotic products, an increased effective light dose exposure in the whole volume of the deep wound when the light does not penetrate totally inside the wound, an additional bactericidal effect under the US impact, and the combined effect of CPUS activation of the immune system.

  15. Systemic combination treatment for psoriasis: a review

    DEFF Research Database (Denmark)

    Jensen, Peter; Skov, Lone; Zachariae, Claus

    2010-01-01

    Psoriasis is a chronic inflammatory skin disease, which affects approximately 2.6% of the population in Northern Europe and Scandinavia. In order to achieve disease control, combinations of systemic treatments are sometimes needed for variable time periods. However, no evidence-based guidelines...... exist for the use of systemic combination therapy. Therefore, our aim was to review the current literature on systemic anti-psoriatic combination regimens. We searched PubMed and identified 98 papers describing 116 studies (23 randomized) reporting on the effect of various systemic combination...

  16. A universal combination treatment for vaginitis.

    Science.gov (United States)

    Bornstein, Jacob; Zarfati, Doron

    2008-01-01

    We compared a novel vaginal tablet consisting of 100 mg of clotrimazole and 100 mg of metronidazole ('Clo-Met') to a 100-mg clotrimazole tablet in the treatment of vaginitis. A multicenter, double-blind, randomized controlled study. Women with vaginal discharge and diagnosed as suffering from vaginitis caused by Trichomonas vaginalis, bacterial vaginosis or Candida albicans, or any combination of the three, and who had not received treatment for vaginitis during the previous month, were studied. 165 patients were enrolled into the study--84 into the combined therapy group, and 81 into the clotrimazole group. In women with Candida vaginitis, Clo-Met was more effective than clotrimazole treatment (p vaginal tablet consisting of clotrimazole and metronidazole is therapeutically effective in candidal vaginitis. The effectiveness of Clo-Met on bacterial vaginosis, T. vaginalis infection as well as on vaginal infections due to a combination of these microorganisms should be studied further.

  17. Combined treatment in punctate inner choroidopathy

    Directory of Open Access Journals (Sweden)

    Terelak-Borys B

    2016-09-01

    Full Text Available Barbara Terelak-Borys, Katarzyna Zagajewska, Irmina Jankowska-Lech, Piotr Tesla, Iwona Grabska-Liberek Department of Ophthalmology, Centre of Postgraduate Medical Education, Prof W Orlowski Clinical Hospital, Warsaw, Poland Purpose: The purpose of this study was to describe a combination treatment for choroidal neovascular (CNV membrane, secondary to punctate inner choroidopathy (PIC.Patient and methods: A 44-year-old female patient was diagnosed with PIC complicated by the development of recurrent juxtafoveal neovascular membrane. The treatment included a sequence of monotherapy regimens: systemic steroid therapy, photodynamic therapy, and intravitreal injections of vascular endothelial growth factor (VEGF inhibitor (anti-VEGF. Owing to the CNV membrane resistance to various types of monotherapy, a combination treatment consisting of local injections of steroid underneath the Tenon’s capsule and intravitreal anti-VEGF injections was used.Results: Systemic steroid therapy resulted in rapid local improvement with a very short remission period. No positive effects of photodynamic therapy were observed. Sequential anti-VEGF injections led to remission periods of several months. Permanent regression of CNV membrane was achieved following combined local application of steroid and intravitreal anti-VEGF injections.Conclusion: A combination treatment including steroid and anti-VEGF medication characterized by anti-inflammatory and antiangiogenic effects may be a very beneficial option for the treatment of recurrent CNV membrane as a complication of PIC. Keywords: punctate inner choroidopathy, neovascular membrane, anti-VEGF injections, photodynamic therapy, steroids

  18. Fixed Dose Combination for TB treatment

    Directory of Open Access Journals (Sweden)

    Tjandra Y. Aditama

    2003-06-01

    Full Text Available According to the World Health Organization, a third of the world’s population is infected with tuberculosis. The disease is responsible for nearly 2 million deaths each year and over 8 million were developing active diseases. Moreover, according to WHO (2000, tuberculosis deaths are estimated to increase to 35 million between 2000-2020. The majority of tuberculosis patients worldwide are still treated with single drugs, or with 2-drug fixed-dose combinations (FDCs. To improve tuberculosis treatment, 2- and 3-drug FDCs were recommended by the World Health Organization (WHO as part of the DOTS strategy. Since 1999 a 4-drug FDC was included on the WHO Model List of Essential Drugs. Today, FDCs are important tools to further improve the quality of care for people with TB, and accelerate DOTS expansion to reach the global TB control targets. Fixed dose combination TB drugs could simplifies both treatment and management of drug supply, and may prevent the emergence of drug resistance .Prevention of drug resistance is just one of the potential benefits of the use of FDCs. FDCs simplify administration of drugs by reducing the number of pills a patient takes each day and decreasing the risk of incorrect prescriptions. Most tuberculosis patients need only take 3–4 FDCs tablets per day during the intensive phase of treatment, instead of the 15–16 tablets per day that is common with single-drug formulations It is much simpler to explain to patients that they need to take four tablets of the same type and colour, rather than a mixture of tablets of different shapes, colours and sizes. Also, the chance of taking an incomplete combination of drugs is eliminated, since the four essential drugs are combined into one tablet. FDCs are also simpler for care-givers as they minimize the risk of confusion. Finally, drug procurement, in all its components (stock management, shipping, distribution, is simplified by FDCs. Adverse reactions to drugs are not more

  19. Fixed-Dose Artesunate–Amodiaquine Combination vs Chloroquine for Treatment of Uncomplicated Blood Stage P. vivax Infection in the Brazilian Amazon: An Open-Label Randomized, Controlled Trial

    Science.gov (United States)

    Alencar, Aline C.; Melo, Gisely C.; Magalhaes, Belisa L.; Machado, Kim; Alencar Filho, Aristóteles C.; Kuehn, Andrea; Marques, Marly M.; Manso, Monica Costa; Felger, Ingrid; Vieira, José L. F.; Lameyre, Valerie; Daniel-Ribeiro, Claudio T.; Lacerda, Marcus V. G.

    2017-01-01

    Background. Despite increasing evidence of the development of Plasmodium vivax chloroquine (CQ) resistance, there have been no trials comparing its efficacy with that of artemisinin-based combination therapies (ACTs) in Latin America. Methods. This randomized controlled trial compared the antischizontocidal efficacy and safety of a 3-day supervised treatment of the fixed-dose combination artesunate-amodiaquine Winthrop® (ASAQ) versus CQ for treatment of uncomplicated P. vivax infection in Manaus, Brazil. Patients were followed for 42 days. Primary endpoints were adequate clinical and parasitological responses (ACPR) rates at day 28. Genotype-adjustment was performed. Results. From 2012 to 2013, 380 patients were enrolled. In the per-protocol (PP) analysis, adjusted-ACPR was achieved in 100% (165/165) and 93.6% (161/172) of patients in the ASAQ and CQ arm (difference 6.4%, 95% CI 2.7%; 10.1%) at day 28 and in 97.4% (151/155) and 77.7% (129/166), respectively (difference 19.7%, 95% CI 12.9%; 26.5%), at day 42. Apart from ITT D28 assessment, superiority of ASAQ on ACPR was demonstrated. ASAQ presented faster clearance of parasitaemia and fever. Based on CQ blood level measurements, CQ resistance prevalence was estimated at 11.5% (95% CI: 7.5-17.3) up to day 42. At least one emergent adverse event (AE) was recorded for 79/190 (41x6%) in the ASAQ group and for 85/190 (44x7%) in the CQ group. Both treatments had similar safety profiles. Conclusions. ASAQ exhibited high efficacy against CQ resistant P. vivax and is an adequate alternative in the study area. Studies with an efficacious comparator, longer follow-up and genotype-adjustment can improve CQR characterization. Clinical Trials Registration. NCT01378286. PMID:27988484

  20. Compliance with a three-day course of artesunate-mefloquine combination and baseline anti-malarial treatment in an area of Thailand with highly multidrug resistant falciparum malaria

    Directory of Open Access Journals (Sweden)

    Na-Bangchang Kesara

    2010-02-01

    Full Text Available Abstract Background Artemisinin-based combination therapy (ACT is presently recommended by the World Health Organization as first-line treatment for uncomplicated Plasmodium falciparum malaria in several countries, as a mean of prolonging the effectiveness of first-line malaria treatment regimens. A three-day course of artesunate-mefloquine (4 mg/kg body weight once daily for three consecutive days, plus 15 and 10 mg/kg body weight mefloquine on the first and second days has been adopted by Malaria Control Programme of Thailand as first-line treatment for uncomplicated falciparum malaria all over the country since 2008. The gametocytocydal anti-malarial drug primaquine is administered at the dose of 30 mg (0.6 mg/kg on the last day. The aim of the present study was to assess patient compliance of this combination regimen when applied to field condition. Methods A total of 240 patients (196 males and 44 females who were attending the malaria clinics in Mae-Sot, Tak Province and presenting with symptomatic acute uncomplicated falciparum malaria, with no reappearance of Plasmodium vivax parasitaemia during follow-up were included into the study. The first dose of the treatment was given to the patients under direct supervision. All patients were given the medication for self-treatment at home and were requested to come back for follow-up on day 3 of the initial treatment. Baseline (day 0 and day 3 whole blood mefloquine and plasma primaquine concentrations were determined by high performance liquid chromatography. Results Two patients had recrudescence on days 28 and 35. The Kaplan-Meier estimate of the 42-day efficacy rate of this combination regimen was 99.2% (238/240. Based on whole blood mefloquine and plasma primaquine concentrations on day 3 of the initial treatment, compliance with mefloquine and primaquine in this three-day artesunate-mefloquine combination regimen were 96.3% (207/215, and 98.5% (197/200, respectively. Baseline mefloquine

  1. Systemic combination treatment for psoriasis: a review

    DEFF Research Database (Denmark)

    Jensen, Peter; Skov, Lone; Zachariae, Claus

    2010-01-01

    exist for the use of systemic combination therapy. Therefore, our aim was to review the current literature on systemic anti-psoriatic combination regimens. We searched PubMed and identified 98 papers describing 116 studies (23 randomized) reporting on the effect of various systemic combination...

  2. Treatment of premature ejaculation: a new combined approach

    Directory of Open Access Journals (Sweden)

    Adel Kurkar

    2015-01-01

    Causes of PE differ considerably. In this paper, we compared the outcomes of two single treatment lines together with a combination of both. The combination therapy was more effective than either line alone.

  3. Willingness-to-pay for a rapid malaria diagnostic test and artemisinin-based combination therapy from private drug shops in Mukono district, Uganda

    DEFF Research Database (Denmark)

    Hansen, Kristian Schultz; Pedrazzoli, Debora; Mbonye, Anthony

    2013-01-01

    as a tool to improve malaria diagnosis, since they have proved accurate and easy to perform with minimal training. Although RDTs could feasibly be performed by drug shop vendors, it is not known how much customers would be willing to pay for an RDT if offered in these settings. We conducted a contingent...... valuation survey among drug shop customers in Mukono District, Uganda. Exit interviews were undertaken with customers aged 15 years and above after leaving a drug shop having purchased an antimalarial and/or paracetamol. The bidding game technique was used to elicit the willingness-to-pay (WTP) for an RDT...... for an RDT and a course of ACT among drug shop customers is considerably lower than prevailing and estimated end-user prices for these commodities. Increasing the uptake of ACTs in drug shops and restricting the sale of ACTs to parasitologically confirmed malaria will therefore require additional measures....

  4. [Combined treatment: regimens, indications and safety profile].

    Science.gov (United States)

    Muñiz Grijalvo, Ovidio; Villar Ortiz, Jose

    2013-01-01

    Statins are the current basis of lipid-lowering therapy, despite which may have limitations on efficacy and safety. In high risk patients who do not achieve current lipid goals, in those intolerant to statins or those with atherogenic dyslipidemia, it is possible combine two or more lipid lowering drugs, including statins, ezetimibe, bile acid sequestrants, fibrates, niacin and prescription omega-3 fatty acids. However, for most of these combination therapies pivotal data on clinical outcomes are still lacking. Copyright © 2013 Elsevier España, S.L. and SEA. All rights reserved.

  5. Gametocyte clearance dynamics following oral artesunate treatment of uncomplicated falciparum malaria in Malian children

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    Djimde Abdoulaye A.

    2016-01-01

    Full Text Available Artemisinin-based combination therapies decrease Plasmodium gametocyte carriage. However, the role of artesunate in monotherapy in vivo, the mechanisms involved, and the utility of gametocyte carriage as a potential tool for the surveillance of antimalarial resistance are poorly understood. In 2010–2011, we conducted an open-label, prospective efficacy study of artesunate as monotherapy in children 1–10 years of age with uncomplicated falciparum malaria in Bougoula-Hameau, Mali. Standard oral doses of artesunate were administered for 7 days and patients were followed up for 28 days. The data were compared to a similar study conducted in 2002–2004. Of 100 children enrolled in the 2010–2011 study, 92 were analyzed and compared to 217 children enrolled in the 2002–2004 study. The proportion of gametocyte carriers was unchanged at the end of treatment (23% at baseline vs. 24% on day 7, p = 1.0 and did not significantly decline until day 21 of follow-up (23% vs. 6%, p = 0.003. The mean gametocyte density at inclusion remained unchanged at the end of treatment (12 gametocytes/μL vs. 16 gametocytes/μL, p = 0.6. Overall, 46% of the 71 initial non-carriers had gametocytes detected by day 7. Similar results were found in the 2002–2004 study. In both studies, although gametocyte carriage significantly decreased by the end of the 28-day follow-up, artesunate did not clear mature gametocytes during treatment and did not prevent the appearance of new stage V gametocytes as assessed by light microscopy. Baseline gametocyte carriage was significantly higher 6 years after the deployment of artemisinin-based combination therapies in this setting.

  6. Initial evidence of reduction of malaria cases and deaths in Rwanda and Ethiopia due to rapid scale-up of malaria prevention and treatment

    Directory of Open Access Journals (Sweden)

    Gausi Khoti

    2009-01-01

    Full Text Available Abstract Background An increasing number of malaria-endemic African countries are rapidly scaling up malaria prevention and treatment. To have an initial estimate of the impact of these efforts, time trends in health facility records were evaluated in selected districts in Ethiopia and Rwanda, where long-lasting insecticidal nets (LLIN and artemisinin-based combination therapy (ACT had been distributed nationwide by 2007. Methods In Ethiopia, a stratified convenience sample covered four major regions where (moderately endemic malaria occurs. In Rwanda, two districts were sampled in all five provinces, with one rural health centre and one rural hospital selected in each district. The main impact indicator was percentage change in number of in-patient malaria cases and deaths in children Results In-patient malaria cases and deaths in children Conclusion Initial evidence indicated that the combination of mass distribution of LLIN to all children

  7. Combined treatment of unresectable pancreatic carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Ohashi, Kazuhiko; Yamao, Kenji; Watanabe, Yoshihiro; Morimoto, Takeshi [Aichi Cancer Center, Nagoya (Japan). Hospital

    1999-07-01

    For patients with unresectable pancreatic carcinoma, a few kind of treatment including chemoradiation, intraoperative radiation and intra-arterial chemotherapy was done. Chemoradiation using 5FU, CDDP, ADM and radiation to the lesion and liver was performed in 16 patients, showing a response rate of 10%. One-year survivals rate and mean a survival period of this group was 11.7% and 6.6 months respectively. Postmortem autopsy in 6 cases revealed insufficient therapeutic effects in both primary and metastatic site. Because of above-mentioned reasons, chemoradiation therapy to the pancreatic carcinoma, which we did, was estimated as ineffective. (author)

  8. 7 CFR 305.10 - Treatment schedules for combination treatments.

    Science.gov (United States)

    2010-01-01

    ... HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE PHYTOSANITARY TREATMENTS Chemical Treatments § 305...) T203-p and T511-1, hot water and chemical dip for citrus (Rutacae) seeds for citrus canker. (1) If any... of 6.0 to 7.5. (4) Seed from regions where citrus canker occurs must be drained, dried, and...

  9. Methodologies in the modeling of combined chemo-radiation treatments

    Science.gov (United States)

    Grassberger, C.; Paganetti, H.

    2016-11-01

    The variety of treatment options for cancer patients has increased significantly in recent years. Not only do we combine radiation with surgery and chemotherapy, new therapeutic approaches such as immunotherapy and targeted therapies are starting to play a bigger role. Physics has made significant contributions to radiation therapy treatment planning and delivery. In particular, treatment plan optimization using inverse planning techniques has improved dose conformity considerably. Furthermore, medical physics is often the driving force behind tumor control and normal tissue complication modeling. While treatment optimization and outcome modeling does focus mainly on the effects of radiation, treatment modalities such as chemotherapy are treated independently or are even neglected entirely. This review summarizes the published efforts to model combined modality treatments combining radiation and chemotherapy. These models will play an increasing role in optimizing cancer therapy not only from a radiation and drug dosage standpoint, but also in terms of spatial and temporal optimization of treatment schedules.

  10. Clinicopathological studies on three preoperative combined treatments for rectal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Yoshioka, Yuji; Ichikawa, Daisuke; Iizuka, Ryouji; Hagiwara, Akeo; Sawai, Kiyoshi; Yamaguchi, Toshiharu; Takahashi, Toshio [Kyoto Prefectural Univ. of Medicine (Japan)

    1995-09-01

    To prevent postoperative local recurrence of rectal cancer, we treated patients using preoperative hyperthermia (5-6 times), irradiation (total 30 Gy) and 5-fluorouracil suppository (2,000-2,500 mg). The subjects were 31 patients given combined treatments and 28 patients given surgery alone. The results were as follows: Histologically, therapeutic effects were recognized in 80.6% of patients receiving combined treatments. The mean distance from the adventitia to the site of cancer infiltration was 6.54 mm in the combined treatments group and 3.35 mm in the surgery alone group. The difference between the two was significant (p<0.05). The rate of local recurrence in the combined treatments group was less than that in the surgery alone group. No systemic side effects nor severe complications were observed during hospitalization in the combined treatments group. The survival rate of the combined treatments group was higher than that of the surgery alone group. It was considered that combined preoperative treatments for rectal cancer were beneficial to survival and local control. (author).

  11. [The combination treatment of malignant bone tumors using fast neutrons].

    Science.gov (United States)

    Chernichenko, V A; Tolstopiatov, B A; Konovalenko, V F; Monich, A Iu; Palivets, A Iu

    1990-01-01

    The study deals with results of a clinical trial evaluating treatment efficacy of a 6 MeV neutron beam produced by Y-120 cyclotron (Kiev). Procedures of preoperative radiotherapy and radical treatment are discussed. Radiotherapy was administered to 52 patients suffering chondrosarcoma (30 cases), osteogenic sarcoma (15) or chordoma (7). Combined treatment (radiation + surgery) was given to 22 patients whereas neutron beam therapy--to 30. All patients with osteogenic sarcoma received adjuvant combination chemotherapy. Three-year survival rate was compared to that observed in controls in whom combined treatment had included gamma-therapy. A significant increase in three-year survival rate was observed for osteogenic sarcoma and chordoma whereas for chondrosarcoma the improvement in survival proved insignificant. The use of fast neutrons in combined treatment of bone tumors was considered promising.

  12. INVESTIGATIONS ON SEWAGE TREATMENT PROCESS USING COMBINED BIO-OXIDIZERS

    Directory of Open Access Journals (Sweden)

    V. N. Jaromsky

    2010-01-01

    Full Text Available The paper presents results of investigations on process of aerobic waste water treatment with combined bio-oxidizers at milk processing enterprises. It has been shown that attached biocenosis, free-floating biocenosis and also bio-module rotation frequency  have exerted a significant influence on the process of an aerobic sewage treatment. It has been established that combined bio-oxidizers can be used for cleaning high concentrated waste water at the enterprises of food industry.

  13. INVESTIGATIONS ON SEWAGE TREATMENT PROCESS USING COMBINED BIO-OXIDIZERS

    OpenAIRE

    V. N. Jaromsky; E. I. Mihnevich

    2010-01-01

    The paper presents results of investigations on process of aerobic waste water treatment with combined bio-oxidizers at milk processing enterprises. It has been shown that attached biocenosis, free-floating biocenosis and also bio-module rotation frequency  have exerted a significant influence on the process of an aerobic sewage treatment. It has been established that combined bio-oxidizers can be used for cleaning high concentrated waste water at the enterprises of food industry.

  14. Combining biological agents and chemotherapy in the treatment of cholangiocarcinoma

    DEFF Research Database (Denmark)

    Jensen, Lars Henrik; Jakobsen, Anders

    2011-01-01

    is not always possible. Chemotherapy is effective and the combination of cisplatin and gemcitabine is considered a standard treatment of inoperable cholangiocarcinoma. Biological targeted treatment to date has minor effect when given as monotherapy, but some of the drugs hold promise as an adjunct...

  15. Cognitive adaptation training combined with assertive community treatment

    DEFF Research Database (Denmark)

    Hansen, Jens Peter; Ostergaard, Birte; Nordentoft, Merete;

    2012-01-01

    Cognitive adaptation training (CAT) targets the adaptive behaviour of patients with schizophrenia and has shown promising results regarding the social aspects of psychosocial treatment. As yet, no reports have appeared on the use of CAT in combination with assertive community treatment (ACT). Our...

  16. [Inpatient treatment of depression. Should one combine psychotherapy and drugs?].

    Science.gov (United States)

    Huber, T J

    2005-03-01

    Antidepressants as well as different psychotherapeutic strategies have been proven efficacious in the treatment of unipolar depression. In the clinical setting both are often combined using psychotherapeutic methods varying from psychoeducation to formal psychotherapy. The present article provides a critical overview of the evidence base for this combination in the inpatient treatment of depression. The current literature is contradictory and difficult to compare. However, combination therapy appears advantageous in therapy-resistant, chronic and severe forms of depressive disorders. Much further research is needed to facilitate well-founded guidelines.

  17. Combinations of drugs in the Treatment of Obesity

    Directory of Open Access Journals (Sweden)

    Marcio C. Mancini

    2010-07-01

    Full Text Available Obesity is a chronic disease associated with excess morbidity and mortality. Clinical treatment, however, currently offers disappointing results, with very high rates of weight loss failure or weight regain cycles, and only two drugs (orlistat and sibutramine approved for long-term use. Drugs combinations can be an option for its treatment but, although widely used in clinical practice, very few data are available in literature for its validation. Our review focuses on the rationale for their use, with advantages and disadvantages; on combinations often used, with or without studies; and on new perspectives of combinations being studied mainly by the pharmaceutical industry.

  18. Cancer treatment: the combination of vaccination with other therapies

    DEFF Research Database (Denmark)

    Andersen, M.H.; Sorensen, R.B.; Schrama, D.

    2008-01-01

    approach to fight cancer, the combination with additional therapy could create a number of synergistic effects. Herein we discuss the possibilities and prospects of vaccination when combined with other treatments. In this regard, cell death upon drug exposure may be immunogenic or non-immunogenic depending...... and endothelial cells. The efficacy of therapeutic vaccination against cancer will over the next few years be studied in settings taking advantage of strategies in which vaccination is combined with other treatment modalities. These combinations should be based on current knowledge not only regarding the biology...... of the cancer cell per se, but also considering how treatment may influence the malignant cell population as well as the immune system Udgivelsesdato: 2008/11...

  19. Effect of combined treatments on viscosity of whey dispersions

    Energy Technology Data Exchange (ETDEWEB)

    Camillo, A.; Sabato, S.F. E-mail: sfsabato@ipen.br

    2004-10-01

    Whey proteins, enriched protein fractions from milk, are of great interest as ingredients due to nutritional value associated with its functional properties. These proteins could have their structural properties improved when some treatments are applied, such as thermal and gamma irradiation or when some compounds are added. The current work aimed to study the viscometer behavior of whey dispersions submitted to two different combined treatments: (1) thermal plus irradiation and (2) thermal plus vacuum and N{sub 2} plus irradiation. Dispersions of whey protein in water (5% and 8% protein (w/v) base) and containing proteins and glycerol at ratios 1:1 and 2:1 (protein:glycerol) were submitted to both combined treatments. The irradiation doses were 0, 5, 15 and 25 kGy. The viscosity of the two combined treatments and for four levels of absorbed doses is presented and the combined effects are discussed. The thermal treatment combined with gamma irradiation contributed to increase the viscosity as irradiation doses increases for both (5% and 8%) concentrations of proteins (p<0.05). For protein and glycerol solutions, the irradiation dose seemed to result in a slightly increase. The vacuum applied before the irradiation showed a small contribution.

  20. Effect of combined treatments on viscosity of whey dispersions

    Science.gov (United States)

    Camillo, A.; Sabato, S. F.

    2004-09-01

    Whey proteins, enriched protein fractions from milk, are of great interest as ingredients due to nutritional value associated with its functional properties. These proteins could have their structural properties improved when some treatments are applied, such as thermal and gamma irradiation or when some compounds are added. The current work aimed to study the viscometer behavior of whey dispersions submitted to two different combined treatments: (1) thermal plus irradiation and (2) thermal plus vacuum and N 2 plus irradiation. Dispersions of whey protein in water (5% and 8% protein (w/v) base) and containing proteins and glycerol at ratios 1:1 and 2:1 (protein:glycerol) were submitted to both combined treatments. The irradiation doses were 0, 5, 15 and 25 kGy. The viscosity of the two combined treatments and for four levels of absorbed doses is presented and the combined effects are discussed. The thermal treatment combined with gamma irradiation contributed to increase the viscosity as irradiation doses increases for both (5% and 8%) concentrations of proteins ( p<0.05). For protein and glycerol solutions, the irradiation dose seemed to result in a slightly increase. The vacuum applied before the irradiation showed a small contribution.

  1. Client Evaluation of Treatment for Alcohol Use Disorder in COMBINE.

    Science.gov (United States)

    Kirouac, Megan; Witkiewitz, Katie; Donovan, Dennis M

    2016-08-01

    Practitioners and researchers across disciplines have been interested in identifying variables that act as indicators of treatment success or failure and one straightforward approach to measuring treatment success is to assess client satisfaction with treatment. Existing measures of treatment satisfaction do not address the specific aspects relevant to alcohol use disorder (AUD) treatment. Researchers in the COMBINE Study developed a new measure of treatment satisfaction to assess satisfaction in AUD treatment: The Evaluation of Treatment (EOT) measure. The aims of the present study were to examine the factor structure of items from the EOT measure and to examine the association between the EOT measure and other measures of client engagement, as well as AUD treatment outcomes. We also extended the model to test for possible mediation effects of treatment evaluation on the relationship between client treatment engagement components and AUD treatment outcomes. Confirmatory factor analyses indicated a 6-factor model with a higher order treatment satisfaction factor provided an excellent fit to the data (χ2 (246)=499.44, p<0.001, CFI=0.99, TLI=0.98, RMSEA =0.040 (90% CI: 0.035, 0.045). Overall, the latent factor of treatment satisfaction was significantly associated with client engagement predictors and treatment evaluation significantly mediated the associations between both working alliance and treatment expectations in the prediction of alcohol-related problems and global severity. Findings suggest that client evaluations of treatment play a substantial role in predicting AUD treatment outcomes and should be considered in future treatment and research.

  2. Propranolol, doxycycline and combination therapy for the treatment of rosacea.

    Science.gov (United States)

    Park, Jung-Min; Mun, Je-Ho; Song, Margaret; Kim, Hoon-Soo; Kim, Byung-Soo; Kim, Moon-Bum; Ko, Hyun-Chang

    2015-01-01

    Doxycycline is the standard systemic treatment for rosacea. Recently, there have been a few reports on β-adrenergic blockers such as nadolol, carvedilol and propranolol for suppressing flushing reactions in rosacea. To our knowledge, there are no comparative studies of propranolol and doxycycline, and combination therapy using both. The aim of this study was to investigate and compare the efficacy and safety of monotherapy of propranolol, doxycycline and combination therapy. A total of 78 patients who visited Pusan National University Hospital and were diagnosed with rosacea were included in this study. Among them, 28 patients were in the propranolol group, 22 the doxycycline group and 28 the combination group. We investigated the patient global assessment (PGA), investigator global assessment (IGA), assessment of rosacea clinical score (ARCS) and adverse effects. Improvement in PGA and IGA scores from baseline was noted in all groups, and the combination therapy was found to be the most effective during the entire period, but this was statistically insignificant. The reduction rate of ARCS during the treatment period was also highest in the combination group (57.4%), followed by the doxycycline group (52.2%) and the propranolol group (51.0%). Three patients in the combination group had mild and transient gastrointestinal disturbances but there was no significant difference from the other groups. We conclude that the combination therapy of doxycycline and propranolol is effective and safe treatment for rosacea and successful for reducing both flushing and papulation in particular.

  3. Combination anticonvulsant treatment of soman-induced seizures.

    Science.gov (United States)

    Koplovitz, I; Schulz, S; Shutz, M; Railer, R; Macalalag, R; Schons, M; McDonough, J

    2001-12-01

    These studies investigated the effectiveness of combination treatment with a benzodiazepine and an anticholinergic drug against soman-induced seizures. The anticholinergic drugs considered were biperiden, scopolamine, trihexaphenidyl, and procyclidine; the benzodiazepines were diazepam and midazolam. Male guinea pigs were implanted surgically with cortical screw electrodes. Electrocorticograms were displayed continually and recorded on a computerized electroencephalographic system. Pyridostigmine (0.026 mg x kg(-1), i.m.) was injected as a pretreatment to inhibit red blood cell acetylcholinesterase by 30-40%. Thirty minutes after pyridostigmine, 2 x LD50 (56 microg x kg(-1)) of soman was injected s.c., followed 1 min later by i.m. treatment with atropine (2 mg x kg(-1)) + 2-PAM (25 mg x kg(-1)). Electrographic seizures occurred in all animals. Anticonvulsant treatment combinations were administered i.m. at 5 or 40 min after seizure onset. Treatment consisted of diazepam or midazolam plus one of the above-mentioned anticholinergic drugs. All doses of the treatment compounds exhibited little or no antiseizure efficacy when given individually. The combination of a benzodiazepine and an anticholinergic drug was effective in terminating soman-induced seizure, whether given 5 or 40 min after seizure onset. The results suggest a strong synergistic effect of combining benzodiazepines with centrally active anticholinergic drugs and support the concept of using an adjunct to supplement diazepam for the treatment of nerve-agent-induced seizures.

  4. Optical Treatment of Strabismic and Combined Strabismic-Anisometropic Amblyopia

    Science.gov (United States)

    2011-01-01

    Objective To determine visual acuity improvement in children with strabismic and combined strabismic-anisometropic (combined-mechanism) amblyopia treated with optical correction alone and to explore factors associated with improvement. Design Prospective multi-center cohort study Participants 146 children 3 to amblyopia (N=52) or combined-mechanism amblyopia (N=94). Methods Optical treatment was provided as spectacles (prescription based on a cycloplegic refraction) that were worn for the first time at the baseline visit. Visual acuity with spectacles was measured using the Amblyopia Treatment Study HOTV© visual acuity protocol at baseline and every 9 weeks thereafter until no further improvement in visual acuity. Ocular alignment was assessed at each visit. Main outcome measure Visual acuity 18 weeks after baseline. Results Overall, amblyopic eye visual acuity improved a mean of 2.6 lines (95% confidence interval: 2.3 to 3.0), with 75% of children improving ≥2 lines and 54% improving ≥3 lines. Resolution of amblyopia occurred in 32% (95% confidence interval: 24% to 41%) of the children. The treatment effect was greater for strabismic amblyopia than for combined-mechanism amblyopia (3.2 versus 2.3 lines, adjusted P=0.003). Visual acuity improved regardless of whether eye alignment improved. Conclusions Optical treatment alone of strabismic and combined-mechanism amblyopia results in clinically meaningful improvement in amblyopic eye visual acuity for most 3 to amblyopia before initiating other therapies. PMID:21959371

  5. Combining clinical variables to optimize prediction of antidepressant treatment outcomes

    OpenAIRE

    Iniesta, R.; Malki, K.; Maier, W; Rietschel, M.; Mors, O; Hauser, J; Henigsberg, N.; Dernovsek, M. Z.; Souery, D.; Stahl, D.; Dobson, R.; Aitchison, K. J.; Farmer, A; Lewis, C.M.; McGuffin, P.

    2016-01-01

    The outcome of treatment with antidepressants varies markedly across people with the same diagnosis. A clinically significant prediction of outcomes could spare the frustration of trial and error approach and improve the outcomes of major depressive disorder through individualized treatment selection. It is likely that a combination of multiple predictors is needed to achieve such prediction. We used elastic net regularized regression to optimize prediction of symptom improvement and remissio...

  6. [Wardenafil in combined treatment of patients with chronic bacterial prostatitis].

    Science.gov (United States)

    Aliaev, Iu G; Vinarov, A Z; Akhvlediani, N D

    2008-01-01

    The efficiency of treatment with phosphodiesterase-5 (PDE-5) inhibitors in combination with antibacterial drugs in chronic bacterial prostatitis (CBP) was studied in a randomized trial with participation of 103 CBP patients (mean age 36.2 +/- 8.4 years). Group 1 patients (n = 32) received levofloxacine (500 mg/day) monotherapy for 4 weeks. Group 2 patients (n = 34) received antibacterial treatment plus wardenafil in a dose 10 mg in the evening. Group 3 patients (n = 37) received combined treatment (fluoroquinolone + wardenafil), PDE-5 inhibitor was taken for more than 2 times a week 10-60 min before the coitus. Treatment efficacy was assessed with NIH-CPSI scale, count of bacteria and leukocytes in the pre- and postmassage urine portions, uroflowmetry. By NIH-CPSI scale, a significant (p quality of life in group 2. The control test discovered pyuria in postmassage urine in 7 (21.9%), 4 (11.8%) and 6 (16.2%) patients of group 1, 2 and 3, respectively. Manifest bacteriuria was registered in 3 (9.4%), 2 (5.9%) and 3 (8.1%) patients, respectively. Uroflowmetry reported significant changes (p patients of group 2. Efficacy of CBP treatment significantly rises in combination of antibacterial treatment with wardenafil.

  7. Combined coagulation flocculation pre treatment unit for municipal wastewater

    Directory of Open Access Journals (Sweden)

    Ibrahim M. Ismail

    2012-10-01

    Full Text Available The potentials of using the hydraulic technique in combined unit for municipal wastewater treatment were studied. A combined unit in which processes of coagulation, flocculation and sedimentation, has been designed utilizing hydraulic mixing instead of mechanical mixing. A jar test treatability study has been conducted to locate the optimum dose of the coagulants to be used. Alum, ferrous sulfate, ferric sulfate, a mixture of ferric and ferrous sulfates, and mixture of lime and ferrous sulfate were all tested. A pilot unit was constructed in the existing wastewater treatment plant at El Mansoura governorate located in north Egypt. The optimum dose of coagulants used in the combined unit gives removal efficiencies for COD, BOD, and total phosphorous as 65%, 55%, and 83%, respectively.

  8. BRUCELLA ENDOCARDITIS IN IRANIAN PATIENTS: COMBINED MEDICAL AND SURGICAL TREATMENT

    Directory of Open Access Journals (Sweden)

    Ebrahim Nematipour

    1995-06-01

    Full Text Available Brucella endocarditis is a Tare but serious complication ofbrucellosis and is the main cause of death reuuedto thisdisease: Itis not rare in the endemic areas and aaualiy accounts for up to 8~lO% ofendocarditis infections: We report seven adult cases of brucella endocarditis in lmam-Khorneini Hospual: Contrary to previous independent reports, female patients were not rare in this study and accountedfor three out ofseven. Four patients were cared for by combined medical and surgical treatment and were recovered Three of the patients that did not receive the combined theraPl could not he saved This report confirms the necessity of prompt combined medical and surgical treatment ofbrucella endocarditis.

  9. Efficacy of antimalarial treatment in Guinea: in vivo study of two artemisinin combination therapies in Dabola and molecular markers of resistance to sulphadoxine-pyrimethamine in N'Zérékoré

    Directory of Open Access Journals (Sweden)

    Coulibaly Léonie

    2007-05-01

    Full Text Available Abstract Background In the last five years, countries have been faced with changing their malaria treatment policy to an artemisinin-based combination therapy (ACT, many with no national data on which to base their decision. This is particularly true for a number of West African countries, including Guinea, where these studies were performed. Two studies were conducted in 2004/2005 in programmes supported by Medecins Sans Frontieres, when chloroquine was still national policy, but artesunate (AS/sulphadoxine-pyrimethamine (SP had been used in refugee camps for two years. Methods In Dabola (central Guinea, 220 children aged 6–59 months with falciparum malaria were randomized to receive either AS/amodiaquine (AQ or AS/SP. In vivo efficacy was assessed following the 2003 World Health Organization guidelines. In a refugee camp in Laine (south of Guinea, where an in vivo study was not feasible due to the unstable context, a molecular genotyping study in 160 patients assessed the prevalence of mutations in the dihydrofolate reductase (dhfr (codons 108, 51, 59 and dihydropteroate synthase (dhps (codons 436, 437, 540 genes of Plasmodium falciparum, which have been associated with resistance to pyrimethamine and sulphadoxine, respectively. Results In Dabola, after 28 days of follow-up, Polymerase Chain Reaction (PCR-adjusted failure rates were 1.0% (95%CI 0–5.3 for AS/AQ and 1.0% (95%CI 0–5.5 for AS/SP. In the refugee camp in Laine, the molecular genotyping study found three dhfr mutations in 85.6% (95%CI 79.2–90.7 patients and quintuple dhfr/dhps mutations in 9.6% (95%CI 5.2–15.9. Conclusion Both AS/AQ and AS/SP are highly efficacious in Dabola, whereas there is molecular evidence of established SP resistance in Laine. This supports the choice of the national programme of Guinea to adopt AS/AQ as first line antimalarial treatment. The results highlight the difficulties faced by control programmes, which have gone through the upheaval of

  10. Metastatic melanoma treatment: Combining old and new therapies.

    Science.gov (United States)

    Davey, Ryan J; van der Westhuizen, Andre; Bowden, Nikola A

    2016-02-01

    Metastatic melanoma is an aggressive form of cancer characterised by poor prognosis and a complex etiology. Until 2010, the treatment options for metastatic melanoma were very limited. Largely ineffective dacarbazine, temozolamide or fotemustine were the only agents in use for 35 years. In recent years, the development of molecularly targeted inhibitors in parallel with the development of checkpoint inhibition immunotherapies has rapidly improved the outcomes for metastatic melanoma patients. Despite these new therapies showing initial promise; resistance and poor duration of response have limited their effectiveness as monotherapies. Here we provide an overview of the history of melanoma treatment, as well as the current treatments in development. We also discuss the future of melanoma treatment as we go beyond monotherapies to a combinatorial approach. Combining older therapies with the new molecular and immunotherapies will be the most promising way forward for treatment of metastatic melanoma. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  11. Combining clinical variables to optimize prediction of antidepressant treatment outcomes.

    Science.gov (United States)

    Iniesta, Raquel; Malki, Karim; Maier, Wolfgang; Rietschel, Marcella; Mors, Ole; Hauser, Joanna; Henigsberg, Neven; Dernovsek, Mojca Zvezdana; Souery, Daniel; Stahl, Daniel; Dobson, Richard; Aitchison, Katherine J; Farmer, Anne; Lewis, Cathryn M; McGuffin, Peter; Uher, Rudolf

    2016-07-01

    The outcome of treatment with antidepressants varies markedly across people with the same diagnosis. A clinically significant prediction of outcomes could spare the frustration of trial and error approach and improve the outcomes of major depressive disorder through individualized treatment selection. It is likely that a combination of multiple predictors is needed to achieve such prediction. We used elastic net regularized regression to optimize prediction of symptom improvement and remission during treatment with escitalopram or nortriptyline and to identify contributing predictors from a range of demographic and clinical variables in 793 adults with major depressive disorder. A combination of demographic and clinical variables, with strong contributions from symptoms of depressed mood, reduced interest, decreased activity, indecisiveness, pessimism and anxiety significantly predicted treatment outcomes, explaining 5-10% of variance in symptom improvement with escitalopram. Similar combinations of variables predicted remission with area under the curve 0.72, explaining approximately 15% of variance (pseudo R(2)) in who achieves remission, with strong contributions from body mass index, appetite, interest-activity symptom dimension and anxious-somatizing depression subtype. Escitalopram-specific outcome prediction was more accurate than generic outcome prediction, and reached effect sizes that were near or above a previously established benchmark for clinical significance. Outcome prediction on the nortriptyline arm did not significantly differ from chance. These results suggest that easily obtained demographic and clinical variables can predict therapeutic response to escitalopram with clinically meaningful accuracy, suggesting a potential for individualized prescription of this antidepressant drug.

  12. Optimising treatment for COPD--new strategies for combination therapy.

    Science.gov (United States)

    Welte, T

    2009-08-01

    Chronic obstructive pulmonary disease (COPD) is a multi-component disease characterised by airflow limitation and airway inflammation. Exacerbations of COPD have a considerable impact on the quality of life, daily activities and general well-being of patients and are a great burden on the health system. Thus, the aims of COPD management include not only relieving symptoms and preventing disease progression but also preventing and treating exacerbations. Attention towards the day-to-day burden of the disease is also required in light of evidence that suggests COPD may be variable throughout the day with morning being the time when symptoms are most severe and patients' ability to perform regular morning activities the most problematic. While available therapies improve clinical symptoms and decrease airway inflammation, they do not unequivocally slow long-term progression or address all disease components. With the burden of COPD continuing to increase, research into new and improved treatment strategies to optimise pharmacotherapy is ongoing - in particular, combination therapies, with a view to their complementary modes of action enabling multiple components of the disease to be addressed. Evidence from recent clinical trials indicates that triple therapy, combining an anticholinergic with an inhaled corticosteroid and a long-acting beta(2)-agonist, may provide clinical benefits additional to those associated with each treatment alone in patients with more severe COPD. This article reviews the evidence for treatment strategies used in COPD with a focus on combination therapies and introduces the 3-month CLIMB study (Evaluation of Efficacy and Safety of Symbicort as an Add-on Treatment to Spiriva in Patients With Severe COPD) which investigated the potential treatment benefits of combining tiotropium with budesonide/formoterol in patients with COPD with regard to lung function, exacerbations, symptoms and morning activities.

  13. Multistrain models predict sequential multidrug treatment strategies to result in less antimicrobial resistance than combination treatment

    DEFF Research Database (Denmark)

    Ahmad, Amais; Zachariasen, Camilla; Christiansen, Lasse Engbo;

    2016-01-01

    considered combination treatments. The current study modeled bacterial growth in the intestine of pigs after intramuscular combination treatment (i.e. using two antibiotics simultaneously) and sequential treatments (i.e. alternating between two antibiotics) in order to identify the factors that favor...... the sensitive fraction of the commensal flora.Growth parameters for competing bacterial strains were estimated from the combined in vitro pharmacodynamic effect of two antimicrobials using the relationship between concentration and net bacterial growth rate. Predictions of in vivo bacterial growth were...

  14. Artemisinin versus nonartemisinin combination therapy for uncomplicated malaria: randomized clinical trials from four sites in Uganda.

    Directory of Open Access Journals (Sweden)

    Adoke Yeka

    2005-07-01

    Full Text Available BACKGROUND: Drug resistance in Plasmodium falciparum poses a major threat to malaria control. Combination antimalarial therapy including artemisinins has been advocated recently to improve efficacy and limit the spread of resistance, but artemisinins are expensive and relatively untested in highly endemic areas. We compared artemisinin-based and other combination therapies in four districts in Uganda with varying transmission intensity. METHODS AND FINDINGS: We enrolled 2,160 patients aged 6 mo or greater with uncomplicated falciparum malaria. Patients were randomized to receive chloroquine (CQ + sulfadoxine-pyrimethamine (SP; amodiaquine (AQ + SP; or AQ + artesunate (AS. Primary endpoints were the 28-d risks of parasitological failure either unadjusted or adjusted by genotyping to distinguish recrudescence from new infections. A total of 2,081 patients completed follow-up, of which 1,749 (84% were under the age of 5 y. The risk of recrudescence after treatment with CQ + SP was high, ranging from 22% to 46% at the four sites. This risk was significantly lower (p < 0.01 after AQ + SP or AQ + AS (7%-18% and 4%-12%, respectively. Compared to AQ + SP, AQ + AS was associated with a lower risk of recrudescence but a higher risk of new infection. The overall risk of repeat therapy due to any recurrent infection (recrudescence or new infection was similar at two sites and significantly higher for AQ + AS at the two highest transmission sites (risk differences = 15% and 16%, p < 0.003. CONCLUSION: AQ + AS was the most efficacious regimen for preventing recrudescence, but this benefit was outweighed by an increased risk of new infection. Considering all recurrent infections, the efficacy of AQ + SP was at least as efficacious at all sites and superior to AQ + AS at the highest transmission sites. The high endemicity of malaria in Africa may impact on the efficacy of artemisinin-based combination therapy. The registration number for this trial is ISRCTN

  15. Emerging treatments and combinations in the management of NSCLC

    DEFF Research Database (Denmark)

    Reck, Martin; Mellemgaard, Anders

    2015-01-01

    growth factor, and platelet-derived growth factor, and was recently approved in Europe for use in combination with docetaxel for the treatment of adults with locally advanced, metastatic, or locally recurrent NSCLC of adenocarcinoma tumor histology, following first-line chemotherapy. Nintedanib has been...... investigated extensively in preclinical research and in a number of clinical studies, the most important of which was the Phase III LUME-Lung 1 study, which investigated nintedanib in combination with docetaxel in patients with advanced NSCLC after failure of first-line chemotherapy. In this study, which led...... to the approval of nintedanib, addition of nintedanib to docetaxel significantly improved overall survival in patients with adenocarcinoma histology. Nintedanib demonstrated a manageable safety profile in combination with docetaxel. This review focuses on the clinical experience with nintedanib in NSCLC...

  16. Clinical Study on Treatment of Depression with Combined Acupuncture & Medicine

    Institute of Scientific and Technical Information of China (English)

    XU Hong; WANG Qiao-chu; HAN Chou-ping

    2003-01-01

    Purpose To observe and compare the curative effects of combined acupuncture and medicine with simple herbal medicine on treatment of depression. Method Altogether 63 cases were enrolled according to the determination of internationally accepted self-evaluation depression scales (SDS), among them 33 cases were treated with combination of acupuncture and herbal medicine (acupuncture-medicine group) and the other 30 cases were in treated with herbal medicine alone (herbal medicine group) Results The total effective rate of acupuncture-medicine group was 90.9% and that of herbal group was 80.0%. And there was significant statistics difference between the curative effects of two groups (P <0.05) without obvious adverse reaction. Conclusion Combination of acupuncture and medicine has better effect in treating depression than herbal medicine group.

  17. The role of combination therapy in the treatment of hypertension.

    Science.gov (United States)

    Ruilope, L M; Coca, A

    1998-01-01

    Antihypertensive therapy is indicated for reducing the risk of cardiovascular morbidity and mortality that accompanies arterial hypertension. Usually, pharmacological treatment is started as monotherapy, which, if unsuccessful, is followed by sequential monotherapy, or by combination therapy. Recent data indicate that combination therapy is required in more than 50% of the hypertensive population when the goal is to reduce blood pressure to below 140/90 mm Hg. The choice and doses of drugs used in combination therapy should be such that their synergistic effect on blood pressure is maximized, the tolerability of the drugs is maintained and side-effects are minimized. The combination of a dihydropyridine calcium antagonist with a beta-blocker or an angiotensin-converting enzyme (ACE) inhibitor is one of the most commonly used combination therapies. Two randomized, double-blind, parallel-group studies compared the antihypertensive effects of the dihydropyridine, barnidipine, with the beta-blocker, atenolol (n = 247), and the ACE inhibitor, enalapril (n = 155). The efficacy and tolerability of barnidipine in combination with either atenolol or enalapril was also investigated. Monotherapy with barnidipine was as effective in reducing blood pressure as monotherapy with either atenolol or enalapril. Combining barnidipine with either atenolol or enalapril reduced blood pressure further, and significantly increased the percentage of patients attaining the required reduction in blood pressure. When patients whose blood pressure was not adequately controlled by enalapril monotherapy were switched to barnidipine monotherapy, the majority then achieved the desired reduction in blood pressure. These results indicate that if barnidipine monotherapy fails to lower blood pressure to the desired values, its combination with either a beta-blocker or an ACE inhibitor is effective and well tolerated.

  18. Nanostructured lipid carriers of artemether-lumefantrine combination for intravenous therapy of cerebral malaria.

    Science.gov (United States)

    Prabhu, Priyanka; Suryavanshi, Shital; Pathak, Sulabha; Patra, Aditya; Sharma, Shobhona; Patravale, Vandana

    2016-11-20

    Patients with cerebral malaria (CM) are unable to take oral medication due to impaired consciousness and vomiting thus necessitating parenteral therapy. Quinine, artemether, and artesunate which are currently used for parenteral malaria therapy have their own drawbacks. The World Health Organization (WHO) has now banned monotherapy and recommends artemisinin-based combination therapy for malaria treatment. However, presently there is no intravenous formulation available for combination therapy of malaria. Artemether-Lumefantrine (ARM-LFN) is a WHO approved combination for oral malaria therapy. However, the low aqueous solubility of ARM and LFN hinders their intravenous delivery. The objective of this study was to formulate ARM-LFN nanostructured lipid carriers (NLC) for intravenous therapy of CM. ARM-LFN NLC were prepared by microemulsion template technique and characterized for size, drug content, entrapment efficiency, drug release, crystallinity, morphology, amenability to autoclaving, compatibility with infusion fluids, stability, antimalarial efficacy in mice, and toxicity in rats. The ARM-LFN NLC showed sustained drug release, amenability to autoclaving, compatibility with infusion fluids, good stability, complete parasite clearance and reversal of CM symptoms with 100% survival in Plasmodium berghei-infected mice, and safety in rats. The biocompatible ARM-LFN NLC fabricated by an industrially feasible technique offer a promising solution for intravenous therapy of CM. Copyright © 2016 Elsevier B.V. All rights reserved.

  19. Drug Combinations as the New Standard for Melanoma Treatment.

    Science.gov (United States)

    Polkowska, Marta; Czepielewska, Edyta; Kozłowska-Wojciechowska, Małgorzata

    2016-12-01

    Advanced melanoma is related to a very grim prognosis and fast progression. Until recently, there has been no indicated treatment that would affect the disease's outcome. However, the progress in immunotherapy and molecular therapy has significantly changed the unfavourable prognosis of melanoma progression and its short survival rate. Both approaches have improved patients' outcomes and provided renewed hope for successful treatment. Moreover, in order to further enhance patients' outcomes and to avoid mechanisms of tumour resistance, investigators attempted a combined approach. Targeted therapy combinations allowed a better response rate and progression-free survival than monotherapy with one of the agents. Another promising combination, but with limiting toxicities, is a concurrent immuno- and molecular-targeted therapy. It is suspected that complimentary usage of these drugs may lead to synergism, providing robust and quick tumour responses as well as long-lasting effects. Results of currently ongoing clinical trials that investigate combination strategies in melanoma are expected to provide more mature data about the effectiveness and the safety profile of those therapies. Until more robust results of these studies occur, the best management of advanced and metastatic melanoma is immunotherapy with anti-PD1 drugs or targeted therapy with concomitant BRAF and MEK inhibitor. However, which of these two options should be used first is still under discussion.

  20. Safety and efficacy of methylene blue combined with artesunate or amodiaquine for uncomplicated falciparum malaria: a randomized controlled trial from Burkina Faso.

    Directory of Open Access Journals (Sweden)

    Augustin Zoungrana

    Full Text Available BACKGROUND: Besides existing artemisinin-based combination therapies, alternative safe, effective and affordable drug combinations against falciparum malaria are needed. Methylene blue (MB was the first synthetic antimalarial drug ever used, and recent studies have been promising with regard to its revival in malaria therapy. The objective of this study was to assess the safety and efficacy of two MB-based malaria combination therapies, MB-artesunate (AS and MB-amodiaquine (AQ, compared to the local standard of care, AS-AQ, in Burkina Faso. METHODS AND FINDINGS: Open-label randomised controlled phase II study in 180 children aged 6-10 years with uncomplicated falciparum malaria in Nouna, north-western Burkina Faso. Follow-up was for 28 days and analysis by intention-to-treat. The treatment groups were similar in baseline characteristics and there was only one loss to follow-up. No drug-related serious adverse events and no deaths occurred. MB-containing regimens were associated with mild vomiting and dysuria. No early treatment failures were observed. Parasite clearance time differed significantly among groups and was the shortest with MB-AS. By day 14, the rates of adequate clinical and parasitological response after PCR-based correction for recrudescence were 87% for MB-AS, 100% for MB-AQ (p = 0.004, and 100% for AS-AQ (p = 0.003. By day 28, the respective figure was lowest for MB-AS (62%, intermediate for the standard treatment AS-AQ (82%; p = 0.015, and highest for MB-AQ (95%; p<0.001; p = 0.03. CONCLUSIONS: MB-AQ is a promising alternative drug combination against malaria in Africa. Moreover, MB has the potential to further accelerate the rapid parasite clearance of artemisinin-based combination therapies. More than a century after the antimalarial properties of MB had been described, its role in malaria control deserves closer attention. TRIAL REGISTRATION: ClinicalTrials.gov NCT00354380.

  1. Combined versus monotherapy or concurrent therapy for treatment of thalassaemia.

    Science.gov (United States)

    Song, Ta-Shu; Hsieh, Yow-Wen; Peng, Ching-Tien; Chen, Tai-Lin; Lee, Hong-Zin; Chung, Jing-Gung; Hour, Mann-Jen

    2014-01-01

    A combined deferasirox (DFX) and deferiprone (DFP) treatment protocol for relieving thalassemia patients' iron-overload was designed and the pharmacokinetic study was performed by LC-MS/MS. For this open-label, randomized trial, eight patients were recruited and randomly allocated to different treatment regimens: (A) monotherapy with single oral dose of DFX 30 mg/kg, (B) monotherapy with DFP 80 mg/kg/day, twice daily, (C) combined therapy with DFX and DFP (DFX 30 mg/kg for first dose, DFP 40 mg/kg 7 hours later, and DFP 40 mg/kg after another 7 h) and (D) concurrent therapy with DFX 30 mg/kg and DFP 80 mg/kg. Descriptive statistics evaluated pharmacokinetic parameters, AUC0-t, AUC0-inf, Cmax, Tmax, T1/2 and MRT. A positive pharmacokinetic drug interaction was observed in combined therapy. In case of DFX, combined therapy tallied about 2-fold larger than monotherapy in AUC, 1.5-fold larger in Cmax, 1 h longer in Tmax, but 1 h shorter in T1/2. Regarding DFP, most such parameters of combined therapy concurred with monotherapy. Conversely, negative drug interaction was observed in concurrent therapy. With DFX, concurrent therapy attained 1.2- to 2.2-fold lower than monotherapy in AUC0-t and Cmax, 0.6-h shorter in Tmax, and 3-fold longer in T1/2. With DFP, concurrent therapy proved approximately 2-fold larger than monotherapy in AUC and Cmax, 2.5-fold longer in T1/2, and 1.4-fold longer in MRT. Follow-up of subjects' clinical examinations and subjective symptoms showed no adverse events. Our findings showed the combined therapy had advantages, safe, convenient and painless for patients, over the existing concurrent therapy with deferoxamine (DFO) and DFX. Copyright © 2014 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  2. Combined photo-Fenton-SBR process for antibiotic wastewater treatment

    Energy Technology Data Exchange (ETDEWEB)

    Elmolla, Emad S., E-mail: em_civil@yahoo.com [Department of Civil Engineering, Faculty of Engineering, Al-Azhar University, Cairo (Egypt); Chaudhuri, Malay [Department of Civil Engineering, Universiti Teknologi PETRONAS, Bandar Seri Iskandar, 31750 Tronoh, Perak (Malaysia)

    2011-09-15

    Highlights: {center_dot} The work focused on hazardous wastewater (antibiotic wastewater) treatment. {center_dot} Complete degradation of the antibiotics achieved by the treatment process. {center_dot} The SBR performance was found to be very sensitive to BOD{sub 5}/COD ratio below 0.40. {center_dot} Combined photo-Fenton-SBR process is a feasible treatment process for the antibiotic wastewater. - Abstract: The study examined combined photo-Fenton-SBR treatment of an antibiotic wastewater containing amoxicillin and cloxacillin. Optimum H{sub 2}O{sub 2}/COD and H{sub 2}O{sub 2}/Fe{sup 2+} molar ratio of the photo-Fenton pretreatment were observed to be 2.5 and 20, respectively. Complete degradation of the antibiotics occurred in one min. The sequencing batch reactor (SBR) was operated at different hydraulic retention times (HRTs) with the wastewater treated under different photo-Fenton operating conditions (H{sub 2}O{sub 2}/COD and H{sub 2}O{sub 2}/Fe{sup 2+} molar ratio). The SBR performance was found to be very sensitive to BOD{sub 5}/COD ratio of the photo-Fenton treated wastewater. Statistical analysis of the results indicated that it was possible to reduce the Fe{sup 2+} dose and increase the irradiation time of the photo-Fenton pretreatment. The best operating conditions of the combined photo-Fenton-SBR treatment were observed to be H{sub 2}O{sub 2}/COD molar ratio 2, H{sub 2}O{sub 2}/Fe{sup 2+} molar ratio 150, irradiation time 90 min and HRT of 12 h. Under the best operating conditions, 89% removal of sCOD with complete nitrification was achieved and the SBR effluent met the discharge standards.

  3. Psychological treatment versus combined treatment of depression: A meta-analysis.

    NARCIS (Netherlands)

    Cuijpers, P.; Straten, van A.; Warmerdam, E.H.; Andersson, G.

    2009-01-01

    Background: A large number of studies have shown that psychological treatments have significant effects on depression. Although several studies have examined the relative effects of psychological and combined treatments, this has not been studied satisfactorily in recent statistical meta-analyses. M

  4. Multistrain models predict sequential multidrug treatment strategies to result in less antimicrobial resistance than combination treatment

    DEFF Research Database (Denmark)

    Ahmad, Amais; Zachariasen, Camilla; Christiansen, Lasse Engbo;

    2016-01-01

    Background: Combination treatment is increasingly used to fight infections caused by bacteria resistant to two or more antimicrobials. While multiple studies have evaluated treatment strategies to minimize the emergence of resistant strains for single antimicrobial treatment, fewer studies have...... generated by a mathematical model of the competitive growth of multiple strains of Escherichia coli.Results: Simulation studies showed that sequential use of tetracycline and ampicillin reduced the level of double resistance, when compared to the combination treatment. The effect of the cycling frequency...... frequency did not play a role in suppressing the growth of resistant strains, but the specific order of the two antimicrobials did. Predictions made from the study could be used to redesign multidrug treatment strategies not only for intramuscular treatment in pigs, but also for other dosing routes....

  5. Treatment of Comorbid Obesity and Major Depressive Disorder: A Prospective Pilot Study for their Combined Treatment

    Directory of Open Access Journals (Sweden)

    Lucy F. Faulconbridge

    2011-01-01

    Full Text Available Background. Obese individuals who suffer from major depressive disorder are routinely screened out of weight loss trials. Treatments targeting obesity and depression concurrently have not been tested. Purpose. To test the short-term efficacy of a treatment that combined behavioral weight management and cognitive behavioral therapy (CBT for obese adults with depression. Methods. Twelve obese females diagnosed with major depressive disorder received weekly group behavioral weight management, combined with CBT for depression, for 16 weeks. Weight, symptoms of depression, and cardiovascular disease (CVD risk factors were measured at baseline and week 16. Results. Participants lost 11.4% of initial weight and achieved significant improvements in symptoms of depression and CVD risk factors. Conclusions. Obese individuals suffering from major depressive disorder can lose weight and achieve improvements in symptoms of depression and CVD risk factors with 16 weeks of combined treatment. A larger randomized controlled trial is needed to establish the efficacy of this treatment.

  6. Combination treatment of tamoxifen with risperidone in breast cancer.

    Directory of Open Access Journals (Sweden)

    Wei-Lan Yeh

    Full Text Available Tamoxifen has long been used and still is the most commonly used endocrine therapy for treatment of both early and advanced estrogen receptor-positive breast cancer in pre- and post-menopause women. Tamoxifen exerts its cytotoxic effect primarily through cytostasis which is associated with the accumulation of cells in the G0/G1 phase of the cell cycle. Apoptotic activity can also be exerted by tamoxifen which involves cleavage of caspase 9, caspase 7, caspase 3, and poly-ADP-ribose polymerase (PARP. Down-regulation of anti-apoptotic proteins Bcl-2 and Bcl-xL and up-regulation of pro-apoptotic proteins Bax and Bak have also been observed. In addition, stress response protein of GRP 94 and GRP 78 have also been induced by tamoxifen in our study. However, side effects occur during tamoxifen treatment in breast cancer patients. Researching into combination regimen of tamoxifen and drug(s that relieves tamoxifen-induced hot flushes is important, because drug interactions may decrease tamoxifen efficacy. Risperidone has been shown to be effective in reducing or eliminating hot flushes on women with hormonal variations. In this present study, we demonstrated that combination of tamoxifen with risperidone did not interfered tamoxifen-induced cytotoxic effects in both in vitro and in vivo models, while fluoxetine abrogated the effects of tamoxifen. This is the first paper suggesting the possibility of combination treatment of tamoxifen with risperidone in breast cancer patients, providing a conceivable resolution of tamoxifen-induced side effects without interfering the efficacy of tamoxifen against breast cancer.

  7. Efficacy of artemether-lumefantrine as a treatment for uncomplicated Plasmodium vivax malaria in eastern Sudan

    Directory of Open Access Journals (Sweden)

    Abdallah Tajeldin M

    2012-12-01

    Full Text Available Abstract Background Artemisinin-based combination therapy (ACT is the treatment of choice for uncomplicated Plasmodium falciparum malaria in most areas of the world, where malaria is endemic, including Sudan. However, few published data are available on the use of ACT for treatment of P. vivax malaria. Methods This study was conducted at a health centre in Kassala, eastern Sudan, from October to December 2011. Patients with uncomplicated P. vivax malaria received artemether-lumefantrine (AL tablets (containing 20mg artemether and 120 mg lumefantrine and were monitored for 28 days. Results Out of the 43 cases enrolled in this study, 38 completed the 28-day follow-up. Their mean age was 25.1 years (SD: 1.5. On day 3 following AL treatment, all of the patients were afebrile and aparasitaemic. By day 28, all 38 patients exhibited adequate clinical and parasitological responses to AL treatment. The cure rate was 100% and 88.4% for the per protocol analysis andfor the intention to treat analysis, respectively. Mild adverse effects (nausea, vomiting, abdominal pain, dizziness and/or rash that resolved spontaneously were observed in four (10.5% of the patients. Conclusion AL combination therapy was fully effective for treatment of P. vivax malaria in the study in eastern Sudan. Trial registration Trial. Gov: NCT01625871

  8. Benchmarking Combined Biological Phosphorus and Nitrogen Removal Wastewater Treatment Processes

    DEFF Research Database (Denmark)

    Gernaey, Krist; Jørgensen, Sten Bay

    2004-01-01

    This paper describes the implementation of a simulation benchmark for studying the influence of control strategy implementations on combined nitrogen and phosphorus removal processes in a biological wastewater treatment plant. The presented simulation benchmark plant and its performance criteria...... are to a large extent based on the already existing nitrogen removal simulation benchmark. The paper illustrates and motivates the selection of the treatment plant lay-out, the selection of the biological process model, the development of realistic influent disturbance scenarios for dry, rain and storm weather...... conditions respectively, the definition of performance indexes that include the phosphorus removal processes, and the selection of a suitable operating point for the plant. Two control loops were implemented: one for dissolved oxygen control using the oxygen transfer coefficient K(L)a as manipulated variable...

  9. Multistrain models predict sequential multidrug treatment strategies to result in less antimicrobial resistance than combination treatment

    DEFF Research Database (Denmark)

    Ahmad, Amais; Zachariasen, Camilla; Christiansen, Lasse Engbo

    2016-01-01

    Background: Combination treatment is increasingly used to fight infections caused by bacteria resistant to two or more antimicrobials. While multiple studies have evaluated treatment strategies to minimize the emergence of resistant strains for single antimicrobial treatment, fewer studies have...... frequency did not play a role in suppressing the growth of resistant strains, but the specific order of the two antimicrobials did. Predictions made from the study could be used to redesign multidrug treatment strategies not only for intramuscular treatment in pigs, but also for other dosing routes....... the sensitive fraction of the commensal flora.Growth parameters for competing bacterial strains were estimated from the combined in vitro pharmacodynamic effect of two antimicrobials using the relationship between concentration and net bacterial growth rate. Predictions of in vivo bacterial growth were...

  10. Combining prevention, treatment and care: lessons from South Africa.

    Science.gov (United States)

    Achmat, Zackie; Simcock, Julian

    2007-07-01

    Over one million people in sub-Saharan Africa now access HIV treatment, and as the prognosis of life expectancy on antiretroviral therapy (ART) improves, the central question that arises for governments, civil society and the private sector must be: how will we pay for the healthcare costs?This paper critically evaluates the need to provide effective treatment, prevention and care for HIV over the long term. Compelling evidence and moral argument suggest that the right combination of treatment and prevention policies, bolstered by grassroots mobilization and effective treatment literacy campaigns, can prevent new infections, save lives and mitigate the impact of HIV/AIDS. South Africa's HIV epidemic and its antiretroviral roll-out provide instructive global templates. The scale of the epidemic, the political responses, the epidemiological evidence and the outcomes data are lessons for countries where there is only a low-level epidemic at present. The investment needed to provide universal ART in South Africa will be substantial, but the economic rationale to act now is compelling. Brazil and to a lesser extent Thailand have responded with increased urgency and foresight. When compared with South Africa, their successes lend further credence to the importance of augmenting HIV prevention efforts with widespread access to treatment and care. Despite the obstacles, important gains have been made in South Africa, with community level health facilities documenting noteworthy treatment and adherence results. Our example suggests that even after tragic mistakes have been made, collective action, evidence-informed programmes, and sustained investment can still save lives and mitigate the epidemic.

  11. Combined treatment of conventional techniques and acupressure in laryngectomized patients

    Directory of Open Access Journals (Sweden)

    Leonor Mora Yero

    2015-07-01

    Full Text Available Background: the use of traditional medicine techniques, specifically acupressure, along with established techniques, is widely used in developed countries for the rehabilitation of the laryngectomized patients.Objective: to describe the effectiveness of the combination of conventional techniques and those using acupressure in laryngectomized patients seen at the department of speech and phoniatrics of Ernesto Guevara Hospital from January, 2013 to December, 2014.Methods: a quasi-experimental study was carried out on a sample of 24 patients who had undergone laryngectomy and presented voluntarily or were referred for voice rehabilitation in the period and place herein mentioned. The sample was divided into two groups of 12 each. The first group was treated by the conventional method and the second group was treated with a combination of the traditional method and acupressure.Results: in the group of patients that received a conventional treatment a 50 % achieved rehabilitation. In the group where conventional techniques were combined with acupressure, rehabilitation of a 91,6 % was achieved. No adverse effects were manifested.Conclusions: the unit of the conventional technique with acupressure reduced the time for the rehabilitation of patients and increased the number of patients rehabilitated.

  12. Combined Immune Therapy for the Treatment of Visceral Leishmaniasis

    Science.gov (United States)

    Bunn, Patrick T.; Singh, Neetu; Chauhan, Shashi Bhushan; Sheel, Meru; Amante, Fiona H.; Montes de Oca, Marcela; Edwards, Chelsea L.; Ng, Susanna S.; Best, Shannon E.; Haque, Ashraful; Beattie, Lynette; Hafner, Louise M.; Sacks, David; Nylen, Susanne; Sundar, Shyam; Engwerda, Christian R.

    2016-01-01

    Chronic disease caused by infections, cancer or autoimmunity can result in profound immune suppression. Immunoregulatory networks are established to prevent tissue damage caused by inflammation. Although these immune checkpoints preserve tissue function, they allow pathogens and tumors to persist, and even expand. Immune checkpoint blockade has recently been successfully employed to treat cancer. This strategy modulates immunoregulatory mechanisms to allow host immune cells to kill or control tumors. However, the utility of this approach for controlling established infections has not been extensively investigated. Here, we examined the potential of modulating glucocorticoid-induced TNF receptor-related protein (GITR) on T cells to improve anti-parasitic immunity in blood and spleen tissue from visceral leishmaniasis (VL) patients infected with Leishmania donovani. We found little effect on parasite growth or parasite-specific IFNγ production. However, this treatment reversed the improved anti-parasitic immunity achieved by IL-10 signaling blockade. Further investigations using an experimental VL model caused by infection of C57BL/6 mice with L. donovani revealed that this negative effect was prominent in the liver, dependent on parasite burden and associated with an accumulation of Th1 cells expressing high levels of KLRG-1. Nevertheless, combined anti-IL-10 and anti-GITR mAb treatment could improve anti-parasitic immunity when used with sub-optimal doses of anti-parasitic drug. However, additional studies with VL patient samples indicated that targeting GITR had no overall benefit over IL-10 signaling blockade alone at improving anti-parasitic immune responses, even with drug treatment cover. These findings identify several important factors that influence the effectiveness of immune modulation, including parasite burden, target tissue and the use of anti-parasitic drug. Critically, these results also highlight potential negative effects of combining different

  13. Combined Immune Therapy for the Treatment of Visceral Leishmaniasis.

    Directory of Open Access Journals (Sweden)

    Rebecca J Faleiro

    2016-02-01

    Full Text Available Chronic disease caused by infections, cancer or autoimmunity can result in profound immune suppression. Immunoregulatory networks are established to prevent tissue damage caused by inflammation. Although these immune checkpoints preserve tissue function, they allow pathogens and tumors to persist, and even expand. Immune checkpoint blockade has recently been successfully employed to treat cancer. This strategy modulates immunoregulatory mechanisms to allow host immune cells to kill or control tumors. However, the utility of this approach for controlling established infections has not been extensively investigated. Here, we examined the potential of modulating glucocorticoid-induced TNF receptor-related protein (GITR on T cells to improve anti-parasitic immunity in blood and spleen tissue from visceral leishmaniasis (VL patients infected with Leishmania donovani. We found little effect on parasite growth or parasite-specific IFNγ production. However, this treatment reversed the improved anti-parasitic immunity achieved by IL-10 signaling blockade. Further investigations using an experimental VL model caused by infection of C57BL/6 mice with L. donovani revealed that this negative effect was prominent in the liver, dependent on parasite burden and associated with an accumulation of Th1 cells expressing high levels of KLRG-1. Nevertheless, combined anti-IL-10 and anti-GITR mAb treatment could improve anti-parasitic immunity when used with sub-optimal doses of anti-parasitic drug. However, additional studies with VL patient samples indicated that targeting GITR had no overall benefit over IL-10 signaling blockade alone at improving anti-parasitic immune responses, even with drug treatment cover. These findings identify several important factors that influence the effectiveness of immune modulation, including parasite burden, target tissue and the use of anti-parasitic drug. Critically, these results also highlight potential negative effects of

  14. Sialendoscopy and Combined Minimally Invasive Treatment for Large Parotid Stones

    Science.gov (United States)

    Zavázalová, Šárka; Vorobiov, Olexii; Astl, Jaromír

    2016-01-01

    Sialendoscopy (SE) represents nowadays one of the standard diagnostic and therapeutic procedures in the treatment of major salivary glands lithiasis. We know from experience that it is successful only in small percentage of patients, when used in monotherapy. However, it represents an indispensable part of all of the combined minimally invasive gland-preserving treatment techniques, the success rate of which is around 90%. In this work, we focused on the role of sialendoscopy in the treatment of patients with larger inflamed fixed stones in glandula parotis. We conducted a total of 364 sialendoscopy procedures in 332 patients on our site. We have confirmed lithiasis as a cause of salivary gland obstruction in 246 (74%) patients. In 9 patients there was larger, single, or multiple inflamed fixed lithiasis of glandula parotis. In this subgroup of patients endoscopically assisted sialolithectomy from external mini-incision has become the method of choice. In 9 of the 9 (100%) cases we have achieved complete elimination of stones, and in 8 of the 9 (89%) cases we have achieved complete elimination of complaints. Sialoendoscopically assisted sialolithectomy of glandula parotis from external mini-incision has proved to be highly effective technique to eliminate stones with minimal complications. PMID:27882318

  15. A Movable Combined Water Treatment Facility for Rainwater Harvesting

    Science.gov (United States)

    Zhang, L.; Liao, L.

    2003-12-01

    Alarming water shortage and increased water scarcity world wide has led to increased interests in alternative water sources. Rainwater harvesting is one of them which is getting more and more attention. There is a huge potential for generalization and extension of rainwater harvesting system as an alternative water supply. This is especially important for arid and semi-arid regions where the water shortage blocks further social, economical development. Earlier laboratory experiments and field study showed that harvested rainwater requires treatments of different degrees in order to meet the WHO drinking water standards. The main focus of this study is to ascertain the quality of stored rainwater for drinking purposes with emphasis on water disinfection and pollutants removal. A movable, low-cost, fully functional small scale treatment facility is proposed and tested under simulated field condition. A number of actual and potential hazardous pollutants were identified in the collected water samples together with laboratory test. The corresponding water purification procedure and fresh-keeping methods are discussed. The final proposal of this movable facility needs to be further examined to achieve optimal combined treatment efficiency.

  16. Disinfection of water by adsorption combined with electrochemical treatment.

    Science.gov (United States)

    Hussain, S N; de Las Heras, N; Asghar, H M A; Brown, N W; Roberts, E P L

    2014-05-01

    The disinfection performance of a unique process of adsorption combined with electrochemical treatment is evaluated. A flake graphite intercalation compound adsorbent was used, which is effective for the removal of organic contaminants and is amenable to anodic electrochemical regeneration. Adsorption of Escherichia coli on the graphite flake was followed by electrochemical treatment under a range of experimental conditions in a sequential batch reactor. The adsorption of E. coli cells was found to be a fast process and was capable of removing >99.98% of cells from solution after 5 min with a ca. 6.5-log10 reduction in E. coli concentration after 10 min. With electrochemical treatment the adsorbent could be reused, with no decrease in E. coli adsorption observed over five cycles. In the presence of chloride, >8.5-log10 reduction of E. coli concentration was achieved. Disinfection was found to be less effective in the absence of chloride. However, selection of appropriate operating conditions enabled effective disinfection in a chloride free system, reducing the potential for formation of disinfection by-products. The energy consumption required to achieve >8.5-log10 disinfection was 2-7 kWh m(-3).

  17. Combined Treatment of Wrist and Trapeziometacarpal Joint Arthritis

    Science.gov (United States)

    Waitzenegger, Thomas; Leclercq, Caroline; Masmejean, Emmanuel; Lenoir, Hubert; Harir, Amir; Coulet, Bertrand; Chammas, Michel

    2015-01-01

    Background Combined thumb basal and wrist joint arthritis (excluding scaphotrapeziotrapezoid arthritis) is rare considering the frequency of arthritis of either joint alone. Combined surgical treatment has never been described in the literature. Furthermore, the scaphoidectomy common to all interventions for Watson stage 2 or 3 wrist arthritis theoretically makes it impossible to perform a trapeziectomy for thumb basal joint arthritis. Question/Purpose The aim of this study was to present and analyze the results of two types of surgical treatment when both wrist and thumb arthritis was present. Materials and Methods Our retrospective series included 11 patients suffering from Eaton Stage III thumb basal joint arthritis and scapholunate advanced collapse (SLAC) II and III-type wrist arthritis. Five patients (group A) underwent trapeziectomy and palliative surgery for their wrist with conservation of the distal pole of the scaphoid (one proximal row carpectomy [PRC] and four four-corner fusions), and six (group B) patients had a trapeziometacarpal arthroplasty either with PRC (two cases) or four-corner arthrodesis (four cases) including total scaphoidectomy. Results The mean follow-up was 57 months. The overall visual analog scale (VAS) score for pain was 1.5 at rest, with no difference between the trapeziectomy and arthroplasty groups. The average Kapandji score was 9.3 (9 in group A and 9.5 in group B). The flexion/extension range of motion for the wrist was 64° following four-corner arthrodesis and 75° following PRC. Only one case of algodystrophy was observed. The radiological analysis revealed no complications. Discussion This study shows that thumb basal joint arthritis and SLAC type wrist arthritis may be treated by combined treatment during the same intervention without any complications. The results of palliative surgery for the wrist, either with trapeziectomy or with a trapeziometacarpal arthroplasty, are comparable. With a trapeziectomy, the

  18. Combined Treatment of Wrist and Trapeziometacarpal Joint Arthritis.

    Science.gov (United States)

    Waitzenegger, Thomas; Leclercq, Caroline; Masmejean, Emmanuel; Lenoir, Hubert; Harir, Amir; Coulet, Bertrand; Chammas, Michel

    2015-11-01

    Background Combined thumb basal and wrist joint arthritis (excluding scaphotrapeziotrapezoid arthritis) is rare considering the frequency of arthritis of either joint alone. Combined surgical treatment has never been described in the literature. Furthermore, the scaphoidectomy common to all interventions for Watson stage 2 or 3 wrist arthritis theoretically makes it impossible to perform a trapeziectomy for thumb basal joint arthritis. Question/Purpose The aim of this study was to present and analyze the results of two types of surgical treatment when both wrist and thumb arthritis was present. Materials and Methods Our retrospective series included 11 patients suffering from Eaton Stage III thumb basal joint arthritis and scapholunate advanced collapse (SLAC) II and III-type wrist arthritis. Five patients (group A) underwent trapeziectomy and palliative surgery for their wrist with conservation of the distal pole of the scaphoid (one proximal row carpectomy [PRC] and four four-corner fusions), and six (group B) patients had a trapeziometacarpal arthroplasty either with PRC (two cases) or four-corner arthrodesis (four cases) including total scaphoidectomy. Results The mean follow-up was 57 months. The overall visual analog scale (VAS) score for pain was 1.5 at rest, with no difference between the trapeziectomy and arthroplasty groups. The average Kapandji score was 9.3 (9 in group A and 9.5 in group B). The flexion/extension range of motion for the wrist was 64° following four-corner arthrodesis and 75° following PRC. Only one case of algodystrophy was observed. The radiological analysis revealed no complications. Discussion This study shows that thumb basal joint arthritis and SLAC type wrist arthritis may be treated by combined treatment during the same intervention without any complications. The results of palliative surgery for the wrist, either with trapeziectomy or with a trapeziometacarpal arthroplasty, are comparable. With a trapeziectomy, the

  19. Utilization of traditional healers for treatment of malaria among female residents in Makurdi city and its environs

    Institute of Scientific and Technical Information of China (English)

    JomboGTA; MbaawuagaEM; DenenAkaaP; DaudaAM; EyongKI; AkosuJT; EtukumanaEA

    2010-01-01

    Objective:To ascertain the role of traditional healers in malaria treatment and its impact on control of the disease. Methods:The study was cross-sectional in nature. Test-run structured and semi-structured questionnaires were either interviewer or self administered to adult women aged 18 years old and above. House holds were selected using systematic random sampling methods. Information such as age, educational level, marital status, occupation and methods of malaria treatment were obtained. Focused group discussions about beliefs and perceptions on utilization of traditional healers and in depth discussions on treatment and control of malaria were also carried out. Results: Of the 2 075 respondents studied, 49.7% (n=1 031) utilized traditional healers for treatment of malaria, including 16.7%(n=172) utilizing traditional healers strictly while 83.3%(n=859) combining it with other treatment methods such as hospital/clinic, pharmacy/chemist shop, herbs or spiritual healing. The major contributors to utilization of traditional healers were:illiteracy and ignorance, poverty, unemployment/underemployment and slow pace of the comprehensive package implementation of the“roll back malaria”(RBM) programme initiate in the community. Conclusions:Health education should be intensified while adequate facilities put in place to commence home management of malaria and probable free distribution of the artemisinin-based combination therapy (ACT).

  20. COMBINED ANAEROBIC-AEROBIC SYSTEM FOR TREATMENT OF TEXTILE WASTEWATER

    Directory of Open Access Journals (Sweden)

    MAHDI AHMED

    2007-04-01

    Full Text Available Textile manufacturing consumes a considerable amount of water in its manufacturing processes. The water is primarily utilized in the dyeing and finishing operations of the textile establishments. Considering both the volume generated and the effluent composition, the textile industry wastewater is rated as the most polluting among all industrial sectors. In this study a combined anaerobic-aerobic reactor was operated continuously for treatment of textile wastewater. Cosmo balls were used to function as growth media for microorganisms in anaerobic reactor. Effect of pH, dissolved oxygen, and organic changes in nitrification and denatrification process were investigated. The results indicated that over 84.62% ammonia nitrogen and about 98.9% volatile suspended solid (VSS removal efficiency could be obtained. Dissolved oxygen (DO, pH were shown to have only slight influences on the nitrification process; and for each 10% removal of nitrogen, only 3% of pH changes were achieved.

  1. Combination bacteriolytic therapy for the treatment of experimental tumors.

    Science.gov (United States)

    Dang, L H; Bettegowda, C; Huso, D L; Kinzler, K W; Vogelstein, B

    2001-12-18

    Current chemotherapeutic approaches for cancer are in part limited by the inability of drugs to destroy neoplastic cells within poorly vascularized compartments of tumors. We have here systematically assessed anaerobic bacteria for their capacity to grow expansively within avascular compartments of transplanted tumors. Among 26 different strains tested, one (Clostridium novyi) appeared particularly promising. We created a strain of C. novyi devoid of its lethal toxin (C. novyi-NT) and showed that intravenously injected C. novyi-NT spores germinated within the avascular regions of tumors in mice and destroyed surrounding viable tumor cells. When C. novyi-NT spores were administered together with conventional chemotherapeutic drugs, extensive hemorrhagic necrosis of tumors often developed within 24 h, resulting in significant and prolonged antitumor effects. This strategy, called combination bacteriolytic therapy (COBALT), has the potential to add a new dimension to the treatment of cancer.

  2. Combining Motivational Interviewing with Cognitive-Behavioral Treatments for Substance Abuse: Lessons from the COMBINE Research Project

    Science.gov (United States)

    Moyers, Theresa B.; Houck, Jon

    2011-01-01

    Motivational Interviewing began as a treatment for substance misuse and has strong empirical support as an intervention for these disorders. It is very common for MI to be combined with other types of treatment when it is used for substance abuse, and this article focuses on one example of this: the COMBINE Research Project. We examine the…

  3. Combining Motivational Interviewing with Cognitive-Behavioral Treatments for Substance Abuse: Lessons from the COMBINE Research Project

    Science.gov (United States)

    Moyers, Theresa B.; Houck, Jon

    2011-01-01

    Motivational Interviewing began as a treatment for substance misuse and has strong empirical support as an intervention for these disorders. It is very common for MI to be combined with other types of treatment when it is used for substance abuse, and this article focuses on one example of this: the COMBINE Research Project. We examine the…

  4. Slaughterhouse wastewater treatment by combined chemical coagulation and electrocoagulation process.

    Science.gov (United States)

    Bazrafshan, Edris; Kord Mostafapour, Ferdos; Farzadkia, Mehdi; Ownagh, Kamal Aldin; Mahvi, Amir Hossein

    2012-01-01

    Slaughterhouse wastewater contains various and high amounts of organic matter (e.g., proteins, blood, fat and lard). In order to produce an effluent suitable for stream discharge, chemical coagulation and electrocoagulation techniques have been particularly explored at the laboratory pilot scale for organic compounds removal from slaughterhouse effluent. The purpose of this work was to investigate the feasibility of treating cattle-slaughterhouse wastewater by combined chemical coagulation and electrocoagulation process to achieve the required standards. The influence of the operating variables such as coagulant dose, electrical potential and reaction time on the removal efficiencies of major pollutants was determined. The rate of removal of pollutants linearly increased with increasing doses of PACl and applied voltage. COD and BOD(5) removal of more than 99% was obtained by adding 100 mg/L PACl and applied voltage 40 V. The experiments demonstrated the effectiveness of chemical and electrochemical techniques for the treatment of slaughterhouse wastewaters. Consequently, combined processes are inferred to be superior to electrocoagulation alone for the removal of both organic and inorganic compounds from cattle-slaughterhouse wastewater.

  5. Slaughterhouse wastewater treatment by combined chemical coagulation and electrocoagulation process.

    Directory of Open Access Journals (Sweden)

    Edris Bazrafshan

    Full Text Available Slaughterhouse wastewater contains various and high amounts of organic matter (e.g., proteins, blood, fat and lard. In order to produce an effluent suitable for stream discharge, chemical coagulation and electrocoagulation techniques have been particularly explored at the laboratory pilot scale for organic compounds removal from slaughterhouse effluent. The purpose of this work was to investigate the feasibility of treating cattle-slaughterhouse wastewater by combined chemical coagulation and electrocoagulation process to achieve the required standards. The influence of the operating variables such as coagulant dose, electrical potential and reaction time on the removal efficiencies of major pollutants was determined. The rate of removal of pollutants linearly increased with increasing doses of PACl and applied voltage. COD and BOD(5 removal of more than 99% was obtained by adding 100 mg/L PACl and applied voltage 40 V. The experiments demonstrated the effectiveness of chemical and electrochemical techniques for the treatment of slaughterhouse wastewaters. Consequently, combined processes are inferred to be superior to electrocoagulation alone for the removal of both organic and inorganic compounds from cattle-slaughterhouse wastewater.

  6. [Acromioclavicular instability: arthroscopic and mini-open combined treatment].

    Science.gov (United States)

    Slullitel, D; Galán, H; Della, V F; Ibañez, F

    2016-01-01

    The surgical treatment of acromioclavicular dislocation remains controversial. We describe herein a combined two-stage technique that includes an arthroscopic approach followed by a mini-invasive approach. 41 patients with acromioclavicular dislocation grades III, IV and V. Acute and chronic lesions and revision surgeries were included during the follow-up. Patients with other shoulder conditions were excluded. Mean age was 28.6 years. Patients were assessed preoperatively with the UCLA and Constant scores, and the pain visual analog scale. The 6- and 12-month postoperative evaluation included X-rays to assess coronal and axial stability, coracoclavicular ossifications, signs of acromioclavicular arthrosis and/or distal clavicular osteolysis. The Constant scores were as follows: 41.3 preoperatively; 89.4 at 6 months; 92.3 at 12 months. The UCLA scores were as follows: 21.7 preoperatively; 29.1 at 6 months; 31.4 at 12 months. The VAS scores were 8.4, 2.3 and 1.2, for the same periods respectively. Two cases had repeated injury due to trauma and one case was dissatisfied with the cosmetic appearance of the scar. The X-ray assessment showed two cases of loss of stability and one case of distal clavicular osteolysis. The combination of two reduction methods, a synthetic one and a biological one allows for a solid anatomical reconstruction that is stable in the coronal and axial planes and good medium-term results.

  7. Combined laser and photodynamic treatment in extensive purulent wounds

    Science.gov (United States)

    Solovieva, A. B.; Tolstih, P. I.; Melik-Nubarov, N. S.; Zhientaev, T. M.; Kuleshov, I. G.; Glagolev, N. N.; Ivanov, A. V.; Karahanov, G. I.; Tolstih, M. P.; Timashev, P. S.

    2010-05-01

    Recently, photodynamic therapy (PDT) has been used for the treatment of festering wounds and trophic ulcers. An important advantage of PDT is its ability to affect bacterial cultures that are resistant to antibiotics. However the use of PDT alone does not usually guarantee a stable antiseptic effect and cannot prevent an external infection of wounds and burns. In this work attention is focused on the healing of the extensive soft tissues wounds with combined laser therapy (LT) and PDT treatment. At the first stage of this process festering tissues (for example spacious purulent wounds with area more than 100 cm2) were illuminated with high-energy laser beam (with power 20 W) in continues routine. The second stage involves “softer” PDT affect, which along with the completion stages of destruction pathological cells, stimulating the process of wound granulation and epithelization. Also, according to our previous results, photosensitizer (photoditazin) is introduced inside the wound with different amphiphilic polymers for increasing the PDT efficacy.

  8. Transformation of metals speciation in a combined landfill leachate treatment.

    Science.gov (United States)

    Wu, Yanyu; Zhou, Shaoqi; Chen, Dongyu; Zhao, Rong; Li, Huosheng; Lin, Yiming

    2011-04-01

    Landfill leachate was treated by a combined sequential batch reactor (SBR), coagulation, Fenton oxidation and biological aerated filter (BAF) technology. The metals in treatment process were fractionated into three fractions: particulate and colloidal (size charge filtration), free ion/labile (cation exchange) and non-labile fractions. Fifty percent to 66% Cu, Ni, Zn, Mn, Pb and Cd were present as particulate/colloidal matter in raw leachate, whereas Cr was present 94.9% as non-labile complexes. The free ion/labile fractions of Ni, Zn, Mg, Mn, Pb and Cd increased significantly after treatment except Cr. Fifty-nine percent to 100% of Al was present mainly as particulate/colloidal matter >0.45 μm and the remaining portions were predicted as non-labile complexes except in coagulation effluent. The speciation of Fe varied significantly in various individual processes. Visual MINTEQ simulation showed that 95-100% colloidal species for Cu, Cd and Pb were present as metal-humic complexes even with the lower dissolved organic carbon. Optimum agreements for the free ion/labile species were within acidic solution, whereas under-estimated in alkaline effluents. Overestimated particulate/colloidal fraction consisted with the hypothesis that a portion of colloids in fraction <0.45 μm were considered as dissolved.

  9. Treatment of combined sewer overflows using ferrate (VI).

    Science.gov (United States)

    Gandhi, Rohan; Ray, Ajay K; Sharma, Virender K; Nakhla, George

    2014-11-01

    This paper presents the results of a study conducted on the treatment of combined sewer overflows using ferrate (VI) [Fe (VI)]. At a Fe (VI) dose of 0.24 mg/L, total chemical oxygen demand (TCOD), soluble chemical oxygen demand (SCOD), total biochemical oxygen demand (TBOD5), soluble biochemical oxygen demand (SBOD5), total suspended solids (TSS), volatile suspended solids (VSS), total phosphorus (TP), total nitrogen (TN), and soluble TN removal efficiencies of 71, 75, 69, 68, 72, 83, 64, 38, and 36%, respectively, were achieved. Kinetic studies revealed that a contact time of only 15 minutes is sufficient to achieve secondary effluent criteria. An innovative technique of using primary sludge (PS) and thickened waste activated sludge as a source for the in situ synthesis of ferrate was developed. A comparative study of treatment efficiencies achieved by Fe (VI) generated from different sources was done. At 0.1 mg/L dose of Fe (VI) synthesized from PS, TCOD, SCOD, TSS, VSS, TP, and TN removal efficiencies of 60, 62, 63, 67, 30, and 25%, respectively, were achieved.

  10. Transformation of metals speciation in a combined landfill leachate treatment

    Energy Technology Data Exchange (ETDEWEB)

    Wu Yanyu [College of Environmental Science and Engineering, South China University of Technology, Guangzhou Higher Education Mega Center, Guangzhou 510006 (China); Key Laboratory of Environmental Protection and Eco-remediation of Guangdong Regular Higher Education Institutions, South China University of Technology, Guangzhou Higher Education Mega Center, Guangzhou 510006 (China); Zhou Shaoqi, E-mail: fesqzhou@scut.edu.cn [College of Environmental Science and Engineering, South China University of Technology, Guangzhou Higher Education Mega Center, Guangzhou 510006 (China); State Key Laboratory of Subtropical Building Science, South China University of Technology, Guangzhou 510641 (China); Key Laboratory of Environmental Protection and Eco-remediation of Guangdong Regular Higher Education Institutions, South China University of Technology, Guangzhou Higher Education Mega Center, Guangzhou 510006 (China); Chen Dongyu; Zhao Rong; Li Huosheng; Lin Yiming [College of Environmental Science and Engineering, South China University of Technology, Guangzhou Higher Education Mega Center, Guangzhou 510006 (China); Key Laboratory of Environmental Protection and Eco-remediation of Guangdong Regular Higher Education Institutions, South China University of Technology, Guangzhou Higher Education Mega Center, Guangzhou 510006 (China)

    2011-04-01

    Landfill leachate was treated by a combined sequential batch reactor (SBR), coagulation, Fenton oxidation and biological aerated filter (BAF) technology. The metals in treatment process were fractionated into three fractions: particulate and colloidal (size charge filtration), free ion/labile (cation exchange) and non-labile fractions. Fifty percent to 66% Cu, Ni, Zn, Mn, Pb and Cd were present as particulate/colloidal matter in raw leachate, whereas Cr was present 94.9% as non-labile complexes. The free ion/labile fractions of Ni, Zn, Mg, Mn, Pb and Cd increased significantly after treatment except Cr. Fifty-nine percent to 100% of Al was present mainly as particulate/colloidal matter > 0.45 {mu}m and the remaining portions were predicted as non-labile complexes except in coagulation effluent. The speciation of Fe varied significantly in various individual processes. Visual MINTEQ simulation showed that 95-100% colloidal species for Cu, Cd and Pb were present as metal-humic complexes even with the lower dissolved organic carbon. Optimum agreements for the free ion/labile species were within acidic solution, whereas under-estimated in alkaline effluents. Overestimated particulate/colloidal fraction consisted with the hypothesis that a portion of colloids in fraction < 0.45 {mu}m were considered as dissolved. - Research Highlights: {yields} Metals in various landfill leachate treatments were size charge fractionated and the speciation transformations were compared. {yields} Species predictions of metals were simulated by Visual MINTEQ model. {yields} Optimum agreements for the free ion/labile species were within acidic solution. {yields} Predictions of colloidal species agree with experimental data well in alkaline solution.

  11. Effectiveness of combined intermittent preventive treatment for children and timely home treatment for malaria control

    Directory of Open Access Journals (Sweden)

    Seakey Atsu K

    2009-12-01

    Full Text Available Abstract Background Whiles awaiting for the arrival of an effective and affordable malaria vaccine, there is a need to make use of the available control tools to reduce malaria risk, especially in children under five years and pregnant women. Intermittent preventive treatment (IPT has recently been accepted as an important component of the malaria control strategy. This study explored the potential of a strategy of intermittent preventive treatment for children (IPTC and timely treatment of malaria-related febrile illness in the home in reducing the parasite prevalence and malaria morbidity in young children in a coastal village in Ghana. Methods The study combined home-based delivery of IPTC among six to 60 months old and home treatment of suspected febrile malaria illness within 24 hours. All children between six and 60 months of age received intermittent preventive treatment using amodiaquine and artesunate, delivered by community assistants every four months (three times in 12 months. Malaria parasite prevalence surveys were conducted before the first and after the third dose of IPTC. Results Parasite prevalence was reduced from 25% to 3% (p Conclusion The evaluation result indicates that IPTC given three times in a year combined with timely treatment of febrile malaria illness, impacts significantly on the parasite prevalence. The marked reduction in the parasite prevalence with this strategy points to the potential for reducing malaria-related childhood morbidity and mortality, and this should be explored by control programme managers.

  12. Optimal price subsidies for appropriate malaria testing and treatment behaviour.

    Science.gov (United States)

    Hansen, Kristian Schultz; Lesner, Tine Hjernø; Østerdal, Lars Peter

    2016-11-04

    Malaria continues to be a serious public health problem particularly in Africa. Many people infected with malaria do not access effective treatment due to high price. At the same time many individuals receiving malaria drugs do not suffer from malaria because of the common practice of presumptive diagnosis. A global subsidy on artemisinin-based combination therapy (ACT) has recently been suggested to increase access to the most effective malaria treatment. Following the recommendation by World Health Organization that parasitological testing should be performed before treatment and ACT prescribed to confirmed cases only, it is investigated in this paper if a subsidy on malaria rapid diagnostic tests (RDTs) should be incorporated. A model is developed consisting of a representative individual with fever suspected to be malaria, seeking care at a specialized drug shop where RDTs, ACT medicines, and cheap, less effective anti-malarials are sold. Assuming that the individual has certain beliefs of the accuracy of the RDT and the probability that the fever is malaria, the model predicts the diagnosis-treatment behaviour of the individual. Subsidies on RDTs and ACT are introduced to incentivize appropriate behaviour: choose an RDT before treatment and purchase ACT only if the test is positive. Solving the model numerically suggests that a combined subsidy on both RDT and ACT is cost minimizing and improves diagnosis-treatment behaviour of individuals. For certain beliefs, such as low trust in RDT accuracy and strong belief that a fever is malaria, subsidization is not sufficient to incentivize appropriate behaviour. A combined subsidy on both RDT and ACT rather than a single subsidy is likely required to improve diagnosis-treatment behaviour among individuals seeking care for malaria in the private sector.

  13. Measuring Patient Adherence to Malaria Treatment: A Comparison of Results from Self-Report and a Customised Electronic Monitoring Device

    OpenAIRE

    Bruxvoort, K; Festo, C; Cairns, M.; Kalolella, A; Mayaya, F; Kachur, SP; Schellenberg, D; Goodman, C

    2015-01-01

    Background Self-report is the most common and feasible method for assessing patient adherence to medication, but can be prone to recall bias and social desirability bias. Most studies assessing adherence to artemisinin-based combination therapies (ACTs) have relied on self-report. In this study, we use a novel customised electronic monitoring device—termed smart blister packs—to examine the validity of self-reported adherence to artemether-lumefantrine (AL) in southern Tanzania. Methods Smart...

  14. Successful treatment for West syndrome with severe combined immunodeficiency.

    Science.gov (United States)

    Motobayashi, Mitsuo; Inaba, Yuji; Fukuyama, Tetsuhiro; Kurata, Takashi; Niimi, Taemi; Saito, Shoji; Shiba, Naoko; Nishimura, Takafumi; Shigemura, Tomonari; Nakazawa, Yozo; Kobayashi, Norimoto; Sakashita, Kazuo; Agematsu, Kazunaga; Ichikawa, Motoki; Koike, Kenichi

    2015-01-01

    Several immune mechanisms are suspected in the unknown etiology of West syndrome (WS). We report a male infant who suffered from WS and X-linked T-B+NK- severe combined immunodeficiency (X-SCID) with a missense mutation of the IL2RG gene (c.202G>A, p.Glu68Lys). He promptly began vitamin B6 and valproic acid treatment, but infantile spasms (IS) and hypsarrhythmia persisted. Administration of intravenous immunoglobulin and the change to topiramate (TPM) at 7 months of age resulted in the rapid resolution of IS. The CD4/8 ratio in his peripheral blood increased from 0.04-0.09 to 0.20-1.95 following unrelated cord blood transplantation (UCBT). In vitro lymphocyte proliferation in response to phytohemagglutinin or concanavalin A and the ability of B lymphocytes to produce antibodies improved as well. Electroencephalogram findings became normal 1 month after UCBT. Thus, we consider that T-cell dysfunction and/or impairments in T-B cell interactions due to X-SCID may have played important roles in the onset of WS. Immune-modulating therapies along with the administration of TPM effectively treated this severe epileptic syndrome in our patient.

  15. Artemisinin resistance containment project in Thailand. II: responses to mefloquine-artesunate combination therapy among falciparum malaria patients in provinces bordering Cambodia

    Directory of Open Access Journals (Sweden)

    Satimai Wichai

    2012-08-01

    Full Text Available Abstract Background The area along the Thai-Cambodian border is considered an epicenter of anti-malarial drug resistance. Recently, parasite resistance to artemisinin-based therapies has been reported in the area. The artemisinin resistance containment project was initiated in November 2008, with the aim to limit resistant parasites and eliminate malaria in this region. This study describes the response to artemisinin-based therapy among falciparum malaria patients in the area, using data from the malaria surveillance programmed under the containment project. Methods The study was conducted in seven provinces of Thailand along the Thai-Cambodian border. Data of Plasmodium falciparum-positive patients during January 2009 to December 2011 were obtained from the electronic malaria information system (eMIS Web-based reporting system. All P. falciparum cases were followed for 42 days, as the routine case follow-up protocol. The demographic characteristics of the patients were described. Statistical analysis was performed to determine the cure rate of the current standard anti-malarial drug regimen--mefloquine-artesunate combination therapy (MAS. The proportion of patients who remained parasite-positive at each follow-up day was calculated. In addition, factors related to the delayed parasite clearance on day-3 post-treatment, were explored. Results A total of 1,709 P. falciparum-positive cases were reported during the study period. Almost 70% of falciparum cases received MAS therapy (n = 1,174. The majority of cases were males, aged between 31 and 50 years. The overall MAS cure rate was >90% over the three-year period. Almost all patients were able to clear the parasite within 7 to 14 days post-treatment. Approximately 14% of patients undergoing MAS remained parasite-positive on day-3. Delayed parasite clearance was not significantly associated with patient gender, age, or citizenship. However, delayed parasite clearance varied across the

  16. Evidence for pyronaridine as a highly effective partner drug for treatment of artemisinin-resistant malaria in a rodent model.

    Science.gov (United States)

    Henrich, Philipp P; O'Brien, Connor; Sáenz, Fabián E; Cremers, Serge; Kyle, Dennis E; Fidock, David A

    2014-01-01

    The increasing prevalence in Southeast Asia of Plasmodium falciparum infections with delayed parasite clearance rates, following treatment of malaria patients with the artemisinin derivative artesunate, highlights an urgent need to identify which of the currently available artemisinin-based combination therapies (ACTs) are most suitable to treat populations with emerging artemisinin resistance. Here, we demonstrate that the rodent Plasmodium berghei SANA strain has acquired artemisinin resistance following drug pressure, as defined by reduced parasite clearance and early recrudescence following daily exposure to high doses of artesunate or the active metabolite dihydroartemisinin. Using the SANA strain and the parental drug-sensitive N strain, we have interrogated the antimalarial activity of five ACTs, namely, artemether-lumefantrine, artesunate-amodiaquine, artesunate-mefloquine, dihydroartemisinin-piperaquine, and the newest combination artesunate-pyronaridine. By monitoring parasitemia and outcome for 30 days following initiation of treatment, we found that infections with artemisinin-resistant P. berghei SANA parasites can be successfully treated with artesunate-pyronaridine used at doses that are curative for the parental drug-sensitive N strain. No other partner drug combination was as effective in resolving SANA infections. Of the five partner drugs tested, pyronaridine was also the most effective at suppressing the recrudescence of SANA parasites. These data support the potential benefit of implementing ACTs with pyronaridine in regions affected by artemisinin-resistant malaria.

  17. Combined oral contraceptive pills for treatment of acne.

    Science.gov (United States)

    Arowojolu, Ayodele O; Gallo, Maria F; Lopez, Laureen M; Grimes, David A

    2012-07-11

    Acne is a common skin disorder among women. Although no uniform approach to the management of acne exists, combination oral contraceptives (COCs), which contain an estrogen and a progestin, often are prescribed for women. To determine the effectiveness of combined oral contraceptives (COCs) for the treatment of facial acne compared to placebo or other active therapies. In January 2012, we searched for randomized controlled trials of COCs and acne in the computerized databases of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, POPLINE, and LILACS. We also searched for clinical trials in ClinicalTrials.gov and the International Clinical Trials Registry Platform (ICTRP) (Aug 2011). For the initial review, we wrote to researchers to seek any unpublished or published trials that we might have missed. We considered randomized controlled trials reported in any language that compared the effectiveness of a COC containing an estrogen and a progestin to placebo or another active therapy for acne in women. We extracted data on facial lesion counts, both total and specific (i.e., open or closed comedones, papules, pustules and nodules); acne severity grades; global assessments by the clinician or the participant, and discontinuation due to adverse events. Data were entered and analyzed in RevMan. For continuous data, we calculated the mean difference (MD) and 95% confidence interval (CI). For dichotomous data, we calculated the Peto odds ratio (OR) and 95% CI. The review includes 31 trials with 12,579 participants. Of 24 comparisons made, 6 compared a COC to placebo, 17 different COCs, and 1 compared a COC to an antibiotic. Of nine placebo-controlled trials with data for analysis, all showed COCs reduced acne lesion counts, severity grades and self-assessed acne compared to placebo. A levonorgestrel-COC group had fewer total lesion counts (MD -9.98; 95% CI -16.51 to -3.45), inflammatory and non-inflammatory lesion counts, and were more likely to

  18. Surveillance of the efficacy of artemether-lumefantrine and artesunate-amodiaquine for the treatment of uncomplicated Plasmodium falciparum among children under five in Togo, 2005-2009

    Directory of Open Access Journals (Sweden)

    Dorkenoo Monique A

    2012-10-01

    Full Text Available Abstract Background Malaria remains a major public health problem in Togo. The national malaria control programme in Togo changed the anti-malarial treatment policy from monotherapy to artemisinin combination therapy in 2004. This study reports the results of therapeutic efficacy studies conducted on artemether-lumefantrine and artesunate-amodiaquine for the treatment of uncomplicated Plasmodium falciparum malaria in Togo, between 2005 and 2009. Methods Children between 6 and 59 months of age, who were symptomatically infected with P. falciparum, were treated with either artemether-lumefantrine or artesunate-amodiaquine. The primary end-point was the 28-day cure rate, PCR-corrected for reinfection and recrudescence. Studies were conducted according to the standardized WHO protocol for the assessment of the efficacy of anti-malarial treatment. Differences between categorical data were compared using the chi-square test or the Fisher’s exact test where cell counts were ≤ 5. Differences in continuous data were compared using a t-test. Results A total of 16 studies were conducted in five sentinel sites, with 459, 505 and 332 children included in 2005, 2007 and 2009, respectively. The PCR-corrected 28-day cure rates using the per-protocol analysis were between 96%-100% for artemether-lumefantrine and 94%-100% for artesunate-amodiaquine. Conclusions Both formulations of artemisinin-based combination therapy were effective over time and no severe adverse events related to the treatment were reported during the studies.

  19. Changing the policy for intermittent preventive treatment with sulfadoxine-pyrimethamine during pregnancy in Malawi.

    Science.gov (United States)

    Mwendera, Chikondi A; de Jager, Christiaan; Longwe, Herbert; Phiri, Kamija; Hongoro, Charles; Mutero, Clifford M

    2017-02-20

    The growing resistance of Plasmodium falciparum to sulfadoxine-pyrimethamine (SP) treatment for uncomplicated malaria led to a recommendation by the World Health Organization for the use of artemisinin-based combination therapy. Inevitably, concerns were also raised surrounding the use of SP for intermittent prevention treatment of malaria during pregnancy (IPTp) amidst the lack of alternative drugs. Malawi was the first country to adopt intermittent prevention treatment with SP in 1993, and updated in 2013. This case study examines the policy updating process and the contribution of research and key stakeholders to this process. The findings support the development of a malaria research-to-policy framework in Malawi. Documents and evidence published from 1993 to 2012 were systematically reviewed in addition to key informant interviews. The online search identified 170 potential publications, of which eight from Malawi met the inclusion criteria. Two published studies from Malawi were instrumental in the WHO policy recommendation which in turn led to the updating of national policies. The updated policy indicates that more than two SP doses, as informed by research, overcome the challenges of the first policy of two SP doses only because of ineffectiveness by P. falciparum resistance and the global lack of replacement drugs to SP for IPTp. International WHO recommendations facilitated a smooth policy change driven by motivated local leadership with technical and financial support from development partners. Policy development and implementation should include key stakeholders and use local malaria research in a research-to-policy framework.

  20. Efficiency of combined treatment and conventional physical treatment in bilateral knee arthrosis

    Directory of Open Access Journals (Sweden)

    Samir Bojičić

    2013-04-01

    Full Text Available Introduction: Degenerative joint disease, which is standardized in Europe by the name of arthrosis or osteoarthrosis, while in the Anglo-Saxon literature is in use for a long time by the name of osteoarthritis (OA although this is not a classical inflammation,is the most common joint disease in general and the most common cause of functional damage of the musculoskeletal system. Recently, the term osteoarthritisappears more frequently in domestic literature. Arthroses are degenerative joint diseases with progressive character, also one of the most frequent diseases in orthopedics. The disease fi rst affects the articular cartilage, then the bony edges of the articular surfaces, and then the articular lining.Methods: Retrospective analysis and evaluation of data of treated patients, with the "Praxis" physical treatment during the period of time from 2000 to the end of 2010 on a sample of 79 patients,valorized the efficacy of Praxis treatment. The  correlation of these results, with valorisation of the efficacy of standard physical treatment in clinics D.Z. " Novi Grad " on a sample of 81 patients, during the period of time from 2000 to the end of 2010, a statistical analysis was performed for comparing the effi cacy of the two methods.Results: There is a functional difference after therapy of bilateral gonarthrosis in clinics D.Z. "Novi Grad" and "Praxis" with statistical reliability.Conclusion: A combined approach in the treatment of knee arthrosis has a wider range of treatment procedures, comprehensively approaches to the problem and gives better results, so we can say that this method has priority compared to the standard approach to the knee arthrosis treatment.

  1. Efficiency of combined treatment and conventional physical treatment in bilateral knee arthrosis

    Directory of Open Access Journals (Sweden)

    Samir Bojičić

    2013-04-01

    Full Text Available Introduction: Degenerative joint disease, which is standardized in Europe by the name of arthrosis or osteoarthrosis, while in the Anglo-Saxon literature is in use for a long time by the name of osteoarthritis (OA although this is not a classical inflammation,is the most common joint disease in general and the most common cause of functional damage of the musculoskeletal system. Recently, the term osteoarthritisappears more frequently in domestic literature. Arthroses are degenerative joint diseases with progressive character, also one of the most frequent diseases in orthopedics. The disease fi rst affects the articular cartilage, then the bony edges of the articular surfaces, and then the articular lining.Methods: Retrospective analysis and evaluation of data of treated patients, with the "Praxis" physical treatment during the period of time from 2000 to the end of 2010 on a sample of 79 patients,valorized the efficacy of Praxis treatment. The  correlation of these results, with valorisation of the efficacy of standard physical treatment in clinics D.Z. " Novi Grad " on a sample of 81 patients, during the period of time from 2000 to the end of 2010, a statistical analysis was performed for comparing the effi cacy of the two methods.Results: There is a functional difference after therapy of bilateral gonarthrosis in clinics D.Z. "Novi Grad" and "Praxis" with statistical reliability.Conclusion: A combined approach in the treatment of knee arthrosis has a wider range of treatment procedures, comprehensively approaches to the problem and gives better results, so we can say that this method has priority compared to the standard approach to the knee arthrosis treatment.

  2. Rationale for combination therapy as initial treatment for hypertension.

    Science.gov (United States)

    Giles, Thomas D

    2003-01-01

    Recent hypertension guidelines recommend initiating antihypertensive therapy with a combination of two or more agents in patients whose blood pressure exceeds their appropriate blood pressure goal by 20/10 mm Hg. This recommendation is based on the knowledge that the majority of patients with blood pressures of this magnitude will not achieve sufficient blood pressure reduction with monotherapy. Further, compared with high-dose monotherapy, combination therapy is often associated with fewer adverse effects and, for this reason, may improve patient adherence. Bringing patients to blood pressure goal quickly is likely to improve clinical outcomes. This article discusses the rationale for using combination antihypertensive therapy as initial therapy for high blood pressure in selected patients and reviews data from a study of 364 high-risk patients with Stage 2 hypertension in which a fixed-dose combination product (amlodipine besylate/benazepril HCl) proved more successful as initial therapy than high-dose monotherapy (amlodipine besylate) in reducing blood pressure.

  3. Olmesartan medoxomil combined with hydrochlorothiazide for the treatment of hypertension

    Directory of Open Access Journals (Sweden)

    Mark Greathouse

    2006-12-01

    Full Text Available Mark GreathouseSouth Hills Cardiology Associates of Pittsburgh, Pittsburgh, PA, USAAbstract: In most patients with hypertension, especially Stage 2 hypertension, adequate control of blood pressure (BP is only achieved with combination drug therapy. When using combination therapy, antihypertensive agents with complementary mechanisms of action are recommended, for example, an angiotensin receptor blocker (ARB in combination with hydrochlorothiazide (HCTZ, a β-blocker + HCTZ, an ACE inhibitor + HCTZ, or a calcium channel blocker + an ACE inhibitor. One such combination is olmesartan medoxomil + HCTZ, which is available as fixed-dose, single-tablet combinations for once-daily administration. In clinical trials, olmesartan medoxomil/HCTZ reduced systolic BP (SBP and diastolic BP (DBP to a greater extent than either component as monotherapy. A clinical study in patients with Stage 1 or 2 hypertension showed that olmesartan medoxomil/HCTZ achieved a similar mean reduction in DBP, but a significantly greater mean reduction in SBP and higher rate of BP control (<140/90 mmHg than observed with losartan/HCTZ, at US/European-approved starting doses. In a non-inferiority trial, the antihypertensive efficacy of olmesartan medoxomil/HCTZ was comparable to that of atenolol/HCTZ. Furthermore, indirect comparisons have shown that olmesartan medoxomil/HCTZ compares favorably with other antihypertensive combination therapies, including other ARB/HCTZ combinations and amlodipine besylate/benazepril. Olmesartan medoxomil/HCTZ is generally well tolerated. In conclusion, olmesartan medoxomil/HCTZ is an effective and well-tolerated combination antihypertensive therapy that results in significant BP reductions and BP control in many patients. Keywords: olmesartan medoxomil, hydrochlorothiazide, angiotensin II receptor blocker, hypertension

  4. The detection and treatment of Plasmodium falciparum malaria: Time for change

    Directory of Open Access Journals (Sweden)

    Nosten F

    2004-01-01

    Full Text Available In most countries where malaria is endemic, P. falciparum malaria is on the rise. This is primarily due to the spread of drug-resistant strains. Drug resistance is mediated by spontaneous changes in the parasite genome that allow resistant parasites to escape the action of the drugs. The spread of drug resistance increases the transmission of malaria parasites. The consequences for the populations at risk are profound both in terms of consequences for health and economy. In order to halt the progression of drug resistance, we need to change the way antimalarials are used. As in tuberculosis and HIV/AIDS, we must use a combination of drugs for the treatment of malaria. Taking into account the pharmacokinetic and pharmacodynamic properties of the various anti-malarial agents, artemisinin-based combination therapy (ACT seems to be the best option. This strategy should be used in conjunction with early diagnosis and appropriate vector control measures to achieve reduction in the emergence and spread of drug resistance.

  5. Combined treatment of somatostatin analogues with pegvisomant in acromegaly

    NARCIS (Netherlands)

    S.E. Franck (Sanne); A. Muhammad (Ammar); A-J. van der Lely (Aart-Jan); S.J.C.M.M. Neggers (Bas)

    2016-01-01

    textabstractTreatment of acromegaly with monotherapy long-acting somatostatin analogues (LA-SSA) as primary treatment or after neurosurgery can only achieve complete normalization of insulin-like growth factor I (IGF-I) in roughly 40 % of patients. Recently, one of the acromegaly consensus groups

  6. Combined treatment of somatostatin analogues with pegvisomant in acromegaly

    NARCIS (Netherlands)

    S.E. Franck; A. Muhammad; A-J. van der Lely (Aart-Jan); S.J.C.M.M. Neggers (Bas)

    2016-01-01

    textabstractTreatment of acromegaly with monotherapy long-acting somatostatin analogues (LA-SSA) as primary treatment or after neurosurgery can only achieve complete normalization of insulin-like growth factor I (IGF-I) in roughly 40 % of patients. Recently, one of the acromegaly consensus groups ha

  7. Combination treatment with herbal medicines and Western medicines in atopic dermatitis: Benefits and considerations.

    Science.gov (United States)

    Kim, Jung-Hoon; Kim, Hyungwoo

    2016-05-01

    Herbal medicines (HMs) are often used in combination with Western medicines (WMs) to improve therapeutic efficacies of orthodox medicines. This review discussed the current status of combination treatment with HMs and WMs in clinical practices. The influence of HMs on bioavailability of WMs was also discussed from the pharmacokinetic point of view. In addition, benefits and considerations of combination treatment were discussed using data obtained from clinical trials and randomized controlled trials of HMs treatment in skin diseases.

  8. Combining ECT and clozapine in the treatment of clozapine ...

    African Journals Online (AJOL)

    patients still remain unproven.4 To date, in terms of evidence base, clozapine ... effective clozapine augmentation treatment strategies need to be .... Thereafter the dose was titrated up by 50 mg every 2 days until .... intravenous diazepam.

  9. Orthodontic treatment combined with autotransplantation after removal of ameloblastoma.

    Science.gov (United States)

    Lim, Won Hee; Chun, Youn Sic

    2009-03-01

    This article describes the use of indirect skeletal anchorage and autotransplantation in a patient who had an ameloblastoma removed. The mandibular left second and third molars were also extracted. Autogenous bone was grafted after surgical removal of the ameloblastoma, and the mandibular right third permanent molar was transplanted into the extraction space. Orthodontic treatment included a miniscrew to bring the transplanted tooth into good occlusion. Four years after treatment, the patient continued to show good results, with no recurrence of the ameloblastoma.

  10. Free treatment, rapid malaria diagnostic tests and malaria village workers can hasten progress toward achieving the malaria related millennium development goals: the Médecins Sans Frontières experience from Chad, Sierra-Leone and Mali

    Directory of Open Access Journals (Sweden)

    Katie Tayler-Smith

    2011-02-01

    Full Text Available Halving the burden of malaria by 2015 and ensuring that 80% of people with malaria receive treatment is among the health related targets of the Millennium Development Goals (MDGs. Despite political momentum toward achieving this target, progress is slow and many with malaria (particularly in poor and rural communities in Africa are still without access to effective treatment. Finding ways to improve access to anti-malarial treatment in Africa is essential to achieve the malaria related and other MDG targets. During its work in Chad, Sierra Leone and Mali in the period 2004 to 2008, Médecins Sans Frontières showed that it was possible to significantly improve access to effective malaria treatment through: i the removal of health centre level user fees for essential healthcare for vulnerable population groups, ii the introduction of free community based treatment for children using malaria village workers to diagnose and treat simple malaria in communities where geographical and financial barriers limited access to effective malaria care, iii the improved diagnosis and treatment of malaria using rapid diagnosis tests and artemisinin based combination therapy, at both health facilities and in the community. This paper describes and discusses these strategies and their related impact.

  11. [Carcinomas of the inner canthus--combined treatment].

    Science.gov (United States)

    Gavriş, M; Gavriş, S

    1998-01-01

    It is described a therapeutical protocol which combines surgery and radiotherapy in a "particular" way for carcinomas of the medial palpebral canthus. This consist of a surgical excision of tumors without covering the denuded area after 2-3 weeks of external radiotherapy--Chaoul type.

  12. Is fixed combination therapy appropriate for initial hypertension treatment?

    Science.gov (United States)

    Elliott, William J

    2002-08-01

    Recent clinical trials in hypertension prove how seldom single drug therapy achieves target blood pressure (BP) and reduces cardiovascular morbidity and mortality. A natural response is the testing and marketing of fixed-dose combination products for hypertension, of which 14 have been approved in the United States since 1993. Currently, only five products are indicated by the Food and Drug Administration for initial therapy of hypertension; all include a diuretic. To achieve such an indication, studies must show not only safety and efficacy of the combination, but also BP lowering that is at least additive compared with the two agents given separately, as well as a "synergy" not present when each agent is given alone. Some advantages to initial combination therapy include greater BP reduction, improved adherence to pill taking, fewer side effects, and lower cost. The most likely candidates for initial combination therapy are patients with initial BP higher than 160/100 mm Hg, or those with a BP goal lower than the customary 140/90 mm Hg. These include patients with target organ damage, clinical cardiovascular disease, proteinuria, renal impairment, or diabetes mellitus. In many of these circumstances, an angiotensin converting enzyme inhibitor or angiotensin II receptor antagonist is frequently recommended; adding a diuretic or calcium antagonist to it is much more likely to result in achievement of the BP goal. More research is being done to explore the combination of not only two representatives from classes of conventional agents, but also other drugs that may help address the multiple manifestations of the "metabolic syndrome" that often accompanies hypertension.

  13. Efficacy of two artemisinin combination therapies for uncomplicated falciparum malaria in children under 5 years, Malakal, Upper Nile, Sudan

    Directory of Open Access Journals (Sweden)

    Alemu Engudaye

    2005-02-01

    Full Text Available Abstract Background The treatment for Plasmodium falciparum malaria in Sudan has been in process of change since 2003. Preceding the change, this study aimed to determine which artemisinin-based combination therapies is more effective to treat uncomplicated malaria in Malakal, Upper Nile, Sudan. Methods Clinical trial to assess the efficacy of 2 antimalarial therapies to treat P. falciparum infections in children aged 6–59 months, in a period of 42 days after treatment. Results A total of 269 children were followed up to 42 days. Artesunate plus Sulfadoxine/Pyrimethamine (AS+SP and Artesunate plus Amodiaquine (AS+AQ were both found to be efficacious in curing malaria infections by rapid elimination of parasites and clearance of fever, in preventing recrudescence and suppressing gametocytaemia. The combination of AS+SP appeared slightly more efficacious than AS+AQ, with 4.4% (4/116 versus 15% (17/113 of patients returning with malaria during the 6-week period after treatment (RR = 0.9, 95% CI 0.81–0.96. PCR analysis identified only one recrudescence which, together with one other early treatment failure, gave efficacy rates of 99.0% for AS+AQ (96/97 and 99.1% for AS+SP (112/113. However, PCR results were incomplete and assuming part of the indeterminate samples were recrudescent infections leads to an estimated efficacy ranging 97–98% for AS+SP and 88–95% for AS+AQ. Conclusion These results lead to the recommendation of ACT, and specifically AS+SP, for the treatment of uncomplicated falciparum malaria in this area of Sudan. When implemented, ACT efficacy should be monitored in sentinel sites representing different areas of the country.

  14. Efficacy and safety of Camosunate for the treatment of uncomplicated malaria in the University of Benin Teaching Hospital, Benin City, Nigeria

    Directory of Open Access Journals (Sweden)

    Damien Uyagu

    2013-10-01

    Full Text Available In Nigeria, nearly 110 million clinical cases of malaria are diagnosed per year, thus being a major public health problem. The problems of resistance resulted in the introduction of the artemisinin based combinations (ACT by the WHO. Artesunate and amodiaquine (AS+AQ is at present the world’s second most widely used ACT. This study is an assessment of the efficacy and safety of Camosunate (a brand of AS+AQ; Geneith Pharmaceutical Ltd., Oshodi, Lagos in the treatment of uncomplicated malaria conducted at the University of Benin Teaching Hospital (UBTH. A cross-sectional assessment of the efficacy and safety of Camosunate was conducted over a period of one year using 120 patients selected after stratification, by random sampling technique. All recruited patients had slide-proven uncom- plicated malaria and were followed up for 28 days on commencement of Camosunate. Data was collected using a structured interviewer- administered questionnaire and was analysed using SPSS version 15. The overall efficacy of Camosunate was found to be 95.8%. Treatment was well tolerated as testified by the fact that there was no case withdrawal due to adverse drug reaction (ADR or treatment emergent signs and symptoms (TESS. Also no evidence of toxicity was recorded. Camosunate is highly efficacious and well tolerated in this area of Nigeria and justifies its use as a first line treatment for uncomplicated malaria.

  15. A famciclovir + celecoxib combination treatment is safe and efficacious in the treatment of fibromyalgia

    Directory of Open Access Journals (Sweden)

    Pridgen WL

    2017-02-01

    Full Text Available William L Pridgen,1 Carol Duffy,2 Judy F Gendreau,3 R Michael Gendreau3 1Innovative Med Concepts, LLC, 2Department of Biological Sciences, University of Alabama, Tuscaloosa, AL, 3Gendreau Consulting, LLC, Poway, CA, USA Objective: Infections and other stressors have been implicated in the development of fibromyalgia. We hypothesized that these stressors could result in recurrent reactivations of latent herpes virus infections, which could lead to the development of fibromyalgia. This study evaluated a famciclovir + celecoxib drug combination (IMC-1, active against suspected herpes virus reactivation and infection, for the treatment of fibromyalgia.Methods: A total of 143 fibromyalgia patients were enrolled at 12 sites in a 16-week, double-blinded, placebo-controlled proof-of-concept trial. Randomized patients received either IMC-1 or placebo in a 1:1 ratio. Outcome measures included a 24-hour recall pain Numerical Rating Scale, the Revised Fibromyalgia Impact Questionnaire (FIQ-R, the Patient’s Global Impression of Change (PGIC questionnaire, the Multidimensional Fatigue Inventory, the NIH Patient-Reported Outcomes Measurement Information System (PROMIS, and the Beck Depression Inventory-II conducted at baseline and weeks 6, 12, and 16 of the study.Results: A significant decrease in fibromyalgia-related pain was observed for patients on IMC-1 treatment versus placebo. PGIC response rates were significantly improved with IMC-1 treatment. Overall, patient self-reported functioning, as measured by the FIQ-R, was significantly improved. Fatigue was also significantly improved as measured by the PROMIS fatigue inventory. The safety profile was encouraging. Despite the celecoxib component of IMC-1, gastrointestinal and nervous system treatment emergent adverse events were reported less frequently in the IMC-1 group, and study completion rates favored IMC-1 treatment.Conclusion: IMC-1 was efficacious and safe in treating symptoms of fibromyalgia

  16. Microhardness of teeth enamel on whitening combined with remineralization treatment

    Directory of Open Access Journals (Sweden)

    Gabriela Strnad

    2011-12-01

    Full Text Available The aim of this study was to evaluate the effect of different bleaching agents used for teeth whitening on the microhardness of the enamel. 35% HP and 17% CP were applied on several samples of human incisors. Different treatment strategies were followed and the results show that all of bleaching agents caused a reduction in Vickers microhardness of specimens. Remineralization treatment was applied on samples, after this process the microhardness of the teeth being restored close to initial values measured prior to whitening.

  17. Combined Periodontal, Orthodontic, and Prosthetic Treatment in an Adult Patient

    Directory of Open Access Journals (Sweden)

    Claudio Vinicius Sabatoski

    2015-01-01

    Full Text Available A 41-year-old man had a significant loss of bone and supporting tissues with pathologic migration of several teeth and several missing teeth. He was treated with an interdisciplinary therapeutic protocol that included nonsurgical periodontal therapy based on strict control of supragingival plaque, subgingival periodontal therapy, orthodontic and endodontic treatment, and replacement of restorations. The orthodontic therapy was performed in a severely reduced bone support and the presence of pathological tooth migration after periodontal disease control. The interdisciplinary treatment protocol was the key to achieve a significant improvement in his facial and dental esthetics, masticatory function, and quality of life.

  18. Treatment of B-cells non-Hodgkin lymphomas with combined immunochemotherapy: ability to treatment optimization

    Directory of Open Access Journals (Sweden)

    N. V. Smirnova

    2015-01-01

    Full Text Available The results of two consecutive multicenter clinical trials enrolled 241 patient with childhood mature B-cells non-Hodgkin lymphomas/leukemia are presented. Patients received treatment according B-NHL 2004mab protocol (n = 83 and B-NHL 2010M (n = 158 with combined immunochemotherapy (ICT in Russian and Belarus pediatric clinics from 2004 to 2015 years. Primary patients with different mature B-NHL (Burkitt lymphoma/leukemia, diffuse large B-cell lymphoma and primary mediastinal B-cell lymphoma (DLBCL and PMBCL aged from 2 to 18 years are included in the studies.Protocol B-NHL 2004mab for treatment of children and adolescents with B-NHL/B-AL, stage III and IV, includes a combination of chemotherapy (PCT and rituximab – an antibody against the B-cells receptor CD20. PCT courses similar to those in the B-NHL BFM90 protocol (group III with the exception of methotrexate dose in induction courses, reduced to 1 g/m2 /24 h in order to reduce toxicity. Rituximab (Mabthera, 375 mg/m2 /h used for the first time in the treatment of children and adolescents with B-NHL. Of the 83 patients included, clinical remission was achieved in 77 (92.8 %. With a median follow time of 51.6 months, remission continued in 23 (85.2 % patients with B-AL, in 32 (88.9 % patients with LB and 19 (95.0 % patients – with DLBCL. With median follow time of 65.2 months, event-free and overall survival was 84 ± 6 and 82 ± 8 %, respectively.Based on previous experience in order to further optimize B-NHL treatment, new protocol B-NHL 2010M with effect-adapted therapy and improvement of stratification risk group criteria was proposed. Overall survival in patients of 1st and 2nd risk groups with full implementation of diagnosis and treatment is approaching 100 %. In interim analysis of 3rd risk group patients, pOS was 88 ± 3 %. The incidence of induction death (infections, metabolic complications remains within 2.7 % (n = 4; refractory cases (n = 2; 1.3 % and relapses (n = 4; 2

  19. Combination treatment of nocturnal enuresis with desmopressin and indomethacin

    DEFF Research Database (Denmark)

    Kamperis, Konstantinos; Hagstrøm, Søren; Faerch, Mia;

    2016-01-01

    BACKGROUND: We investigated the effect of combining indomethacin and desmopressin in treating children with monosymptomatic nocturnal enuresis (MNE) and desmopressin-resistant nocturnal polyuria. METHODS: Twenty-three children with MNE, nocturnal polyuria, and partial or no response to desmopressin...... of nights with enuresis. The dissociation of antidiuretic and antienuretic effect may reflect nocturnal bladder reservoir dysfunction in children who present with normal daytime bladder function....

  20. Current concepts in combination therapy for the treatment of hypertension: combined calcium channel blockers and RAAS inhibitors

    Directory of Open Access Journals (Sweden)

    Alberto F Rubio-Guerra

    2009-11-01

    Full Text Available Alberto F Rubio-Guerra1, David Castro-Serna2, Cesar I Elizalde Barrera2, Luz M Ramos-Brizuela21Metabolic and Research Clinic, 2Internal Medicine Department, Hospital General de Ticomán SS DF, MéxicoAbstract: Recent guidelines for the management of hypertension recommend target blood pressures <140/90 mmHg in hypertensive patients, or <130/80 mmHg in subjects with diabetes, chronic kidney disease, or coronary artery disease. Despite the availability and efficacy of antihypertensive drugs, most hypertensive patients do not reach the recommended treatment targets with monotherapy, making combination therapy necessary to achieve the therapeutic goal. Combination therapy with 2 or more agents is the most effective method for achieving strict blood pressure goals. Fixed-dose combination simplifies treatment, reduces costs, and improves adherence. There are many drug choices for combination therapy, but few data are available about the efficacy and safety of some specific combinations. Combination therapy of calcium antagonists and inhibitors of the renin-angiotensin-aldosterone system (RAAS are efficacious and safe, and have been considered rational by both the JNC 7 and the 2007 European Society of Hypertension – European Society of Cardiology guidelines for the management of arterial hypertension. The aim of this review is to discuss some relevant issues about the use of combinations with calcium channel blockers and RAAS inhibitors in the treatment of hypertension.Keywords: hypertension, calcium channel blockers, renin-angiotensin-aldosterone system inhibitors, fixed-dose combination, adherence

  1. Computational dosimetry of a simulated combined standard X-Rays and BNCT treatment

    Energy Technology Data Exchange (ETDEWEB)

    Casal, M.R., E-mail: mcasal@cnea.gov.ar [Instituto de Oncologia ' Angel H. Roffo' , Universidad de Buenos Aires, Av. San Martin 5481, Bs.As. (Argentina)] [Comision Nacional de Energia Atomica, Av. General Paz 1499, San Martin, Buenos Aires (Argentina); Herrera, M.S., E-mail: mariettaherrera@gmail.com [Comision Nacional de Energia Atomica, Av. General Paz 1499, San Martin, Buenos Aires (Argentina)] [Consejo Nacional de Investigaciones Cientificas y Tecnicas (CONICET) Av. Rivadavia 191, Buenos Aires (Argentina)] [Escuela de Ciencia y Tecnologia, Universidad de General San Martin, 25 de Mayo and M. de Irigoyen, San Martin (Argentina); Gonzalez, S.J., E-mail: srgonzal@cnea.gov.ar [Comision Nacional de Energia Atomica, Av. General Paz 1499, San Martin, Buenos Aires (Argentina)] [Consejo Nacional de Investigaciones Cientificas y Tecnicas (CONICET) Av. Rivadavia 191, Buenos Aires (Argentina)

    2011-12-15

    There has been increasing interest in combining Boron Neutron Capture Therapy (BNCT) with standard radiotherapy, either concomitantly or as a BNCT treatment of a recurrent tumor that was previously irradiated with a medical electron linear accelerator (LINAC). In this work we report the simulated dosimetry of treatments combining X-rays and BNCT

  2. Clinicopathological studies on preoperative three combined treatments with hyperthermo-chemo-radiotherapy for rectal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Yoshioka, Yuji [Kyoto Prefectural Univ. of Medicine (Japan)

    1995-08-01

    To prevent local recurrence of rectal cancer postoperatively, we treated patients using preoperative hyperthermia (5-6 times), irradiation (total 30 Gy) and a 5-Fluorouracil suppository (2000-2500 mg). The subjects were 31 patients given combined preoperative treatments and 28 patients given surgery alone. The results were as follows: Histologically, therapeutic effects were recognized in 80.6% of the combined treatments group. The mean distance from the adventitia to the site of cancer infiltration was 6.44 mm in the combined treatments group and 3.35 mm in the surgery alone group. The difference between the two was significant (p<0.05). The combined treatments produced a reduced tumor infiltration into the anal side, and resulted in making a safe margin for anastomosis. The rate of local recurrence in the combined treatments group was less than that of the surgery alone group. No systematic side effects or severe complications were observed during hospitalization in the combined treatments group. The survival rate of the combined treatments group was higher than that of the surgery alone group. It was considered that combined preoperative treatments for rectal cancer is beneficial to expand indications of super low anterior resection. (author).

  3. Acupuncture combined with spinal tui na for treatment of primary dysmenorrhea in 30 cases.

    Science.gov (United States)

    Guo, Aisong; Meng, Qingyi

    2008-03-01

    To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P < 0.05). Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.

  4. Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.

  5. IMPROVED MANUFACTURING CANNED "COMPOTE CHERRY" USING COMBINED HEAT TREATMENT

    Directory of Open Access Journals (Sweden)

    A. F. Demirova

    2013-01-01

    Full Text Available The results of studies on the development of new modes of heat sterilization compote cherry using stepwise heating in a stream of hot air and hot water dushevaniem air cooled rotating container. Revealed that the modes provide commercial sterility of finished products, reducing the length of the heat treatment and the quality of the finished product. Are some of the modes of heat sterilization step of cherry compote in a stream of heated air and water dushevaniem air-cooled rotating container.

  6. Combined Cellulase and Wrinkle-free Treatment on Cotton Fabric

    Institute of Scientific and Technical Information of China (English)

    周立明; 杨国荣; 袁进华

    2001-01-01

    1,2, 3,4 - butanetetracarboxylic acid (BTCA) offers an alternative to the conventional N-methlol compounds as a crosslinking agent for cellulose textiles. Cellulase treatment is an effective method to improve the handle of the cotton fabric. Thus it is of particular interest to treat cotton fabric using cellulase and BTCA simultaneously.In this study, BTCA was applied to the cellulase pretreated cotton fabric, and softener was also used. The results show that the treated fabric does not only have good wrinkle-free property but also good handle.

  7. Effects of massage treatment combined with topical cactus and aloe on puerperal milk stasis.

    Science.gov (United States)

    Meng, Shan; Deng, Qingchun; Feng, Chunyu; Pan, Yinglian; Chang, Qing

    2015-01-01

    Puerperal milk stasis is one of the most common puerperal complication that directly affects breastfeeding. Massage treatment with topical cactus and aloe for puerperal milk stasis might be a superior treatment, and it does not affect breastfeeding. The intervention group was treated with massages with cactus and aloe cold compresses, and the control group was treated with massage treatment or cactus and aloe cold compresses alone. We evaluated the efficacies of the treatments through comparisons of the feeding patterns, hardness, and pain after treatment between the three groups. We found that breastfeeding rates were significantly increased in the massage combine with combined with cactus and aloe cold compress group (P massage combine with combined with cactus and aloe cold compress group than in the massage or cold compress group (P Massage treatment with topical cactus and aloe topical effectively improved the pain status, hard lump of puerperal milk stasis and increase breastfeeding rate.

  8. Combination therapy for early rheumatoid arthritis: a treatment holiday perspective.

    Science.gov (United States)

    Hirata, Shintaro; Tanaka, Yoshiya

    2015-01-01

    To date, the significance of early intervention with methotrexate and biological disease-modifying anti-rheumatic drugs for rheumatoid arthritis (RA) has not been realized. Longitudinal safety and cost have arisen as new concerns. The concept of a treatment holiday, drug discontinuation after achieving remission, may solve these problems. The authors performed a systematic literature review and identified 13 reports from 10 studies (TNF20, BeSt, OPITMA, HIT-HARD, IMPROVED, PRIZE, IDEA, EMPIRE, tREACH and AVERT) for early RA (≤2 years). Eight out of 13 reports (61.5%) were published in 2013 or 2014, indicating emerging interest in recent years. Also, the authors performed a sub-analysis of the HONOR study (n = 51) to compare early (≤2 years) and established RA. The proportions of remission (REM) and low disease activity were higher in early RA (REM: 63.0 vs 33.3%, p = 0.0346; low disease activity: 77.8 vs 45.8%, p = 0.0185). In conclusion, early intervention is beneficial for successful treatment holiday, which may lead to risk and cost reduction. However, further investigation is required.

  9. Comparison of combined application treatment with one-visit varnish treatments in an orthodontic population

    Science.gov (United States)

    Tuzuner, Tamer; Ozel, Mehmet B.; Bostanoglu, Ozge

    2013-01-01

    Objective: To evaluate the effect of chlorhexidine-thymol varnish alone, its combination with chlorhexidine-fluoride containing dentifrice and fluoride varnish on oral hygiene and caries prevention in orthodontic patients. Study design: Sixty patients, aged 12-18, with orthodontic fixed appliances were randomly assigned into three groups as follows: Group 1 (n=20): 1% chlorhexidine and 1% thymol varnish (Cervitec®Plus); Group 2 (n=20): Cervitec®Plus+ 0.2% chlorhexidine and 0.2% sodium fluoride (900 ppm fluoride) (Cervitec®Gel)); and Group 3 (n=20): 0.1% fluoride varnish (Fluor Protector®). Mutans streptococci (MS), lactobacilli (LB) levels, buffering capacity (BC), visible plaque index (VPI), and gingival bleeding index (GBI) scores were evaluated at four stages: T0, before orthodontic bonding; T1, one week after orthodontic bonding; T2, one week; and T3, four weeks after the first application, respectively. Inter and intra group comparisons were made by the Kruskal-Wallis, Mann-Whitney U, Friedman and Wilcoxon Signed-Rank tests with Bonferroni step-down correction (P0.017) were found in Group1-2 compared with T0. Significantly lower LB levels were recorded in Group 2 at T2 compared with T0 (P0.017). Conclusions: Addition of Cervitec®Plus+Cervitec®Gel combination to the standard oral hygiene regimen may be beneficial for orthodontic patients for maintaining oral health by reducing bacterial colonisation and gingivitis. Key words:Chlorhexidine, flouride, mutans streptococci, lactobacilli, antibacterial effect, plaque, gingivitis, orthodontic treatment. PMID:23385499

  10. EFFECT OF ICE BAG, DYNAMIC STRETCHING AND COMBINED TREATMENTS ON THE PREVENTION AND TREATMENT OF DELAY ONSET MUSCLE SORENESS

    OpenAIRE

    Warin Krityakiarana; Jariya Budworn; Chatchawan Khajohnanan; Nutchanad Suramas; Watcharaporn Puritasang

    2014-01-01

    Objective: To investigate the effects of ice bag, dynamic stretching, combined ice and dynamic stretching, and control (non-treated) on the prevention and treatment of delayed onset muscle soreness (DOMS) in biceps muscle. Subjects: Fifty-five participants (aged 18 to 25 years) were engaged in this study and randomly assigned into four groups (control group (non-treated) (CG), n = 13; ice bag, n = 14; dynamic stretching, n = 14; and combined treatment, n = 14). Method: Before inducing D...

  11. Radiotherapy combined with surgery as treatment for advanced cervical cancer

    Energy Technology Data Exchange (ETDEWEB)

    Perches, R.D.; Lobaton, A.T.; Garcia, M.C.

    1983-12-01

    Experience obtained in a group of 44 patients with advanced cervical cancer is reported. In this study, patients with residual cancer underwent laparotomy eight weeks after one or two different radiotherapy protocols. Sixty-eight percent of patients underwent radical surgery, 85% of patients pelvic exenterations, and 15% radical hysterectomies. In 27% of patients, no evidence of residual cancer was found in surgical specimens. Radical surgery was well tolerated, and one-third of patients were free of disease for one year or more. Control of disease was obtained in 50% of pelvic extenterations and in 60% of radical hysterectomies, regardless of prognosis, clinical stage or radiotherapy scheme. Although results show an improvement of up to 22% when comparing this to other more conventional treatments, it has been concluded that a wider experience in order to support the findings must be obtained.

  12. Radiotherapy combined with surgery as treatment for advanced cervical cancer

    Energy Technology Data Exchange (ETDEWEB)

    Perches, R.D.; Lobaton, A.T.; Garcia, M.C.

    1983-12-01

    Experience obtained in a group of 44 patients with advanced cervical cancer is reported. In this study, patients with residual cancer underwent laparotomy eight weeks after one or two different radiotherapy protocols. Sixty-eight percent of patients underwent radical surgery, 85% of patients pelvic exenterations, and 15% radical hysterectomies. In 27% of patients, no evidence of residual cancer was found in surgical specimens. Radical surgery was well tolerated, and one-third of patients were free of disease for one year or more. Control of disease was obtained in 50% of pelvic extenterations and in 60% of radical hysterectomies, regardless of prognosis, clinical stage or radiotherapy scheme. Although results show an improvement of up to 22% when comparing this to other more conventional treatments, it has been concluded that we must obtain a wider experience in order to support the findingsmust be obtained.

  13. Radiotherapy combined with surgery as treatment for advanced cervical cancer.

    Science.gov (United States)

    Perches, R D; Lobaton, A T; Garcia, M C

    1983-12-01

    Experience obtained in a group of 44 patients with advanced cervical cancer is reported here. In this study, patients with residual cancer underwent laparotomy eight weeks after one or two different radiotherapy protocols. Sixty-eight percent of patients underwent radical surgery, 85% of patients pelvic exenterations, and 15% radical hysterectomies. In 27% of patients, no evidence of residual cancer was found in surgical specimens. Radical surgery was well tolerated, and one-third of patients were free of disease for one year or more. Control of disease was obtained in 50% of pelvic exenterations and in 60% of radical hysterectomies, regardless of prognosis, clinical stage or radiotherapy scheme. Although results show an improvement of up to 22% when comparing this to other more conventional treatments, we have concluded that we must obtain a wider experience in order to support our findings.

  14. Peripheral Edema Occurring during Treatment with Risperidone Combined with Citalopram

    Directory of Open Access Journals (Sweden)

    Seyed Hamzeh Hosseini

    2012-01-01

    Full Text Available An 80-year-old female presented with symptoms of depression, worthlessness, hopelessness, loss of energy, insomnia, impatience, and forgetfulness associated with persecutory delusion that had begun about one year before her visit. She was diagnosed with major depression with psychotic signs and began treatment with risperidone (2 mg/night and citalopram (20 mg/day. After 20 days, she returned and reported partial improvement in her symptoms, although she had developed severe swelling of the hands and feet. The results of liver and renal function tests and rheumatologic tests were found to be within normal limits. Risperidone was discontinued for a week, and the swelling resolved completely. Risperidone was then administered again, and the swelling returned so that the patient had to discontinue taking the drug. The reappearance of edema on rechallenge is strong evidence implicating risperidone as the cause of the swelling.

  15. Pitavastatin approved for treatment of primary hypercholesterolemia and combined dyslipidemia

    Directory of Open Access Journals (Sweden)

    Jun Sasaki

    2010-11-01

    Full Text Available Jun SasakiPharmaceutical Medicine, International University of Health and Welfare Graduate School, Fukuoka, JapanAbstract: Pitavastatin was first developed in Japan and is expanding the regions in which it is clinically available. A considerable number of clinical studies have been conducted and published to date on the usefulness of pitavastatin for patients with primary hypercholesterolemia or combined dyslipidemia. Pitavastatin demonstrates potent low-density lipoprotein cholesterol reduction at low doses of 1–4 mg/day. It also affects the regression of coronary plaques, as observed in intravascular ultrasound-guided percutaneous coronary intervention studies. Moreover, the persistent, long-term high-density lipoprotein cholesterol elevation observed in the populations treated with pitavastatin is worthy of further attention. The reported improvements in lipid profiles are consistent among the studies conducted in Japan, Korea, Thailand, and Europe. In light of accumulating clinical experience worldwide, pitavastatin is now expected to establish its position for preventing and treating cardiovascular disease.Keywords: randomized clinical trial, Japan, Korea, Thailand, Europe

  16. Treatment of hirsutism with combined pill containing drospirenone.

    Science.gov (United States)

    Gregoriou, Odisseas; Papadias, Kostantinos; Konidaris, Sokratis; Bakalianou, Kostantina; Salakos, Nikolaos; Vrachnis, Nikolaos; Creatsas, George

    2008-04-01

    The aim of the present study was to evaluate the biochemical and clinical effects of the combined pill consisting of ethinyl estradiol (EE) and drospirenone (DRSP) in hirsute patients. Fifty-two adolescents or young women from Greece were treated with 30 mug EE and 3 mg DRSP for 1 year. Hirsutism was evaluated by the Ferriman-Gallway (FG) score in the initial visit and at 3, 6 and 12 months. Follicle-stimulating hormone, luteinizing hormone, etradiol, free and total testosterone (T), sex hormone-binding globulin (SHBG), androstenedione and dehydroepiandrosterone sulfate were determined at the same intervals. Hirsutism improved and FG scores reduced to 77.4%, 67.2% and 51.8% at 3, 6 and 12 months, respectively. Plasma SHBG levels rose, while free and total T levels reduced from the third month onwards. In conclusion, the EE/DRSP pill improves hirsutism in women via antiandrogenic and antimineralocorticoid action. The biochemical manifestations of hyperandrogenism are also improved.

  17. [Treatment outcomes of colon cancer surgery combined with radical lymphadenectomy].

    Science.gov (United States)

    Lipská, L; Visokai, V; Mrácek, M; Levý, M

    2008-05-01

    The authors analyzed a group of 1281 subjects with colorectal cancer operated and followed up in a single institution from I/1992 to VIII/2007. Colon carcinoma patients were assessed separately (C18). Patients with rectal and rectosigmoid tumors are not included in the presentation. A total of 846 patients were operated for colon carcinomas. In 546 subjects, radical R0 resections were achieved. In the R0 group, the male/female ratio is 315/231, age 29-94 years, the mean age of 69 years. The R0 group stratification by TNM classification was: I 17.8%, II 49.6%, III 24.0%, IV 8.1%, TNMx 0.5%. Irrespective of the TNM staging, three-year, five-year and ten-year survival rates were 80%, 71%, and 51%, resp. The median survival time was 9.85 years. Postoperative morality was 5.5%, morbidity 29.8%, anastomic leak occured in 5.7%. Systematic lymph node dissection up to the apical level, had been gradually introduced as an integral part of the R0 surgery. The aim of the study is to analyze outcomes of the colon carcinoma surgical management, combined with radical lymphadenectomy. Furthermore, effects of the extensive procedure on the postoperative morbidity and moratility rates are analyzed as well.

  18. Novel combination treatments targeting chronic myeloid leukemia stem cells.

    Science.gov (United States)

    Al Baghdadi, Tareq; Abonour, Rafat; Boswell, H Scott

    2012-04-01

    Chronic myeloid leukemia (CML) is currently considered incurable in most patients. Stem cell transplantation, an accepted curative option for which extensive experience has been gained, is limited by high morbidity and mortality rates, particularly in older patients. Tyrosine kinase inhibitors targeting BCR-ABL are widely used and induce remission in a high proportion of patients, but resistance and incomplete response to these agents portends eventual relapse and disease progression. Although BCR-ABL inhibitors eradicate most CML cells, they are largely ineffective against the reservoir of quiescent leukemic stem cells (LSCs). Thus a strong medical need exists for therapies that effectively eradicate LSCs and is currently a focus of extensive research. To date, evidence obtained from in vitro studies, animal models, and clinical CML specimens suggests that an effective approach may be to partner existing BCR-ABL inhibitors with compounds targeting key stem cell molecular effectors, including Wnt/β-catenin, hedgehog pathway components, histone deacetylase (HDAC), transforming growth factor-β (TGF-β), Janus kinase 2, promyelocytic leukemia protein, and arachidonate 5-lipoxygenase (ALOX5). Novel combinations may sensitize LSCs to BCR-ABL inhibitors, thereby overcoming resistance and creating the possibility of improving disease outcome beyond the current standard of care. Copyright © 2012. Published by Elsevier Inc.

  19. A combined electrocoagulation-electrooxidation treatment for industrial wastewater.

    Science.gov (United States)

    Linares-Hernández, Ivonne; Barrera-Díaz, Carlos; Bilyeu, Bryan; Juárez-GarcíaRojas, Pablo; Campos-Medina, Eduardo

    2010-03-15

    This study addresses the elimination of persistent organic compounds in industrial wastewater using a synergistic combination of electrocoagulation and electrooxidation. Electrocoagulation is a relatively quick process (30 min), which is very effective in removing colloidal and suspended particles, as seen in changes in coliforms, turbidity, and color and in the general absorbance by UV-vis spectroscopy. However, it is relatively ineffective in eliminating stable persistent organic compounds--in this work, only half of the COD was eliminated from wastewater and an oxidation peak in the cyclic voltammetry scan remained. Electrooxidation is very effective in breaking down organic compounds through oxidation as reflected in the elimination of COD, BOD(5), and oxidative peak in cyclic voltammetry, but requires so much time (21 h) that it has very limited practicality, especially when colloidal and suspended particles are present. Electrooxidative mineralization of electrocoagulated wastewater, in which most of the colloids and charged species have been removed, takes less than 2h. In the coupled technique, electrocoagulation quickly coagulates and removes the colloidal and suspended particles, as well as many charged species, then electrooxidation oxidizes the remaining organics. The coupled process eliminates COD, BOD(5), color, turbidity, and coliforms in a practical amount of time (2h).

  20. Experimental Study of Advanced Treatment of Coking Wastewater Using MBR-RO Combined Process

    Science.gov (United States)

    Zhang, Lei; Hwang, Jiannyang; Leng, Ting; Xue, Gaifeng; Chang, Hongbing

    A membrane bioreactor-reverse osmosis (MBR-RO) combined process was used for advanced treatment of coking wastewater from secondary biological treatment. MBR and RO units' treatment efficiency for the pollution removal were conducted, and effects of raw water conductivity and trans-membrane pressure on water yield and desalination rate in RO unit were investigated in detail. The experimental results proved that MBR-RO combined process ran steadily with good treatment effect, which could obtain stable effluent water quality and met the requirement of "Design Criterion of the Industrial Circulating Cooling Water Treatment" (GB 50050-2007).

  1. Evaluation of a Combined Treatment Approach for Childhood Apraxia of Speech

    Science.gov (United States)

    Iuzzini, Jenya; Forrest, Karen

    2010-01-01

    The current study investigated the impact of a dual treatment approach that included stimulability training protocol (STP) paired with a modified core vocabulary treatment (mCVT) on the speech sounds produced by children with CAS. The combined treatment was assessed for changes in consistency and expansion of the phonetic inventories of four…

  2. Evaluation of a Combined Treatment Approach for Childhood Apraxia of Speech

    Science.gov (United States)

    Iuzzini, Jenya; Forrest, Karen

    2010-01-01

    The current study investigated the impact of a dual treatment approach that included stimulability training protocol (STP) paired with a modified core vocabulary treatment (mCVT) on the speech sounds produced by children with CAS. The combined treatment was assessed for changes in consistency and expansion of the phonetic inventories of four…

  3. Combined surgical and medical treatment of giant prolactinoma: case report

    Directory of Open Access Journals (Sweden)

    Rădoi Mugurel

    2016-06-01

    Full Text Available The operative management of giant pituitary prolactinoma represents a significant challenge for neurosurgeons, due to the degree of local tumor infiltration into adjacent structures such as cavernous sinus. The degree of parasellar tumor extension can be classified according to the Knosp grading system’ while suprasellar extension is qualified in accordance with the modified Hardys classification system. This report describes the case of a male patient with a giant pituitary prolactinoma in which a partial tumor resection via a subfrontal approach was achieved. Typically, resection rates of less than 50% have been reported following surgery on giant pituitary adenomas. Prolactin levels were very high, consistent with invasive giant prolactinoma. Our patient was treated with Cabergoline which eventually normalized the prolactin level and significantly reduced the size of the residual tumor. This case serves to illustrate that in the presence of significant suprasellar and parasellar extension, multi-modal treatment strategies with surgery and dopamine agonist, is the gold standard in the management of locally aggressive pituitary prolactinomas.

  4. A new sensitizer DVDMS combined with multiple focused ultrasound treatments: an effective antitumor strategy

    Science.gov (United States)

    Xiong, Wenli; Wang, Pan; Hu, Jianmin; Jia, Yali; Wu, Lijie; Chen, Xiyang; Liu, Quanhong; Wang, Xiaobing

    2015-12-01

    Sonodynamic therapy (SDT) was developed as a promising noninvasive approach. The present study investigated the antitumor effect of a new sensitizer (sinoporphyrin sodium, referred to as DVDMS) combined with multiple ultrasound treatments on sarcoma 180 both in vitro and in vivo. The combined treatment significantly suppressed cell viability, potentiated apoptosis, and markedly inhibited angiogenesis in vivo. In vivo, the tumor weight inhibition ratio reached 89.82% fifteen days after three sonication treatments plus DVDMS. This effect was stronger than one ultrasound alone (32.56%) and than one round of sonication plus DVDMS (59.33%). DVDMS combined with multiple focused ultrasound treatments initiated tumor tissue destruction, induced cancer cell apoptosis, inhibited tumor angiogenesis, suppressed cancer cell proliferation, and decreased VEGF and PCNA expression levels. Moreover, the treatment did not show obvious signs of side effects or induce a drop in body weight. These results indicated that DVDMS combined with multiple focused ultrasounds may be a promising strategy against solid tumor.

  5. Successful treatment of a large oral verrucous hyperplasia with photodynamic therapy combined with cryotherapy

    Directory of Open Access Journals (Sweden)

    Yu-Chao Chang

    2013-03-01

    Full Text Available Studies have shown that topical 5-aminolevulinic acid-mediated photodynamic therapy (ALA-PDT can be used successfully for the treatment of oral verrucous hyperplasia (OVH. Studies have also demonstrated that cryotherapy could be used as a treatment modality for OVH lesions. In this case report, we tested the efficacy of topical ALA-PDT, combined with cryogun cryotherapy, for an extensive OVH lesion on the right buccal mucosa of a 65-year-old male areca quid chewer. The tumor was cleared after six treatments of combined topical ALA-PDT and cryogun cryotherapy. No recurrence of the lesion was found after a follow-up period of 18 months. We suggest that our combined treatment protocol may be effective in treating OVH lesions. The treatment course may be slightly shortened with this combined protocol and was well tolerated by the patient.

  6. Initial evidence of reduction of malaria cases and deaths in Rwanda and Ethiopia due to rapid scale-up of malaria prevention and treatment

    Science.gov (United States)

    Otten, Mac; Aregawi, Maru; Were, Wilson; Karema, Corine; Medin, Ambachew; Bekele, Worku; Jima, Daddi; Gausi, Khoti; Komatsu, Ryuichi; Korenromp, Eline; Low-Beer, Daniel; Grabowsky, Mark

    2009-01-01

    Background An increasing number of malaria-endemic African countries are rapidly scaling up malaria prevention and treatment. To have an initial estimate of the impact of these efforts, time trends in health facility records were evaluated in selected districts in Ethiopia and Rwanda, where long-lasting insecticidal nets (LLIN) and artemisinin-based combination therapy (ACT) had been distributed nationwide by 2007. Methods In Ethiopia, a stratified convenience sample covered four major regions where (moderately) endemic malaria occurs. In Rwanda, two districts were sampled in all five provinces, with one rural health centre and one rural hospital selected in each district. The main impact indicator was percentage change in number of in-patient malaria cases and deaths in children < 5 years old prior to (2001–2005/6) and after (2007) nationwide implementation of LLIN and ACT. Results In-patient malaria cases and deaths in children < 5 years old in Rwanda fell by 55% and 67%, respectively, and in Ethiopia by 73% and 62%. Over this same time period, non-malaria cases and deaths generally remained stable or increased. Conclusion Initial evidence indicated that the combination of mass distribution of LLIN to all children < 5 years or all households and nationwide distribution of ACT in the public sector was associated with substantial declines of in-patient malaria cases and deaths in Rwanda and Ethiopia. Clinic-based data was a useful tool for local monitoring of the impact of malaria programmes. PMID:19144183

  7. Apoptosis induced by piroxicam plus cisplatin combined treatment is triggered by p21 in mesothelioma.

    Directory of Open Access Journals (Sweden)

    Alfonso Baldi

    Full Text Available BACKGROUND: Malignant mesothelioma (MM is a rare, highly aggressive tumor, associated to asbestos exposure. To date no chemotherapy regimen for MM has proven to be definitively curative, and new therapies for MM treatment need to be developed. We have previously shown in vivo that piroxicam/cisplatin combined treatment in MM, specifically acts on cell cycle regulation triggering apoptosis, with survival increase. METHODOLOGY/PRINCIPAL FINDINGS: We analyzed, at molecular level, the apoptotic increase caused by piroxicam/cisplatin treatment in MM cell lines. By means of genome wide analyses, we analyzed transcriptional gene deregulation both after the single piroxicam or cisplatin and the combined treatment. Here we show that apoptotic increase following combined treatment is mediated by p21, since apoptotic increase in piroxicam/cisplatin combined treatment is abolished upon p21 silencing. CONCLUSIONS/SIGNIFICANCE: Piroxicam/cisplatin combined treatment determines an apoptosis increase in MM cells, which is dependent on the p21 expression. The results provided suggest that piroxicam/cisplatin combination might be tested in clinical settings in tumor specimens that express p21.

  8. Treatment of steroid dependant cases of recurrent lepra reaction with a combination of thalidomide and clofazimine.

    Science.gov (United States)

    Ramu, G; Girdhar, A

    1979-10-01

    22 Adult Male Lepromatous patients suffering from recurrent lepra reaction have been allotted to either a regimen of combined treatment with Clofazimine and Thalidomide alone. The initial dosage of either of the drugs was 300 mg daily administered in divided doses of 100 mg three times a day. The preliminary assessment of the ongoing study, indicates that the combined treatment controls the reactional state more rapidly than monotherapy with Thalidomide alone. Results of treatment as regards relief of neuritis and arthritis are particularly gratifying. Four month.ases relapsed into reactional status from 2 days to 15 days. 5 cases on the combined therapy relapsed from one to three months. Three other cases required six months and three cases 8 months treatment before clofazimine could be withdrawn. It would appear that a maintenance therapy of 6 months with flofazimine would be necessary for maintaining the control of reactional episodes while employing this combined therapy.

  9. Combination of Acupuncture with Medication for Treatment of Hyperplasia of Mammary Glands in 46 Cases

    Institute of Scientific and Technical Information of China (English)

    YU Guo-hua; ZOU Lai-yong; LIU Jian-guo; DUAN Shu-min

    2010-01-01

    @@ Hyperplasia of mammary glands is a common disease of the breast in women.The following is a clinical report on treatment of the disease by combination of acupuncture with medication in 46 cases from February 2007 to October 2008.

  10. Experience of Acute Respiratory Infections Treatment in Children with Combination Drug Askoril

    Directory of Open Access Journals (Sweden)

    S.A. Kramarev

    2015-08-01

    Full Text Available Respiratory diseases are mostly accompanied by changes of mucociliary clearance. The paper presents the possibility of using combination preparation with different points of application for the treatment of tracheobronchial drainage disturbances in respiratory diseases in children.

  11. Treatment of patients with refractory chronic lymphocytic leukemia with alemtuzumab, alone or in combination with fludarabine

    Directory of Open Access Journals (Sweden)

    E. V. Kataeva

    2014-07-01

    Full Text Available In present study the immediate and long-term therapy results of 14 patients with refractory chronic lymphocytic leukemia (CLL are analyzed. Treatment program included alemtuzumab alone or in combination with fludarabine.

  12. Treatment of patients with refractory chronic lymphocytic leukemia with alemtuzumab, alone or in combination with fludarabine

    Directory of Open Access Journals (Sweden)

    E. V. Kataeva

    2011-01-01

    Full Text Available In present study the immediate and long-term therapy results of 14 patients with refractory chronic lymphocytic leukemia (CLL are analyzed. Treatment program included alemtuzumab alone or in combination with fludarabine.

  13. Gametocyte carriage in uncomplicated Plasmodium falciparum malaria following treatment with artemisinin combination therapy

    DEFF Research Database (Denmark)

    Abdulla, Salim; Achan, Jane; Adam, Ishag

    2016-01-01

    Background: Gametocytes are responsible for transmission of malaria from human to mosquito. Artemisinin combination therapy (ACT) reduces post-treatment gametocyte carriage, dependent upon host, parasite and pharmacodynamic factors. The gametocytocidal properties of antimalarial drugs are importa...

  14. Combination of nerve blockade and intravenous alfentanil is better than single treatment in relieving postoperative pain

    Directory of Open Access Journals (Sweden)

    Yeong-Ray Wen

    2012-02-01

    Conclusion: Our results indicated that in an incisional pain model, multimodal analgesia is superior to single or no pretreatment; however, the combination of multimodal analgesic treatments should be individually discerned depending on nociceptive types and analgesic mechanisms.

  15. Chloroquine resistant Plasmodium falciparum malaria in Osogbo Nigeria: efficacy of amodiaquine + sulfadoxine-pyrimethamine and chloroquine + chlorpheniramine for treatment

    Directory of Open Access Journals (Sweden)

    TO Ogungbamigbe

    2008-02-01

    Full Text Available Chloroquine (CQ resistance in Plasmodium falciparum contributes to increasing malaria-attributable morbidity and mortality in Sub-Saharan Africa. Despite a change in drug policy, continued prescription of CQ did not abate. Therefore the therapeutic efficacy of CQ in uncomplicated falciparum malaria patients was assessed in a standard 28-day protocol in 116 children aged between six and 120 months in Osogbo, Southwest Nigeria. Parasitological and clinical assessments of response to treatment showed that 72 (62.1% of the patients were cured and 44 (37.9% failed the CQ treatment. High initial parasite density and young age were independent predictors for early treatment failure. Out of the 44 patients that failed CQ, 24 received amodiaquine + sulphadoxine/pyrimethamine (AQ+SP and 20 received chlorpheniramine + chloroquine (CH+CQ combinations. Mean fever clearance time in those treated with AQ+SP was not significantly different from those treated with CH+CQ (p = 0.05. There was no significant difference in the mean parasite density of the two groups. The cure rate for AQ+SP group was 92% while those of CH+CQ was 85%. There was a significant difference in parasite clearance time (p = 0.01 between the two groups. The 38% treatment failure for CQ reported in this study is higher than the 10% recommended by World Health Organization in other to effect change in antimalarial treatment policy. Hence we conclude that CQ can no more be solely relied upon for the treatment of falciparum malaria in Osogbo, Nigeria. AQ+SP and CH+CQ are effective in the treatment of acute uncomplicated malaria and may be considered as useful alternative drugs in the absence of artemisinin-based combination therapies.

  16. Mechanism of action of recombinant interleukin-2 combined with allicin in treatment of pancreatic cancer

    Directory of Open Access Journals (Sweden)

    ZHU Lining

    2016-10-01

    Full Text Available Objective To investigate the effect of recombinant interleukin-2 (rIL-2 combined with allicin in the treatment of pancreatic cancer and related mechanisms. Methods A nude mouse xenograft model was established. A total of 60 nude mice were randomized into control group, rIL-2 treatment group, allicin treatment group, and combined treatment group. At 4 weeks after treatment, peripheral blood was collected, tumor volume, tumor weight, and survival time were recorded, and survival rates were calculated. Flow cytometry was used to analyze the apoptosis of tumor cells and measure the percentages of CD4+ T, CD8+ T, and natural killer (NK cells, ELISA was used to measure the level of interferonγ (IFNγ, and Western blot was used to measure the expression of Bcl-2 protein in tumor tissue. An analysis of variance was used for comparison of continuous data between groups, and SNK-q test was used for further comparison between any two groups. Results At 4 weeks after treatment, the rIL-2 treatment group, allicin treatment group, and combined treatment group showed significant reductions in tumor volume compared with the control group (all P<0.05, and the combined treatment group showed the greatest reduction (P<0.01. The combined treatment group had a tumor inhibition rate of 90.5% and a prolonged survival time (60% of the mice survived at 55 days. Compared with the control group, the combined treatment group showed significant increases in the apoptosis rate of tumor cells (23.3%±4.3% vs 9.0%±3.7%, P<0.05 and the expression of pro-apoptotic protein Bcl-2. The treatment groups showed significant increases in the percentages of CD4+ T, CD8+ T, and NK cells compared with the control group (F=23.74, 26.38, and 19.72, all P<0.001. Compared with the other three groups, the combined treatment group showed a significant increase in the IFNγ level (F=9.84, P=0.026. Conclusion Combined treatment with allicin and rIL-2 can enhance the innate immunity and

  17. Hardening of the surface layers of commercial pure titanium VT1-0 under combined treatment

    Science.gov (United States)

    Bashchenko, Lyudmila P.; Gromov, Viktor E.; Budovskikh, Evgenii A.; Ivanov, Yurii F.; Soskova, Nina A.

    2015-10-01

    The treatment of VT1-0 titanium samples was carried out by concentrated energy fluxes. The combined treatment included surface carburizing with the joint use of powder samples of compounds with high physical and mechanical properties (namely, titanium diboride TiB2, silicon carbide SiC and zirconium oxide ZrO2) and subsequent electron beam treatment of surface layers formed in electroexplosive treatment. The combined treatment of surface layers resulted in the multifold increase in microhardness, which reduces depending on the depth of hardening zone. After electron-beam treatment, the depth of hardening zone is increased. During electron-beam treatment, the two-layer hardening zone forms.

  18. Hardening of the surface layers of commercial pure titanium VT1-0 under combined treatment

    Energy Technology Data Exchange (ETDEWEB)

    Bashchenko, Lyudmila P., E-mail: luda.baschenko@gmail.com; Gromov, Viktor E., E-mail: gromov@physics.sibsiu.ru; Budovskikh, Evgenii A., E-mail: budovskih-ea@physics.sibsiu.ru; Soskova, Nina A., E-mail: gromov@physics.sibsiu.ru [Siberian State Industrial University, Novokuznetsk, 654007 (Russian Federation); Ivanov, Yurii F., E-mail: yufi55@mail.ru [Institute of High Current Electronics SB RAS, Tomsk, 634055 (Russian Federation); National Research Tomsk State University, Tomsk, 634050 (Russian Federation)

    2015-10-27

    The treatment of VT1-0 titanium samples was carried out by concentrated energy fluxes. The combined treatment included surface carburizing with the joint use of powder samples of compounds with high physical and mechanical properties (namely, titanium diboride TiB{sub 2}, silicon carbide SiC and zirconium oxide ZrO{sub 2}) and subsequent electron beam treatment of surface layers formed in electroexplosive treatment. The combined treatment of surface layers resulted in the multifold increase in microhardness, which reduces depending on the depth of hardening zone. After electron-beam treatment, the depth of hardening zone is increased. During electron-beam treatment, the two-layer hardening zone forms.

  19. Older adults' acceptance of psychological, pharmacological, and combination treatments for geriatric depression.

    Science.gov (United States)

    Hanson, Ashley E; Scogin, Forrest

    2008-07-01

    We examined older adults' ratings of the acceptability of geriatric depression treatments. We presented 120 community-dwelling participants with vignettes describing an older adult experiencing either mild to moderate or severe depression. Participants rated the acceptability of three different treatments: cognitive therapy (CT), antidepressant medication (AM), and a combination treatment of CT and AM (COM). For general acceptability, participants rated COM as a more acceptable treatment for depression than both CT and AM. With respect to perceived negative aspects of treatments, they rated CT as a more acceptable treatment for mild to moderate depression than both AM and COM. Participants rated both COM and CT as more acceptable treatments for severe depression than AM. Results indicate that combining psychotherapy and AM may be viewed as most acceptable by community-dwelling, nondepressed older adults.

  20. Local constraints to access appropriate malaria treatment in the context of parasite resistance in Cambodia: a qualitative study.

    Science.gov (United States)

    Verschuere, Jesse; Decroo, Tom; Lim, Dara; Kindermans, Jean-Marie; Nguon, Chea; Huy, Rekol; Alkourdi, Yasmine; Peeters Grietens, Koen; Gryseels, Charlotte

    2017-02-17

    Despite emerging drug resistance in Cambodia, artemisinin-based combination therapy (ACT) is still the most efficacious therapy. ACT is available free of charge in the Cambodian public sector and at a subsidized rate in the private sector. However, un- and mistreated cases in combination with population movements may lead to the further spread of resistant parasites, stressing the importance of understanding how the perceived aetiology of malaria and associated health-seeking behaviour may delay access to appropriate treatment. A qualitative study explored these factors after an epidemiological survey confirmed parasite resistance in Preah Vihear province. In Cambodian cosmology, illnesses can be inflicted by supernatural beings or originate from 'natural' causes because of disorder in the social, domestic or outdoor environment. Initial treatment options consist of cheap and accessible home-based care (manual therapy, herbs and biomedical medication) targeting single symptoms. If there is no steady recovery or if the condition quickly aggravates, care will be sought from 'village doctors', public health facilities, private pharmacies or, in case of suspicion of a supernatural cause, from a specialized indigenous healer. The choice of provider is mostly based on the family's financial situation, access to and trust in the provider, and the congruence between the suspected aetiology of the illness and the treatment offered by the provider. Different treatment options are often combined during the same illness episode through a serial process of trial and error guided by the observable improvements in the patient's condition. Cambodian perceptions of illness that focus on single symptoms and their perceived severity may lead to the identification of one or multiple illnesses at the same time, rarely suspecting malaria from the start and implying different patterns of health seeking behaviour and treatment choice. However, decisions to self-diagnose and treat at home

  1. EFFECT OF ICE BAG, DYNAMIC STRETCHING AND COMBINED TREATMENTS ON THE PREVENTION AND TREATMENT OF DELAY ONSET MUSCLE SORENESS

    Directory of Open Access Journals (Sweden)

    Warin Krityakiarana

    2014-12-01

    Full Text Available Objective: To investigate the effects of ice bag, dynamic stretching, combined ice and dynamic stretching, and control (non-treated on the prevention and treatment of delayed onset muscle soreness (DOMS in biceps muscle. Subjects: Fifty-five participants (aged 18 to 25 years were engaged in this study and randomly assigned into four groups (control group (non-treated (CG, n = 13; ice bag, n = 14; dynamic stretching, n = 14; and combined treatment, n = 14. Method: Before inducing DOMS, the range of motion (ROM and maximum voluntary contraction (MVC were measured. The dynamic stretching was performed before inducing DOMS. Subjects performed biceps eccentric exercise at 110% of the predicted one-repetition maximum (1-RM, for each subject, to induce muscle soreness. Pain, ROM and MVC were assessed at 0, 24, 48, 72, and 96 hours after induction of DOMS. Results: These non-significant results for mode of treatment and time interaction showed that combined treatment, ice bag, or dynamic stretching alone is not effective at significantly reducing the symptoms of DOMS. Conclusion: These results are non-significant, the pattern of the data showed that the combined treatment may be contraindicated in the prevention of DOMS and ice bag or dynamic stretching might be the best choice of treatment. Further investigation is strongly recommended.

  2. Patients’ views about treatment with combination therapy for Rheumatoid Arthritis: a comparative qualitative study

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    Lempp Heidi

    2012-10-01

    Full Text Available Abstract Background Combinations of disease-modifying anti-rheumatic drugs (DMARDs are increasingly used to control active rheumatoid arthritis (RA; however there is little information about patients’ perspectives, their expectations, concerns and experiences of this intensive treatment. Method We interviewed a quota sample of 18 patients from a single tertiary outpatient clinic, stratified by gender, ethnicity and age, based on the outpatient clinic population. Patients with early RA (2 years received combined conventional DMARDs or DMARDs with biologics. Results Four main themes emerged from the analytical framework: (i patients’ expectations about the combined treatment focuses mainly on physical symptoms; (ii the impact of the treatment on quality of life varied with the new medication in both groups (iii concerns about new interventions concentrated mainly on potential side effects; and (iv combination therapy can be self-managed in close collaboration with clinic staff, but this requires individualised management approaches. These themes resonate with von Korff’s collaborative management of chronic illness model. Conclusion To our knowledge this is the first qualitative study that examined systematically in patients with early and established RA their expectations, impact on quality of life, concerns about side effects and the management of the treatment when taking combined medication with DMARDs or DMARDs and biologics. Patients have generally positive views of combination DMARDs. Within routine practice settings, achieving medication concordance with complex combined DMARD regimens is challenging, and the concerns vary between patients; careful individual assessments are essential to successfully deliver such intensive treatment.

  3. Use of combination of leflunomide with biological agents in treatment of rheumatoid arthritis.

    NARCIS (Netherlands)

    Kalden, J.R.; Antoni, C.; Alvaro-Gracia, J.M.; Combe, B.; Emery, P.; Kremer, J.M.J.; Strand, C.V.; Riel, P.L.C.M. van; Smolen, J.S.

    2005-01-01

    An Expert Panel Meeting was held in May 2004 to assess experience with combination therapy with leflunomide and biological agents in the treatment of rheumatoid arthritis (RA), to identify both optimal use of such combinations and precautions for use. Eleven published prospective or retrospective st

  4. Combination treatment of neuropathic pain: Danish expert recommendations based on a Delphi process

    DEFF Research Database (Denmark)

    Holbech, Jakob Vormstrup; Jung, A.; Jonsson, T.

    2017-01-01

    , but combination therapy had not been included in guidelines until recently. Based on clinical empiricism and scientific evidence, a Delphi consensus process provided a consolidated guidance on pharmacological combination treatment of NeP. METHODS: A two-round virtual internet-based Delphi process with 6 Danish...

  5. Relationship between treatment-seeking behaviour and artemisinin drug quality in Ghana

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    Klein Eili Y

    2012-04-01

    Full Text Available Abstract Background Artemisinin-based combination therapy (ACT is currently the recommended first-line treatment for uncomplicated malaria infections. However, a significant proportion of ACT is assumed to be of poor quality, particularly in Africa. In addition, little is known about how treatment-seeking behaviour of individuals or drug price is associated with drug quality. Methods Caregivers of children less than 5 years of age were interviewed on their knowledge of malaria and their choices for treatment. Artemisinin drugs were then purchased from sellers that caregivers preferred or had previously patronized. The active ingredients were quantified by nuclear magnetic resonance spectroscopy. Results A negative relationship was anticipated between the education level of caregivers and the quality of anti-malarial drugs purchased. However, of the 33 drugs collected from 16 different shops, only one contained less than 80% of its purported active ingredient, and most drugs were within 90% of their listed amounts. No link was found between drug quality and price. Nonetheless, while ACT is the recommended first-line treatment in Ghana, 21% of the drugs collected were artemisinin monotherapy, and 27% of the ACT was not co-formulated. Among caregivers, higher education was found to be associated with both an increased likelihood of seeking treatment in a clinic first, as opposed to visiting drug shops or using herbal remedies, and with purchasing drugs from licensed sellers. Conclusion Surprisingly, drug quality was found to be uniformly high and thus no significant relationship between price, treatment-seeking behaviour and the content of the active ingredients was observed. However, artemisinin monotherapy, which the WHO considers inappropriate therapy, was still widely available in Ghana in 2010. Monotherapy was more likely to be available in unlicensed vendors where less-educated caregivers generally shopped. This linkage between education

  6. Incidence of malaria and efficacy of combination antimalarial therapies over 4 years in an urban cohort of Ugandan children.

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    Tamara D Clark

    Full Text Available BACKGROUND: Combination therapies are now recommended to treat uncomplicated malaria. We used a longitudinal design to assess the incidence of malaria and compare the efficacies of 3 combination regimens in Kampala, Uganda. METHODOLOGY/PRINCIPAL FINDINGS: Children aged 1-10 years were enrolled from randomly selected households in 2004-05 and 2007, and were followed at least monthly through 2008. Insecticide-treated bednets (ITNs were provided in 2006. Children were randomized upon their first episode, and then treated for all episodes of uncomplicated malaria with amodiaquine/sulfadoxine-pyrimethamine (AQ/SP, artesunate/amodiaquine (AS/AQ, or artemether/lumefantrine (AL. Risks of parasitological failure were determined for each episode of uncomplicated malaria and clinical parameters were followed. A total of 690 children experienced 1464 episodes of malaria. 96% of these episodes were uncomplicated malaria and treated with study drugs; 94% were due to Plasmodium falciparum. The rank order of treatment efficacy was AL > AS/AQ > AQ/SP. Failure rates increased over time for AQ/SP, but not the artemisinin-based regimens. Over the 4-year course of the study the prevalence of asymptomatic parasitemia decreased from 11.8% to 1.4%, the incidence of malaria decreased from 1.55 to 0.32 per person year, and the prevalence of anemia (hemoglobin <10 gm/dL decreased from 5.9% to 1.0%. No episodes of severe malaria (based on WHO criteria and no deaths were seen. CONCLUSIONS/SIGNIFICANCE: With ready access to combination therapies and distribution of ITNs, responses were excellent for artemisinin-containing regimens, severe malaria was not seen, and the incidence of malaria and prevalence of parasitemia and anemia decreased steadily over time. TRIAL REGISTRATION: isrctn.org ISRCTN37517549.

  7. Treatment of severe atopic dermatitis with a combination of subcutaneous allergen immunotherapy and cyclosporin.

    Science.gov (United States)

    Nahm, Dong-Ho; Kim, Myoung-Eun

    2012-01-01

    The clinical efficacy of subcutaneous allergen immunotherapy (SCIT) for the treatment of patients with severe atopic dermatitis (AD) using house dust mite (HDM) extract has been reported. Cyclosporin has been regarded as an effective medication for treatment of severe AD. In this study, we investigated a clinical usefulness of combined treatment with SCIT and cyclosporin in patients with severe AD. Nine patients with severe AD and hypersensitivity to HDM were treated with a combination of SCIT using HDM extract and cyclosporin for 12 months. The primary efficacy outcome was the change in the standardized clinical severity scoring system for AD (SCORAD) values, measured at 6 and 12 months, in comparison with the values at baseline. Daily dose of cyclosporin was decreased or discontinued according to the degrees of clinical improvements in individual patients. In 8 patients who completed 12 months of treatment, the SCORAD values significantly decreased from 71.5 ± 15.5 (mean ± SD) at baseline to 20.4 ± 14.6 at 6 months and 26.3 ± 13.6 at 12 months (Wilcoxon signed-rank test, p=0.01), and no significant systemic side effects were observed. Cyclosporin was discontinued in 4 of 8 patients within 8 months after starting the combined treatment. In this study, combined treatment with SCIT and cyclosporin resulted in significant clinical improvements in patients with severe AD. Further studies are needed to test the clinical usefulness of this combined treatment for patients with severe AD.

  8. The impact of text message reminders on adherence to antimalarial treatment in northern Ghana: a randomized trial.

    Science.gov (United States)

    Raifman, Julia R G; Lanthorn, Heather E; Rokicki, Slawa; Fink, Günther

    2014-01-01

    Low rates of adherence to artemisinin-based combination therapy (ACT) regimens increase the risk of treatment failure and may lead to drug resistance, threatening the sustainability of current anti-malarial efforts. We assessed the impact of text message reminders on adherence to ACT regimens. Health workers at hospitals, clinics, pharmacies, and other stationary ACT distributors in Tamale, Ghana provided flyers advertising free mobile health information to individuals receiving malaria treatment. The messaging system automatically randomized self-enrolled individuals to the control group or the treatment group with equal probability; those in the treatment group were further randomly assigned to receive a simple text message reminder or the simple reminder plus an additional statement about adherence in 12-hour intervals. The main outcome was self-reported adherence based on follow-up interviews occurring three days after treatment initiation. We estimated the impact of the messages on treatment completion using logistic regression. 1140 individuals enrolled in both the study and the text reminder system. Among individuals in the control group, 61.5% took the full course of treatment. The simple text message reminders increased the odds of adherence (adjusted OR 1.45, 95% CI [1.03 to 2.04], p-value 0.028). Receiving an additional message did not result in a significant change in adherence (adjusted OR 0.77, 95% CI [0.50 to 1.20], p-value 0.252). The results of this study suggest that a simple text message reminder can increase adherence to antimalarial treatment and that additional information included in messages does not have a significant impact on completion of ACT treatment. Further research is needed to develop the most effective text message content and frequency. ClinicalTrials.gov NCT01722734.

  9. The impact of text message reminders on adherence to antimalarial treatment in northern Ghana: a randomized trial.

    Directory of Open Access Journals (Sweden)

    Julia R G Raifman

    Full Text Available BACKGROUND: Low rates of adherence to artemisinin-based combination therapy (ACT regimens increase the risk of treatment failure and may lead to drug resistance, threatening the sustainability of current anti-malarial efforts. We assessed the impact of text message reminders on adherence to ACT regimens. METHODS: Health workers at hospitals, clinics, pharmacies, and other stationary ACT distributors in Tamale, Ghana provided flyers advertising free mobile health information to individuals receiving malaria treatment. The messaging system automatically randomized self-enrolled individuals to the control group or the treatment group with equal probability; those in the treatment group were further randomly assigned to receive a simple text message reminder or the simple reminder plus an additional statement about adherence in 12-hour intervals. The main outcome was self-reported adherence based on follow-up interviews occurring three days after treatment initiation. We estimated the impact of the messages on treatment completion using logistic regression. RESULTS: 1140 individuals enrolled in both the study and the text reminder system. Among individuals in the control group, 61.5% took the full course of treatment. The simple text message reminders increased the odds of adherence (adjusted OR 1.45, 95% CI [1.03 to 2.04], p-value 0.028. Receiving an additional message did not result in a significant change in adherence (adjusted OR 0.77, 95% CI [0.50 to 1.20], p-value 0.252. CONCLUSION: The results of this study suggest that a simple text message reminder can increase adherence to antimalarial treatment and that additional information included in messages does not have a significant impact on completion of ACT treatment. Further research is needed to develop the most effective text message content and frequency. TRIAL REGISTRATION: ClinicalTrials.gov NCT01722734.

  10. Protocol for a prospective observational study of conventional treatment and traditional Korean medicine combination treatment for children with cerebral palsy.

    Science.gov (United States)

    Yoo, Jeong-Eun; Yun, Young-Ju; Shin, Yong-Beom; Kim, Nam-Kwen; Kim, Soo-Yeon; Shin, Myung-Jun; Yu, Sun-Ae

    2016-06-08

    Cerebral palsy leads to many complications as well as delayed motor development, and early intensive rehabilitation in infancy, which is based on the theory of brain plasticity, is emphasized. In addition to conventional treatment, including physical, occupational, or speech-language therapies, children also have a demand for traditional Korean medicine interventions such as acupuncture or herbal medicine; however, a lack of evidence has made traditional Korean medicine difficult to implement in practice. We planned a multicentre, prospective, observational study to assess the effectiveness, safety and cost-effectiveness of conventional treatment and traditional Korean medicine combination treatment for children with cerebral palsy. Three hundred children with cerebral palsy aged 6 to 78 months will be recruited from six institutions. Data from each child are collected every month for a one-year period, during which time treatment might be changed or discontinued. A qualified investigator visits the sites to measure effectiveness variables, including Gross Motor Function Measure and Paediatric Evaluation of Disability Inventory. Adverse events and cost-effectiveness variables are collected using surveys conducted at baseline, mid-study, and end of study, as well as monthly tracking surveys. In the analyses, participants will be classified into two groups: group A children will be the conventional treatment group with physical, occupational, speech-language or other conventional rehabilitation therapies, whereas group B children will be the combination treatment group with traditional Korean medicine interventions, that is, herbal medicine, chuna, moxibustion and acupuncture, in addition to conventional treatment. Only a few clinical case reports have evaluated the effectiveness and safety of traditional Korean medicine; therefore, more data are required to provide optimal information to children with cerebral palsy and their guardians. We hypothesized that

  11. Clinical research on the efficacy of Mirena in combined with mifepristone in the treatment of adenomyosis

    Institute of Scientific and Technical Information of China (English)

    Li-Juan Cao; Xin-Jun Shu

    2016-01-01

    Objective:To observe the clinical effect of levonorgestrel slow-release system (LNG-IUS, Mirena) in combined with mifepristone in the treatment of adenomyosis (AM). Methods:A total of 76 patients with AM who were admitted in our hospital from January, 2013 to January, 2015 were included in the study and randomized into the treatment group and the control group with 38 cases in each group. The patients in the treatment group were given Mirena in combined with mifepristone, while the patients in the control group were only placed with Mirena. The changes of symptoms and sex hormone levels before and after treatment between the two groups were compared. B ultrasound was used to examine the uterine volume and intimal thickness. Results:The comparison of menstrual cycle before and after treatment between the two groups was not statistically significant. After treatment, the menstrual duration in the two groups was significantly shortened when compared with before treatment, PBAC and VAS scores were significantly reduced. The improvement degree of dysmenorrhea after treatment in the treatment was significantly superior to that in the control group. The endometrial thickness and uterine volume after treatment in the two groups were significantly reduced when compared with before treatment, but the comparison between the two groups was not statistically significant. The serum CA125 after treatment in the treatment group was significantly lower than that in the control group. The comparison of LH, FSH, and E2 levels before and after treatment between the two groups was not statistically significant. Conclusions:Mirena in combined with mifepristone in the treatment of AM can effectively alleviate the clinical symptoms with no effect on sex hormone levels;therefore, it deserves to be widely recommended in the clinic.

  12. [Acupuncture combined with catgut embedding therapy for treatment of 158 cases of facial paralysis].

    Science.gov (United States)

    Li, Ling

    2005-03-01

    To observe therapeutic effect of acupuncture combined with catgut embedding therapy on peripheral facial paralysis. Treatment group of 158 cases were treated by acupuncture combined with catgut embedding therapy and control group of 54 cases were treated by acupuncture, and their therapeutic effects were compared. There was no significant difference in the total effective rate (P > 0.05), but the cured rate in the treatment group was significantly higher than that in the control group (P Acupuncture combined with catgut embedding therapy is a better therapy for facial paralysis.

  13. Treatment of symptomatic epilepsy with lesionectomies combined with bipolar coagulation of the surrounding cortex

    Institute of Scientific and Technical Information of China (English)

    杨忠旭; 栾国明

    2003-01-01

    Objective To observe the clinical effects of lesionectomies combined with bipolar coagulation of the surrounding cortex (BCSC) on symptomatic epilepsy.Methods The effectiveness of lesionectomies combined with BCSC (71 patients) and of lesionectomies alone (78 patients) were compared in follow-up surveys conducted 2-5 years (average of 37 months) post-operation.Results Treatment in the BCSC group was significantly more effective than in the lesionectomy group (P<0.01). Meanwhile, patients in the BCSC group suffered no permanent post-operative complications.Conclusion Lesionectomy combined with BCSC is a new, effective and safe treatment for symptomatic epilepsy.

  14. External beam re-irradiation, combination chemoradiotherapy, and particle therapy for the treatment of recurrent glioblastoma

    Science.gov (United States)

    Taunk, Neil K.; Moraes, Fabio Y.; Escorcia, Freddy E.; Mendez, Lucas Castro; Beal, Kathryn; Marta, Gustavo N.

    2016-01-01

    SUMMARY Glioblastoma is a common aggressive primary malignant brain tumor, and is nearly universal in progression and mortality after initial treatment. Re-irradiation presents a promising treatment option for progressive disease, both palliating symptoms and potentially extending survival. Highly conformal radiation techniques such as stereotactic radiosurgery and hypofractionated radiosurgery are effective short courses of treatment that allow delivery of high doses of therapeutic radiation with steep dose gradients to protect normal tissue. Patients with higher performance status, younger age, and longer interval between primary treatment and progression represent the best candidates for re-irradiation. Multiple studies are also underway involving combinations of radiation and systemic therapy to bend the survival curve and improve the therapeutic index. In the multimodal treatment of recurrent high-grade glioma, the use of surgery, radiation, and systemic therapy should be highly individualized. Here we comprehensively review radiation therapy and techniques, along with discussion of combination treatment and novel strategies. PMID:26781426

  15. Combination treatment in Alzheimer's disease: results of a randomized, controlled trial with cerebrolysin and donepezil.

    Science.gov (United States)

    Alvarez, X Antón; Cacabelos, R; Sampedro, C; Couceiro, V; Aleixandre, M; Vargas, M; Linares, C; Granizo, E; García-Fantini, M; Baurecht, W; Doppler, E; Moessler, H

    2011-08-01

    Treatment with neurotrophic agents might enhance and/or prolong the effects of cholinesterase inhibitors (ChEIs) in Alzheimer's disease (AD). We compared the safety and efficacy of the neurotrophic compound Cerebrolysin (10 ml; n=64), donepezil (10 mg; n=66) and a combination of both treatments (n=67) in mild-to-moderate (mini-mental state examination-MMSE score 12-25) probable AD patients enrolled in a randomized, double-blind trial. Primary endpoints were global outcome (Clinician's Interview-Based Impression of Change plus caregiver input; CIBIC+) and cognition (change from baseline in AD Assessment Scale-cognitive subscale+; ADAS-cog+) at week 28. Changes in functioning (AD Cooperative Study-Activities of Daily Living scale, ADCS-ADL) and behaviour (Neuropsychiatric Inventory, NPI) were secondary endpoints. Treatment effects in cognitive, functional and behavioral domains showed no significant group differences; whereas improvements in global outcome favored Cerebrolysin and the combination therapy. Cognitive performance improved in all treatment groups (mean±SD for Cerebrolysin: -1.7±7.5; donepezil: -1.2±6.1; combination: -2.3±6.0) with best scores in the combined therapy group at all study visits. Cerebrolysin was as effective as donepezil, and the combination of neurotrophic (Cerebrolysin) and cholinergic (donepezil) treatment was safe in mild-to-moderate AD. The convenience of exploring long-term synergistic effects of this combined therapy is suggested.

  16. Fixed-combination treatments for intraocular hypertension in Chinese patients - focus on bimatoprost-timolol.

    Science.gov (United States)

    Fang, Yuan; Ling, Zhihong; Sun, Xinghuai

    2015-01-01

    Glaucoma is a common eye disease that can lead to irreversible vision loss if left untreated. The early diagnosis and treatment of primary open-angle glaucoma is challenging, and visual impairment in Chinese glaucoma patients is a serious concern. Most of these patients need more than one topical antiglaucoma agent to control their intraocular pressures (IOPs). In the People's Republic of China, the daily cost of different glaucoma medication varies greatly, and the treatment habits differ throughout the country. Prostaglandin analogs (PGAs) are recommended as first-line monotherapy, because of their efficacy and low risk of systemic side effects. Fixed-combination drops, particularly PGA-based fixed combinations, have recently been developed and used in patients with progression or who have failed to achieve their target IOPs. Here, we reviewed the current literature on the use of bimatoprost-timolol fixed combination (BTFC) in the People's Republic of China. BTFC has achieved good efficacy and tolerability in Chinese clinical trials. In addition, BTFC is more cost effective compared with other fixed combinations available in the People's Republic of China. Fixed-combination drops may offer benefits, such as keeping the ocular surface healthy, convenience of administration, and improvement in long-term adherence and quality of life. Therefore, BTFC has great potential for the treatment of Chinese glaucoma patients. However, the long-term efficacy of BTFC, comparisons of BTFC with other fixed-combination drugs, and treatment adherence and persistence with treatment in Chinese patients are unknown and will require further study.

  17. Combination of intravitreal bevacizumab and peripheral photocoagulation: an alternative treatment in eales disease.

    Science.gov (United States)

    Cp, Juarez; Al, Gramajo; Jd, Luna

    2013-01-01

    To report the efficacy of combination therapy (bevacizumab and photocoagulation) in a case of Eales Disease this study has been performed. Bevacizumab (Avastin, 1.25 mg/0.05 ml) was injected intravitreously for the treatment of iris and retinal neovascularization in a 56-year old Hispanic female with photocoagulation treatment to control the recurrence of vitreous haemorrhage. Our results revealed that stabilization of the disease and improvement in visual acuity were achieved without any signs of recurrence. Intravitreal bevacizumab in combination with photocoagulation treatment of ischemic retinal areas may be a good alternative for patients with recurrent vitreous haemorrhage due to Eales disease.

  18. High-flow vascular malformation treatment using ultrasound-guided laser combined with polidocanol sclerotherapy.

    Science.gov (United States)

    Zhang, Yan; Zhou, Ping; Li, Lan; Li, Jia-le

    2015-07-01

    The current treatment for vascular malformations includes surgery, sclerotherapy, and embolization. However, each method has its limitations, such as recurrence, complications, scarring, and radiation exposure. Therefore, identifying an effective, minimally invasive treatment that reduces lesion recurrence is particularly important. We describe in detail a patient who received treatment with ultrasound-guided laser interruption of feeding vessels combined with polidocanol sclerotherapy after the recurrence of forearm high-flow vascular malformation.

  19. Durable remission of folliculotropic mycosis fungoides achieved with a combined topical treatment with cytarabine and carmustine.

    Science.gov (United States)

    Heisig, Monika; Maj, Joanna; Szepietowski, Jacek C; Reich, Adam

    2016-01-01

    Folliculotropic mycosis fungoides (MF) is an uncommon subtype of MF which has a more aggressive natural history and is more resistant to treatment than other forms of MF. In this article, an innovative method of treatment is presented. We describe a successful use of topical cytarabine combined with topical carmustine in a patient with a folliculotropic MF. Based on our patient history we suggest this method as an effective therapy option for patients with folliculotropic MF unresponsive to other forms of treatment.

  20. Combination of Advanced Oxidation Processes and biological treatments for wastewater decontamination-A review

    Energy Technology Data Exchange (ETDEWEB)

    Oller, I., E-mail: isabel.oller@psa.es [Plataforma Solar de Almeria (CIEMAT), Carretera Senes, Km 4. 04200 Tabernas (Almeria) (Spain); Malato, S. [Plataforma Solar de Almeria (CIEMAT), Carretera Senes, Km 4. 04200 Tabernas (Almeria) (Spain); Sanchez-Perez, J.A. [Department of Chemical Engineering, University of Almeria, Crta de Sacramento s/n, 04120 Almeria (Spain)

    2011-09-15

    Nowadays there is a continuously increasing worldwide concern for development of alternative water reuse technologies, mainly focused on agriculture and industry. In this context, Advanced Oxidation Processes (AOPs) are considered a highly competitive water treatment technology for the removal of those organic pollutants not treatable by conventional techniques due to their high chemical stability and/or low biodegradability. Although chemical oxidation for complete mineralization is usually expensive, its combination with a biological treatment is widely reported to reduce operating costs. This paper reviews recent research combining AOPs (as a pre-treatment or post-treatment stage) and bioremediation technologies for the decontamination of a wide range of synthetic and real industrial wastewater. Special emphasis is also placed on recent studies and large-scale combination schemes developed in Mediterranean countries for non-biodegradable wastewater treatment and reuse. The main conclusions arrived at from the overall assessment of the literature are that more work needs to be done on degradation kinetics and reactor modeling of the combined process, and also dynamics of the initial attack on primary contaminants and intermediate species generation. Furthermore, better economic models must be developed to estimate how the cost of this combined process varies with specific industrial wastewater characteristics, the overall decontamination efficiency and the relative cost of the AOP versus biological treatment.

  1. Effects of Combined Treatment with Sansanmycin and Macrolides on Pseudomonas aeruginosa and Formation of Biofilm

    Institute of Scientific and Technical Information of China (English)

    YUE LI; YUN-YING XIE; RU-XIAN CHEN; HONG-ZHANG XU; GUO-JI ZHANG; JIN-ZHE LI; XIAO-MIAN LI

    2009-01-01

    Objective To observe the effects of combined treatment with sansanmycin and macrolides on Pseudomonas aeruginosa and formation of biofilm. Methods Micro-dilution method was used to determine the minimal inhibitory concentrations (MICs) of sansanmycin, gentamycin, carbenicillin, polymyxin B, roxithromycin, piperacillin, and tazobactam. PA1 and PA27853 biofilms were observed under optical microscope after staining and under SEM after treatment with sansanmycin at different dosages and combined treatment with sansanmycin and roxithromycin. Viable bacteria in PA1 and PA27853 biofilms were counted after treatment with sansanmycin at different dosages or combined treatment with sansanmycin and roxithromycin. Results The MIC of sansanmycin was lower than that of gentamycin and polymyxin B, but was higher than that of carbenicillin. Roxithromycin enhanced the penetration of sansanmycin to PA1 and PA27853 strains through biofilms. PA1 and PA27853 biofilms were gradually cleared with the increased dosages of sansanmycin or with the combined sansanmycin and roxithromycin. Conclusion Sub-MIC levels of roxithromycin and sansanmycin substantially inhibit the generation of biofilms and proliferation of bacteria. Therefore, combined antibiotics can be used in treatment of intractable bacterial infection.

  2. Combination of enzymatic, mechanical and ultrasonic treatments for improvement of the properties of secondary pulps

    Directory of Open Access Journals (Sweden)

    Juliana Cristina da Silva

    2013-12-01

    Full Text Available This study evaluated the property recovery capability of handsheets formed from secondary fibers by combining different techniques. To attain that, pulps derived from post-consumer cardboard scrap were subjected to various refining intensities respectively in a PFI mill (0, 400, 800 and 1200revolutions and ultrasound (0, 10, 20 and 30minutes, followed by enzymatic treatments with enzymes Cellulase, Hemicellulase, Mixture 1 and Mixture 2 (both mixtures composed of cellulase and hemicellulase. The papermaking potential of the pulps was evaluated by means of physical and mechanical tests on the resulting paper after the relevant treatments. It was found that both the combination of PFI mill refining with enzymatic treatments and the combination of ultrasound with enzymatic treatments were effective in improving paper properties. It was also found that interfiber bonding properties such as tensile index and ring crush strength had greater increases, in relation to the initial pulp, in pulps derived from the combined PFI mill refining with enzymatic treatments. As for intrinsic fiber strength properties, such as tear resistance, had greater increases in pulps derived from the combined ultrasound with enzymatic treatments.

  3. An open randomized controlled trial to compare the efficacy of two fixed dose combinations of artemesinin based combinations for uncomplicated falciparum malaria in Bangladesh.

    Science.gov (United States)

    Samad, R; Rahman, M R; Yunus, E B; Hussain, M A; Arif, S M; Islam, M N; Hafiz, S A M M A; Hossain, M M; Faiz, M A

    2013-12-01

    National Malaria Control Program (NMCP) of Bangladesh has introduced Artemisinin Based Combination (ACT), Coartem(R) (Artemether-Lumefantrine (AL), fixed dose combination, in the confirmed cases of uncomplicated P. falciparum malaria since 2004. Despite the reduction of mortality due to malaria, the development and spread of anti-malarial drug resistance wordwide posing a threat to the health services and will make it difficult to control malaria in Bangladesh in future. We need to have an alternative to Coartem which could be Artesunate-amodiaquine (AA) in a fixed dose combination (FDC), a cheaper altenative not yet evidenced to be effective and safe to our population. In this study we compared the efficacy and safety of Artemether + Lumefantrene (FDC, Coartem) with Artesunate +Amodiaquine tablets (100/270 mg FDC) for the treatment of uncomplicated P. falciparum malaria in three high risk multi-drug resistant malaria prevalent areas of Bangladesh. It was an open label randomized controlled trial conducted between December 2008 and November 2009 in 4 upazillas in patients over the age 12 to 60 years diagnosed as a case of uncomplicated P. falciparum malaria. The outcome of the cases were measured as clinical response, parasitological response, defervescence time and parasite clearance time. Drug safety was assessed by comparing the adverse events. A total of 252 cases were randomized to receive Artesunate + Amodiaquine (AA group, 147 cases) and Artemether + Lumefantrene (AL group, 106 cases), one lost to follow up at day 28 in AA group. The distribution of the cases was comparable by age, sex and study sites. Treatment success' response was observed 100% in the AL group and AA group had 99%, two failures with AA were late treatment failures and the difference was not statistically significant (p > .1). The parasitological sensitive (S) response was observed in 97% of cases in AL group and 95% in the AA group, and was not a statistically significant difference

  4. Combined treatment with sodium butyrate and PD153035 enhances keratinocyte differentiation

    Science.gov (United States)

    Carrion, Sandra Leon; Sutter, Carrie Hayes; Sutter, Thomas R.

    2014-01-01

    Epidermal growth factor (EGF) receptor (EGFR) signaling is a critical determinant of keratinocyte proliferation and differentiation in both normal and diseased skin. Here we explore the effects of combined treatment with the differentiation-promoting agent sodium butyrate (SB) and the EGFR inhibitor (EGFRI) PD153035 on terminal differentiation of normal human epidermal keratinocytes (NHEKs). Cells treated with SB showed increased expression of the levels of mRNA and protein of the differentiation markers filaggrin and transglutaminase 1. Co-treatment with EGF significantly blunted these effects of SB. Combined treatment with SB and PD153035 alleviated these inhibitory actions of EGF, resulting in improved effects of decreased cell growth and increased terminal differentiation, relative to the individual treatments. These results indicate that the combined use of a differentiation-promoting agent and an EGFR inhibitor may offer an additional approach to the management of hyperproliferative skin diseases. PMID:24451036

  5. Ledipasvir/sofosbuvir: the fixed dose combination in the new era of treatment for HCV

    Directory of Open Access Journals (Sweden)

    Alessia Ciancio

    2015-07-01

    Full Text Available Interferon-based treatment is not suitable for many patients with hepatitis C virus (HCV infection because of contraindications, other reasons for ineligibility and side-effects. The fixed dosed combination ledipasvir/sofosbuvir (LDV / SOF is the first approved regimen that doesn’t require administration with interferon or ribavirin. LDV / SOF is also the first single-pill approved for the treatment of chronic HCV genotype 1 in both treatment-naïve and treatment-experienced patients. The results of the phase III studies demonstrate the combination has been very well tolerated and SVR rates consistently above 90%. Objective of this review is to present clinical evidence of efficacy and safety of the combination LDV / SOF in different subgroups of patients with HCV.

  6. [Ozonotherapy as an efficient component of the combined treatment of the patients presenting with bacterial vaginosis].

    Science.gov (United States)

    Yarustovskaya, O V; Kulikov, A G; Shtro, L P

    2015-01-01

    The objective of the present study was to evaluate the effectiveness of the combined treatment of the patients suffering from bacterial vaginosis using various methods of ozone therapy. The comprehensive clinical and laboratory examination and treatment involved 102 patients of the child-bearing age divided into 3 groups, matched for the age and the main clinical manifestations of the disease. All the patients comprising group IlIl received basic therapy alone while the treatment of the patients of group I consisted of local ozone therapy and that of the patients of group 11 of the combination of local and general ozone therapy. The study has demonstrated the enhanced effectiveness of the combined local and general ozone therapy compared with the two other modalities and the feasibility of its application for the treatment of the patients presenting with bacterial vaginosis.

  7. Study on the mechanism of statins combined with Shenmai injection in the treatment of sepsis

    Institute of Scientific and Technical Information of China (English)

    Yu-Jing Zhang; Jun-Li Zhang; Peng Li; Zhong-Xun Xu; Yi Wei; Wei-Lei Wang

    2016-01-01

    Objective:To explore the mechanism of statins combined with Shenmai injection in the treatment of sepsis, and to provide help for clinical treatment of sepsis.Methods: Study on the diagnosis and treatment of 160 patients with sepsis in our hospital from January 2012 to January 2016, according to the random number table method, sepsis patients were divided into observation group and control group, 80 cases in each, the control group was given conventional treatment, the observation group was treated with atorvastatin and Shenmai injection on the basis of the control group, immune cells, immune factors and blood coagulation function related indexes were detected in patients before and 3 d after treatment.Results:Before treatment, there was no significant difference in serum related immune factors, immune cells and blood coagulation function related indexes between the two groups; compared with before treatment, in the observation group after atorvastatin combined with Shenmai injection treatment, the related immune factors TNF-α, IL-6, hs-CRP significantly decreased, the immune cells CD4+ and NK significantly increased while CD8+ significantly decreased, and the blood coagulation function related indexes PLT significantly increased while PT, APTT and FIB significantly decreased, the differences existed statistical significance; compared with the control group after conventional treatment, in the observation group after combined treatment, the related immune factors TNF-α, IL-6, hs-CRP significantly decreased, the related immune cells CD4+ and NK significantly increased while CD8+ significantly decreased, and the blood coagulation function related indexes PLT significantly increased while PT, APTT and FIB significantly decreased, the differences between the two groups existed statistical significance. Conclusion:Atorvastatin combined with Shenmai injection can improve the immune function and blood coagulation function in patients with sepsis, and provide help for

  8. Cost-effectiveness study of three antimalarial drug combinations in Tanzania.

    Directory of Open Access Journals (Sweden)

    Virginia Wiseman

    2006-10-01

    Full Text Available BACKGROUND: As a result of rising levels of drug resistance to conventional monotherapy, the World Health Organization (WHO and other international organisations have recommended that malaria endemic countries move to combination therapy, ideally with artemisinin-based combinations (ACTs. Cost is a major barrier to deployment. There is little evidence from field trials on the cost-effectiveness of these new combinations. METHODS AND FINDINGS: An economic evaluation of drug combinations was designed around a randomised effectiveness trial of combinations recommended by the WHO, used to treat Tanzanian children with non-severe slide-proven malaria. Drug combinations were: amodiaquine (AQ, AQ with sulfadoxine-pyrimethamine (AQ+SP, AQ with artesunate (AQ+AS, and artemether-lumefantrine (AL in a six-dose regimen. Effectiveness was measured in terms of resource savings and cases of malaria averted (based on parasitological failure rates at days 14 and 28. All costs to providers and to patients and their families were estimated and uncertain variables were subjected to univariate sensitivity analysis. Incremental analysis comparing each combination to monotherapy (AQ revealed that from a societal perspective AL was most cost-effective at day 14. At day 28 the difference between AL and AQ+AS was negligible; both resulted in a gross savings of approximately US1.70 dollars or a net saving of US22.40 dollars per case averted. Varying the accuracy of diagnosis and the subsistence wage rate used to value unpaid work had a significant effect on the number of cases averted and on programme costs, respectively, but this did not change the finding that AL and AQ+AS dominate monotherapy. CONCLUSIONS: In an area of high drug resistance, there is evidence that AL and AQ+AS are the most cost-effective drugs despite being the most expensive, because they are significantly more effective than other options and therefore reduce the need for further treatment. This is

  9. Diagnosis and treatment of spinal fractures combined with paraplegia and diaphragm injury

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Objective: To study the mechanism and treatment principle of spinal fractures combined with paraplegia and diaphragm injury.   Methods: A total of 16 patients (14 males and 2 females, aged from 18 to 50 years) with spinal fractures combined with paraplegia and diaphragm injury, receiving emergency treatment and admitted to our hospital in the past 20 years, were retrospectively analyzed in this study.   Results: The injuries were caused by direct or indirect violence. Six cases were of fractures of cervical spine combined with paraplegia and diaphragm injury, 2 of fractures of thoracic vertebra combined with paraplegia and diaphragm injury, and 8 of thoracolumbar fractures combined with paraplegia and diaphragm injury. Six cases received non-operative treatment, but died finally. Ten cases received spine surgical treatment, of which 4 died and 6 were improved. The total mortality rate was 62.5%.   Conclusions: Spinal fractures combined with paraplegia and diaphragm injury are one of the most severe traumas in departments of orthopaedics. Paraplegia can be found easily, but diaphragm injury is often neglected and missed. When a patient suffers from both of them, he is in danger of death. What measures should be taken to rescue the patients life depends on the severity of the wounds.

  10. Combining UV-C treatment with biocontrol yeast to control postharvest decay of melon.

    Science.gov (United States)

    Huang, Ke; Zou, Yong; Luo, Jie; Liu, Yiqing

    2015-09-01

    Significant losses in harvested melon can be directly attributable to decay fungi. In the present study, the use of UV-C treatment combined with biocontrol yeast, Pichia cecembensis, was evaluated for their ability to control postharvest decay of melon fruits after they were artificially inoculated with Fusarium oxysporum and Alternaria alternata. Natural infection of fruit was also assessed. As a stand-alone treatment, UV-C or P. cecembensis significantly reduced Fusarium rot and Alternaria rot, and also the level of natural infection on melon fruit, relative to the untreated control. The combination of UV-C or P. cecembensis, however, provided a superior level of decay control on artificially inoculated and naturally infected fruit, compared to either treatment alone. None of the treatments impaired fruit quality. Integrating the use of UV-C treatment with biocontrol yeast has potential as an effective method to control postharvest decay of melon.

  11. Combined ultrasonication and thermal pre-treatment of sewage sludge for increasing methane production.

    Science.gov (United States)

    Trzcinski, Antoine Prandota; Tian, Xinbo; Wang, Chong; Lin, Li Leonard; Ng, Wun Jern

    2015-01-01

    This article focuses on the combination of ultrasonic and thermal treatment of sewage sludge (SS). The combination involved ultrasonicating a fraction of the sludge and thermal treatment at various temperatures and this resulted in solubilization of proteins and carbohydrates, and so contributing to increased COD solubilization. During the treatment, SCOD, soluble proteins and carbohydrates increased from 760 mg L(-1) to 10,200 mg L(-1), 110 mg L(-1) to 2,900 mg L(-1) and 60 mg L(-1) to 630 mg L(-1), respectively. It was found ultrasonication of only a fraction of the sludge (>20%) followed by thermal treatment led to significant improvement compared to thermal and ULS treatments applied on their own. At 65°C, the kinetic of solubilization was improved and the hyper-thermophilic treatment time could be reduced to a few hours when ultrasonication was used first. A linear correlation (R(2) = 95%) was found between the SCOD obtained after ultrasonication pre-treatment and anaerobic biodegradability. The combined treatment resulted in 20% increase in biogas production during the anaerobic digestion of the pre-treated sludge.

  12. Combined pulsed dye and CO2 lasers in the treatment of angiolymphoid hyperplasia with eosinophilia.

    Science.gov (United States)

    Sagi, Lior; Halachmi, Shlomit; Levi, Assi; Amitai, Dan Ben; Enk, Claes D; Lapidoth, Moshe

    2016-08-01

    Angiolymphoid hyperplasia with eosinophilia (ALHE) is an uncommon dermatosis of unknown etiology that manifests as characteristic red nodules and papules with a predilection for the scalp and periauricular region. Treatment is required for both esthetic and functional reasons, as lesions may ulcerate and bleed. Many treatment approaches have been reported, including excision, systemic medical approaches, topical or intralesional therapies, and non-invasive modalities including cryotherapy, electrosurgery, and laser. Treatments have exhibited variable efficacy, and the recurrence rate is 100 %. We report the combination of pulsed dye laser and CO2 laser in the treatment of ALHE in 14 patients. All patients exhibited clinical response after a mean of 2.4 ± 0.4 treatment sessions. The clinical efficacy of the combined treatment, together with its well-tolerated nature, render the use of pulsed dye laser in combination with CO2 laser, a viable treatment for debulking ALHE lesions. Ongoing maintenance treatments are needed to due to the high degree of relapse.

  13. Effects of the combined arginase and canavanine treatment on leukemic cells in vitro and in vivo

    Directory of Open Access Journals (Sweden)

    O. I. Vovk

    2016-04-01

    Full Text Available It was previously demonstrated in in vitro experiments that canavanine (Cav, a natural toxic arginine analogue of plant origin, is a promising candidate for augmenting the antineoplastic effects of arginine starvation. We demonstrated herein that recombinant human arginase, an arginine degrading enzyme, abrogated growth and significantly increased Cav cytotoxicity toward cultured L1210 murine leukemic cells. Cav co-treatment further reduced cells viability in a time-dependent manner and significantly promoted apoptosis induction. In the pilot study we also evaluated for the first time the potential toxicity of the combined arginine deprivation and Cav treatment in healthy mice. Administration of Cav alone or in combination with pegylated cobalt-containing human arginase (Co-hARG did not evoke any apparent toxic effects in these animals, with no significant behavioural and survival changes after several weeks of the treatment. The therapeutic effects of the combination of Co-hARG and Cav were provisionally evaluated on the highly aggressive murine L1210 leukemia, which is semi-sensitive to arginine deprivation as a monotreatment. Combination of two drugs did not result in significant prolongation of the survival of leukemia-bearing mice. Thus, we have shown that the proposed combinational treatment is rather non-toxic for the animals. It has to be further evaluated in animal studies with alternative tumor models and/or drug doses and treatment modalities.

  14. Efficacy of combination of glycolic acid peeling with topical regimen in treatment of melasma.

    Science.gov (United States)

    Chaudhary, Savita; Dayal, Surabhi

    2013-10-01

    Various treatment modalities are available for management of melasma, ranging from topical and oral to chemical peeling, but none is promising alone. Very few studies are available regarding efficacy of combination of topical treatment with chemical peeling. Combination of chemical peeling and topical regimen can be a good treatment modality in the management of this recalcitrant disorder. To assess the efficacy of combination of topical regimen (2% hydroquinone, 1% hydrocortisone and 0.05% tretinoin) with serial glycolic acid peeling in the treatment of melasma in Indian patients. Forty Indian patients of moderate to severe epidermal variety melasma were divided into two groups of 20 each. One Group i.e. peel group received topical regimen (2% hydroquinone, 1% hydrocortisone and 0.05% tretinoin) with serial glycolic acid peeling and other group i.e. control group received topical regimen (2% hydroquinone, 1% hydrocortisone, 0.05% tretinoin). There was an overall decrease in MASI from baseline in 24 weeks of therapy in both the groups (P value glycolic acid peel with topical regimen showed early and greater improvement than the group which was receiving topical regimen only. This study concluded that combining topical regimen (2% hydroquinone, 1% hydrocortisone and 0.05% tretinoin) with serial glycolic acid peeling significantly enhances the therapeutic efficacy of glycolic acid peeling. The combination of glycolic acid peeling with the topical regimen is a highly effective, safe and promising therapeutic option in treatment of melasma.

  15. Clinical Study of Endostar Combined with DP Protocol in Treatment of Advanced Esophageal Cancer

    Directory of Open Access Journals (Sweden)

    Wen-ying DENG

    2015-09-01

    Full Text Available Objective: To observe the clinical outcomes of Endostar combined with DP regimen for treating advanced esophageal cancer.Methods: A total of 62 patients with advanced esophageal cancer admitted from May, 2011 to May, 2013 were enrolled for a prospective, randomized controlled trial and 2 cases were excluded from the study because of Ⅳ degree of digestive tract reaction and myelosuppression. Therefore, 60 cases could be evaluated, and then divided into combined group (given Endostar+DP plan and single chemotherapy group, 30 cases in each group. The level of VEGF, tumor size and CT perfusion (CTP parameters, including blood flow (BF, blood volume (BV, mean transit time (MTT, and permeability surface (PS before and after treatment were determined for comparison. Kaplan-Merier method was used to analyze the overall survival (OS of 2 groups.Results: The efficacy of combined group was superior to single chemotherapy group. The level of vascular endothelial growth factor (VEGF in combined group was obviously lower than that in single chemotherapy group after treatment (P<0.01. Compared with treatment before in combined group, BF, BV and PS decreased while MTT increased after treatment (P<0.05. However, there were no significant differences in single chemotherapygroup before and after treatment (P>0.05. The median OS was 30 months (95%CI: 20.935-39.065 for combined group and 21 months (95%CI: 15.109-26.591 for single chemotherapy group, respectively (P=0.048. The 1-, 2- and 3-year survival rates were 86.2%, 59.3% and 36.6% in combined group, and 70.8%, 32.1% and 17.8% in single chemotherapy group, respectively.Conclusion: Endostar can down-regulate the expression of VEGF, improve the state of hypertransfusion and high permeability of tumor vessels, has better curative effect without slighter adverse reactions, and prolong the survival time of patients with advanced esophageal cancer when combined with chemotherapy.

  16. Treatment update: thiazolidinediones in combination with metformin for the treatment of type 2 diabetes

    Directory of Open Access Journals (Sweden)

    John M Stafford

    2007-10-01

    Full Text Available John M Stafford1, Tom Elasy21Division of Diabetes Endocrinology and Metabolism, Vanderbilt University; 2Vanderbilt Eskind Diabetes Clinic, Vanderbilt University Medical CenterAbstract: Type 2 diabetes mellitus (DM2 is characterized by excessive hepatic gluconeogenesis, increased insulin resistance and a progressive inability of pancreatic beta cells to produce sufficient insulin. DM2 evolves as a progression from normal glucose tolerance, to impaired glucose tolerance (IGT to frank diabetes mellitus, reflecting the establishment of insulin resistance and beta cell dysfunction. Insulin resistance not only contributes to impaired glycemic control in DM2, but to the development of hypertension, dyslipidemia and endothelial dysfunction. Cardiovascular disease is the primary morbidity for patients with DM2. The onset of insulin resistance and cardiovascular insult likely occurs well before the onset of IGT is detected clinically. Biguanides and thiazolidinediones (TZDs are two classes of oral agents for the management of DM2 that improve insulin resistance, and thus have potential cardiovascular benefits beyond glycemic control alone. Metformin additionally inhibits hepatic gluconeogenesis. The combined use of two of these agents targets key pathophysiologic defects in DM2. Single pill combinations of rosiglitazone/metformin and pioglitazone/metformin have recently been approved for use in the US and Europe. This article reviews the clinical data behind the use of metformin in combination with TZDs for the management of diabetes, its impact on vascular health, side effects and potential mechanisms of action for combined use.Keywords: thiazolidinediones; metformin; Type 2 diabetes

  17. Treatment update: thiazolidinediones in combination with metformin for the treatment of type 2 diabetes

    Directory of Open Access Journals (Sweden)

    John M Stafford

    2007-09-01

    Full Text Available John M Stafford1, Tom Elasy21Division of Diabetes Endocrinology and Metabolism, Vanderbilt University; 2Vanderbilt Eskind Diabetes Clinic, Vanderbilt University Medical CenterAbstract: Type 2 diabetes mellitus (DM2 is characterized by excessive hepatic gluconeogenesis, increased insulin resistance and a progressive inability of pancreatic beta cells to produce sufficient insulin. DM2 evolves as a progression from normal glucose tolerance, to impaired glucose tolerance (IGT to frank diabetes mellitus, reflecting the establishment of insulin resistance and beta cell dysfunction. Insulin resistance not only contributes to impaired glycemic control in DM2, but to the development of hypertension, dyslipidemia and endothelial dysfunction. Cardiovascular disease is the primary morbidity for patients with DM2. The onset of insulin resistance and cardiovascular insult likely occurs well before the onset of IGT is detected clinically. Biguanides and thiazolidinediones (TZDs are two classes of oral agents for the management of DM2 that improve insulin resistance, and thus have potential cardiovascular benefits beyond glycemic control alone. Metformin additionally inhibits hepatic gluconeogenesis. The combined use of two of these agents targets key pathophysiologic defects in DM2. Single pill combinations of rosiglitazone/metformin and pioglitazone/metformin have recently been approved for use in the US and Europe. This article reviews the clinical data behind the use of metformin in combination with TZDs for the management of diabetes, its impact on vascular health, side effects and potential mechanisms of action for combined use.Keywords: thiazolidinediones; metformin; Type 2 diabetes

  18. Combination treatment of physical modalities in the treatment of musculoskeletal pain syndromes: a prospective-controlled study

    Directory of Open Access Journals (Sweden)

    Karin Pieber

    2010-12-01

    Full Text Available The aim of the study was to evaluate the effect of combinations of several physical therapies in the treatment of musculoskeletal pain syndromes by a prospective, controlled study. Forty patients (5 men and 35 women, 18-80 years with musculoskeletal pain syndrome were included. Thirty patients were assigned to the intervention group and 10 patients to the control group. The intervention group received a combination of physical therapies according to the clinical needs (electrotherapy, fango packs, mud packs, ultrasound, massage, exercise therapy. Treatment consisted of 10 sessions. The control group did not receive any physical therapy in the waiting period. The intervention group was examined at the beginning and the end of the treatment period. The control group was evaluated at the beginning and the end of the waiting period (before their physical therapy treatment started. Main outcome measurements were: Visual analogue scale for pain (VAS; Timed Get up and Go Test (TUG; Functional Reach Test (FRT. In addition bodily, emotional and social functioning was accessed by selected ICF-Items and items of the SF-36 health survey (SF-36. The main outcome measures showed significant improvement in the intervention group compared to the control group. Furthermore, ICF- and SF-36-Items also improved. In conclusion significant pain relief and improvement of function was achieved by a combination treatment of physical therapies in patients with musculoskeletal pain syndromes.

  19. Hydrolysis of Miscanthus for bioethanol production using dilute acid presoaking combined with wet explosion pre-treatment and enzymatic treatment

    DEFF Research Database (Denmark)

    Sørensen, Annette; Teller, Philip Johan; Hilstrøm, Troels

    2008-01-01

    xylose prior to wet explosion. The acid presoaking extracted 63.2% xylose and 5.2% glucose. Direct enzymatic hydrolysis of the presoaked biomass was found to give only low sugar yields of 24-26% glucose. Wet explosion is a pre-treatment method that combines wet-oxidation and steam explosion. The effect......Miscanthus is a high yielding bioenergy crop. In this study we used acid presoaking, wet explosion, and enzymatic hydrolysis to evaluate the combination of the different pre-treatment methods for bioethanol production with Miscanthus. Acid presoaking is primarily carried out in order to remove...... of wet explosion on non-presoaked and presoaked Miscanthus was investigated using both atmospheric air and hydrogen peroxide as the oxidizing agent. All wet explosion pre-treatments showed to have a disrupting effect on the lignocellulosic biomass, making the sugars accessible for enzymatic hydrolysis...

  20. [Efficacy of early combined high-dose steroid + PGE1 treatment for sudden deafness].

    Science.gov (United States)

    Kubota, Toshinori; Watanabe, Tomoo; Yokota, Masashi; Ito, Tsukasa; Aoyagi, Masaru

    2012-05-01

    The efficacy of combined high-dose steroid and PGE1 treatment initiated immediately after the onset of sudden deafness was analyzed with the outcome of 174 patients begun on treatment within 7 days of the onset of sudden deafness. Four potential prognostic factors (days from onset to treatment, age, initial hearing level, presence of vertigo) and hearing outcome were examined with a multiple logistic regression analysis. Days from onset to treatment and age significantly correlated with hearing improvement. The efficacy of the treatment of patients begun on treatment within 3 days of the onset was significantly better than that of patients on treatment 4-7 days after the onset (p sudden deafness, and started within 3 days of the onset of sudden deafness in patients 50 years old and older.

  1. Talocalcaneal coalition combined with flatfoot in children: diagnosis and treatment: a review.

    Science.gov (United States)

    Zhou, Binghua; Tang, Kanglai; Hardy, Mark

    2014-01-01

    Talocalcaneal coalition often leads to a flatfoot deformity in children. Previous reports have uncovered many aspects of tarsal coalition and flatfoot respectively, including the etiology, clinical presentation, and diagnostic imaging, as well as treatment. However, the optimum surgical procedure for talocalcaneal coalition combined with flatfoot has not been definitively determined. The nonconformity of treatment options is due to our incomplete knowledge of biomechanics, diagnosis, and indication of treatment for talocalcaneal coalition with flatfoot. The objectives of this review are to provide an overview of the current knowledge about etiology, biomechanics, classification, diagnosis, and treatment options for talocalcaneal coalitions with flatfoot and highlight its therapies in children.

  2. Utilization of activated sludge plants for enhanced treatment of combined sewage.

    Science.gov (United States)

    Nikolavcic, B; Svardal, K; Wandl, G; Günther, N; Spatzierer, G

    2008-01-01

    A process is introduced which utilizes secondary clarifiers for the treatment of combined sewage. Under storm water conditions, surplus sewage bypasses the aeration tanks after primary treatment and is directly introduced into the secondary clarifiers. The hydraulic capacity of existing activated sludge plants can be increased without additional tank volume. Particulate matter as well as dissolved compounds are removed to a high extent. Investigations on a full scale treatment plant (100,000 p.e.) show that the effluent quality is comparable with full biological treatment, even if the hydraulic loading is increased by 50%. IWA Publishing 2008.

  3. [Clinical observation on acupuncture combined with motortherapy for early treatment of cerebral palsy high risk infants].

    Science.gov (United States)

    Zhong, Xiao-Bei; Xia, Zi-Hong; Kong, Yan-Ying; Yuan, Yi; Liu, Li-Wei

    2007-02-01

    To observe the effect of early treatment with acupuncture and motortherapy on developmental quotient (DQ) of cerebral palsy high risk infants. Sixty cerebral palsy high risk infants were divided into an acupuncture combined with motortherapy group (treatment group) and a control group, 30 cases in each group. Changes of DQ were investigated by the children mental development scale. The DQ in the treatment group was significantly higher than that in the control group (P cerebral palsy in the treatment group significantly lower than that in the control group (P cerebral palsy for cerebral palsy high risk infants at early stage.

  4. Profile of capecitabine/temozolomide combination in the treatment of well-differentiated neuroendocrine tumors

    Science.gov (United States)

    Kotteas, Elias A; Syrigos, Konstantinos N; Saif, Muhammad Wasif

    2016-01-01

    Neuroendocrine tumors are a rare and heterogeneous group of tumors with a variety of primary origins and variable aggressiveness. Platinum-based chemotherapy has been the cornerstone of treatment for the poorly differentiated tumors. However, well-differentiated neuroendocrine tumors are quite chemoresistant and therapy options are limited. Octreotide analogs and tyrosine kinase inhibitors are widely acceptable treatments due to substantial efficacy and tolerable toxicity. On the contrary, monotherapy or combinations of the only approved cytotoxic agent streptozocin with other drugs have been almost abandoned because of excessive toxic events. In recent years, the combination of capecitabine and temozolomide has emerged as the most promising and efficacious treatment. The oral route of administration and the substantial improvement in the outcomes with manageable toxicity are the major advantages. We reviewed the current literature and presented the profile of the capecitabine/temozolomide combination in the management of well-differentiated neuroendocrine tumors. PMID:26929640

  5. New Combinational Method for Noninvasive Treatments of Superficial Tissues for Body Aesthetics Applications

    Science.gov (United States)

    Rybyanets, A. N.; Naumenko, A. A.

    The paper introduces an innovative combinational treatment method based on ultrasonic standing waves (USW) technology for noninvasive surgical, therapeutic, lypolitic or cosmetic treatment of tissues including subcutaneous adipose tissue, cellulite or skin on arbitrary body part of patient. The method is based on simultaneous or successive applying of constructively interfering physically and biologically sensed influences: USW, ultrasonic shear waves, radio-frequency (RF) heating, and vacuum massage. The paper provides basic physical principles of USW as well as critical comparison of USW and HIFU methods. The results of finite-elements and finite- difference modeling of USW transducer design and nodal pattern structure in tissue are presented. Biological effects of USW-tissue interaction and synergetic aspects of USW and RF combination are explored. Combinational treatment transducer designs and original in-vitro experiments on tissues are described.

  6. Autoinducer-2 analogs and electric fields - an antibiotic-free bacterial biofilm combination treatment.

    Science.gov (United States)

    Subramanian, Sowmya; Gerasopoulos, Konstantinos; Guo, Min; Sintim, Herman O; Bentley, William E; Ghodssi, Reza

    2016-10-01

    Bacterial biofilms are a common cause of chronic medical implant infections. Treatment and eradication of biofilms by conventional antibiotic therapy has major drawbacks including toxicity and side effects associated with high-dosage antibiotics. Additionally, administration of high doses of antibiotics may facilitate the emergence of antibiotic resistant bacteria. Thus, there is an urgent need for the development of treatments that are not based on conventional antibiotic therapies. Presented herein is a novel bacterial biofilm combination treatment independent of traditional antibiotics, by using low electric fields in combination with small molecule inhibitors of bacterial quorum sensing - autoinducer-2 analogs. We investigate the effect of this treatment on mature Escherichia coli biofilms by application of an alternating and offset electric potential in combination with the small molecule inhibitor for 24 h using both macro and micro-scale devices. Crystal violet staining of the macro-scale biofilms shows a 46 % decrease in biomass compared to the untreated control. We demonstrate enhanced treatment efficacy of the combination therapy using a high-throughput polydimethylsiloxane-based microfluidic biofilm analysis platform. This microfluidic flow cell is designed to reduce the growth variance of in vitro biofilms while providing an integrated control, and thus allows for a more reliable comparison and evaluation of new biofilm treatments on a single device. We utilize linear array charge-coupled devices to perform real-time tracking of biomass by monitoring changes in optical density. End-point confocal microscopy measurements of biofilms treated with the autoinducer analog and electric fields in the microfluidic device show a 78 % decrease in average biofilm thickness in comparison to the negative controls and demonstrate good correlation with real-time optical density measurements. Additionally, the combination treatment showed 76 % better treatment

  7. [Combined endoscopic-laparoscopic techniques for one-stage treatment of concomitant cholelithiasis and choledocholithiasis].

    Science.gov (United States)

    Wu, Junzheng; Xu, Xiaofei; Liu, Hao; Li, Guoxin

    2013-11-01

    To assess the clinical effects of combined endoscopic-laparoscopic technique for one-stage treatment of cholelithiasis with concomitant choledocholithiasis. A retrospective analysis was conducted of the clinical data of 30 patients (Group A) with cholelithiasis and choledocholithiasis receiving one-stage laparoscopic cholecystectomy (LC) combined with intraoperative encoscopic retrograde cholangio-pancreatography (ERCP) and 32 patients (Group B) receiving LC combined with 1aparoscopic common bile duct exploration. The operative time, blood loss, conversion to open surgery rate, time to postoperative ambulation, calculi residual rate, hospitalization cost and length of hospital stay were analyzed comparatively. There were statistically differences between the two groups in hospitalization cost and length of hospital stay (P0.05). Combined endoscopic-laparoscopic techniques can be a safe and feasible option for one-stage treatment of concomitant cholelithiasis and choledocholithiasis to allow rapid postoperative recovery with a shortened hospital stay.

  8.   Combination treatment of monosymptomatic enuresis nocturna with alarm and desmopressin

    DEFF Research Database (Denmark)

    Kamperis, Konstantinos; Hagstrøm, Søren; Rittig, Søren

    2006-01-01

      AIM To retrospectively evaluate the combination treatment with alarm and desmopressin in a population of children with monosymptomatic enuresis nocturna (MNE). MATERIAL AND METHODS 218 children with MNE (age 5-14y) treated in our outpatient clinics were investigated in the present study. All...... children had completed the diagnostic procedures of our center comprising 2-week home recordings, desmopressin titration, uroflowmetry and urinalysis. The latest ICCS standardization was used for characterizations. All children were treated with the enuresis alarm alone or in combination with desmopressin...... complete dryness. We found no differences with regards to age, gender, enuresis frequency, average and maximal voided volumes between children that achieved dryness with alarm or combination of alarm and desmopressin. However, children ending in combination treatment shared significantly higher nocturnal...

  9. Effect of phacoemulsification combined with intraocular lens implantation on diabetic cataract treatment

    Institute of Scientific and Technical Information of China (English)

    Wei Gao; Chao Zhang; Li Jia; Hong Tang

    2016-01-01

    Objective:To observe the effect of phacoemulsification combined with intraocular lens implantation on inflammatory factors, oxidative stress reaction and the hemorheology in patients with diabetic cataract, for helping clinical treatment of patients with diabetic cataract. Methods: A total of 160 diabetic cataract patients in our hospital were selected and randomly divided into observation group and control group, each group were 80 cases, control group was treated with conventional therapy, observation group was treated with phacoemulsification combined with intraocular lens implantation based on conventional therapy, the changes of inflammatory factors, oxidative stress reaction and the hemorheology were detected before and after treatment.Results: The difference of inflammatory factors, oxidative stress reaction and the hemorheology in the two groups before treatment was not statistically significant (P>0.05). Inflammatory factors (IL-2, IL-6, hs-CRP and TNF-α), MDA in both groups after treatment significantly increased compared with that before treatment.; oxidative stress reaction parameters (CAT, SOD, GSH-Px), hemorheology parameters (WHV, WLV, PV) in both groups after treatment significantly decreased compared with that before treatment. Changes in PCV and FIB in two groups after treatment was not statistically significant compared with that before treatment (P>0.05). MDA, Inflammatory factors (IL-2, IL-6, , hs-CRP and TNF-α) and hemorheology parameters (WHV, WLV, PV) in observation group after treatment decreased more significantly than that in control group (P0.05). Conclusions:Phacoemulsification combined with intraocular lens implantation could improve inflammatory factors, oxidative stress reaction parameters and hemorheology parameters in diabetic cataract patients, and help clinical treatment of diabetic cataract patients.

  10. Hyperbaric oxygen therapy in tinnitus with normal hearing in association with combined treatment.

    Science.gov (United States)

    Holy, Richard; Prazenica, Pavol; Stolarikova, Eva; Dosel, Petr; Fundova, Petra; Kovar, Daniel; Astl, Jaromir

    2016-01-01

    Tinnitus is a phantom perception of sound in the absence of overt acoustic stimulation. The focus of our attention is a combined therapy of tinnitus. In this prospective study (2013-2014) we evaluated the data of normal-hearing patients with tinnitus treated with various treatment modalities. In Group 1 we evaluated the data of 84 patients/124 ears after six weeks of treatment with betahistine dihydrochloride (72 mg). In Group 2, we evaluated the data of 36 patients/ 55 ears unimproved from Group 1 who were then treated for six weeks with hyperbaric oxygen (HBO₂) therapy combined with gingko biloba extract (120 mg). In Group 1, tinnitus disappeared in 9.7%, alleviated in 18.5% and improved overall in 28.2%. Average intensity of tinnitus before/after treatment was 37 decibels (dB)/33 dB. Tinnitus intensities after treatment are statistically significantly lower (p = 0.001) than the values before treatment. In Group 2 tinnitus disappeared in 5.4%, 36.4% achieved alleviation, and 41.8% showed overall improvement. The average intensity of tinnitus before/after treatment was 41dB/ 38dB. The values of tinnitus intensity after combined therapy are statistically significantly lower (p = 0.046). We have shown that both methods treatment of tinnitus are statistically significant. HBO₂therapy was recommended for the general public.

  11. New oxaliplatin-based combinations in the treatment of colorectal cancer.

    Science.gov (United States)

    Cassidy, J; Hochster, H

    2003-11-01

    The synergism between oxaliplatin and 5-fluorouracil (5FU)/leucovorin in the treatment of colorectal cancer raises the prospect of further clinically effective combinations. Phase I/II trials of capecitabine, an oral fluoropyrimidine, plus oxaliplatin have established this combination (XELOX) as an effective treatment for advanced disease, with response rates of over 50% in first line therapy. Phase III studies of XELOX are now in progress, while further studies are investigating the combined use of oxaliplatin and a second oral fluoropyrimidine, UFT, after positive phase I/II results. Studies of combined oxaliplatin and irinotecan treatment have reported response rates varying from 25% to 60% in second-line therapy of treatment resistant metastatic disease, and 42% in first line therapy. The optimum dosing combination of these two agents has yet to be determined however, and in many patients it is likely that greater overall survival will be achieved by using them in successive lines rather than in combination. Clinical studies have also demonstrated clinically significant response rates when oxaliplatin is combined with other agents including raltitrexed and mitomycin C. Alongside these novel chemotherapeutic combinations, a range of biological therapies is now being investigated in combination with oxaliplatin in advanced colorectal cancer. Cetuximab (C225) is a monoclonal antibody that inhibits signalling through the epidermal growth factor receptor (EGFR), a pathway that has been associated with a variety of pathological process in cancer including dysregulated growth, differentiation, angiogenesis, cell motility and cell adhesion. Studies of second-line therapy combining oxaliplatin and cetuximab in advanced disease and in patients with unresectable liver-only metastases are in progress in the United States. A phase I/II study is also investigating the combined use of oxaliplatin and ZD1839 ('Iressa'), a small molecule inhibitor of the EGFR specific tyrosine

  12. The role of combination medical therapy in the treatment of acromegaly.

    Science.gov (United States)

    Lim, Dawn Shao Ting; Fleseriu, Maria

    2017-02-01

    Uncontrolled acromegaly results in approximately 2-fold excess mortality. Pituitary surgery is first-line therapy, and medical treatment is indicated for persistent disease. While cabergoline and pegvisomant are used in select patients, somatostatin receptor ligands (SRLs) remain the cornerstone of medical treatment. Management of patients poorly responsive to SRLs is therefore, challenging. The purpose of this review is to highlight the options for combination medical therapy in the treatment of acromegaly, with an emphasis on efficacy and safety. All original articles/abstracts detailing combination medical therapy in acromegaly were identified from a PubMed search. Studies reviewed included retrospective and open-label prospective studies. While the combination of SRL and cabergoline was generally well tolerated, a lower baseline insulin-like growth factor-1 (IGF-1) level was the best predictor of efficacy; this combination may be most effective in patients with mildly elevated IGF-1. SRL-pegvisomant combination normalized IGF-1 in the majority of patients; continued efficacy despite individual drug dosing reduction was also reported. The risk of significant liver enzyme elevation was, however, higher than that reported with SRL monotherapy; close monitoring is recommended. Data on pegvisomant-cabergoline combination is limited, but this may be an option in the setting of SRL intolerance. Reports on temozolomide used in combination with other medical therapies in patients with aggressive GH-secreting tumors are also summarized. While more prospective, randomized controlled trials on long-term efficacy and safety are needed, combination medical therapy remains a treatment strategy that should be considered for acromegaly patients poorly responsive to SRLs.

  13. Treatment of 180 Cases of Adhesive Shoulder Periarthritis by Combined Therapy

    Institute of Scientific and Technical Information of China (English)

    WU Qiao-ling; KUAI Le

    2007-01-01

    One hundred and eighty patients of shoulder periarthritis were treated by combined traction, acupuncture, physiotherapy, Tuina and functional exercise. After 10 treatments, 133 cases were cured, 36 cases got marked effectiveness, 8 cases got effectiveness, 3 cases had no effectiveness and the total effective rate was 98.3%. Combined therapy can relieve adhesion of soft tissues induced by various causes to achieve the purpose of accelerating recovery.

  14. Genotoxicity and cytotoxicity of cisplatin treatment combined with anaesthetics on EAT cells in vivo.

    Science.gov (United States)

    Brozovic, Gordana; Orsolic, Nada; Knezevic, Fabijan; Horvat Knezevic, Anica; Benkovic, Vesna; Sakic, Katarina; Hrgovic, Zlatko; Bendelja, Kreso; Fassbender, Walter J

    2009-06-01

    In this study, DNA damage in tumour cells, as well as irreversible cell damage leading to apoptosis induced in vivo by the combined application of cisplatin and inhalation anaesthetics, was investigated. The genotoxicity of anaesthetics on Ehrlich ascites tumour (EAT) cells of mice, alone or in combined application with cisplatin, was estimated by using the alkaline comet assay. The percentage of EAT cell apoptosis was quantified by flow cytometry. Groups of EAT-bearing mice were (i) treated intraperitoneally with cisplatin, (ii) exposed to repeated anaesthesia with inhalation anaesthetic, and (iii) subjected to combined treatment of exposure to anaesthetics after cisplatin for 3 days. Sevoflurane, halothane and isoflurane caused strong genotoxic effects on tumour cells in vivo. The tested anaesthetics alone showed no direct effect on programmed cell death although sevoflurane and especially halothane decreased the number of living EAT cells in peritoneal cavity lavage. Repeated anaesthesia with isoflurane had stimulatory effects on EAT cell proliferation and inhibited tumour cell apoptosis (6.11%), compared to the control group (10.26%). Cisplatin caused massive apoptosis of EAT cells (41.14%) and decreased the number of living EAT cells in the peritoneal cavity. Combined cisplatin and isoflurane treatment additionally increased EAT cell apoptosis to 51.32%. Combined treatment of mice with cisplatin and all anaesthetics increased the number of living tumour cells in the peritoneal cavity compared to cisplatin treatment of mice alone. These results suggest that the inhalation of anaesthetics may protect tumour cells from the cisplatin-induced genotoxic and cytotoxic effects.

  15. Combined treatment with sulpiride and paroxetine for accelerated response in patients with major depressive disorder.

    Science.gov (United States)

    Uchida, Hiroyuki; Takeuchi, Hiroyoshi; Suzuki, Takefumi; Nomura, Kensuke; Watanabe, Koichiro; Kashima, Haruo

    2005-12-01

    Although serotonin reuptake inhibitors are recommended as first-line agents for major depressive disorder, delayed onset of action is problematic, and faster effective treatment is needed. Sulpiride, a dopamine-mediated agent, has been reported to show faster antidepressant efficacy, and we examined the efficacy of adjunctive sulpiride in combination with paroxetine (PAX), compared with PAX alone, to clarify whether the combined treatment exerts faster effect. Forty-one major depressive disorder patients were enrolled in this 12-week open-label trial and were randomly assigned to a PAX (10-40 mg/d) or a PAX (10-40 mg/d) plus sulpiride (100 mg/d) group. Assessments included the Montgomery-Asberg Depression Rating Scale, the 17-item Hamilton Rating Scale for Depression, and the Zung Self-rating Depression Scale on an intent-to-treat basis, and safety was also monitored. Thirty-three patients completed the study. Both PAX + sulpiride and PAX treatments showed a mean reduction in the total Montgomery-Asberg Depression Rating Scale score of 34.4 to 5.6 and 32.2 to 10.4, respectively (P Depression Rating Scale, Hamilton Rating Scale for Depression, and Zung Self-rating Depression Scale scores between week 1 and the study end point (P < 0.05). Median times to response among responders alone for the combined treatment and monotherapy were 2 and 6 weeks, respectively. Both treatments were well tolerated, with no clinically significant differences in safety measures except for an elevation of prolactin in the combined treatment group. The combination treatment may be a safe and effective strategy for accelerating antidepressant response.

  16. [Efficacy of Ingavirin in the combined treatment of ARVI complicated by tonsillitis].

    Science.gov (United States)

    2011-01-01

    This paper was designed to report the results of an open randomized comparative study of therapeutic efficacy of Ingavirin used for the treatment of adult patients with acute respiratory viral infections (ARVI) complicated by lacunar tonsillitis. The study has demonstrated that the combined application of an antibacterial agent and Ingavirin showing antiviral and anti-inflammatory properties produces a significantly more pronounced therapeutic effect compared with the standard treatment of the disease in question. This finding gives reason to recommend Ingavirin for the wide clinical application as an agent for combined therapy of acute respiratory viral infections.

  17. Alogliptin in combination with metformin and pioglitazone for the treatment of type 2 diabetes mellitus.

    Science.gov (United States)

    Holland, Daniel Q; Neumiller, Joshua J

    2014-01-01

    Alogliptin is a selective dipeptidyl peptidase-4 inhibitor recently marketed for once-daily administration in the treatment of type 2 diabetes mellitus (T2DM). Fixed-dose combinations of alogliptin with both metformin and pioglitazone are also commercially available, providing a measure of convenience in addition to an effective mode of delivering combination therapy to improve glycemic control. Alogliptin has been studied clinically as initial therapy in treatment-naïve patients with T2DM and as initial therapy or add-on in combination with other antidiabetic agents. Clinical trial data with alogliptin demonstrate clinical efficacy in terms of glycosylated hemoglobin A1c and fasting plasma glucose reductions when used both as monotherapy and as a component of two- or three-drug combination regimens for the treatment of T2DM. Extensive Phase II and Phase III clinical trial data support the use of alogliptin in combination with metformin and pioglitazone. Glycemic reduction with both combinations is similar to the sum of the respective monotherapies, with adverse event rates similar - or more moderate - than those observed with up-titration of monotherapy or the addition of other antihyperglycemic agents.

  18. Protection from ischemia by preconditioning, postconditioning, and combined treatment in rabbit testicular ischemia reperfusion injury.

    Science.gov (United States)

    Zhang, Xiaoying; Lv, Fangqing; Tang, Jie

    2016-10-15

    This study aimed to investigate the protection of ischemic preconditioning (IPreC), ischemic postconditioning (IPostC) and combined treatment on ischemia reperfusion injury (IRI) of testis. A rabbit testicular ischemia reperfusion (IR) model was established with determining of rabbit serum testosterone, nitric oxide (NO), malondialdehyde (MDA), protein carbonyl (PC), superoxide dismutase (SOD), myeloperoxidase (MPO), glutathione peroxidase (GSH-Px), and tissues pathology. After IR, the NO, MDA, PC, SOD, MPO, and GSH-Px expression significantly increased in torsive testis, and significantly decreased after IPreC, IPostC, and combined treatment in torsive testis when compared to contralateral testis. In torsive testis, testicular tissues was severely damaged with spermatogenic cells disappearing, and were filled with light eosin edema liquid. Cell apoptosis index significantly increased, and the ratio of Bcl-2/Bax significantly decreased. After IPreC, IPostC, and combined treatment, testicular tissues were restored to normal, cell apoptosis index significantly decreased, and the ratio of Bcl-2/Bax significantly increased. It indicates that IPreC, IPostC, and combined treatment has an obvious protective effect on testicular IRI, by decreasing the oxidative stress index and cell apoptosis, provides a significant reference for the treatment of testicular torsion induced infertility, and exhibits a great value in clinical applications.

  19. The TCM-Combined Treatment for Aphasia Due to Cerebrovascular Disorders

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Objective: To evaluate the therapeutic effects of scalp acupuncture (with the cluster needling, a long needle-retention and an intermittent manipulation) combined with the Schuell's stimulation and psychological care for treatment of aphasia due to cerebrovascular disorders. Method: 36 eligible cases of aphasia were randomly assigned into a treatment group and a control group. The scoring system for assessment of aphasia in speaking Chinese set by CMA Neurological Branch and that of BADE were adopted for grading the severity/degree of aphasia before and after the treatment. Results: The total effective rate in the treatment group was 84.21%, and that in the control group was 70.59%, with a very statistically significant difference (P<0.01). Conclusion: The combined scheme produced a better therapeutic effect.

  20. CLINICAL OBSERVATION ON THERAPEUTIC EFFECTS OF COMBINED TREATMENT OF NONINSULIN DEPENDENT DIABETES

    Institute of Scientific and Technical Information of China (English)

    ZHU Jin-gui; QU Hui-qing

    2005-01-01

    Objective: To observe the therapeutic effect of combined treatment of diabetes mellitus (DM) and its complications. Methods: 30 cases of noninsulin dependent diabetes were treated by electroacupuncture (EA)of Tianzhu (天柱 BL 10), Dashu (大杼 BL 11), Fengmen (风门 BL 12), Jueyinshu (厥阴俞 BL 14), etc, massage at the acupoints along the Bladder Meridian, point injection of Vitamin B1, B6, B12 plus lidocaine at Neiguan (内关 PC 6) and Sanyinjiao (三阴交 SP 6, once every 3 days), cupping and physiotherapy comprehensively. The therapeutic effect was analyzed after 40 treatments. Results: After treatment, of the 30 cases, 23 (76.7%) experienced remarkable improvement in their symptoms and the rest 7 (23.3%) had improvement, with the total effective rate being 100%. Conclusion: The abovementioned combined treatment method works well in improving clinical symptoms of type Ⅱ DM patients.

  1. Artesunate-amodiaquine treatment for children with uncomplicated malaria in Kalimantan and Sulawesi: clinical complaints, tolerability and compliance

    Directory of Open Access Journals (Sweden)

    Retno Gitawati

    2012-01-01

    Full Text Available Background Artesunate–amodiaquine combination (AS+AQ is one type of artemisinin-based combination therapy (ACT and has been used in Indonesia since 2004 for uncomplicated malaria, both in adults and children. However, its use in the Indonesia Malaria Program has not yet been evaluated. Objective To evaluate the clinical complaints and tolerability to AS+AQ treatment, as well as compliance in children with uncomplicated malaria. Methods This was a cross-sectional study, conducted in sentinel puskesmas (primary health centers in Kalimantan and Sulawesi. Subjects were 126 children aged under 15 years, with P. falciparum, P. vivax, or mixed falciparum-vivax malaria infections. All subjects were treated with a single dose of AS+AQ for three consecutive days and followed-up 3 times (D3, D7 and D28 to record clinical complaints and tolerability after drug administration. Parents/guardians underwent in-depth interviews on the knowledge, attitudes and practices of the ACT used as well as clinical complaints following AS+AQ treatment. Results Of the 126 subjects evaluated, 30 were infected with P. falciparum, 59 with P. vivax, and 37 with both species. About 84% of the subjects reported clinical complaints after AS+AQ administration (D0-D2, most commonly lethargy, nausea and vomiting, similar to the clinical symptoms of malaria. All complaints were reported to be mild and tolerable. Oonly one subject was lost to follow-up. Conclusion Clinical complaints experienced by malaria-infected children following AS+AQ treatment were relatively tolerable. Subjects’ compliance to AS+AQ treatment was satisfactory.[Paediatr Indones. 2012;52:10-5].

  2. The practice and effect of combined duty of administrative management, medical treatment and nursing

    Directory of Open Access Journals (Sweden)

    Min HU

    2014-09-01

    Full Text Available Objective: To explore the effect of combined duty mode on discovery and control of medical nursing hidden trouble. Method: In order to make sure that patients are in the first place, we should take the mode of combined duty of administrative management, medical treatment and nursing. Results:The incidence of nursing errors and defects reduced, and patients’ satisfaction improved. the differences were statistically significant (P<0.01 or P<0.05.Results: Combined duty can the reduce medical nursing defects, improve the efficiency of quality health care services and the management efficiency.

  3. Treatment of medium and late stage esophageal carcinoma with combined endoscopic metal stenting and radiotherapy

    Institute of Scientific and Technical Information of China (English)

    钟捷; 吴云林; 许帧; 刘晓天; 许斌; 翟祖康

    2003-01-01

    Objective To evaluate clinical feasibility and efficacy of endoscopic metal stenting combined with radiotherapy for treatment of medium and late stages of esophageal carcinoma. Methods Thirty-four patients of late stage esophageal carcinoma were treated with endoscopic stent implantation in combination with radiotherapy. Evaluations of CES stainless steel metal stent on the effect of radiation, clinical symptom alleviation and complication and survival rates in both groups were made. Conclusion Endoscopic metal stenting in combination with radiotherapy was a feasible and practical management in treating medium and late stages esophageal carcinoma and was superior to simple metal stent implantation.

  4. Changes in cognitive symptoms after a buspirone-melatonin combination treatment for Major Depressive Disorder.

    Science.gov (United States)

    Targum, Steven D; Wedel, Pamela C; Fava, Maurizio

    2015-09-01

    Cognitive deficits are often associated with acute depressive episodes and contribute to the functional impairment seen in patients with Major Depressive Disorder (MDD). Many patients sustain residual cognitive deficits after treatment that may be independent of the core MDD disorder. We tracked changes in cognitive deficits relative to antidepressant treatment response using the patient self-rated Massachusetts General Hospital Cognitive and Physical Functioning Questionnaire (MGH-CPFQ) during a 6-week, double-blind trial of a combination antidepressant treatment (buspirone 15 mg with melatonin-SR 3 mg) versus buspirone (15 mg) monotherapy versus placebo in MDD patients with acute depressive episodes. The CPFQ includes distinct cognitive and physical functioning dimension subscales. Treatment response was determined using the Inventory of Depressive Symptomatology (IDSc30). Treatment responders improved significantly more on the total CPFQ than non-responders (p symptoms and that some aspects of cognition may be specific targets for treatment within a population of patients with MDD.

  5. Efficacy of Combined Magnetic Field Treatment on Spinal Fusion: A Review of the Literature.

    Science.gov (United States)

    Phillips, Mark; Drew, Brian; Sprague, Sheila; Aleem, Ilyas

    2016-01-01

    Vertebral fractures place significant burdens on patients, caregivers, and the healthcare system at large. Nonunion is a frequent complication following vertebral fracture treatment, often resulting in significant patient pain and morbidity. Bone growth stimulators are an adjunct treatment modality proposed to increase rates of fracture healing. Combined magnetic field (CMF) bone growth stimulators have specifically been shown to increase union rates in patients with vertebral fractures. Certain populations, such as the elderly, postmenopausal women, and smokers, have demonstrated a preferentially greater response to CMF treatment. The present review focuses on the mechanism of action, efficacy, cost effectiveness, indications, contraindications, and safety of CMF treatment as an adjunct treatment for vertebral fractures. Future large high-quality investigations of adjunct CMF treatment for spine fusion patients focusing on patient-important outcomes are warranted.

  6. Talocalcaneal coalition combined with flatfoot in children: diagnosis and treatment: a review

    OpenAIRE

    Zhou, Binghua; Tang, Kanglai; Hardy, Mark

    2014-01-01

    Talocalcaneal coalition often leads to a flatfoot deformity in children. Previous reports have uncovered many aspects of tarsal coalition and flatfoot respectively, including the etiology, clinical presentation, and diagnostic imaging, as well as treatment. However, the optimum surgical procedure for talocalcaneal coalition combined with flatfoot has not been definitively determined. The nonconformity of treatment options is due to our incomplete knowledge of biomechanics, diagnosis, and indi...

  7. Combined endodontic therapy and surgery in the treatment of dens invaginatus Type 3: case report.

    Science.gov (United States)

    da Silva Neto, Ulisses Xavier; Hirai, Vinício Hidemitsu Goto; Papalexiou, Vula; Gonçalves, Silvana Beltrami; Westphalen, Vânia Portela Ditzel; Bramante, Clovis Monteiro; Martins, Wilson Denis

    2005-12-01

    An accurate understanding of the morphology of the root canal system is a prerequisite for successful root canal treatment. Invaginated teeth have a complex root canal configuration that cannot be instrumented effectively and should be treated by both endodontic therapy and surgery. A case of dens invaginatus Type 3 in a maxillary lateral incisor with a periapical lesion and its successful treatment by these combined methods is reported.

  8. Combined treatment with oral metronidazole and N-acetylcysteine is effective in ethylmalonic encephalopathy.

    Science.gov (United States)

    Viscomi, Carlo; Burlina, Alberto B; Dweikat, Imad; Savoiardo, Mario; Lamperti, Costanza; Hildebrandt, Tatjana; Tiranti, Valeria; Zeviani, Massimo

    2010-08-01

    Ethylmalonic encephalopathy is caused by mutations in ETHE1, a mitochondrial matrix sulfur dioxygenase, leading to failure to detoxify sulfide, a product of intestinal anaerobes and, in trace amounts, tissues. Metronidazole, a bactericide, or N-acetylcysteine, a precursor of sulfide-buffering glutathione, substantially prolonged the lifespan of Ethe1-deficient mice, with the combined treatment being additive. The same dual treatment caused marked clinical improvement in five affected children, with hardly any adverse or side effects.

  9. Clinical Experience on Treatment of Cervical Spondylosis with Combined Acupuncture, Tuina and Psychotherapy

    Institute of Scientific and Technical Information of China (English)

    陈莉秋; 苗荃; 马庭秀; 刘立飞; 韩丑萍

    2009-01-01

    @@ Cervical spondylosis is common in the middle-aged or senile population and can greatly affect their body-mind health[1]. The common treatment methods include traction, tuina, acupuncture and medication[2]. However, psychological factors, such as anxiety, depression or fear are often neglected during the treatment[3]. The authors investigated the effect of combined psycho- therapy, acupuncture and tuina on the cervical spondylosis.

  10. Granulomatous Cheilitis: Successful Treatment of Two Recalcitrant Cases with Combination Drug Therapy

    Directory of Open Access Journals (Sweden)

    Ambika Gupta

    2014-01-01

    Full Text Available Granulomatous cheilitis is a rare, idiopathic, inflammatory disorder which usually affects young adults. It is characterized by persistent, diffuse, nontender, soft-to-firm swelling of one or both lips. Various treatment modalities have been suggested. In spite of the best treatment, recurrence of the disease is very common. We report two cases of granulomatous cheilitis treated with a combination of steroids, metronidazole, and minocycline with no signs of relapse at one-year follow-up.

  11. Granulomatous Cheilitis: Successful Treatment of Two Recalcitrant Cases with Combination Drug Therapy

    OpenAIRE

    Ambika Gupta; Harneet Singh

    2014-01-01

    Granulomatous cheilitis is a rare, idiopathic, inflammatory disorder which usually affects young adults. It is characterized by persistent, diffuse, nontender, soft-to-firm swelling of one or both lips. Various treatment modalities have been suggested. In spite of the best treatment, recurrence of the disease is very common. We report two cases of granulomatous cheilitis treated with a combination of steroids, metronidazole, and minocycline with no signs of relapse at one-year follow-up.

  12. New developments in the treatment of metastatic melanoma - role of dabrafenib-trametinib combination therapy.

    Science.gov (United States)

    Luke, Jason J; Ott, Patrick A

    2014-01-01

    Development of selective inhibitors of BRAF has improved the survival of patients with BRAF-mutant melanoma. The progression-free survival after treatment with a BRAF inhibitor is modest, however, and BRAF inhibitors induce cutaneous toxicity, likely due to paradoxical activation of the mitogen-activated protein kinase pathway. Combining selective BRAF and MEK inhibition, such as the BRAF inhibitor dabrafenib and the MEK inhibitor trametinib, has been shown to improve the response rate and progression-free survival in patients with advanced melanoma while significantly alleviating the paradoxical activation of mitogen-activated protein kinase. This combination treatment results in a reduction in skin toxicity relative to that seen with a BRAF inhibitor alone; however, addition of the MEK inhibitor adds other toxicities, such as pyrexia and gastrointestinal or ocular toxicity. While combined BRAF-MEK inhibition appears primed to become a standard molecular approach for BRAF-mutant melanoma, the utility of the combination has to be considered in the rapidly changing landscape of immunotherapeutics, such as immune checkpoint blockade using anti-cytotoxic T lymphocyte antigen-4 and anti-programmed death-1/programmed death-L1 antibodies. Here we review the development of the dabrafenib plus trametinib combination, the characteristics of each drug and the combination, and the role of this combination in the management of patients with BRAF-mutant melanoma.

  13. Combination PPARγ and RXR Agonist Treatment in Melanoma Cells: Functional Importance of S100A2

    Directory of Open Access Journals (Sweden)

    Joshua P. Klopper

    2010-01-01

    Full Text Available Nuclear hormone receptors, including RXR and PPARγ, represent novel therapeutic targets in melanoma. We have previously shown that the DRO subline of the amelanotic melanoma A375 responds to rexinoid and thiazolidinedione (TZD treatment in vitro and in vivo. We performed microarray analysis of A375(DRO after TZD and combination rexinoid/TZD treatment in which the calcium binding protein S100A2 had increased expression after rexinoid or TZD treatment and a synergistic increase to combination treatment. Increased S100A2 expression is dependent on an intact PPARγ receptor, but it is not sufficient to mediate the antiproliferative effects of rexinoid/TZD treatment. Over expression of S100A2 enhanced the effect of rexinoid and TZD treatment while inhibition of S100A2 expression attenuated the response to rexinoid/TZD treatment, suggesting that S100A2 is necessary for optimal response to RXR and PPARγ activation by respective ligands. In summary, we have identified potential downstream mediators of rexinoid and TZD treatment in a poorly differentiated melanoma and found that alterations in S100A2 expression affect RXR and PPARγ signaling in A375(DRO cells. These studies provide insight into potential mechanisms of tumor response or resistance to these novel therapies.

  14. Treatment of condyloma acuminata in pregnant women with cryotherapy combined with proanthocyanidins: Outcome and safety.

    Science.gov (United States)

    Yang, Li-Juan; Zhu, Dong-Ning; Dang, Yan-Ling; Zhao, Xiong

    2016-06-01

    Patients with condyloma acuminata (CA) during pregnancy represent a special risk group. The outcomes of many treatment methods for such cases are not satisfactory. The purpose of the present study was to evaluate the treatment outcome and safety of cryotherapy combined with proanthocyanidins (PCs) for CA in pregnant women. In this study, 46 pregnant women with CA were treated with cryotherapy combined with PCs. The lesions were sprayed with liquid nitrogen until the color of the wart changed from flesh colored to purple. A PC-containing formulation was then sprayed onto a non-woven fabric or single-layer gauze and applied to the affected area. The PC treatment was applied for 20 min, 2 or 3 times per day. All patients were followed up at 1 and 3 months. No visible warts remained after the cryotherapy and PC treatment. At the 1-month follow-up, only 1 case of recurrence was identified. At 3 months, 5 cases of recurrence were identified, and the recurrence rate was 10.9%. The satisfaction rate of the patients was 94% at 1 month and 87% at 3 months after treatment. All pregnancies resulted in healthy live births without delivery complications. Cryotherapy combined with PCs is indicated to be a safe and effective procedure and may serve as a treatment option for pregnant women with CA.

  15. Hyperbaric oxygen combined with drug therapy in the treatment of acute cerebral infarction clinical analysis

    Institute of Scientific and Technical Information of China (English)

    Wen-Cui Lin; Kang Lin; Jing Wang; Shuai Li

    2015-01-01

    Objective:To explore the effects of hyperbaric oxygen combined with edaravone, salviae miltiorrhizae and ligustrazine and sodium ozagrel in the treatment of acute cerebral infarction clinical analysis.Methods: A total of 200 cases of acute cerebral infraction patients were randomly divided into observation group and control group. The control group was treated with edaravone, salvia miltiorrhizae and ligustrazine and sodium ozagrel; on the basis of treatment in control group, the observation group was combined with hyperbaric oxygen therapy. The neurological deficit scores were observed before and after treatment in patients of two groups, meanwhile the activities of daily living (ADL) and clinical effects were compared.Results: The total effective rate in observation group (92%) was significantly higher than control group (79%), the differences were statistically significant; the score of ADL in observation group after treatment was obviously higher than control group [(79.91±5.16)vs (61.62±5.60)], and the differences were statistically significant. The neurological deficit scores after treatment were obviously lower than the control group [(9.55±4.13)vs (15.46±4.92)], the differences were statistically significant.Conclusion: Hyperbaric oxygen combined with edaravone, salvia miltiorrhizae and ligustrazine and sodium ozagrel in the treatment of acute cerebral infarction can improve the symptoms of microcirculation and neurologic impairment, and improve the patient s quality of life.

  16. Effect of Danshu capsules combined with Xiyanping on acute cholecystitis treatment

    Institute of Scientific and Technical Information of China (English)

    Hong-Liang Wang; Lv-Rong Yuan; Ya-Ming Liu

    2016-01-01

    Objective:To observe the effect of Danshu capsules combined with Xiyanping on acute cholecystitis treatment and offer help to acute cholecystitis treatment.Methods: A total of 180 patients with acute cholecystitis were selected and randomly divided into groups: the observation group (90 people) and the control group (90 people). The patients in the control group were treated with conventional therapy and the patients in the observation group were treated with Danshu capsules combined with Xiyanping on the basis of conventional therapy. Immunological cell, cholecystitis related factors, inflammatory factors, and the coagulation function related factors were detected and analyzed before and after treatment.Results:Coagulation function related factors (PT and APTT), CD8+, cholecystitis related factors (total bilirubin, amylase and PCT), inflammatory factor (hs-CRP, TNF-α, IL-6 and IL-10) in both groups after treatment significantly decreased. PA, immunological cell (CD3+, CD4+ and CD4+/CD8+) significantly increased compared with that before treatment (P0.05). Coagulation function related factors (PT and APTT), CD8+, cholecystitis related factors (total bilirubin, amylase and PCT), and inflammatory factor (hs-CRP, TNF-α, IL-6 and IL-10) in observation group after treatment decreased more significantly than that in control group (P<0.05).Conclusions: Danshu capsules combined with Xiyanping can perfect effectively immunological cell, cholecystitis related factors, inflammatory factors and coagulation function related factors on patients with acute cholecystitis, and it has important clinical significance for acute cholecystitis.

  17. Efficacy of chloroquine for the treatment of Plasmodium vivax in the Saharan zone in Mauritania.

    Science.gov (United States)

    Ould Ahmedou Salem, Mohamed Salem; Mohamed Lemine, Yeslim Ould; Deida, Jemila Mint; Lemrabott, Mohamed Aly Ould; Ouldabdallahi, Mohamed; Ba, Mamadou Dit Dialaw; Boukhary, Ali Ould Mohamed Salem; Khairy, Mohamed Lemine Ould; Abdel Aziz, Mohamed Boubacar; Ringwald, Pascal; Basco, Leonardo K; Niang, Saidou Doro; Lebatt, Sidi Mohamed

    2015-01-28

    In 2006, the Mauritanian Ministry of Health adopted a new therapeutic strategy based on the systematic use of artemisinin-based combination therapy (ACT), artesunate-amodiaquine and artemether-lumefantrine, for the first- and second-line treatment of uncomplicated malaria, respectively, regardless of Plasmodium spp. In the Saharan zone of the country, recent studies have shown that Plasmodium vivax largely predominates over Plasmodium falciparum. Anti-malarial drug response of P. vivax has not been evaluated in Mauritania. The aim of the present study was to evaluate the clinical efficacy and tolerance of chloroquine to treat P. vivax malaria in Mauritanian patients. Plasmodium vivax-infected patients aged > 6 months old were enrolled in Nouakchott and Atar in September-October 2013. Chloroquine was administered at the standard dose of 25 mg base/kg body weight over three days. Patients were followed until day 28, according to the standard 2009 World Health Organization protocol. A total of 128 patients (67 in Nouakchott and 61 in Atar) were enrolled in the study. Seven patients (5.5%) were either excluded or lost to follow-up. Based on the per protocol analysis, chloroquine efficacy (adequate clinical and parasitological response) was 100%. Treatment was well-tolerated. One patient was excluded on day 1 due to urticaria and treated with artesunate-amodiaquine. Although the current national treatment guideline recommends artesunate-amodiaquine for the first-line treatment of uncomplicated malaria, including P. vivax malaria, chloroquine may still have an important role to play in anti-malarial chemotherapy in Mauritania. Further epidemiological studies are required to map the distribution of P. vivax and P. falciparum in the country.

  18. Combined Treatment with Morphine and Δ9-Tetrahydrocannabinol in Rhesus Monkeys: Antinociceptive Tolerance and Withdrawal.

    Science.gov (United States)

    Gerak, L R; France, C P

    2016-05-01

    Opioid receptor agonists are effective for treating pain; however, tolerance and dependence can develop with repeated use. Combining opioids with cannabinoids can enhance their analgesic potency, although it is less clear whether combined treatment alters opioid tolerance and dependence. In this study, four monkeys received 3.2 mg/kg morphine alone or in combination with 1 mg/kg Δ(9)-tetrahydrocannabinol (THC) twice daily; the antinociceptive effects (warm water tail withdrawal) of morphine, the cannabinoid receptor agonists WIN 55,212 [(R)-(1)-[2,3-dihydro-5-methyl-3-(4-morpholinylmethyl)pyrrolo[1,2,3-de]-1,4-benzoxazin-6-yl]-1-naphthalenylmethanone mesylate] and CP 55,940 (2-[(1R,2R,5R)-5-hydroxy-2-(3-hydroxypropyl) cyclohexyl]-5-(2-methyloctan-2-yl)phenol), and the κ opioid receptor agonist U-50,488 (trans-3,4-dichloro-N-methyl-N-[2-(1-pyrrolidinyl)-cyclohexyl]benzenacetamide methanesulfonate) were examined before, during, and after treatment. To determine whether concurrent THC treatment altered morphine dependence, behavioral signs indicative of withdrawal were monitored when treatment was discontinued. Before treatment, each drug increased tail withdrawal latency to 20 seconds (maximum possible effect). During treatment, latencies did not reach 20 seconds for morphine or the cannabinoids up to doses 3- to 10-fold larger than those that were fully effective before treatment. Rightward and downward shifts in antinociceptive dose-effect curves were greater for monkeys receiving the morphine/THC combination than monkeys receiving morphine alone. When treatment was discontinued, heart rate and directly observable withdrawal signs increased, although they were generally similar in monkeys that received morphine alone or with THC. These results demonstrated that antinociceptive tolerance was greater during treatment with the combination, and although treatment conditions were sufficient to result in the development of dependence on morphine, withdrawal was not

  19. Treatment effects and genotoxicity relevance of the toxic organic pollutants in semi-coking wastewater by combined treatment process.

    Science.gov (United States)

    Liu, Yongjun; Liu, Jing; Zhang, Aining; Liu, Zhe

    2017-01-01

    The removal effects of main toxic organic pollutants in semi-coking wastewater by combined treatment process were investigated, while the genotoxicity relevance of wastewater from different treatment units were monitored by using Vicia faba bioassays. Results showed that 37 kinds of toxic organic pollutants were detected in the crude sewage, most of them were removed by physicochemical pretreatment, and the total concentration of organic pollutants decreased from 4826 mg L(-1) to 546 mg L(-1). After pretreatment, benzenes, phenols, quinolines and indoles in the wastewater were mainly removed by anaerobic/aerobic biodegradation, but the polycyclic aromatic hydrocarbons (PAHs) were removed mainly by advanced treatment, total concentration of toxic organic pollutants was lower than 0.5 mg L(-1) in the effluent. Genotoxicity evaluation results showed that the wastewater from coagulating sedimentation unit or foregoing had significant mutagenic properties. However, the micronuclei (MN) frequency (‰, which was calculated by observing 1000 cells) induced by wastewater after adsorption with modified coke was only 8.06‰, it was no significant difference compared with negative control (7.43‰). It could be concluded that the adsorption treatment was required for the safety of effluent, and the physicochemical-biochemical combined process in this study was suitable for high concentration semi-coking wastewater treatment. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. Effect of mouse nerve growth factor combined with mecobalamine on treatment of diabetic peripheral neuropathy

    Institute of Scientific and Technical Information of China (English)

    De-Rong Hu

    2016-01-01

    Objective:To observe the clinical effect of mouse nerve growth fact (NGF) combined with mecobalamine on treatment of diabetic peripheral n-europathy (DPN).Methods:A total of 84 cases of patients with DPN treated in ourhospital between April 2012 and June 2015 were selected, and divided into study group and control group randomly (n=42); Control group was only given mecobalamine treatment, while study group was given mouse nerve growth factor combined with mecobalamine treatment for 4 weeks. TThe motor nerve conduction velocity median nerve (MNCV), sensory nerve conduction velocity (SNCV), serum high sensitivity c-reactive protein (hs-CRP) and Toronto clinical scoring system (TCSS) changes of median nerve and nervus peroneus communis before and after treatment were compared. Results:There were no significant differences in MNCV, SNCV of mediannerve and nervus peroneus communis before treatment. MNCV and SNCV of both groups after treatment were significantly increased. MNCV, SNCV of mediannerve and nervus peroneus communis in study group was significantly higher than that in control group. hs-CRP and TCSS scoring of both groups before treatment showed no statistic significant difference. hs-CRP scoring of both groups after treatment showed no significant difference. TCSS scoring was significantly lower than that in control group. Adverse reaction total occurrence rate after given drug in study group was 16.67% (7/42), compared with 7.14% (3/42) in control group, difference was significant.Conclusions:Mouse NGF combined with mecobalamine could achieve good curative effect. It is of higher safety in the treatment of patients with DPN, and deserves popularization and application.

  1. Cellulite: a new treatment approach combining subdermal Nd: YAG laser lipolysis and autologous fat transplantation.

    Science.gov (United States)

    Goldman, Alberto; Gotkin, Robert H; Sarnoff, Deborah S; Prati, Clarissa; Rossato, Flávia

    2008-01-01

    Cellulite is an alteration of the topography of the skin that occurs in body areas where fat deposition seems to be under the influence of estrogen: mainly the hips, buttocks, thighs, and abdomen. The presence of cellulite is a significant source of patient dissatisfaction. There is currently no cure or consistently effective treatment for cellulite. The authors sought to show that the subdermal application of the neodymium-doped yttrium aluminium garnet (Nd:YAG) laser combined with autologous fat transplantation is a safe and effective treatment for cellulite. From January 2003 to December 2006, 52 female patients with Curri grade III to IV cellulite were treated with subdermal 1064-nm Nd:YAG laser lipolysis combined with autologous fat transplantation. Patient assessment was collected for data analysis. After the treatment, tissue samples were obtained in some subjects in order to ascertain the histologic effects of the laser treatment. This treatment resulted in significant clinical improvement in cellulite. The adverse effects were mild and temporary, and the postoperative period was well tolerated. A majority of patients (84.6%) rated the results of treatment as either good or excellent. The treatment of severe cases of cellulite (Curri grades III and IV) by a combination of 1064-nm Nd:YAG laser lipolysis and autologous fat transplantation proved to be both safe and effective. In addition, subdermal laser lipolysis has the advantage of inducing neocollagenesis and stimulating postoperative skin tightening. This represents a new treatment option for the ubiquitous cellulite disorder. Although this treatment has shown promising results in this pilot study, further studies are necessary in order to draw final conclusions.

  2. [Upgrading of clinicoimmunological effectiveness of combined treatment in patients with chronic prostatitis].

    Science.gov (United States)

    Bratchikov, O I; Shestakov, S G; Shumakova, E A; Makhov, S V

    2008-01-01

    Our investigation of immune and cytokine status in patients with chronic prostatitis shows that basic treatment neither normalizes nor improves life quality in patients with chronic prostatitis. The addition of azoximer injections to basic treatment of chronic prostatitis improves or normalizes the majority of abnormal parameters of immune and cytokine status except neutrophil phagocyte activity, IL-1beta concentration in the blood serum, IL-6 and IL-1beta concentration in prostatic gland secretion. Chronic prostatitis treatment with azoximer injections in combination with LRS has positive immunological and clinical effects.

  3. Combined endovascular intervention and percutaneous thrombin injection in the treatment of iatrogenic pseudoaneurysm. Case report.

    Science.gov (United States)

    Gabriel, M; Juszkat, R; Pukacki, F; Waliszewski, K

    2007-06-01

    One of the basic techniques of treatment of iatrogenic pseudoaneurysms is percutaneous thrombin injection. Unfortunately, success rate of this treatment can be limited in cases associated with extensive damage to arterial wall. Our paper presents one case of combined treatment involving endovascular occlusion of the entry to the false aneurysm and percutaneous thrombin injection into the pseudoaneurysm chamber. In our opinion this technique can be successfully applied in patients with contraindications for compression therapy, surgical intervention or failure of traditional injection due to large entry, multiple arterial wall damage or accompanying arteriovenous fistula.

  4. Effectiveness of psychotherapeutic, pharmacological, and combined treatments for chronic depression: a systematic review (METACHRON

    Directory of Open Access Journals (Sweden)

    von Wolff Alessa

    2010-11-01

    Full Text Available Abstract Background Chronic depressions represent a substantial part of depressive disorders and are associated with severe consequences. Several studies were performed addressing the effectiveness of psychotherapeutic, pharmacological, and combined treatments for chronic depressions. Yet, a systematic review comparing the effectiveness of multiple treatment options and considering all subtypes of chronic depressions is still missing. Methods/Design Aim of this project is to summarize empirical evidence on efficacy and effectiveness of treatments for chronic depression by means of a systematic review. The primary objectives of the study are to examine, which interventions are effective; to examine, if any differences in effectiveness between active treatment options exist; and to find possible treatment effect modifiers. Psychotherapeutic, pharmacological, and combined treatments will be considered as experimental interventions and no treatment, wait-list, psychological/pharmacological placebo, treatment as usual, and other active treatments will be seen as comparators. The population of patients will include adults with chronic major depression, dysthymia, double depression, or recurrent depression without complete remission between episodes. Outcomes of the analyses are depressive symptoms, associated consequences, adverse events, and study discontinuation. Only randomized controlled trials will be considered. Discussion Given the high prevalence and serious consequences of chronic depression and a considerable amount of existing primary studies addressing the effectiveness of different treatments the present systematic review may be of high relevance. Special attention will be given to the use of current methodological standards. Findings are likely to provide crucial information that may help clinicians to choose the appropriate treatment for chronically depressed patients.

  5. Combinational Treatment of Curcumin and Quercetin against Gastric Cancer MGC-803 Cells in Vitro

    Directory of Open Access Journals (Sweden)

    Jian-Ye Zhang

    2015-06-01

    Full Text Available Gastric cancer remains a major health problem worldwide. Natural products, with stronger antitumor activity and fewer side effects, are potential candidates for pharmaceutical development as anticancer agents. In this study, quercetin and curcumin were chosen for testing and were applied separately and in combination to human gastric cancer MGC-803 cells. The MTT assay was used to evaluate cell growth inhibition. Annexin V-FITC/PI was carried out to measure apoptosis rate. Flow cytometry was performed to analyze mitochondrial membrane potential levels. Western blots were applied to detect expression of cytochrome c, total and phosphorylated ERK and AKT. Combined treatment with curcumin and quercetin resulted in significant inhibition of cell proliferation, accompanied by loss of mitochondrial membrane potential (ΔΨm, release of cytochrome c and decreased phosphorylation of AKT and ERK. These results indicate that the combination of curcumin and quercetin induces apoptosis through the mitochondrial pathway. Notably, effect of combined treatment with curcumin and quercetin on gastric cancer MGC-803 cells is stronger than that of individual treatment, indicating that curcumin and quercetin combinations have potential as anti-gastric cancer drugs for further development.

  6. Combinational Treatment of Curcumin and Quercetin against Gastric Cancer MGC-803 Cells in Vitro.

    Science.gov (United States)

    Zhang, Jian-Ye; Lin, Min-Ting; Zhou, Meng-Jia; Yi, Tao; Tang, Yi-Na; Tang, Si-Li; Yang, Zhi-Jun; Zhao, Zhong-Zhen; Chen, Hu-Biao

    2015-06-22

    Gastric cancer remains a major health problem worldwide. Natural products, with stronger antitumor activity and fewer side effects, are potential candidates for pharmaceutical development as anticancer agents. In this study, quercetin and curcumin were chosen for testing and were applied separately and in combination to human gastric cancer MGC-803 cells. The MTT assay was used to evaluate cell growth inhibition. Annexin V-FITC/PI was carried out to measure apoptosis rate. Flow cytometry was performed to analyze mitochondrial membrane potential levels. Western blots were applied to detect expression of cytochrome c, total and phosphorylated ERK and AKT. Combined treatment with curcumin and quercetin resulted in significant inhibition of cell proliferation, accompanied by loss of mitochondrial membrane potential (ΔΨm), release of cytochrome c and decreased phosphorylation of AKT and ERK. These results indicate that the combination of curcumin and quercetin induces apoptosis through the mitochondrial pathway. Notably, effect of combined treatment with curcumin and quercetin on gastric cancer MGC-803 cells is stronger than that of individual treatment, indicating that curcumin and quercetin combinations have potential as anti-gastric cancer drugs for further development.

  7. Combined and sequential treatment of oral and maxillofacial malignancies: an evolving concept and clinical protocol

    Institute of Scientific and Technical Information of China (English)

    ZHENG Jia-wei; QIU Wei-liu; ZHANG Zhi-yuan

    2008-01-01

    Objective To introduce the concept and rational regimens and present the latest development of combined treatment of oral and maxillofacial malignancies.Data sources The related published literature was searched through the CNKI database and MEDLINE using the terms of oral cancer, oral and maxillofacial malignancies, combined and sequential therapy, multidisciplinary approach.Study selection The available related literature was read and evaluated. Studies that met the inclusion criteria were selected.Results The results show that oral and maxillofacial malignancies diagnosed at an eady stages (stages Ⅰ and Ⅱ) can be well treated with surgery alone and/or radiotherapy with optimal outcome, but advanced or recurrent diseases should be treated with rational combined and sequential treatment modalities. The use of concomitant chemoradiotherapy,taxane-containing, three-drug induction regimens and Cetuximab in combination with chemotherapy or radiotherapy demonstrated favorable results in previously untreated patients with head and neck squamous cell carcinoma.Conclusions The concept of combined and sequential treatment of advanced oral and maxillofacial malignancies should be widely accepted, and the rational regimen for individual and each type of entity should be determined based on the anatomical site and the patient's performance status.

  8. Effects of combined UV and chlorine treatment on chloroform formation from triclosan.

    Science.gov (United States)

    Ben, Weiwei; Sun, Peizhe; Huang, Ching-Hua

    2016-05-01

    The co-exposure to UV irradiation and free chlorine may occur in certain drinking water and wastewater treatment systems. This study investigated the effects of simultaneous low pressure ultraviolet (LPUV) irradiation and free chlorination on the formation of chloroform from triclosan which is a commonly used antibacterial agent. Different treatment systems (i.e., combined UV/chlorine, UV alone, and chlorine alone) were applied to examine the degradation of triclosan and formation of chloroform. The fate of representative intermediates, including chlorinated triclosan, dechlorinated triclosan intermediates and 2,4-dichlorophenol, were tracked to deduce the effect of combined UV/chlorine on the transformation of chloroform formation precursors. The relation between intermediates degradation and chloroform formation was investigated in depth by conducting stepwise experiments with UV and chlorine in different sequences. Results indicate that the combined UV/chlorine notably enhanced the chloroform formation from triclosan. From the reaction mechanism perspective the combined UV/chlorine, where the direct photolysis may play an important role, could accelerate the decay of intermediates and facilitate the generation of productive chloroform precursors. The radicals had modest influence on the degradation of triclosan and intermediates and partly hindered the formation of chloroform. These results emphasize the necessity of considering disinfection by-products formation in the application of combined UV/chlorine technology during water treatment.

  9. Use of biologic agents in combination with other therapies for the treatment of psoriasis.

    Science.gov (United States)

    Cather, Jennifer C; Crowley, Jeffrey J

    2014-12-01

    Psoriasis is a chronic inflammatory skin disorder, which is associated with a significant negative impact on a patient's quality of life. Traditional therapies for psoriasis are often not able to meet desired treatment goals, and high-dose and/or long-term use is associated with toxicities that can result in end-organ damage. An improved understanding of the involvement of cytokines in the etiology of psoriasis has led to the development of biologic agents targeting tumor necrosis factor (TNF)-α and interleukins (ILs)-12/23. While biologic agents have improved treatment outcomes, they are not effective in all individuals with psoriasis. The combination of biologic agents with traditional therapies may provide improved therapeutic options for patients who inadequately respond to a single drug or when efficacy may be increased with supplementation of another treatment. In addition, combination therapy may reduce safety concerns and cumulative toxicity, as lower doses of individual agents may be efficacious when used together. This article reviews the current evidence available on the efficacy and safety of combining biologic agents with systemic therapies (methotrexate, cyclosporine, or retinoids) or with phototherapy, and the combination of biologic agents themselves. Guidance is provided to help physicians identify situations and the characteristics of patients who would benefit from combination therapy with a biologic agent. Finally, the potential clinical impact of biologic therapies in development (e.g., those targeting IL-17A, IL-17RA, or IL-23 alone) is analyzed.

  10. Treatment And Results Of Combined Mild Bone Loss Instability With The Modified Laterjet

    OpenAIRE

    Yang, Justin Shu; Mazzocca, Augustus D.; Arciero, Robert A.

    2015-01-01

    Objectives: Recurrent anterior glenohumeral dislocation in the setting of an engaging Hill-Sachs lesion is high. The Latarjet procedure has been well-described for restoring glenohumeral stability in patients with over 25% glenoid bone loss. However, the treatment for patients with combined humeral head and mild (

  11. A comparison between finasteride, flutamide, and finasteride plus flutamide combination in the treatment of hirsutism.

    Science.gov (United States)

    Unluhizarci, K; Ozel, D; Tanriverdi, F; Karaca, Z; Kelestimur, F

    2009-01-01

    To investigate the clinical efficacy and safety of the finasteride (5 mg/day) plus flutamide (125 mg/day) combination therapy in unselected women with hirsutism, 44 women were involved in the study. The effects of such combination treatment have not been reported previously. The patients were assigned to 3 treatment groups: 14 patients (group 1) were treated with finasteride (5 mg per day), 16 patients (group 2) were treated with flutamide (125 mg per day), and 14 patients (group 3) were treated with finasteride (5 mg per day) plus flutamide (125 mg per day) for 12 months. Serum FSH, LH, estradiol, total testosterone, free testosterone, androstenedione, DHEAS, and SHBG were obtained. Hirsutism score was measured before and after treatment. Blood chemistry and side effects were evaluated during the study. The reductions in hirsutism score (% of the baseline) at 6 months were as follows: 24% for group 1, 35% for group 2, and 33% for group 3. Combination therapy resulted in (49%) similar improvement to flutamide alone (45%), but significantly (phirsutism when compared to finasteride (32%) after 12 months of treatment. In conclusion, flutamide is more effective than finasteride and the combination of these two drugs is not better than flutamide alone, but better than finasteride in hirsute women.

  12. Effect of Combined Treatment Using Wilfortrine and Paclitaxel in Liver Cancer and Related Mechanism

    Science.gov (United States)

    Li, Shuzhen; Zheng, Lei

    2016-01-01

    Background Liver cancer is a common malignant tumor with high mortality. Currently, effective medicines against liver cancer are still lacking. Paclitaxel is a wide-spectrum anti-tumor agent, while wilfortrine has been shown to have an inhibitory effect on the proliferation of liver cancer cells. This study thus investigated the potential effect of paclitaxel combined with wilfortrine on cultured liver cancer cells and related mechanisms, in order to provide evidence for pathogenesis and treatment of liver cancer. Material/Methods Liver cancer cell line HpeG2 was divided into control, paclitaxel, wilfortrine, and combined treatment groups. Cell proliferation was tested by MTT, while invasion was detected in Transwell chamber assay. Apoptotic protein Bcl-2 and Bax expression levels were further quantified using real-time PCR and Western blotting. Results Both of those 2 drugs can effectively inhibit cancer cell proliferation, depress invasion ability, increase Bcl-2 expression, and elevate Bax expression levels (p<0.05 in all cases). The combined therapy had better treatment efficacy compared to either of those drugs alone (p<0.05). Conclusions The combined treatment using wilfortrine and paclitaxel can inhibit proliferation and invasion of liver cancer cells via down-regulating Bcl-2 and up-regulating Bax, with better efficacy than single use of either drug. PMID:27043783

  13. Combination therapy including serratiopeptidase improves outcomes of mechanical-antibiotic treatment of periimplantitis.

    Science.gov (United States)

    Sannino, G; Gigola, P; Puttini, M; Pera, F; Passariello, C

    2013-01-01

    This study was designed as a retrospective analysis of clinical outcomes of cases of periimplantitis treated by mechanical debridement and the administration of antibiotics combined or not with the administration of either the proteolytic enzyme serratiopeptidase (SPEP) or non-steroidal anti-inflammatory drugs (NSAIDs). Clinical charts of 544 partially edentulous patients treated for periimplantitis between June 1996 and December 2010 were analyzed to obtain clinical data of the affected implants just before the beginning of treatment and 12 months later to evaluate the outcomes of combined mechanical antibiotic treatment alone or in combination with the co-administration of the anti-inflammatory SPEP or NSAIDs. The comparative analysis revealed that therapeutic outcomes were significantly different in the three groups. Failure rate in the group that received SPEP (6 percent) was significantly lower compared to the group that received NSAIDS (16.9 percent; P less than 0.01) and to the group that received no anti-inflammatory therapy (18.9 percent; P less than 0.01). Treatment including SPEP was associated with significantly better healing also when successful treatments alone were considered. The data reported in this paper strongly support the hypothesis that SPEP is a valid addition to protocols for the combined therapy of peri-implantitis. In fact, it allows to enhance success rates significantly and also favors better tissue repair around successfully treated implants as compared to other regimens.

  14. Combination Comprising Parthenolide For Use In The Treatment Of Alzheimer's Disease And Other Neurodegenerative Disorders

    KAUST Repository

    Bajic, Vladimir B.

    2015-06-18

    The present invention generally concerns particular methods and compositions for treatment of a neurodegenerative disease, such as Alzheimer\\'s Disease. In particular embodiments, there is a composition comprising Parthenolide and a second agent, including an inhibitor of TLR4/MD-2/CD14, nAChR agonist, Resatorvid, Curcumin, Tilorone or a Tilorone analog, or a combination thereof.

  15. Combination of the transurethral resection and prostate HIFU ablation at treatment of the localized cancer

    Directory of Open Access Journals (Sweden)

    Popkov V.M.

    2014-09-01

    26 patients were included into HIFU and 74 group in group of the combined treatment (TURP+HIFU. Selection criteria for HIFU ablation were the localized cancer of a prostate concerning which earlier it wasn't carried out treatments, and level of a PSA at the time of statement of the diagnosis 15 ng/ml. All patients corresponding to these by criteria, were considered as candidates for treatment and inclusion in the analysis. The nadir and stability of PSA, the histologic conclusion, IPSS, quality of life and complication were estimated at time of postoperative supervision. Results: Statistically significant influence of a combination TURP+HIFU for the term of transurethral drainage of a bladder (a median of 40 days against 7 days, incontience frequency (15.4% against 6.9%, infections of urinary ways (47.9% against 11.4% and IPSS change during the postoperative period (on the average 8.91 against 3.37 is noted. During the short period of supervision it wasn't observed considerable changes in relation to efficiency: in HIFU group the frequency of repeated sessions made 25%, in TUR/HIFU group 4%. Conclusion: HIFU therapy is modern, minimum invasive method of a cancer therapy of a prostate. The combination of a transurethral resection and HIFU ablation significantly reduces the frequency of the complications connected with treatment. Maintaining the patient after combined TURP and HIFU ablation is comparable with maintaining the patient after usual TURP.

  16. Predictors and treatment strategies of HIV-related fatigue in the combined antiretroviral therapy era

    NARCIS (Netherlands)

    Jong, Eefje; Oudhoff, Lisanne A.; Epskamp, Cynthia; Wagener, Marlies N.; van Duijn, Miranda; Fischer, Steven; van Gorp, Eric C. M.

    2010-01-01

    Objective To assess predictors and reported treatment strategies of HIV-related fatigue in the combined antiretroviral (cART) era. Method Five databases were searched and reference lists of pertinent articles were checked. Studies published since 1996 on predictors or therapy of HIV-related fatigue

  17. Sonodynamic therapy with photosensitizers and its combination with photodynamic therapy in treatment of malignant tumors

    Directory of Open Access Journals (Sweden)

    D. A. Zerkovskiy

    2014-01-01

    Full Text Available The article reviews mechanisms of sonodynamic therapy with photosensitizers (ultrasound + photosensitizer and combination of sonodynamic with photodynamic therapy (ultrasound + photosensitizer + light exposure for treatment of malignant tumors. Efficacy of these methods with photosensitizers of different chemical structure in experimental study in vitro and in vivo on different tumor models and in clinical trials was assessed. 

  18. Early preventive treatment for severe acute pancreatitis combined with lung injury

    Institute of Scientific and Technical Information of China (English)

    刘学民; 刘青光; 潘承恩

    2002-01-01

    @@ Severe acute pancreatitis (SAP) can cause systematic inflammatory response syndrome (SIRS),which leads to injury or failure of the internal organs and systems.1 Among them,acute respiratory distress syndrome(ARDS)is a severe or fatal complication.In this article,the early preventive treatment for SAP combined with lung injure is studied.

  19. New, combined, and reduced dosing treatment protocols cure Trypanosoma cruzi infection in mice.

    Science.gov (United States)

    Bustamante, Juan M; Craft, Julie M; Crowe, Byron D; Ketchie, Sarah A; Tarleton, Rick L

    2014-01-01

    The development of treatment protocols with reduced toxicity and equivalent or improved efficacy for Trypanosoma cruzi infection is a priority. We tested the effectiveness of benznidazole (BZ), nifurtimox (NFX), other prospective drugs in intermittent and combined treatment protocols to cure T. cruzi infection initiated with susceptible and drug-resistant parasite strains. A 40-day course of BZ, NFX, or the oxaborale AN4169 cured 100% of mice, whereas posaconazole (POS), and NTLA-1 (a nitro-triazole) cured approximately 90% and 20% of mice, respectively. Reducing the overall dosage of BZ or NFX by using an intermittent (once every 5 days) schedule or combining 5 daily doses of POS with 7 intermittent doses of BZ also provided approximately 100% cure. T. cruzi strains resistant to BZ were also found to be resistant to other drugs (POS), and extending the time of treatment or combining drugs did not increase cure rates with these isolates. Thus, dosing schedules for anti-T. cruzi compounds should be determined empirically, and compounds targeting different pathways may be combined to yield effective therapies with reduced toxicity. This work also suggests that standard treatment protocols using BZ and NFX may be significantly overdosing patients, perhaps contributing to the adverse events.

  20. Psychotherapeutic Treatment in Combination with Relaxation in a Flotation Tank: Effects on "Burn-Out Syndrome"

    Science.gov (United States)

    Kjellgren, Anette; Buhrkall, Hanne; Norlander, Torsten

    2010-01-01

    The focus of this study was to investigate experiences gained from treatment combining relaxation in flotation tank with psychotherapy for sufferers from "burn-out syndrome". Six people participated in a ten week program. They were all interviewed; the data were analyzed using the Empirical Phenomenological Psychological method. Five…

  1. [The Effectiveness of Cognitive Behavioral Therapy, Medication, or Combined Treatment For Child Hood Anxiety Disorders].

    Science.gov (United States)

    Sevi Tok, Emine Sevinç; Arkar, Haluk; Bildik, Tezan

    2016-01-01

    The aims of this study were to evaluate the effectiveness of the Fear Hunter cognitive behavioral therapy program, which was developed for the treatment of childhood anxiety disorders, and to compare its effectiveness with standard medication treatment. A total of 46 participants (aged 8 to 12) that applied to the Ege University, Faculty of Medicine, Child and Adolescent Psychiatry clinic and had a diagnosis of anxiety disorder were recruited for the study. The participants were randomly assigned to cognitive behavioral therapy (CBT), standard drug treatment (ST), or combined treatment (CBT+ ST) groups according to the order of application. Subjects were evaluated using pretest, posttest and 3 months follow-up measurements. The participants were assessed by the researcher using The Screen for Child Anxiety Related Emotional Disorders (SCARED), The Children's Negative Cognitive Errors Questionnaire (CNCEQ), Health Related Quality of Life in Children (Kid-KINDL), and Children's Depression Inventory (CDI). The results of repeated measures ANOVA showed that, although general anxiety scores of all treatment conditions significantly decreased at posttest and follow up, a combination of two therapies (CBT+ST) had a significantly superior response rate. Moreover, all treatment conditions including CBT (CBT+ST and CBT) were superior to ST in terms of negative cognitive errors, quality of life, and depression. It is thought that The Fear Hunter Therapy Program is an effective treatment technique because; it provides significant improvement in the primary and secondary symptoms (e.g. quality of life, depression, negative automatic thoughts) of childhood anxiety disorders.

  2. Combination of ozonation with conventional aerobic oxidation for distillery wastewater treatment.

    Science.gov (United States)

    Sangave, Preeti C; Gogate, Parag R; Pandit, Aniruddha B

    2007-05-01

    Laboratory-scale experiments were conducted in order to investigate the effect of ozone as pre-aerobic treatment and post-aerobic treatment for the treatment of the distillery wastewater. The degradation of the pollutants present in distillery spent wash was carried out by ozonation, aerobic biological degradation processes alone and by using the combinations of these two processes to investigate the synergism between the two modes of wastewater treatment and with the aim of reducing the overall treatment costs. Pollutant removal efficiency was followed by means of global parameters directly related to the concentration of organic compounds in those effluents: chemical oxygen demand (COD) and the color removal efficiency in terms of absorbance of the sample at 254 nm. Ozone was found to be effective in bringing down the COD (up to 27%) during the pretreatment step itself. In the combined process, pretreatment of the effluent led to enhanced rates of subsequent biological oxidation step, almost 2.5 times increase in the initial oxidation rate has been observed. Post-aerobic treatment with ozone led to further removal of COD along with the complete discoloration of the effluent. The integrated process (ozone-aerobic oxidation-ozone) achieved approximately 79% COD reduction along with discoloration of the effluent sample as compared to 34.9% COD reduction for non-ozonated sample, over a similar treatment period.

  3. Efficacy of artemether-lumefantrine and dihydroartemisinin-piperaquine for treatment of uncomplicated malaria in children in Zaire and Uíge Provinces, angola.

    Science.gov (United States)

    Plucinski, Mateusz M; Talundzic, Eldin; Morton, Lindsay; Dimbu, Pedro Rafael; Macaia, Aleixo Panzo; Fortes, Filomeno; Goldman, Ira; Lucchi, Naomi; Stennies, Gail; MacArthur, John R; Udhayakumar, Venkatachalam

    2015-01-01

    The development of resistance to antimalarials is a major challenge for global malaria control. Artemisinin-based combination therapies, the newest class of antimalarials, are used worldwide but there have been reports of artemisinin resistance in Southeast Asia. In February through May 2013, we conducted open-label, nonrandomized therapeutic efficacy studies of artemether-lumefantrine (AL) and dihydroartemisinin-piperaquine (DP) in Zaire and Uíge Provinces in northern Angola. The parasitological and clinical responses to treatment in children with uncomplicated Plasmodium falciparum monoinfection were measured over 28 days, and the main outcome was a PCR-corrected adequate clinical and parasitological response (ACPR) proportion on day 28. Parasites from treatment failures were analyzed for the presence of putative molecular markers of resistance to lumefantrine and artemisinins, including the recently identified mutations in the K13 propeller gene. In the 320 children finishing the study, 25 treatment failures were observed: 24 in the AL arms and 1 in the DP arm. The PCR-corrected ACPR proportions on day 28 for AL were 88% (95% confidence interval [CI], 78 to 95%) in Zaire and 97% (91 to 100%) in Uíge. For DP, the proportions were 100% (95 to 100%) in Zaire, and 100% (96 to 100%) in Uíge. None of the treatment failures had molecular evidence of artemisinin resistance. In contrast, 91% of AL late-treatment failures had markers associated with lumefantrine resistance on the day of failure. The absence of molecular markers for artemisinin resistance and the observed efficacies of both drug combinations suggest no evidence of artemisinin resistance in northern Angola. There is evidence of increased lumefantrine resistance in Zaire, which should continue to be monitored.

  4. COMBINATION OF 5-FU AND EPIRUBICIN IN THE TREATMENT OF ADVANCED GASTRIC CANCER

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    Ardeshir Ghavamzadeh

    1993-06-01

    Full Text Available This study was undertaken to assess the effectiveness of 5-FU plus epirubicin in the treatment of the advanced gastric cancer. For this purpose, 22 patients with no previous treatment were studied. All of the patients were unoperable or metastatic. Follow up checking continued for 24 months. Our selected therapeutic regimen consisted of a combination of 500 mg/m2 5-FU dialy for five days, and 75 mg/m2 epirubicin for one day. The response rate in this study was 47.4% and the mean survival rate was 9.7 months. By far, the most common complication was gastrointestinal disturbances and no carditoxicity was seen. Having presented the results of this study and comparing it with the other therapeutic regimens like FAM combination, this selected two drug combination seems to be a useful therapeutic protocol.

  5. Treatment of vertebrobasilar insufficiency--associated vertigo with a fixed combination of cinnarizine and dimenhydrinate.

    Science.gov (United States)

    Otto, Volker; Fischer, Bernhard; Schwarz, Mario; Baumann, Wolfgang; Preibisch-Effenberger, Rudolf

    2008-01-01

    Thirty-seven patients suffering from vertigo associated with vertebrobasilar insufficiency participated in our prospective, single-center, double-blind, comparative study. Patients were randomly allocated to treatment with placebo; betahistine (12 mg betahistine dimesylate, one tablet three times daily); or the fixed combination of 20 mg cinnarizine and 40 mg dimenhydrinate (one tablet three times daily) for 4 weeks. The primary efficacy end point was the decrease of the mean vertigo score (S(M)), which was based on the patients' assessments of 12 individual vertigo symptoms after 4 weeks of treatment. Patients treated with the fixed combination showed significantly greater reductions of S(M) as compared to patients receiving placebo (p betahistine (p betahistine, 73%; placebo, 82%). In conclusion, the fixed combination proved to be statistically more effective than the common antivertiginous drug betahistine in reducing vertebrobasilar insufficiency-associated vertigo symptoms.

  6. COMPARISON OF COMBINED LITHIUM WITH CARBAMAZEPINE, BENZODIAZEPINES AND NEUROLEPTICS IN TREATMENT OF ACUTE MANIA IN AN INPATIENT STUDY

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    Ahmadi Abhari

    1996-06-01

    Full Text Available The effect of neuroloptics. Carbamacepine and hensmliacepines in treatment of 8.3 patients with acute mania was studied. According to drug types. Patients were divided into 5 groups:"n1 lithium combined with ilubupridol. "n2 Lithium combined with one plxenoshiacine "n3 Lithium combined with two phenothiazines. "n4 Lithium combined with cubumazepine and "n5 Lithium combined with benzxliazepines "nNo singnificunt differences in duration of treatment among the groups were found. According to increased risk of extrapyramidol symptoms in treatment with neuroloptics, carbamazepine or benzxliazepines are preferred in treatment of acute mania as safer comedicutions.  

  7. Retinoic acid and glycolic acid combination in the treatment of acne scars.

    Science.gov (United States)

    Chandrashekar, B S; Ashwini, K R; Vasanth, Vani; Navale, Shreya

    2015-01-01

    Acne is a prevalent condition in society affecting nearly 80-90% of adolescents often resulting in secondary damage in the form of scarring. Retinoic acid (RA) is said to improve acne scars and reduce postinflammatory hyperpigmentation while glycolic acid (GA) is known for its keratolytic properties and its ability to reduce atrophic acne scars. There are studies exploring the combined effect of retinaldehyde and GA combination with positive results while the efficacy of retinoic acid and GA (RAGA) combination remains unexplored. The aim of this study remains to retrospectively assess the efficacy of RAGA combination on acne scars in patients previously treated for active acne. A retrospective assessment of 35 patients using topical RAGA combination on acne scars was done. The subjects were 17-34 years old and previously treated for active acne. Case records and photographs of each patient were assessed and the acne scars were graded as per Goodman and Baron's global scarring grading system (GSGS), before the start and after 12 weeks of RAGA treatment. The differences in the scar grades were noted to assess the improvement. At the end of 12 weeks, significant improvement in acne scars was noticed in 91.4% of the patients. The RAGA combination shows efficacy in treating acne scars in the majority of patients, minimizing the need of procedural treatment for acne scars.

  8. Retinoic acid and glycolic acid combination in the treatment of acne scars

    Directory of Open Access Journals (Sweden)

    B S Chandrashekar

    2015-01-01

    Full Text Available Introduction: Acne is a prevalent condition in society affecting nearly 80-90% of adolescents often resulting in secondary damage in the form of scarring. Retinoic acid (RA is said to improve acne scars and reduce postinflammatory hyperpigmentation while glycolic acid (GA is known for its keratolytic properties and its ability to reduce atrophic acne scars. There are studies exploring the combined effect of retinaldehyde and GA combination with positive results while the efficacy of retinoic acid and GA (RAGA combination remains unexplored. Aim: The aim of this study remains to retrospectively assess the efficacy of RAGA combination on acne scars in patients previously treated for active acne. Materials and Methods: A retrospective assessment of 35 patients using topical RAGA combination on acne scars was done. The subjects were 17-34 years old and previously treated for active acne. Case records and photographs of each patient were assessed and the acne scars were graded as per Goodman and Baron′s global scarring grading system (GSGS, before the start and after 12 weeks of RAGA treatment. The differences in the scar grades were noted to assess the improvement. Results: At the end of 12 weeks, significant improvement in acne scars was noticed in 91.4% of the patients. Conclusion: The RAGA combination shows efficacy in treating acne scars in the majority of patients, minimizing the need of procedural treatment for acne scars.

  9. Combining biologic and phototherapy treatments for psoriasis: safety, efficacy, and patient acceptability

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    Farahnik B

    2016-07-01

    Full Text Available Benjamin Farahnik,1 Viraat Patel,2 Kourosh Beroukhim,3 Tian Hao Zhu,4 Michael Abrouk,2 Mio Nakamura,5 Rasnik Singh,3 Kristina Lee,5 Tina Bhutani,5 John Koo5 1University of Vermont College of Medicine, Burlington, VT; 2School of Medicine, University of California, Irvine, 3David Geffen School of Medicine, University of California, Los Angeles, 4University of Southern California Keck School of Medicine, Los Angeles, 5Department of Dermatology, Psoriasis and Skin Treatment Center, University of California, San Francisco, CA, USA Background: The efficacy and safety of biologic and phototherapy in treating moderate-to-severe psoriasis is well known. However, some patients may not respond well to biologic agents or phototherapy on their own and may require combination therapy. Skillfully combining a biologic agent and phototherapy may provide an additive improvement without much increase in risks.Objective: To summarize the current state of evidence for the efficacy and safety of combining biologics with phototherapy in the treatment of moderate-to-severe plaque psoriasis.Methods: We conducted an extensive search on Pubmed database for English language literature that evaluated the use of a combination of biologic and phototherapy for the treatment of moderate-to-severe psoriasis through January 2016. The search included the following keywords: psoriasis, etanercept, adalimumab, infliximab, ustekinumab, biologics, phototherapy, and combination therapy.Results: The primary literature included randomized controlled trials, a head-to-head study, open-label controlled and uncontrolled trials, case series, and case reports. Etanercept was used in over half of the reported cases, but other biologic agents used included ustekinumab, adalimumab, and infliximab. The vast majority of phototherapy was narrowband ultraviolet B (NBUVB radiation. Most cases reported enhanced improvement with combination therapy. Serious adverse events throughout the study duration

  10. Treatment of small cell lung cancer with TRA-8 in combination with cisplatin and radiation.

    Science.gov (United States)

    Bonner, James A; Willey, Christopher D; Yang, Eddy S; Dobelbower, Michael C; Sanford, Leisa L; Bright, Sheila J; Buchsbaum, Donald J; Raisch, Kevin P

    2011-10-01

    Limited stage small cell lung cancer (SCLC) represents a minority of SCLC. Despite extensive clinical trials, standard treatment remains cisplatin-based chemotherapy and thoracic irradiation (TI). This study focused on the interaction of cisplatin/radiation with the anti-human DR5 monoclonal antibody TRA-8 in SCLC cells. TRA-8 binds specifically to DR5 and has been shown to activate apoptosis. Four human SCLC cell lines were utilized for experimentation (SCLC-41, SCLC-58, SCLC-68, and SCLC-74). Immunoblot analysis was used to determine relative protein levels of DR5, DR4 and pro-caspase 8 for each cell line. Using a tetrazolium-based assay (XTT), the IC(50) values for cisplatin with or without TRA-8 were determined for the SCLC cell lines. Four SCLC lines were assayed with a combination of TRA-8 (10 μg/ml), 2 Gy radiation and various concentrations of cisplatin. Apoptosis was evaluated using Annexin V-FITC and cleaved caspase immunoblotting. Using a SCLC-58 subcutaneous xenograft model, treatment began 21 d after tumor cell injection. Treatment included weekly cisplatin (4 mg/kg) and radiation of 1 Gy (24 h after cisplatin) and TRA-8 (200 μg) was administered i.p. twice weekly for three weeks. Immunoblot analysis showed similar levels of DR5 for all cell lines with variable levels of DR4. Various concentrations of TRA-8 antibody (≤ 10 μg/ml) induced no significant cytotoxicity in the SCLC cell lines. The in vitro combination treatment with TRA-8 (10 μg/ml), 1.25 μg/ml cisplatin and 2 Gy radiation showed increased cytotoxicity when compared to combinations without TRA-8. Furthermore, the triple combination demonstrated the greatest amount of apoptosis as measured by Annexin V staining. The in vivo studies showed the combination of 1G y, cisplatin and TRA-8 extended the tumor doubling time to 44 d as compared to any doublet treatment groups that ranged from 12 to 20 d. Analysis of survival data showed 100% of the combination group (RT+cisplatin+TRA-8) were

  11. Current role of treatment in men with lower urinary tract symptoms combined with overactive bladder

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    Seung Hwan Lee

    2014-06-01

    Full Text Available Lower urinary tract symptoms (LUTS and benign prostatic hyperplasia (BPH are highly prevalent in older men. The storage subcategory of LUTS is synonymous with overactive bladder (OAB syndrome, which is an empirical diagnosis. Traditionally, alpha-blockers are widely prescribed to manage the LUTS of BPH, although storage symptoms may persist in many men despite treatment. Therefore, because therapies that target the prostate often fail to alleviate storage symptoms, they may not be the appropriate therapy for OAB. In past years, most physicians appeared to give more weight in elderly men to voiding symptoms than to storage symptoms and to be more concerned with initial treatment with anticholinergics for males with storage symptoms. Considering the recent increase in data on the efficacy and safety of combination treatment with alpha receptor antagonists and antimuscarinic agents, the standard pharmacologic treatment of patients with LUTS combined with OAB should be an alpha receptor antagonist and an antimuscarinic agent. Beta-3 adrenoreceptor agonists may also potentially be useful for the treatment of male LUTS combined with OAB.

  12. Scoliosis treatment using a combination of manipulative and rehabilitative therapy: a retrospective case series

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    Lawrence Gary

    2004-09-01

    Full Text Available Abstract Background The combination of spinal manipulation and various physiotherapeutic procedures used to correct the curvatures associated with scoliosis have been largely unsuccessful. Typically, the goals of these procedures are often to relax, strengthen, or stretch musculotendinous and/or ligamentous structures. In this study, we investigate the possible benefits of combining spinal manipulation, positional traction, and neuromuscular reeducation in the treatment of idiopathic scoliosis. Methods A total of 22 patient files were selected to participate in the protocol. Of these, 19 met the study criterion required for analysis of treatment benefits. Anteroposterior radiographs were taken of each subject prior to treatment intervention and 4–6 weeks following the intervention. A Cobb angle was drawn and analyzed on each radiograph, so pre and post comparisons could be made. Results After 4–6 weeks of treatment, the treatment group averaged a 17° reduction in their Cobb angle measurements. None of the patients' Cobb angles increased. A total of 3 subjects were dismissed from the study for noncompliance relating to home care instructions, leaving 19 subjects to be evaluated post-intervention. Conclusions The combined use of spinal manipulation and postural therapy appeared to significantly reduce the severity of the Cobb angle in all 19 subjects. These results warrant further testing of this protocol.

  13. Combination quetiapine therapy in the long-term treatment of patients with bipolar I disorder

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    Calabrese JR

    2005-07-01

    Full Text Available Abstract Objective Determine the long-term effectiveness of quetiapine in combination with standard treatments in preventing relapses for patients with bipolar I disorders Method Twenty-one outpatients with type I bipolar disorder who had inadequate responses to ongoing standard therapies were treated with add-on quetiapine in an open-label study. The quetiapine dose was increased until clinical response occurred. Illness response was assessed using the Clinical Global Impression (CGI scale. Relapse rates before and during quetiapine treatment were compared by calculating incidence risk ratios. Results Quetiapine was added to ongoing standard therapy for 26 to 78 weeks. Thirteen patients received combination therapy for at least 52 weeks. The mean quetiapine dose received was 518 ± 244 mg/day. There were highly significant improvements in overall relapse rate, manic/mixed relapse rate, and depression relapse rate in the period during quetiapine treatment compared with the period before quetiapine was initiated. The calculated relative risk of relapse in the absence of quetiapine treatment was 2.9 overall (95% confidence interval, 1.5~5.6, 3.3 for manic/mixed relapse (95% confidence interval, 1.5~7.1, and 2.4 for depressive relapse (95% confidence interval, 1.3~4.4. The mean Clinical Global Impression scores improved significantly from baseline during 26 weeks of quetiapine treatment in 21 patients (p = 0.002 and remained significantly better during a 52-week treatment period in 13 patients (p = 0.036. Conclusion Long-term treatment with quetiapine combination therapy reduced the probability of manic/mixed and depressive relapses and improved symptoms in patients with bipolar I disorder who had inadequate responses to ongoing standard treatment.

  14. Clinical efficacy of lamotrigien in combined with valproic acid in the treatment of epilepsy

    Institute of Scientific and Technical Information of China (English)

    Yu-Mei Wen; Xiu-Juan Liu; Xiao-Yu Liu; Ming-Xia Xu

    2016-01-01

    Objective:To observe the clinical efficacy of lamotrigien (LTG) in combined with valproic acid (VAP) in the treatment of epilepsy and their effects on lipid metabolism indicators and recognition function.Methods:A total of 80 patients with epilepsy who were admitted in our hospital from January, 2014 to January, 2015 were included in the study and randomized into the observation group and the control group with 30 cases in each group. The patients in the observation group were given LTG in combined with VAP, while the patients in the control group were only given VAP. The clinical efficacy in the two groups was compared. Changes of various lipid indicators and recognition function in the two groups were detected.Results:The total effective rate in the observation group was significantly higher than that in the control group. The attentiveness, memory delay, and MOCA score after treatment in the observation group were significantly elevated when compared with before treatment, and were significantly higher than those in the control group. The comparison of implementing competence before and after treatment in the observation group was not statistically significant . The levels of TC, TG, LDL-C, and HDL-C after treatment in the observation group were not significantly different from those before treatment. The levels of TC, TG, and LDL-C after treatment in the control group were significantly elevated when compared with before treatment and were significantly higher than those in the observation group in the same period.Conclusions:LTG in combined with VAP can effectively control the seizure frequency in patients with epilepsy with a small effect on lipid metabolism, and significantly improve the cognition ability; therefore, it deserves to be widely recommended in the clinic.

  15. [Combined treatment supported by piracetam and/or acyclovir in idiopathic sudden sensorineural hearing loss: experience with 81 cases].

    Science.gov (United States)

    Karakurt, Süleyman Emre; Ozkul, Mehmet Doğan; Cukurova, Ibrahim; Demirhan, Erhan; Yiğitbaşi, Orhan Gazi

    2009-01-01

    To investigate the efficiency of piracetam and acyclovir in treating sudden hearing loss. Eightyone patients (44 males, 37 females; mean age 40.4 year; range 18 to 72 years) who had treatment between January 2002 and December 2006 with diagnosis of idiopathic sudden hearing loss were evaluated retrospectively. These patients were divided into four groups according to the treatment they received. The patients who had combined treatment constituted the first group; those who had combined treatment and piracetam the second; those who had combined treatment and acyclovir the third; those who had combined treatment, acyclovir, and piracetam the fourth group. For the four treatment groups, in the pre-and post-treatment (10th day) evaluation of the treatment efficiency made by calculation of the hearing thresholds in 250-8000 Hz frequencies, no significant difference between the groups was determined (p>0.05). No additional benefit was obtained with acyclovir and piracetam in treatment.

  16. Le Fort II midfacial distraction combined with orthognathic surgery in the treatment of nasomaxillary hypoplasia.

    Science.gov (United States)

    Yu, Hongbo; Dai, Jiewen; Wang, Xudong; Zhang, Wenbin; Shen, Steve Guofang

    2014-05-01

    Patients with nasomaxillary hypoplasia have severe facial concavity and compromised skeletal class III malocclusion. Its treatment is still a challenge to surgeons. Our aim was to evaluate the combination of midfacial distraction and orthognathic surgery in the treatment of nasomaxillary hypoplasia. Four patients with nasomaxillary hypoplasia were enrolled in this study. After Le Fort II osteotomy, the rotational distraction of nasomaxillary complex was performed to rehabilitate facial convexity. Then bilateral sagittal split ramus osteotomy with or without Le Fort I osteotomy was used to correct malocclusion. All patients healed uneventfully, and the maxillae moved forward conspicuously. No obvious pain and severe discomfort were complained during distraction. A significant advancement and downward movement of the maxilla were shown by cephalometric analysis. The combination of midfacial distraction and orthognathic surgery provides us an ideal alternative in the treatment of nasomaxillary hypoplasia.

  17. Treatment for recurrent medulloblastoma with intrathecal liposomal cytarabine and systemic metronomic combination therapy.

    Science.gov (United States)

    Nygaard, Randi; Kivivuori, Sanna-Maria

    2012-03-01

    The prognosis of recurrent medulloblastoma is dismal, with a median survival of less than 1 year. Our patient was initially diagnosed with high-risk medulloblastoma when he was 14 years old. He had a recurrence 18 months after the end of therapy. Recurrence treatment consisted of 13 intrathecal applications of liposomal cytarabine over an 18-month period, and oral metronomic antiangiogenic therapy with thalidomide, celecoxib, and etoposide. Side effects from the intrathecal treatment were most likely related to arachnoiditis despite prolonged prophylaxis with steroids. He also developed partial hearing loss. Neutropenia was the main side effect of the metronomic therapy. He remains alive, with a good quality of life and without evidence of disease 34 months from the start of recurrence therapy. This combination of local antineoplastic and systemic antiangiogenic therapy seems to be promising for recurrent medulloblastoma. However, more patients and standardized protocols are needed to verify the benefit of this combination therapy and to define the correct duration of treatment.

  18. Efficacy of fixed-dose combination artesunate-amodiaquine versus artemether-lumefantrine for uncomplicated childhood Plasmodium falciparum malaria in Democratic Republic of Congo: a randomized non-inferiority trial

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    Espié Emmanuelle

    2012-05-01

    Full Text Available Abstract Background In 2005, the Democratic Republic of Congo (DRC adopted artesunate and amodiaquine (ASAQ as first-line anti-malarial treatment. In order to compare the efficacy of the fixed-dose formulation ASAQ versus artemether-lumefantrine (AL, a randomized, non-inferiority open-label trial was conducted in Katanga. Methods Children aged six and 59 months with uncomplicated Plasmodium falciparum malaria were enrolled and randomly allocated into one of the two regimens. The risk of recurrent parasitaemia by day 42, both unadjusted and adjusted by PCR genotyping to distinguish recrudescence from new infection, was analysed. Results Between April 2008 and March 2009, 301 children were included: 156 with ASAQ and 145 with AL. No early treatment failures were reported. Among the 256 patients followed-up at day 42, 32 patients developed late clinical or parasitological failure (9.9% (13/131 in the ASAQ group and 15.2% (19/125 in the AL group. After PCR correction, cure rates were 98.3% (95%CI, 94.1-99.8 in the ASAQ group and 99.1% (95%CI, 94.9-99.9 in the AL group (difference −0.7%, one sided 95% CI −3.1. Kaplan-Meier PCR-adjusted cure rates were similar. Both treatment regimens were generally well tolerated. Conclusion Both ASAQ and AL are highly effective and currently adequate as the first-line treatment of uncomplicated falciparum malaria in this area of Katanga, DRC. However, in a very large country, such as DRC, and because of possible emergence of resistance from other endemic regions, surveillance of efficacy of artemisinin-based combination treatments, including other evaluations of the resistance of ASAQ, need to be done in other provinces. Trial registration The protocol was registered with the clinicaltrials.gov, open clinical trial registry under the identifier number NCT01567423.

  19. Protective efficacy of malaria case management and intermittent preventive treatment for preventing malaria mortality in children: a systematic review for the Lives Saved Tool

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    Steketee Richard W

    2011-04-01

    Full Text Available Abstract Background The Lives Saved Tool (LiST model was developed to estimate the impact of the scale-up of child survival interventions on child mortality. New advances in antimalarials have improved their efficacy of treating uncomplicated and severe malaria. Artemisinin-based combination therapies (ACTs for uncomplicated Plasmodium falciparum malaria and parenteral or rectal artemisinin or quinine for severe malaria syndromes have been shown to be very effective for the treatment of malaria in children. These interventions are now being considered for inclusion in the LiST model. However, for obvious ethical reasons, their protective efficacy (PE compared to placebo is unknown and their impact on reducing malaria-attributable mortality has not been quantified. Methods We performed systematic literature reviews of published studies in P. falciparum endemic settings to determine the protective efficacy (PE of ACT treatment against malaria deaths among children with uncomplicated malaria, as well as the PE of effective case management including parenteral quinine against malaria deaths among all hospitalized children. As no randomized placebo-controlled trials of malaria treatment have been conducted, we used multiple data sources to ascertain estimates of PE, including a previously performed Delphi estimate for treatment of uncomplicated malaria. Results Based on multiple data sources, we estimate the PE of ACT treatment of uncomplicated P. falciparum malaria on reducing malaria mortality in children 1–23 months to be 99% (range: 94-100%, and in children 24-59 months to be 97% (range: 86-99%. We estimate the PE of treatment of severe P. falciparum malaria with effective case management including intravenous quinine on reducing malaria mortality in children 1-59 months to be 82% (range: 63-94% compared to no treatment. Conclusions This systematic review quantifies the PE of ACT used for treating uncomplicated malaria and effective case

  20. A review of producing hard coatings by means of duplex treatments using an electroplated coating–thermochemical treatment combination

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    Héctor Cifuentes Aya

    2011-12-01

    Full Text Available Duplex treatments have been developed to overcome the disadvantages presented by simple treatments to surfaces of different materials and have, in a combined and complementary way, the properties that each of these methods supplies individually. The difference between thermal expansion coefficients for Fe and Cr in hard chrome plating leads to crack formation in the deposited coat, through which corrosive agents migrate and reduce the system’s integrity.Direct deposition by physical vapour deposition (PVD, used for obtaining chromium nitride films on steel substrates, is limited by high production costs, the low thickness obtained and low resistance to corrosion due to the presence of micro pores. Some studies have combined an electroplated chromium with thermochemical treatments made in a controlled atmosphere or vacuum furnaces or by plasma. This kind of duplex treatment allows compounds such as CrxN, CrxCyN and CrxCy to be obtained from chemical and micro structural transformation of chromium with nitrogen and/or carbon, the sealing of cracks in the coating and increasing the magnitude of properties like hardness and density, improving wear and abrasion and corrosion resistance.

  1. Non-small cell lung carcinoma of the superior sulcus : Favourable outcomes of combined modality treatment in carefully selected patients

    NARCIS (Netherlands)

    Kappers, I.; Belderbos, J. S. A.; Burgers, J. A.; van Zandwijk, N.; Groen, H. J. M.; Klomp, H. M.

    The combination of radiotherapy and concurrent chemotherapy followed by surgery (trimodality treatment) is currently regarded as optimal treatment for non-small cell lung cancer of the superior sulcus (SST) or Pancoast tumour. The possibility to administer intensive combined modality treatment is

  2. Novel combination treatment of type 2 diabetes DPP-4 inhibition + metformin

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    Bo Ahrén

    2008-04-01

    Full Text Available Bo AhrénDepartment of Clinical Sciences, Division of Medicine, Lund University, Lund, SwedenAbstract: Inhibition of dipeptidyl peptidase-4 (DPP-4 as a novel therapy for type 2 diabetes is based on prevention of the inactivation process of bioactive peptides, the most important in the context of treatment of diabetes of which is glucagon-like peptide-1 (GLP-1. Most clinical experience with DPP-4 inhibition is based on vildagliptin (GalvusR, Novartis and sitagliptin (JanuviaR, Merck. These compounds improve glycemic control both in monotherapy and in combination with other oral hyperglycemic agents. Both have also been shown to efficiently improve glycemic control when added to ongoing metformin therapy in patients with inadequate glycemic control. Under that condition, they reduce HbA1c levels by 0.65%–1.1% (baseline HbA1c 7.2–8.7% in studies up to 52 weeks of duration in combination versus continuous therapy with metformin alone. Sitagliptin has also been examined in initial combination therapy with metformin have; HbA1c was reduced by this combination by 2.1% (baseline HbA1c 8.8% after 24 weeks of treatment. Both fasting and prandial glucose are reduced by DPP-4 inhibition in combination with metformin in association with improvement of insulin secretion and insulin resistance and increase in concentrations of active GLP-1. The combination of DPP-4 inhibition and metformin has been shown to be highly tolerable with very low risk of hypoglycemia. Hence, DPP-4 inhibition in combination with metformin is an efficient, safe and tolerable combination therapy for type 2 diabetes.Keywords: DPP-4 inhibition, sitagliptin, vildagliptin, metformin, type 2 diabetes

  3. Novel combination treatment of type 2 diabetes DPP-4 inhibition + metformin.

    Science.gov (United States)

    Ahrén, Bo

    2008-01-01

    Inhibition of dipeptidyl peptidase-4 (DPP-4) as a novel therapy for type 2 diabetes is based on prevention of the inactivation process of bioactive peptides, the most important in the context of treatment of diabetes of which is glucagon-like peptide-1 (GLP-1). Most clinical experience with DPP-4 inhibition is based on vildagliptin (GalvusR, Novartis) and sitagliptin (JanuviaR, Merck). These compounds improve glycemic control both in monotherapy and in combination with other oral hyperglycemic agents. Both have also been shown to efficiently improve glycemic control when added to ongoing metformin therapy in patients with inadequate glycemic control. Under that condition, they reduce HbA1C levels by 0.65%-1.1% (baseline HbA1C 7.2-8.7%) in studies up to 52 weeks of duration in combination versus continuous therapy with metformin alone. Sitagliptin has also been examined in initial combination therapy with metformin have; HbA1 was reduced by this combination by 2.1% (baseline HbA1C 8.8%) after 24 weeks of treatment. Both fasting and prandial glucose are reduced by DPP-4 inhibition in combination with metformin in association with improvement of insulin secretion and insulin resistance and increase in concentrations of active GLP-1. The combination of DPP-4 inhibition and metformin has been shown to be highly tolerable with very low risk of hypoglycemia. Hence, DPP-4 inhibition in combination with metformin is an efficient, safe and tolerable combination therapy for type 2 diabetes.

  4. Clonal evolution of hepatitis B virus polymerase gene mutations during lamivudine-adefovir combination treatment

    Institute of Scientific and Technical Information of China (English)

    Soon Young Ko; Byung Kook Kim; So Young Kwon; Kyun-Hwan Kim; Jeong Han Kim; Won Hyeok Choe; Chang HongLee

    2012-01-01

    AIM:To identify hepatitis B virus polymerase gene mutations during antiviral therapy using lamivudineadefovir sequential monotherapy followed by lamivudine-adefovir combination therapy.METHODS:The patient cohort included four adult chronic hepatitis B patients who had undergone sequential monotherapy,first with lamivudine (LMV)and then,after developing viral breakthrough,with adefovir (ADV) therapy.All of the patients had non-response or viral breakthrough after LMV-ADV sequential monotherapy,which resulted in the switching of their antiviral regimen to LMV-ADV combination therapy.Eleven serum samples from the four patients who showed non-response to rescue LMV-ADV combination therapy were collected sequentially at a time before the antiviral treatment and then during the LMV monotherapy,ADV monotherapy,and LMV-ADV combination therapy.For the genotypic analysis,the whole 1310-bp polymerase gene region was amplified,cloned and sequenced.RESULTS:All patients had been previously treated with 100 mg of LMV once daily for a 15-to 26-mo period.The emergence of resistance mutations to LMV,such as rtM204V/I and/or rtL180M,were found in all patients.Their antiviral regimens were switched to ADV monotherapy as the second line treatment.All patients had viral breakthrough or non-response after the LMV-ADV sequential monotherapy.ADV-resistant mutations were detected after 13 to 19 mo of LMV-ADV sequential monotherapy.The rtA181V/T mutations were predominantly identified during the ADV treatment in the LMV-resistant patients.Twenty-seven of 38 clones were combined with an amino acid change at rt181;three clones had mutations in rt236 and one clone had a combined mutation.The rtA181V/T mutations were not suppressed by the LMV-ADV combination therapy.Thirty-nine of 64 clones showed an rtA181V/T mutation and six clones showed combined mutations in rt181 and rt236.Mutations in rt204 re-emerged during the combination treatment.The rt181 and rt204 mutations did not co-exist in one

  5. Combining mindfulness meditation with cognitive-behavior therapy for insomnia: a treatment-development study.

    Science.gov (United States)

    Ong, Jason C; Shapiro, Shauna L; Manber, Rachel

    2008-06-01

    This treatment-development study is a Stage I evaluation of an intervention that combines mindfulness meditation with cognitive-behavior therapy for insomnia (CBT-I). Thirty adults who met research diagnostic criteria for Psychophysiological Insomnia (Edinger et al., 2004) participated in a 6-week, multi-component group intervention using mindfulness meditation, sleep restriction, stimulus control, sleep education, and sleep hygiene. Sleep diaries and self-reported pre-sleep arousal were assessed weekly while secondary measures of insomnia severity, arousal, mindfulness skills, and daytime functioning were assessed at pre-treatment and post-treatment. Data collected on recruitment, retention, compliance, and satisfaction indicate that the treatment protocol is feasible to deliver and is acceptable for individuals seeking treatment for insomnia. The overall patterns of change with treatment demonstrated statistically and clinically significant improvements in several nighttime symptoms of insomnia as well as statistically significant reductions in pre-sleep arousal, sleep effort, and dysfunctional sleep-related cognitions. In addition, a significant correlation was found between the number of meditation sessions and changes on a trait measure of arousal. Together, the findings indicate that mindfulness meditation can be combined with CBT-I and this integrated intervention is associated with reductions in both sleep and sleep-related arousal. Further testing of this intervention using randomized controlled trials is warranted to evaluate the efficacy of the intervention for this population and the specific effects of each component on sleep and both psychological and physiological arousal.

  6. Systemic but no local effects of combined zoledronate and parathyroid hormone treatment in experimental autoimmune arthritis.

    Directory of Open Access Journals (Sweden)

    Kresten Krarup Keller

    Full Text Available INTRODUCTION: Local bone erosions and osteoporosis in rheumatoid arthritis (RA are the result of a more pronounced bone resorption than bone formation. Present treatment strategies for RA inhibit inflammation, but do not directly target bone erosions. The aim of the study was in experimental arthritis to investigate the juxtaarticular and systemic effects of simultaneous osteoclast inhibition with zoledronate (ZLN and osteoblast stimulation with parathyroid hormone (PTH. METHODS: Arthritis was induced in 36 SKG mice. The mice were randomized to three treatment groups and an untreated group: ZLN, PTH, PTH+ZLN, and untreated. Arthritis score and ankle width measurements were performed. Histological sections were cut from the right hind paw, and design-based stereological estimators were used to quantify histological variables of bone volume and bone formation and resorption. The femora were DXA- and μCT-scanned, and the bone strength was determined at the femoral neck and mid-diaphysis. RESULTS: Locally, we found no differences in arthritis score or ankle width throughout the study. Similarly, none of the treatments inhibited bone erosions or stimulated bone formation in the paw. Systemically, all treatments improved bone mineral density, strength of the femoral neck and mid-diaphysis, and μCT parameters of both cortical and trabecular bone. In addition, there was an additive effect of combination treatment compared with single treatments for most trabecular parameters including bone mineral density and bone volume fraction. CONCLUSIONS: No local effect on bone was found by the combined action of inhibiting bone resorption and stimulating bone formation. However, a clear systemic effect of the combination treatment was demonstrated.

  7. The combination treatment using CO₂ laser and photodynamic therapy for HIV seropositive men with intraanal warts.

    Science.gov (United States)

    Xu, Juan; Xiang, Li; Chen, Jiayuan; He, Qin; Li, Qing; Li, Jing; Wang, Jing

    2013-05-01

    We evaluate the effectiveness of combination treatment using photodynamic therapy after carbon dioxide laser in preventing the recurrence of condylomata acuminata for intraanal warts in HIV positive homosexual men. A retrospective survey of 41 patients referred to the STD clinic of the Fourth People's Hospital of Shenzhen for the treatment of intraanal warts among HIV positive homosexual men between Janurary 2009 and September 2011. The patients who accepted CO₂ laser monotherapy for the same diagnosis were used as the comparison group. After the confirmation of the diagnosis of HIV infection and intraanal warts, the patients were treated with the combination treatment using PDT with 5-ALA thermal gel immediately after CO₂ laser ablation of the warts. PDT was performed with irradiation of 100 J/cm² at an irradiance of 100-150 mW/cm² with a semiconductor laser, wavelength 635 nm. PDT therapy was repeated twice with 2 weekly intervals. Follow up examinations including an anoscopy every 4 weeks after the latest PDT. After 3 cycles of PDT treatments, 39 cases of anoscopy examination showed no new or recurrent lesions. At the end of the sixth months, recurrence occurred in 12(29%) cases. HPV 11 was present in 6 (50%) of these recurrences. HPV 6/11 or 16/18 remains positive in 19 cases (46.3%) and HPV negative in 22 cases. The combination treatment with CO₂ laser and PDT is much more effective in reducing the treatment cycles and the time intervals of the whole treatment for intraanal warts in HIV infected people. Copyright © 2012 Elsevier B.V. All rights reserved.

  8. Combination treatment with interleukin-2 and radiation for advanced renal cell carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Ohnishi, Tetsuro; Machida, Toyohei; Saito, Kenichi; Ueda, Masataka; Tashiro, Kazuya; Kanehira, Chihiro; Mochizuki, Sachio (Jikei Univ., Tokyo (Japan). School of Medicine); Sawada, Takuko

    1992-12-01

    We attempted combination treatment with interleukin-2 (IL-2) and radiation for twelve advanced renal cell carcinoma patients. Treated lesions were lung in 3 (25.0%), bone in 2 (16.7%), retroperitoneal lymph node in 2 (16.7%), lung plus bone in 2 (16.7%), subcutaneous on the sternum in 1 (8.3%), renal bed in 1 (8.3%) and primary kidney in 1 (8.3%). The efficacy of this treatment modality was CR (complete remission) in 1 and PR (partial remission) in 2, with a response rate of 25.0% (3/12). As to the lesion response and response periods, there were CR in recurrence of renal bed (26 months), PR in retroperitoneal lymph node metastasis (16 weeks) and PR in subcutaneous on the sternum (6 weeks). Two of 4 patients with lung metastasis developed severe lung fibrosis, and continued no evidence of progression for 20 to 22 months. On the other hand, both of 2 patients showing PD (progressive disease) had bony metastases. The immunological changes induced by this combination treatment were an observable increase of WBC and peripheral blood lymphocytes (PBL). The subsets of PBL in responding patients revealed an increase of CD3-, CD4-, CD-8, and the ratio of CD4/CD8, CD16-and CD25-positive cells during the treatment session. In terms of complications all patients showed general fatigue and anorexia, and half of them had fever. With regard to the laboratory findings, all patients showed eosinophilia. Side effects were, however, not so serious as to prevent treatment. We concluded that this treatment modality is effective for patients with soft tissue metastasis, i.e., recurrence on the renal bed, and lung. However, it is difficult to cure patients with bony metastasis by this combination treatment. (author).

  9. Clinical efficacy of valsartan combined with hydrochlorothiazide in treatment of elderly hypertension

    Institute of Scientific and Technical Information of China (English)

    Ya-Ting Shao; Xin-Liang Huang; Tiao Bai

    2016-01-01

    Objective:To explore the clinical efficacy of valsartan combined with hydrochlorothiazide in the treatment of elderly hypertension.Methods:A total of 150 elderly patients with primary hypertension who were admitted in our hospital from January, 2015 to January, 2016 were included in the study and randomized into the observation group and the control group. The patients in the control group were given valsartan, 80 mg/time, 1 time/d. On this basis, the patients in the observation group were given additional hydrochlorothiazide 12.5 mg/time, 1 time/d. The patients in the two groups were administered with drugs in the morning. Six-month treatment was regarded as one course. The change of 24 h ambulatory blood pressure before and after treatment was detected, and the efficacy was evaluated. The heart color ultrasound was used to detect LVM and LVMI before and after treatment in the two groups.Results:The total effective rate in the observation group (90.7%) was significantly superior to that in the control group (70.7%) (P<0.05). The mean SBP and DBP 24h after treatment in the two groups were significantly reduced when compared with before treatment (P<0.05), and those in the observation group were significantly superior to those in the control group (P<0.05). LVM and LVMI after treatment in the two groups were significantly reduced when compared with before treatment (P<0.05), and those in the observation group were significantly superior to those in the control group (P<0.05).Conclusions:The combination of valsartan and hydrochlorothiazide in the treatment of elderly hypertension can effectively enhance the clinical efficacy, and effectively control the blood pressure. It is superior to that by a single drug; therefore, and deserves to be widely recommended in the clinic.

  10. Macrofilaricidal Activity in Wuchereria bancrofti after 2 Weeks Treatment with a Combination of Rifampicin plus Doxycycline

    Directory of Open Access Journals (Sweden)

    Alexander Yaw Debrah

    2011-01-01

    Full Text Available Infection with the filarial nematode Wuchereria bancrofti can lead to lymphedema, hydrocele, and elephantiasis. Since adult worms cause pathology in lymphatic filariasis (LF, it is imperative to discover macrofilaricidal drugs for the treatment of the infection. Endosymbiotic Wolbachia in filariae have emerged as a new target for antibiotics which can lead to macrofilaricidal effects. In Ghana, a pilot study was carried out with 39 LF-infected men; 12 were treated with 200 mg doxycycline/day for 4 weeks, 16 were treated with a combination of 200 mg doxycycline/day + 10 mg/kg/day rifampicin for 2 weeks, and 11 patients received placebo. Patients were monitored for Wolbachia and microfilaria loads, antigenaemia, and filarial dance sign (FDS. Both 4-week doxycycline and the 2-week combination treatment reduced Wolbachia load significantly. At 18 months posttreatment, four-week doxycycline resulted in 100% adult worm loss, and the 2-week combination treatment resulted in a 50% adult worm loss. In conclusion, this pilot study with a combination of 2-week doxycycline and rifampicin demonstrates moderate macrofilaricidal activity against W. bancrofti.

  11. Emerging treatments and combinations in the management of NSCLC: clinical potential of nintedanib

    Directory of Open Access Journals (Sweden)

    Reck M

    2015-07-01

    Full Text Available Martin Reck,1 Anders Mellemgaard2 1Department of Thoracic Oncology, Lung Clinic Grosshansdorf, and member of the Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany; 2Department of Oncology, Herlev University Hospital, Copenhagen, Denmark Abstract: There remains an unmet need for effective, well-tolerated treatment options in advanced non-small cell lung cancer (NSCLC to alleviate the disease burden for a broad selection of patients. Nintedanib is a potent, oral, triple angiokinase inhibitor of vascular endothelial growth factor, fibroblast growth factor, and platelet-derived growth factor, and was recently approved in Europe for use in combination with docetaxel for the treatment of adults with locally advanced, metastatic, or locally recurrent NSCLC of adenocarcinoma tumor histology, following first-line chemotherapy. Nintedanib has been investigated extensively in preclinical research and in a number of clinical studies, the most important of which was the Phase III LUME-Lung 1 study, which investigated nintedanib in combination with docetaxel in patients with advanced NSCLC after failure of first-line chemotherapy. In this study, which led to the approval of nintedanib, addition of nintedanib to docetaxel significantly improved overall survival in patients with adenocarcinoma histology. Nintedanib demonstrated a manageable safety profile in combination with docetaxel. This review focuses on the clinical experience with nintedanib in NSCLC and discusses the clinical potential of this agent for use in combination with chemotherapy. Keywords: nintedanib, non-small cell lung cancer, second-line treatment, docetaxel, adenocarcinoma, antiangiogenesis

  12. Rational combination treatment with histone deacetylase inhibitors and immunomodulatory drugs in multiple myeloma.

    Science.gov (United States)

    Hideshima, T; Cottini, F; Ohguchi, H; Jakubikova, J; Gorgun, G; Mimura, N; Tai, Y-T; Munshi, N C; Richardson, P G; Anderson, K C

    2015-05-15

    Immunomodulatory drugs (IMiDs) thalidomide, lenalidomide (Len) and pomalidomide trigger anti-tumor activities in multiple myeloma (MM) by targetting cereblon and thereby impacting IZF1/3, c-Myc and IRF4. Histone deacetylase inhibitors (HDACi) also downregulate c-Myc. We therefore determined whether IMiDs with HDACi trigger significant MM cell growth inhibition by inhibiting or downregulating c-Myc. Combination treatment of Len with non-selective HDACi suberoylanilide hydroxamic acid or class-I HDAC-selective inhibitor MS275 induces synergic cytotoxicity, associated with downregulation of c-Myc. Unexpectedly, we observed that decreased levels of cereblon (CRBN), a primary target protein of IMiDs, was triggered by these agents. Indeed, sequential treatment of MM cells with MS275 followed by Len shows less efficacy than simultaneous treatment with this combination. Importantly ACY1215, an HDAC6 inhibitor with minimal effects on class-I HDACs, together with Len induces synergistic MM cytotoxicity without alteration of CRBN expression. Our results showed that only modest class-I HDAC inhibition is able to induce synergistic MM cytotoxicity in combination with Len. These studies may provide the framework for utilizing HDACi in combination with Len to both avoid CRBN downregulation and enhance anti-MM activities.

  13. Propranolol and prednisolone combination for the treatment of segmental haemangioma in PHACES syndrome.

    Science.gov (United States)

    Gnarra, M; Solman, L; Harper, J; Batul Syed, S

    2015-07-01

    Posterior fossa malformations-haemangiomas-arterial anomalies-cardiac defects-eye abnormalities-sternal cleft and supraumbilical raphe syndrome (also known as PHACES syndrome) is a rare neurocutaneous disorder. Children presenting with these manifestations need careful ophthalmological, cardiac and neurological assessment. They may have one or more of these extracutaneous manifestations, the most common being cerebral and cardiovascular anomalies. There is controversy about treating these children with propranolol especially if they have cerebrovascular involvement with narrow, dysplastic or absent blood vessels. The concern with propranolol is that hypotension may lead to reduced cerebral blood flow and neurological consequences. Prior to propranolol the systemic treatment for haemangiomas was prednisolone and then the concern was the opposite, namely hypertension. Our proposal was whether a combination of these two drugs would provide a safer and faster recovery. We report three retrospective cases of PHACES syndrome, each of whom received treatment with a combination of propranolol and prednisolone: two children were started on prednisolone and propranolol was added because the haemangiomas failed to respond adequately; the third child was started on propranolol and developed peripheral ischaemia and ulceration necessitating a reduction in dose addition of a low dose of prednisolone. All three patients, who failed on the one treatment, responded well to combination therapy without any significant complications. These outcomes suggest that for some patients with PHACES syndrome the use of combination treatment with propranolol and prednisolone could be advantageous, potentially allowing for the introduction of low doses of each with an enhanced combined effect. The doses can be increased gradually depending on the magnetic resonance imaging findings.

  14. Tolfenamic acid, metoclopramide, caffeine and their combinations in the treatment of migraine attacks.

    Science.gov (United States)

    Tokola, R A; Kangasniemi, P; Neuvonen, P J; Tokola, O

    1984-12-01

    Tolfenamic acid is a fenamate which inhibits prostaglandin (PG) biosynthesis and may act as a PG antagonist as well. Caffeine and metoclopramide are used in combination with analgesics and ergotamine in the treatment of migraine attacks, but controlled clinical studies on fixed combinations with analgesics are rare. The effects of orally given tolfenamic acid (200 mg), caffeine (100 mg), metoclopramide (10 mg), tolfenamic acid + caffeine (200 mg + 100 mg), tolfenamic acid + metoclopramide (200 mg + 10 mg) and placebo were studied in 49 migraine patients (3 men, 46 women) in a double-blind randomized cross-over study comprising 482 migraine attacks. The patients were allowed to take either one or two capsules of each preparation for an attack. Additional drugs were allowed after 3 h. Parameters characterizing the effects and side-effects of the drugs were registered. Tolfenamic acid and its combinations were found to be effective in the treatment of acute migraine, but caffeine and metoclopramide alone did not differ from placebo. Combination with metoclopramide was better than tolfenamic acid alone as judged by the smaller dose needed and the intensity of attack. Between tolfenamic acid alone and its caffeine combination there were no statistically significant differences.

  15. Combination antibiotic treatment of serious methicillin-resistant Staphylococcus aureus infections.

    Science.gov (United States)

    Davis, J S; Van Hal, S; Tong, S Y C

    2015-02-01

    Outcomes from methicillin-resistant Staphylococcus aureus (MRSA) infections are relatively poor, at least in part due to the limitations of vancomycin (the current standard treatment for MRSA). Combination antibiotic treatment for MRSA infections is an attractive alternative as it could address most of vancomycin's shortcomings, including poor tissue penetration, slow bacterial killing, and emerging resistance in some strains of MRSA. However, the theoretical promise of combination therapy for MRSA infections has not been borne out in most in vitro and animal studies. Multiple combinations have been tested and have been either antagonistic, indifferent, or have had conflicting findings in various studies. This includes combinations of two primarily active agents (such as vancomycin plus daptomycin or linezolid), or the addition of gentamicin or rifampin to either vancomycin or daptomycin. However, hope on this front has come from an unexpected quarter. Although MRSA is by definition inherently resistant to nearly all β-lactam antibiotics, this class of drugs has consistently shown evidence of synergy with either daptomycin or vancomycin in over 25 separate in vitro studies, and a limited number of animal and human observational studies. However, there are currently insufficient data to recommend β-lactam combination therapy in routine clinical use. Results of current and planned randomized controlled trials of this strategy are awaited.

  16. Sofosbuvir plus ledipasvir in combination for the treatment of hepatitis C infection.

    Science.gov (United States)

    Bourlière, Marc; Adhoute, Xavier; Ansaldi, Christelle; Oules, Valérie; Benali, Souad; Portal, Isabelle; Castellani, Paul; Halfon, Philippe

    2015-01-01

    Sofsobuvir is the first-in-class NS5B nucleotide inhibitor to be launched as a treatment for the hepatitis C virus (HCV). Its viral potency, pan genotypic activity and high barrier to resistance make it the ideal candidate to become a backbone for several IFN-free regimens. Ledipasvir is a NS5A inhibitor with multi genotypic activity but modest barrier to resistance. The once-daily fixed-dose combination of sofosbuvir plus ledipasvir is the first-in-market single-tablet regimen for the treatment of hepatitis C infection. Recent data demonstrated that this FDC alone, or in combination with ribavirin, is able to achieve HCV cure of at least 90% or more among genotype 1,4, 5 and 6 patients. This combination appears to be suboptimal in genotype 3 patients and other direct acting antiviral combinations with sofosbuvir will help to fulfill this gap in the near future. The safety profile of the fixed dose combination is good. Resistance is not an issue with sofosbuvir but may be a significant issue with regards to ledipasvir for those rare individuals who harbor baseline HCV NS5A resistance-associated variants that conferred a high resistance level. The rational for using FDCs and the available clinical data are reviewed.

  17. A Monte Carlo tool for combined photon and proton treatment planning verification

    Energy Technology Data Exchange (ETDEWEB)

    Seco, J [Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States); Jiang, H [University of Arkansas for Medical Sciences, 4301 W. Markham Street, Little Rock, Arkansas 72202 USA (United States); Herrup, D [Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States); Kooy, H [Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States); Paganetti, H [Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States)

    2007-06-15

    Photons and protons are usually used independently to treat cancer. However, at MGH patients can be treated with both photons and protons since both modalities are available on site. A combined therapy can be advantageous in cancer therapy due to the skin sparing ability of photons and the sharp Bragg peak fall-off for protons beyond the tumor. In the present work, we demonstrate how to implement a combined 3D MC toolkit for photon and proton (ph-pr) therapy, which can be used for verification of the treatment plan. The commissioning of a MC system for combined ph-pr involves initially the development of a MC model of both the photon and proton treatment heads. The MC dose tool was evaluated on a head and neck patient treated with both combined photon and proton beams. The combined ph-pr dose agreed with measurements in solid water phantom to within 3%mm. Comparison with commercial planning system pencil beam prediction agrees within 3% (except for air cavities and bone regions)

  18. Combined treatment of hepatocellular carcinoma with partial splenic embolization and transcatheter hepatic arterial chemoembolization

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    AIM: To prospectively evaluate the efficacy and safety of partial splenic embolization (PSE) combined with transcatheter hepatic arterial chemoembolization (TACE)in treatment of hepatocellular carcinoma (HCC).METHODS: Fifty patients suffering from primary HCC associated with hypersplenism caused by cirrhosis were randomly assigned to 2 groups: group A receiving PSE combined with TACE (n = 26) and group B receiving TACE alone (n = 24). Follow-up examinations included calculation of peripheral blood cells (leukcytes,platelets and red blood cells) and treatment-associated complications.RESULTS: Prior to treatment, there was no significant difference in sex, age, Child-Pugh grade, tumor diameter,mass pathology type and peripheral blood cell counts between the 2 groups. After treatment, leukocyte and platelet counts were significantly higher in group A during the 3-mo follow-up period (P < 0.05), but lower in group B (P < 0.05). Severe complications occurred in 3 patients (11.5%) of group A and in 19 patients (79.2%) of group B (P < 0.05), and there was no significant difference in symptoms of post-embolization syndrome,including abdominal pain, fever, mild nausea and vomiting between the 2 groups (P > 0.05).CONCLUSION: PSE combined with TACE is more effective and safe than TACE alone for patients with HCC associated with hypersplenism caused by cirrhosis.

  19. Responses of Cynara cardunculus L. to single and combined cadmium and nickel treatment conditions.

    Science.gov (United States)

    Papazoglou, E G

    2011-02-01

    A greenhouse pot experiment was carried out to study the responses of Cynara cardunculus L. (cardoon) to cadmium and nickel. Three groups of 12 pots each were planted with cardoon plants and spiked with single and combined cadmium and nickel aqueous solutions. The bioavailable metal concentrations, measured in soil, ranged widely and were up to 246.7 mg kg⁻¹ for Cd and 61.1 mg kg⁻¹ for Ni. Under Cd treatment, cardoon growth remained unaffected, while increased Ni soil concentrations inhibited plant growth and were lethal to the highly treated plants. In the combined Cd and Ni treatments, an antagonistic effect was observed between the two metals. Cadmium and nickel concentrations in cardoon tissues rose with increasing metal concentrations in the soil. Cadmium and nickel contents in shoots reached 169.3 and 342.3 mg kg⁻¹ in the single treatments while, under the combined Cd and Ni treatments, they were up to 235.0 and 440.7 mg kg⁻¹, respectively. Generally, mean contents of both metals in the shoots were higher than in the roots and the translocation factor was greater than 1. A possible enhancing effect of nickel on cadmium uptake was observed. Cardoon showed characteristics of a Cd accumulator. Copyright © 2010 Elsevier Inc. All rights reserved.

  20. The Integration of Vacuum Brazing into Heat Treatment - A Progressive Combined Process

    Institute of Scientific and Technical Information of China (English)

    Ingo Reinkensmeier; Henkjan Buursen

    2004-01-01

    The continuous constructive challenge to improve the functionality and efficiency of components always results in higher demands on production engineering, against the background of the generally increasing cost pressure. In many cases, you will just succeed in producing competitive and innovative products by combining and coupling of different procedures to an independent (hybrid) technology. The use of hybrid procedures for metal joining and heat treatment of metallic materials finds more and more industrial fields of application. Modern vacuum lines with integrated pressurized gas quenching are considered high-performance and flexible means of production for brazing and heat treatment tasks as well in the turbine industry as in the mould making and tool manufacturing industry. In doing so, the heat treatment is coupled with the brazing cycle in a combined process so that the brazing temperatures and soak times are adapted to the necessary temperatures and times for solution heat treatment and austeniting. This user-oriented article describes on the one hand examples of brazing of turbine components, but above all the practical experience from the plastics processing industry, where the requirement for a high-efficient cooling of injection moulding dies gains more and more importance.The combined procedure "Vacuum Brazing and Hardening" offers plenty of possibilities to produce mould inserts with an efficient tempering system in an economic way.

  1. Cold atmospheric plasma in combination with mechanical treatment improves osteoblast growth on biofilm covered titanium discs.

    Science.gov (United States)

    Duske, Kathrin; Jablonowski, Lukasz; Koban, Ina; Matthes, Rutger; Holtfreter, Birte; Sckell, Axel; Nebe, J Barbara; von Woedtke, Thomas; Weltmann, Klaus Dieter; Kocher, Thomas

    2015-06-01

    Treatment of implants with peri-implantitis is often unsuccessful, because an instrumented implant surface and residual microbial biofilm impedes re-osseointegration. The application of cold atmospheric plasma (CAP) could be a simple and effective strategy to overcome the inherent problems of peri-implantitis treatment. CAP is able to destroy and eliminate bacterial biofilms. Additionally, it increases the wettability of titanium, which supports cellular attachment. In this study, the behaviour of osteoblasts on titanium discs was analysed after treatment of bacterial biofilms with CAP, brushing, or a combination of both. A human plaque biofilm was cultured on titanium discs. Treatment with a brush (BR), 1% oxygen/argon CAP (PL), or brushing combined with CAP (BR+PL) was used to eliminate the biofilm. Discs without biofilm (C), autoclaved biofilm (AUTO) and untreated biofilm (BIO) served as controls. Subsequently, human osteoblastic cell growth (MG-63) was observed after 1 and 24 h. Biofilm remnants on BR and PL impaired osteoblastic cell development, whereas the BR+PL provided an increased area of osteoblastic cells. A five-day cell growth was only detectable on BR+PL treated discs. The combination of established brushing and CAP application may be a promising strategy to treat peri-implantitis.

  2. Combining Pharmacological and Psychological Treatments for Binge Eating Disorder: Current Status, Limitations, and Future Directions.

    Science.gov (United States)

    Grilo, Carlos M; Reas, Deborah L; Mitchell, James E

    2016-06-01

    Binge eating disorder (BED) is characterized by recurrent binge eating and marked distress about binge eating without the extreme compensatory behaviors for weight control that characterize other eating disorders. BED is prevalent, associated strongly with obesity, and is associated with heightened levels of psychological, psychiatric, and medical concerns. This article provides an overview of randomized controlled treatments for combined psychological and pharmacological treatment of BED to inform current clinical practice and future treatment research. In contrast to the prevalence and significance of BED, to date, limited research has been performed on combining psychological and pharmacological treatments for BED to enhance outcomes. Our review here found that combining certain medications with cognitive behavioral therapy (CBT) or behavioral weight loss (BWL) interventions produces superior outcomes to pharmacotherapy only but does not substantially improve outcomes achieved with CBT/BWL only. One medication (orlistat) has improved weight losses with CBT/BWL albeit minimally, and only one medication (topiramate) has enhanced reductions achieved with CBT in both binge eating and weight. Implications for future research are discussed.

  3. Summary of combined treatment under endoscope on 70 esophagus cancer inpatients

    Science.gov (United States)

    Wang, Cheng; Nong, Meilong; Li, Laisheng; Jia, Fang; Hao, Runchun

    1993-03-01

    We announce with satisfaction that combined treatment on 70 inpatients who suffered esophageal cancer in its middle or late course is perfectly successful. The combined methods include phototherapy, microwave therapy, and anticarcinogen local injection. The results are as follows: CR 3 cases, holds 4.3% of the total inpatients; PR 36 cases, 51.4%; MR 24 cases, 34.3%; NR 7 cases, 10%; the total effective rate 90%. Splendid results of treatment on enlarging the canal, improving dysphagia, and releasing obstruction have been obtained. The dysphagic grade increased from 66 to 148, the grade of esophagostenosis from 64 to 147, and the obstruction releasing rate is 69 out of 70 (that is 98.6%). The histological observation after treatment shows that 59/62 inpatients being reported as having cancer cells appear to have retrogression accompanied with a few or large quantities of necrotic cancer cells, and 3 inpatients were changed to negative reaction. No obvious poisoning or side effects arose. The combined treatment is more advantageous on those of old age or the physically weak and those who cannot stand for an operation, radiotherapy, or normal chemotherapy.

  4. Clinical Observation on Treatment of Cervical Spondylosis with Combined Acupuncture and Cupping Therapies

    Institute of Scientific and Technical Information of China (English)

    万学文

    2007-01-01

    目的:观察针刺结合拔罐治疗颈椎病的临床疗效.方法:针罐组(30例)采用针刺结合拔罐治疗,针刺组(30例)采用单纯针刺治疗,治疗30天观察疗效.结果:两组治愈率、总有效率、半年后复发率、平均疗程经χ2检验P<0.01两组有显著性差异.结论:针刺结合拔罐治疗颈椎病疗效好,疗程短,不易复发.%Objective: To observe the clinical efficacy of treating cervical spondylosis with combined acupuncture and cupping therapies. Method: The patients in the treatment group (30 cases) were treated with combined acupuncture and cupping therapies; and the patients in the control group (30 cases) were treated with acupuncture therapy alone. Then the clinical efficacy was observed after 30 days of treatment. Result: The χ2 test showed that there was significant difference (P<0.01) between the two groups in recovery rate, total effective rate, relapse rate after six months, and average treatment course. Conclusion: Combined acupuncture and cupping therapies is a better therapy for cervical spondylosis with a shorter treatment course and low relapse rate.

  5. Comparison of clinical efficacies of sodium ascorbyl phosphate, retinol and their combination in acne treatment.

    Science.gov (United States)

    Ruamrak, C; Lourith, N; Natakankitkul, S

    2009-02-01

    Acne vulgaris impairs the appearance of an individual and causes psychological irritation. Inflammatory acne lesion is caused by multifactor incorporates in each step of acne pathogenesis. In an attempt to archive inflammatory lesion treatment with the promise of prevention of acne vulgaris, randomized and double-blind studies on the comparison of the efficacies of topical formulations containing 5% sodium ascorbyl phosphate (SAP) and 0.2% retinol, separately as well as in combination application, were conducted. The resulting data showed that SAP reduced the inflammatory lesion by 20.14% and 48.82% within 4 and 8 weeks respectively. Application of the formulation containing retinol slightly improved the treatment efficacy as the lesion reduced by 21.79% and 49.50% after 4 and 8 weeks respectively. The combination treatment significantly reduced the inflammatory lesion by 29.28% after 4 weeks and 63.10% after 8 weeks of application. The most effective treatment was by using the combination of 5% SAP and 0.2% retinol, which incorporated the synergistic effects on lipid peroxidation and sebaceous gland function in addition to the enhancement of SAP permeability by the desquamation of stratum corneum influenced by retinol, keratin plug removal and anti-inflammatory effect of retinol. This study promises for the development of cosmetic products to overcome aesthetic and psychological problems caused by acne vulgaris.

  6. Inactivation of enteric microorganisms with chemical disinfectants, UV irradiation and combined chemical/UV treatments.

    Science.gov (United States)

    Koivunen, J; Heinonen-Tanski, H

    2005-04-01

    The relative disinfection efficiencies of peracetic acid (PAA), hydrogen peroxide (H2O2) and sodium hypochlorite (NaOCl) against Escherichia coli, Enterococcus faecalis, Salmonella enteritidis and coliphage MS2 virus were studied in laboratory-scale experiments. This study also evaluated the efficiency of combined PAA/ultraviolet irradiation (UV) and H2O2/UV treatments to determine if the microbial inactivation was synergistic. Microbial cultures were added into a synthetic wastewater-like test medium and treated by chemical disinfectants with a 10 min contact time, UV irradiation or the combination of chemical and UV treatments. A peracetic acid dose of 3 mg/l resulted in approximately 2-3 log enteric bacterial reductions, whereas 7-15 mg/l PAA was needed to achieve 1-1.5 log coliphage MS2 reductions. Doses of 3-150 mg/l hydrogen peroxide achieved below 0.2 log microbial reductions. Sodium hypochlorite treatments caused 0.3-1 log microbial reductions at an 18 mg/l chlorine dose, while 2.6 log reductions of E. faecalis were achieved at a 12 mg/l chlorine dose. The results indicate that PAA could represent a good alternative to chlorine compounds in disinfection procedures, especially in wastewaters containing easily oxidizable organic matter. Hydrogen peroxide is not an efficient disinfectant against enteric microorganisms in wastewaters. The combined PAA/UV disinfection showed increased disinfection efficiency and synergistic benefits with all the enteric bacteria tested but lower synergies for the coliphage MS2. This suggests that this method could improve the efficiency and reliability of disinfection in wastewater treatment plants. The combined H2O2/UV disinfection only slightly influenced the microbial reductions compared to UV treatments and showed some antagonism and no synergies.

  7. Acute Liver Failure Associated with Levetiracetam and Lacosamide Combination Treatment for Unspecified Epileptic Disorder

    Directory of Open Access Journals (Sweden)

    Ylse Gutiérrez-Grobe

    2013-01-01

    Full Text Available Background and Aim. Levetiracetam is a second-generation antiepileptic drug. It is approved as an adjunctive treatment of partial onset seizures with or without secondary generalization. It is considered safe with less than 1% of patients with transient elevations of liver enzymes. Methods. We report a case of acute liver failure secondary to Levetiracetam in combination with Lacosamide documented with a liver biopsy. Results. Liver biopsy demonstrated acute liver injury with a predominant submassive necrosis pattern and features of a drug-induced hepatitis. Conclusions. This is the first published case of acute liver failure due to antiepileptic therapy with Levetiracetam in combination with Lacosamide.

  8. Clinical Study on Treatment of Tourette's Syndrome with Acupuncture-Chinese Herbs Combination

    Institute of Scientific and Technical Information of China (English)

    CHI Xu; JIN Ze; CUI Shu-zi; BAO Da-peng; SUN Yuan-zheng; HAN Chou-ping

    2003-01-01

    Objective: To observe the clinical effect on treatment of Tourette's syndrome with combination of acupuncture and Chinese herbs. Method: Sixty cases were randomly divided into acupuncture-Chinese group and western drug group, which have been treated with acupuncture plus modified Tranquilizing Liver-wind Decoction and orally taken holoperidol respectively.Result: Therapeutic effect comparison between the two groups showed a significant difference (P<0.05).Conclusion: Combination of scalp acupuncture and Chinese herbs has good effect in treating Tourette's syndrome, with better result than western drug.

  9. Photothermal therapy combined with dinitrophenyl hapten for the treatment of late stage malignant melanoma

    Science.gov (United States)

    Li, Xiaosong; Du, Nan; Li, Haijun; Long, Shan; Chen, Dianjun; Zhou, Feifan; Xu, Yuanyuan; Wang, Fuli; Chen, Wei R.

    2017-02-01

    To evaluate the efficacy and safety of photothermal with dinitrophenyl hapten (DNP) for patients with malignant melanoma (MM), Patients with pathology confirmed stage III or IV MM were enrolled. Seventy-two patients were randomized into two groups, DNP alone group (n=36) and DNP plus photothermal therapy group (n=36). The results showed that the patients in the combination treatment group had longer median progression-free survival time (19.0m vs. 12.0m, p=0.007). No severe adverse events were observed in both groups. Thus, the combination of photothermal therapy and DNP maybe a new therapeutic strategy for patients with advanced MM.

  10. Physiotherapy treatment after combined cruciate ligament reconstruction of the knee: a review

    OpenAIRE

    Anderson Delano; Aline Mendonça de Andrade; Thiago Freire

    2007-01-01

    The purpose of this paper was to describe the physiotherapy treatment after combined reconstruction of the cruciate ligaments of the knee. In order to do so a literature review was made and the articles from Medline and Lilacs databases were selected, published between 1997 and 2006, in English and Portuguese. The articles that featured any of the following keywords were chosen: “rehabilitation”, “anterior cruciate ligament (ACL)”, “posterior cruciate ligament (PCL)”, “combined reconstruction...

  11. Indatuximab ravtansine (BT062 combination treatment in multiple myeloma: pre-clinical studies

    Directory of Open Access Journals (Sweden)

    Kurt Schönfeld

    2017-01-01

    Full Text Available Abstract Indatuximab ravtansine is a monoclonal antibody-linked cytotoxic agent that specifically targets CD138-expressing cells. Monotherapy has been shown to significantly inhibit multiple myeloma tumour growth in vivo and improve host survival. Here, we show that in most cell lines tested, indatuximab ravtansine acts additively or even synergistically with clinically approved therapies for treatment of multiple myeloma. In addition, in vivo mouse xenograft models confirmed the activity of indatuximab ravtansine in combination with lenalidamide and lenalidomide/dexamethasone. Indatuximab ravtansine may therefore be a suitable combination partner for multiple myeloma, and a clinical study is ongoing.

  12. Combining targeted therapy and immune checkpoint inhibitors in the treatment of metastatic melanoma

    Institute of Scientific and Technical Information of China (English)

    Teresa Kim; Rodabe N Amaria; Christine Spencer; Alexandre Reuben; Zachary A Cooper; Jennifer A Wargo

    2014-01-01

    Melanoma is the deadliest form of skin cancer and has an incidence that is rising faster than any other solid tumor. Metastatic melanoma treatment has considerably progressed in the past ifve years with the introduction of targeted therapy (BARF and MEK inhibitors) and immune checkpoint blockade (anti-CTLA4, anti-PD-1, and anti-PD-L1). However, each treatment modality has limitations. Treatment with targeted therapy has been associated with a high response rate, but with short-term responses. Conversely, treatment with immune checkpoint blockade has a lower response rate, but with long-term responses. Targeted therapy affects antitumor immunity, and synergy may exist when targeted therapy is combined with immunotherapy. hTis article presents a brief review of the rationale and evidence for the potential synergy between targeted therapy and immune checkpoint blockade. Challenges and directions for future studies are also proposed.

  13. Treatment of gastroduodenal ulcers with cimetidine in combination with low-dose propantheline

    DEFF Research Database (Denmark)

    Paerregaard, A; Hendel, L; Schultz-Larsen, K

    1983-01-01

    Fifty-eight adult outpatients with endoscopically verified gastric, prepyloric or duodenal ulcers completed a double-blind trial of treatment with either cimetidine, 1 g daily, plus propantheline, 45 mg daily (group A) or cimetidine, 1 g daily, plus placebo (group B). After neither three nor six...... weeks of treatment was there any significant difference between the two groups with regard to ulcer healing or symptomatic relief. The ulcers of 22 (79%) of the 28 patients in group A and 25 (83%) of the 30 patients in group B were healed after six weeks, and 93% of the patients in both groups became...... painfree. We were thus not able to show any advantage in combining cimetidine treatment for ulcer healing with low-dose propantheline. In a small open trial the patients with healed ulcers received prophylactic treatment for 12 months with 1) cimetidine 800 mg daily, 2) cimetidine 400 mg at bedtime plus...

  14. A randomized trial on effectiveness of artemether-lumefantrine versus artesunate plus amodiaquine for unsupervised treatment of uncomplicated Plasmodium falciparum malaria in Ghanaian children

    Directory of Open Access Journals (Sweden)

    Hogan Benedikt

    2008-12-01

    Full Text Available Abstract Background Numerous trials have demonstrated high efficacy and safety of artemisinin-based combination therapy (ACT under supervised treatment. In contrast, effectiveness studies comparing different types of ACT applied unsupervised are scarce. The aim of this study was to compare effectiveness, tolerability and acceptance of artesunate plus amodiaquine (ASAQ against that of artemether-lumefantrine (AL in Ghanaian children with uncomplicated Plasmodium falciparum malaria. Methods A randomized open-label trial was conducted at two district hospitals in the Ashanti region, Ghana, an area of intense malaria transmission. A total of 246 children under five years of age were randomly assigned to either ASAQ (Arsucam® or AL (Coartem®. Study participants received their first weight-adjusted dose under supervision. After the parent/guardian was advised of times and mode of administration the respective three-day treatment course was completed unobserved at home. Follow-up visits were performed on days 3, 7, 14 and 28 to evaluate clinical and parasitological outcomes, adverse events, and haematological recovery. Length polymorphisms of variable regions of msp1 and msp2 were determined to differentiate recrudescences from reinfections. Acceptance levels of both treatment regimens were assessed by means of standardized interviews. Results Adequate clinical and parasitological responses after AL and ASAQ treatment were similar (88.3% and 91.7%, respectively. Interestingly, more late clinical failures until day 28 occurred in AL-treated children than in those who received ASAQ (17.5% and 7.3%, respectively; Hazard Ratio 2.41, 95% CI 1.00–5.79, p Haematological recovery and drug tolerability were not found to be significantly different in both study arms. The acceptance of treatment with ASAQ was higher than that with AL (rank-scores 10.6 and 10.3, respectively; p Conclusion Unobserved AL and ASAQ treatment showed high adequate clinical and

  15. Efficacy and safety of fixed-dose artesunate-amodiaquine vs. artemether-lumefantrine for repeated treatment of uncomplicated malaria in Ugandan children.

    Directory of Open Access Journals (Sweden)

    Adoke Yeka

    Full Text Available The safety and efficacy of the two most widely used fixed-dose artemisinin-based combination therapies (ACT, artesunate-amodiaquine (ASAQ and artemether-lumefantrine (AL are well established for single episodes of uncomplicated Plasmodium falciparum malaria, but the effects of repeated, long-term use are not well documented. We conducted a 2-year randomized, open-label, longitudinal, phase IV clinical trial comparing the efficacy and safety of fixed-dose ASAQ and AL for repeated treatment of uncomplicated malaria in children under 5 years at Nagongera Health Centre, Uganda. Participants were randomized to ASAQ or AL and all subsequent malaria episodes were treated with the same regimen. 413 children were enrolled and experienced a total of 6027 malaria episodes (mean 15; range, 1-26. For the first malaria episode, the PCR-corrected-cure rate for ASAQ (97.5% was non-inferior to that for AL (97.0%; 95% CI [-0.028; 0.037]. PCR-corrected cure rates for subsequent malaria episodes that had over 100 cases (episodes 2-18, ranged from 88.1% to 98.9% per episode, with no clear difference between the treatment arms. Parasites were completely cleared by day 3 for all malaria episodes and gametocyte carriage was less than 1% by day 21. Fever clearance was faster in the ASAQ group for the first episode. Treatment compliance for subsequent episodes (only first dose administration observed was close to 100%. Adverse events though common were similar between treatment arms and mostly related to the disease. Serious adverse events were uncommon, comparable between treatment arms and resolved spontaneously. Anemia and neutropenia occurred in <0.5% of cases per episode, abnormal liver function tests occurred in 0.3% to 1.4% of cases. Both regimens were safe and effective for repeated treatment of malaria.Current Controlled Trials NCT00699920.

  16. Optimal Combinations of Broadly Neutralizing Antibodies for Prevention and Treatment of HIV-1 Clade C Infection.

    Science.gov (United States)

    Wagh, Kshitij; Bhattacharya, Tanmoy; Williamson, Carolyn; Robles, Alex; Bayne, Madeleine; Garrity, Jetta; Rist, Michael; Rademeyer, Cecilia; Yoon, Hyejin; Lapedes, Alan; Gao, Hongmei; Greene, Kelli; Louder, Mark K; Kong, Rui; Karim, Salim Abdool; Burton, Dennis R; Barouch, Dan H; Nussenzweig, Michel C; Mascola, John R; Morris, Lynn; Montefiori, David C; Korber, Bette; Seaman, Michael S

    2016-03-01

    The identification of a new generation of potent broadly neutralizing HIV-1 antibodies (bnAbs) has generated substantial interest in their potential use for the prevention and/or treatment of HIV-1 infection. While combinations of bnAbs targeting distinct epitopes on the viral envelope (Env) will likely be required to overcome the extraordinary diversity of HIV-1, a key outstanding question is which bnAbs, and how many, will be needed to achieve optimal clinical benefit. We assessed the neutralizing activity of 15 bnAbs targeting four distinct epitopes of Env, including the CD4-binding site (CD4bs), the V1/V2-glycan region, the V3-glycan region, and the gp41 membrane proximal external region (MPER), against a panel of 200 acute/early clade C HIV-1 Env pseudoviruses. A mathematical model was developed that predicted neutralization by a subset of experimentally evaluated bnAb combinations with high accuracy. Using this model, we performed a comprehensive and systematic comparison of the predicted neutralizing activity of over 1,600 possible double, triple, and quadruple bnAb combinations. The most promising bnAb combinations were identified based not only on breadth and potency of neutralization, but also other relevant measures, such as the extent of complete neutralization and instantaneous inhibitory potential (IIP). By this set of criteria, triple and quadruple combinations of bnAbs were identified that were significantly more effective than the best double combinations, and further improved the probability of having multiple bnAbs simultaneously active against a given virus, a requirement that may be critical for countering escape in vivo. These results provide a rationale for advancing bnAb combinations with the best in vitro predictors of success into clinical trials for both the prevention and treatment of HIV-1 infection.

  17. New developments in the treatment of metastatic melanoma – role of dabrafenib–trametinib combination therapy

    Directory of Open Access Journals (Sweden)

    Luke JJ

    2014-06-01

    Full Text Available Jason J Luke, Patrick A Ott Melanoma Disease Center, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA Abstract: Development of selective inhibitors of BRAF has improved the survival of patients with BRAF-mutant melanoma. The progression-free survival after treatment with a BRAF inhibitor is modest, however, and BRAF inhibitors induce cutaneous toxicity, likely due to paradoxical activation of the mitogen-activated protein kinase pathway. Combining selective BRAF and MEK inhibition, such as the BRAF inhibitor dabrafenib and the MEK inhibitor trametinib, has been shown to improve the response rate and progression-free survival in patients with advanced melanoma while significantly alleviating the paradoxical activation of mitogen-activated protein kinase. This combination treatment results in a reduction in skin toxicity relative to that seen with a BRAF inhibitor alone; however, addition of the MEK inhibitor adds other toxicities, such as pyrexia and gastrointestinal or ocular toxicity. While combined BRAF–MEK inhibition appears primed to become a standard molecular approach for BRAF-mutant melanoma, the utility of the combination has to be considered in the rapidly changing landscape of immunotherapeutics, such as immune checkpoint blockade using anti-cytotoxic T lymphocyte antigen-4 and anti-programmed death-1/programmed death-L1 antibodies. Here we review the development of the dabrafenib plus trametinib combination, the characteristics of each drug and the combination, and the role of this combination in the management of patients with BRAF-mutant melanoma. Keywords: BRAF, dabrafenib, trametinib, melanoma

  18. Efficacy of Aliskiren/Hydrochlorothiazide Combination for the Treatment of Hypertension: A Meta-Analytical Approach

    Science.gov (United States)

    Morgado, Manuel P; Rolo, Sandra A; Castelo-Branco, Miguel

    2011-01-01

    Background: Single-pill combinations of aliskiren/hydrochlorothiazide have recently been approved by the European Medicines Agency for the treatment of hypertension. Objective: This study aimed to assess the antihypertensive efficacy of aliskiren/hydrochlorothiazide combination in reducing systolic and diastolic blood pressure in hypertensive patients. Methods: A search in International Pharmaceutical Abstracts, MEDLINE, The Cochrane Library and ISI Web of Knowledge was performed from 2000 to November 2009, to identify randomized, double-blind, clinical trials using aliskiren/hydrochlorothiazide for the treatment of hypertension. Studies were included if they evaluated the antihypertensive efficacy of aliskiren/hydrochlorothiazide in patients with mild or moderate essential hypertension and age ≥ 18 years. The meta-analytical approach calculated the weighted average reductions of systolic and diastolic blood pressure for each daily dosage combination. Results: We included 5 clinical trials testing several combinations of aliskiren/hydrochlorothiazide and containing data on 5448 patients. In all studies blood pressure was assessed at inclusion (baseline) and after 8 weeks of therapy. Blood pressure reductions and control rates were significantly (p < 0.05) higher with the aliskiren/hydrochlorothiazide combinations than with placebo and the same doses of aliskiren or hydrochlorothiazide alone. The weighted mean reductions (mm Hg) from baseline of systolic and diastolic blood pressure for each aliskiren/hydrochlorothiazide combination were: -15.8/-10.3 (150/25 mg); -15.9/-11.8 (300/12.5 mg); -16.9/-11.6 (300/25 mg). Blood pressure control rates (%) for the above combinations were, at least, respectively: 43.8, 50.1 and 51.9. Conclusions: Aliskiren/hydrochlorothiazide provided clinically significant additional blood pressure reductions and improved blood pressure control rates over aliskiren or hydrochlorothiazide monotherapy. PMID:21660247

  19. Clinical Study of Endostar Combined with DP Protocol in Treatment of Advanced Esophageal Cancer

    Institute of Scientific and Technical Information of China (English)

    DENG Wen-ying; LI Ning; LUO Su-xia

    2015-01-01

    Objective: To observe the clinical outcomes of Endostar combined with DP regimen for treating advanced esophageal cancer. Methods: A total of 62 patients with advanced esophageal cancer admitted from May, 2011 to May, 2013 were enrolled for a prospective, randomized controlled trial and 2 cases were excluded from the study because ofⅣ degree of digestive tract reaction and myelosuppression. Therefore, 60 cases could be evaluated, and then divided into combined group (given Endostar+DP plan) and single chemotherapy group, 30 cases in each group. The level of VEGF, tumor size and CT perfusion (CTP) parameters, including blood flow (BF), blood volume (BV), mean transit time (MTT), and permeability surface (PS) before and after treatment were determined for comparison. Kaplan-Merier method was used to analyze the overall survival (OS) of 2 groups. Results:The efifcacy of combined group was superior to single chemotherapy group. The level of vascular endothelial growth factor (VEGF) in combined group was obviously lower than that in single chemotherapy group after treatment (P0.05). The median OS was 30 months (95%CI: 20.935-39.065) for combined group and 21 months (95%CI: 15.109-26.591) for single chemotherapy group, respectively (P=0.048). The 1-, 2- and 3-year survival rates were 86.2%, 59.3% and 36.6% in combined group, and 70.8%, 32.1% and 17.8% in single chemotherapy group, respectively. Conclusion: Endostar can down-regulate the expression of VEGF, improve the state of hypertransfusion and high permeability of tumor vessels, has better curative effect without slighter adverse reactions, and prolong the survival time of patients with advanced esophageal cancer when combined with chemotherapy.

  20. Combined treatment with dabrafenib and trametinib with immune-stimulating antibodies for BRAF mutant melanoma.

    Science.gov (United States)

    Homet Moreno, Blanca; Mok, Stephen; Comin-Anduix, Begonya; Hu-Lieskovan, Siwen; Ribas, Antoni

    2016-07-01

    The combination of targeted therapy with BRAF and MEK inhibitors has become the standard of care in patients with BRAF (V600E) mutant melanoma, but responses are not durable. In addition, the impressive clinical benefits with anti-PD-1 and anti-PD-L1 antibodies (Ab) in patients with heavily pretreated metastatic melanoma and the synergistic effect of dabrafenib, trametinib and anti-PD-1 compared with single therapy alone groups support the idea that combining dabrafenib, trametinib and immunotherapy based on PD-1 blockade could be an interesting approach in the treatment of metastatic melanoma. With our mouse model of syngeneic BRAF (V600E) driven melanoma (SM1), we tested whether the addition of an immunostimulatory Ab targeting CD137 (4-1BB) and/or CD134 (OX40) would enhance the antitumor effect of dabrafenib, trametinib and anti-PD-1 or anti-PD-L1 therapy. In vitro studies showed that the combination group of dabrafenib, trametinib and anti-PD-1 increases CD8(+) tumor infiltrating lymphocytes (TILs), as well as CD4(+) T cells and tumor-associated macrophages (TAMs). An upregulation of PD-L1 was observed in the combination of dabrafenib, trametinib and anti-PD-1 therapy. Combination of dabrafenib, trametinib and anti-PD-1, with either anti-CD137 or anti-CD134, showed a superior antitumor effect, but the five-agent combination was not superior to the four-agent combinations. In conclusion, the combination of dabrafenib, trametinib, anti-PD1 or anti-PD-L1 therapy results in robust antitumor activity, which is further improved by adding the immune-stimulating Ab anti-CD137 or anti-CD134. Our findings support the testing of these combinations in patients with BRAF (V600E) mutant metastatic melanoma.

  1. Combined treatment with dabrafenib and trametinib with immune-stimulating antibodies for BRAF mutant melanoma

    Science.gov (United States)

    Homet Moreno, Blanca; Mok, Stephen; Comin-Anduix, Begonya; Hu-Lieskovan, Siwen; Ribas, Antoni

    2016-01-01

    The combination of targeted therapy with BRAF and MEK inhibitors has become the standard of care in patients with BRAFV600E mutant melanoma, but responses are not durable. In addition, the impressive clinical benefits with anti-PD-1 and anti-PD-L1 antibodies (Ab) in patients with heavily pretreated metastatic melanoma and the synergistic effect of dabrafenib, trametinib and anti-PD-1 compared with single therapy alone groups support the idea that combining dabrafenib, trametinib and immunotherapy based on PD-1 blockade could be an interesting approach in the treatment of metastatic melanoma. With our mouse model of syngeneic BRAFV600E driven melanoma (SM1), we tested whether the addition of an immunostimulatory Ab targeting CD137 (4-1BB) and/or CD134 (OX40) would enhance the antitumor effect of dabrafenib, trametinib and anti-PD-1 or anti-PD-L1 therapy. In vitro studies showed that the combination group of dabrafenib, trametinib and anti-PD-1 increases CD8+ tumor infiltrating lymphocytes (TILs), as well as CD4+ T cells and tumor-associated macrophages (TAMs). An upregulation of PD-L1 was observed in the combination of dabrafenib, trametinib and anti-PD-1 therapy. Combination of dabrafenib, trametinib and anti-PD-1, with either anti-CD137 or anti-CD134, showed a superior antitumor effect, but the five-agent combination was not superior to the four-agent combinations. In conclusion, the combination of dabrafenib, trametinib, anti-PD1 or anti-PD-L1 therapy results in robust antitumor activity, which is further improved by adding the immune-stimulating Ab anti-CD137 or anti-CD134. Our findings support the testing of these combinations in patients with BRAFV600E mutant metastatic melanoma. PMID:27622011

  2. Efficacy of single dose combinations of albendazole, ivermectin and diethylcarbamazine for the treatment of bancroftian filariasis.

    Science.gov (United States)

    Ismail, M M; Jayakody, R L; Weil, G J; Nirmalan, N; Jayasinghe, K S; Abeyewickrema, W; Rezvi Sheriff, M H; Rajaratnam, H N; Amarasekera, N; de Silva, D C; Michalski, M L; Dissanaike, A S

    1998-01-01

    In a 'blind' trial on 50 male asymptomatic microfilaraemic subjects with Wuchereria bancrofti infection, the safety, tolerability and filaricidal efficacy of a single dose of albendazole (alb) 600 mg alone or in combination with ivermectin (iver) 400 micrograms/kg or diethylcarbamazine citrate (DEC) 6 mg/kg was compared with a single dose of the combination DEC 6 mg/kg and iver 400 micrograms/kg over a period of 15 months after treatment. All but one subject, with 67 microfilariae (mf)/mL, had pre-treatment counts > 100 mf/mL. All 4 treatments significantly reduced mf counts, but alb/iver was the most effective regimen for clearing mf from night blood: 9 of 13 subjects (69%) were amicrofilaraemic by membrane filtration 15 months after treatment compared to one of 12 (8%), 3 of 11 (27%), and 3 of 10 (30%) in the groups treated with alb, alb/DEC, and DEC/iver, respectively. Filarial antigen tests suggested that all 4 treatments had significant activity against adult W. bancrofti; alb/DEC had the greatest activity according to this test, with antigen levels decreasing by 77% 15 months after therapy. All 4 regimens were well tolerated and clinically safe, although mild, self-limited systemic reactions were observed in all treatment groups. These results suggest that alb/iver is a safe and effective single dose regimen for suppression of microfilaraemia in bancroftian filariasis that could be considered for control programmes. Additional benefits of this combination are its potent, broad spectrum activity against intestinal helminths and potential relative safety in areas of Africa where DEC cannot be used for filariasis control because of co-endemicity with onchocerciasis or loiasis.

  3. Calcofluor white combination antifungal treatments for Trichophyton rubrum and Candida albicans.

    Directory of Open Access Journals (Sweden)

    Joanne M Kingsbury

    Full Text Available Superficial mycoses caused by dermatophyte fungi are among the most common infections worldwide, yet treatment is restricted by limited effective drugs available, drug toxicity, and emergence of drug resistance. The stilbene fluorescent brightener calcofluor white (CFW inhibits fungi by binding chitin in the cell wall, disrupting cell wall integrity, and thus entails a different mechanism of inhibition than currently available antifungal drugs. To identify novel therapeutic options for the treatment of skin infections, we compared the sensitivity of representative strains of the dermatophyte Trichophyton rubrum and Candida albicans to CFW and a panel of fluorescent brighteners and phytoalexin compounds. We identified the structurally related stilbene fluorescent brighteners 71, 85, 113 and 134 as fungicidal to both T. rubrum and C. albicans to a similar degree as CFW, and the stilbene phytoalexins pinosylvan monomethyl ether and pterostilbene inhibited to a lesser degree, allowing us to develop a structure-activity relationship for fungal inhibition. Given the abilities of CFW to absorb UV(365 nm and bind specifically to fungal cell walls, we tested whether CFW combined with UV(365 nm irradiation would be synergistic to fungi and provide a novel photodynamic treatment option. However, while both treatments individually were cytocidal, UV(365 nm irradiation reduced sensitivity to CFW, which we attribute to CFW photoinactivation. We also tested combination treatments of CFW with other fungal inhibitors and identified synergistic interactions between CFW and some ergosterol biosynthesis inhibitors in C. albicans. Therefore, our studies identify novel fungal inhibitors and drug interactions, offering promise for combination topical treatment regimes for superficial mycoses.

  4. Effectiveness of Provider and Community Interventions to Improve Treatment of Uncomplicated Malaria in Nigeria: A Cluster Randomized Controlled Trial.

    Directory of Open Access Journals (Sweden)

    Obinna Onwujekwe

    Full Text Available The World Health Organization recommends that malaria be confirmed by parasitological diagnosis before treatment using Artemisinin-based Combination Therapy (ACT. Despite this, many health workers in malaria endemic countries continue to diagnose malaria based on symptoms alone. This study evaluates interventions to help bridge this gap between guidelines and provider practice. A stratified cluster-randomized trial in 42 communities in Enugu state compared 3 scenarios: Rapid Diagnostic Tests (RDTs with basic instruction (control; RDTs with provider training (provider arm; and RDTs with provider training plus a school-based community intervention (provider-school arm. The primary outcome was the proportion of patients treated according to guidelines, a composite indicator requiring patients to be tested for malaria and given treatment consistent with the test result. The primary outcome was evaluated among 4946 (93% of the 5311 patients invited to participate. A total of 40 communities (12 in control, 14 per intervention arm were included in the analysis. There was no evidence of differences between the three arms in terms of our composite indicator (p = 0.36: stratified risk difference was 14% (95% CI -8.3%, 35.8%; p = 0.26 in the provider arm and 1% (95% CI -21.1%, 22.9%; p = 0.19 in the provider-school arm, compared with control. The level of testing was low across all arms (34% in control; 48% provider arm; 37% provider-school arm; p = 0.47. Presumptive treatment of uncomplicated malaria remains an ingrained behaviour that is difficult to change. With or without extensive supporting interventions, levels of testing in this study remained critically low. Governments and researchers must continue to explore alternative ways of encouraging providers to deliver appropriate treatment and avoid the misuse of valuable medicines.ClinicalTrials.gov NCT01350752.

  5. Treatment of biomass gasification wastewater using a combined wet air oxidation/activated sludge process

    Energy Technology Data Exchange (ETDEWEB)

    English, C.J.; Petty, S.E.; Sklarew, D.S.

    1983-02-01

    A lab-scale treatability study for using thermal and biological oxidation to treat a biomass gasification wastewater (BGW) having a chemical oxygen demand (COD) of 46,000 mg/l is described. Wet air oxidation (WA0) at 300/sup 0/C and 13.8 MPa (2000 psi) was used to initially treat the BGW and resulted in a COD reduction of 74%. This was followed by conventional activated sludge treatment using operating conditions typical of municipal sewage treatment plants. This resulted in an additional 95% COD removal. Overall COD reduction for the combined process was 99%. A detailed chemical analysis of the raw BGW and thermal and biological effluents was performed using gas chromatography/mass spectrometry (GC/MS). These results showed a 97% decrease in total extractable organics with WA0 and a 99.6% decrease for combined WA0 and activated sludge treatment. Components of the treated waters tended to be fewer in number and more highly oxidized. An experiment was conducted to determine the amount of COD reduction caused by volatilization during biological treatment. Unfortunately, this did not yield conclusive results. Treatment of BGW using WA0 followed by activated sludge appears to be very effective and investigations at a larger scale are recommended.

  6. Combination of photodynamic and ultrasonic therapy for treatment of infected wounds in animal model

    Science.gov (United States)

    Menyaev, Yulian A.; Zharov, Vladimir P.

    2006-02-01

    One of the important problems of modern medicine is treatment of infected wounds. There are many diversified expedients of treatment, but none of them obey the modern physician completely. The aim of this study is to develop and test a new combined method of photodynamic ultrasonic therapy (PDUST) for treatment of infected wounds with focus on experimental trials. PDUST is based on a combination of two methods: photodynamic (PD) therapy (PDT) with photosensitizer and low frequency ultrasonic (US) therapy with antibiotic as tools for treatment of wounds and effectively killing bacteria. The main parameters are: US frequency - 26.5 kHz; US tip elongation - 40+/-20 μm wavelength of light emitting diodes (LED) array - 660+/-10 nm; light intensity on biotissue surface - 1-2 mW/cm2; photosensitizer - an aluminum disulfonated phtalocyanine dissolved in a physiological solution in concentration 10 mg/l. The experiments were carried out with 70 male chinchilla rabbits divided into 7 groups, thus the dynamics of wounds healing were studied in different modes of PDUST. The PD and US methods supplement each other and in conjunction provide additive and especially synergetic effects. The experimental data demonstrated advantages of new technology in comparison with conventional methods in cases of treatment of extended suppurative inflammatory and profound wounds. The more detailed study of PDUST method's mechanism, which is based on low intensity of LED light, PD therapy and US influence is required.

  7. [Focal immunophysiotherapy in combined treatment of men with manifestations of papilloma virus infection].

    Science.gov (United States)

    Kuntsevich, L D; Komov, N N; Shibaeva, E V; Komarova, V D; Kopytova, T V; Pyshkina, E I; Shchelchkova, N A

    2010-01-01

    We compared efficacy of combined treatment of males with anogenital warts given intramuscular cycloferon or cycloferon electrophoresis. Patients with manifest HPV infection (n=107) were divided into two groups. Group 1 (n=72) received intramuscular cycloferon (2 ml 12.5% solution each other day for 10 days), group 2 (n=35) received cycloferon electrophoresis on genital region (2 ml 12.5% solution daily in 1-2 days, 5 injections). Measurements were made of local cytokines in urethral secretion, IFN-alpha, IFN-gamma, lactoferrin, sexual hormones (estradiol and testosterone) in blood serum before and after treatment. Focal immunophysiotherapy with cycloferon in combined treatment of males with anogenital warts vs intramuscular cycloferon treatment reduces recurrence rate 2 times, has no negative effect on serum level of sexual hormones, a course dose and duration of immunotherapy decreased 2-fold, is well tolerated, is not painful. Cycloferon electrophoresis has a more potent effect on improvement of local immunity. Thus, local immunophysiotherapy with cycloferon can be a method of choice in the treatment of manifest HPV infection in males.

  8. COMBINED MEDICATIONS OF LOCAL ACTION IN THE TREATMENT OF PAIN AND SORE THROAT SYMPTOMS

    Directory of Open Access Journals (Sweden)

    M. I. Petrovskaya

    2012-01-01

    Full Text Available For relief symptoms of pain and sore throat the prescription of combined topical preparations containing antiseptic and analgesic components is the most appropriate from the pathogenetic point of view. This article discusses the use of local therapy for the treatment of acute inflammatory diseases associated with pain, feeling a tickle in throat. The author introduces the local action drug, which has antiseptic and analgesic effects and is safe and effective in the symptomatic treatment of pharyngitis, tonsillitis and laryngitis in children older than 4 years.

  9. Lack of Response in Severe Pneumocystis Pneumonia to Combined Caspofungin and Clindamycin Treatment: a Case Report

    Institute of Scientific and Technical Information of China (English)

    Yao Zhang; Hua Zhang; Jun XU; Chan Wu; Xiao-jun Ma

    2011-01-01

    PNEUMOCYSTIS pneumonia (PCP) is among the most common opportunistic infections in patients with acquired immune deficiency syndrome (AIDS).Although trimethoprim-sulfamethoxazole (TMP-SMX) is the first line therapy for that condition given its efficacy,approximately one third of patients experienced dose-limiting toxicity.1 For cases of severe to moderate PCP,if TMP-SMX treatment fails or is contraindicated,primaquine combined with clindamycin or intravenous pentamidine is recommended as second line therapy.2 However,both primaquine and pentamidine are associated with severe adverse reactions and often unavailable at hospitals in China.3 As a result,other treatment options have been explored.

  10. Treatment of trauma-affected refugees with venlafaxine versus sertraline combined with psychotherapy

    DEFF Research Database (Denmark)

    Sonne, Charlotte; Lohmann, Jessica Mariana Carlsson; Bech, Per

    2016-01-01

    and sertraline on Post-Traumatic Stress Disorder (PTSD), depression and functional impairment in trauma-affected refugees. Methods: The study was a randomised pragmatic trial comparing venlafaxine and sertraline in combination with psychotherapy and social counselling. PTSD symptoms were measured on the Harvard......: Two hundred seven adult refugee patients were included in the trial (98 in the venlafaxine and 109 in the sertraline group). Of these, 195 patients were eligible for intention-to-treat analyses. Small but significant pre-treatment to post-treatment differences were found on the Harvard Trauma...

  11. A study of an effective sunitinib–chemotherapeutic combination regimen for bladder cancer treatment using a mouse model

    Directory of Open Access Journals (Sweden)

    Dah-Shyong Yu

    2014-06-01

    Conclusion: Combination of the tyrosine kinase receptor inhibitor sunitinib with gemcitabine chemotherapy synergistically enhances tumor cytotoxicity and may provide a new treatment modality for advanced bladder cancer.

  12. Combined conjunctival autograft and overlay amniotic membrane transplantation; a novel surgical treatment for pterygium.

    Science.gov (United States)

    Ghanavati, Siamak Zarei; Shousha, Mohamed Abou; Betancurt, Carolina; Perez, Victor L

    2014-01-01

    The authors report the long-term results of combined conjunctival autograft and overlay amniotic membrane transplantation (AMT) for treatment of pterygium as a new surgical technique. Nineteen patients including 12 male and 7 female subjects with pterygium (primary, 14 cases; recurrent, 5 cases) underwent combined conjunctival autograft and overlay AMT and were followed from 10 to 26 months. Mean age was 44.21±12.49 (range, 29.0-73.0) years. In one patient with grade T3 primary pterygium, the lesion recurred (5.2%, recurrence rate). No intra-and postoperative complication developed. This procedure seems a safe and effective surgical technique for pterygium treatment. Protection of the ocular surface during the early postoperative period reduces the friction-induced inflammation and might be helpful to prevent the recurrence.

  13. Sterilization of ready-to-cook Bibimbap by combined treatment with gamma irradiation for space food

    Science.gov (United States)

    Park, Jae-Nam; Song, Beom-Seok; Kim, Jae-Hun; Choi, Jong-il; Sung, Nak-Yun; Han, In-Jun; Lee, Ju-Woon

    2012-08-01

    Bibimbap, Korean traditional cooked rice mixed with various kinds of vegetables, together with mushrooms and a ground meat, and seasoned with red pepper paste, was developed as a ready-to-cook food by combined treatment with irradiation for the use in space. By gamma irradiation of 25 kGy, the total aerobic bacteria of Bibimbap that was initial by 6.3 log CFU/g decreased to below detection limit, but its sensory qualities were drastically decreased. To enhance the sensory quality, the effects of antioxidant in Bibimbap were evaluated. A treatment with 0.1% of vitamin C, vacuum packaging and gamma-irradiated at 25 kGy and -70 °C showed higher sensory scores than only the irradiation process. This result indicates that the radiation technology may be useful to produce a variety of space foods with high quality of taste and flavor, when combined with other methods.

  14. Study of the combining adsorption-micro filtration process for the treatment of coloured waters

    Energy Technology Data Exchange (ETDEWEB)

    Addaou, A.; Laajeb, A.; Lahsini, A.; Bentama, J.; Rodriguez, M. A.

    2012-11-01

    Generally textile effluents are highly coloured, contain non-biodegradable compounds and they have high content of solid wastes, comprising fibres and paper wastes. The discharge of such effluents in the environment is worrying for both toxicological and esthetical reasons. The aim of the present work is to study the performances of the combining micro filtration-adsorption process for the treatment of coloured waters. Methylene Blue (MB) was used as model compound. The effects of significant operating parameters such as transmembrane pressure (TMP) and bentonite concentration on the process performance characterized by flux and rejection factor were investigated. Experiments carried out with Methylene Blue solutions confirmed the potential of this combined process for the treatment of dyed waters. (Author) 13 refs.

  15. Combined treatment of a lateral incisor with palato-radicular groove: 1 year follow-up

    Directory of Open Access Journals (Sweden)

    Gülen Kamak

    2014-01-01

    Full Text Available Periodontic - endodontic lesion with a palato-radicular groove as a contributing factor for periodontitis is the most important diagnostic and therapeutic challenges faced by periodontists and the maxillary lateral incisors are the most frequently affected teeth. These developmental grooves promotes the accumulation of plaque and calculus, which destroys the sulcular epithelium and later deeper parts of the periodontium, finally resulting in the formation of a severe localized periodontal lesion since proper cleaning of that site is difficult, if not impossible, for the patient. There are different types of treatment such as scaling and root planning, odontoplasty, amalgam restoration, and extraction of the tooth to treat palatogingival groove and associated periodontal bone defects. In this case, a successful management of an endodontic-periodontal combined lesion by combined treatment and guided tissue regeneration was presented.

  16. Fixed-combination treatments for intraocular hypertension in Chinese patients – focus on bimatoprost-timolol

    Directory of Open Access Journals (Sweden)

    Fang Y

    2015-05-01

    Full Text Available Yuan Fang,1,* Zhihong Ling,1,* Xinghuai Sun1–4 1Department of Ophthalmology and Visual Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College, Fudan University, 2Shanghai Key Laboratory of Visual Impairment and Restoration, 3Key Laboratory of Myopia, Ministry of Health, 4State Key Laboratory of Medical Neurobiology, Institutes of Brain Science, Fudan University, Shanghai, People’s Republic of China *These authors contributed equally to this work Abstract: Glaucoma is a common eye disease that can lead to irreversible vision loss if left untreated. The early diagnosis and treatment of primary open-angle glaucoma is challenging, and visual impairment in Chinese glaucoma patients is a serious concern. Most of these patients need more than one topical antiglaucoma agent to control their intraocular pressures (IOPs. In the People’s Republic of China, the daily cost of different glaucoma medication varies greatly, and the treatment habits differ throughout the country. Prostaglandin analogs (PGAs are recommended as first-line monotherapy, because of their efficacy and low risk of systemic side effects. Fixed-combination drops, particularly PGA-based fixed combinations, have recently been developed and used in patients with progression or who have failed to achieve their target IOPs. Here, we reviewed the current literature on the use of bimatoprost-timolol fixed combination (BTFC in the People’s Republic of China. BTFC has achieved good efficacy and tolerability in Chinese clinical trials. In addition, BTFC is more cost effective compared with other fixed combinations available in the People’s Republic of China. Fixed-combination drops may offer benefits, such as keeping the ocular surface healthy, convenience of administration, and improvement in long-term adherence and quality of life. Therefore, BTFC has great potential for the treatment of Chinese glaucoma patients. However, the long-term efficacy of BTFC, comparisons

  17. Opportunities for Combined Heat and Power at Wastewater Treatment Facilities: Market Analysis and Lessons from the Field

    Science.gov (United States)

    This report presents the opportunities for combined heat and power (CHP) applications in the municipal wastewater treatment sector, and it documents the experiences of the wastewater treatment facility (WWTF) operators who have employed CHP.

  18. Combined modality treatment improves tumor control and overall survival in patients with early stage Hodgkin's lymphoma: a systematic review

    DEFF Research Database (Denmark)

    Herbst, Christine; Rehan, Fareed A; Brillant, Corinne;

    2010-01-01

    Combined modality treatment (CMT) of chemotherapy followed by localized radiotherapy is standard treatment for patients with early stage Hodgkin's lymphoma. However, the role of radiotherapy has been questioned recently and some clinical study groups advocate chemotherapy only for this indication...

  19. Efficacy of Single and Combined Antibiotic Treatments of Anthrax in Rabbits.

    Science.gov (United States)

    Weiss, Shay; Altboum, Zeev; Glinert, Itai; Schlomovitz, Josef; Sittner, Assa; Bar-David, Elad; Kobiler, David; Levy, Haim

    2015-12-01

    Respiratory anthrax is a fatal disease in the absence of early treatment with antibiotics. Rabbits are highly susceptible to infection with Bacillus anthracis spores by intranasal instillation, succumbing within 2 to 4 days postinfection. This study aims to test the efficiency of antibiotic therapy to treat systemic anthrax in this relevant animal model. Delaying the initiation of antibiotic administration to more than 24 h postinfection resulted in animals with systemic anthrax in various degrees of bacteremia and toxemia. As the onset of symptoms in humans was reported to start on days 1 to 7 postexposure, delaying the initiation of treatment by 24 to 48 h (time frame for mass distribution of antibiotics) may result in sick populations. We evaluated the efficacy of antibiotic administration as a function of bacteremia levels at the time of treatment initiation. Here we compare the efficacy of treatment with clarithromycin, amoxicillin-clavulanic acid (Augmentin), imipenem, vancomycin, rifampin, and linezolid to the previously reported efficacy of doxycycline and ciprofloxacin. We demonstrate that treatment with amoxicillin-clavulanic acid, imipenem, vancomycin, and linezolid were as effective as doxycycline and ciprofloxacin, curing rabbits exhibiting bacteremia levels of up to 10(5) CFU/ml. Clarithromycin and rifampin were shown to be effective only as a postexposure prophylactic treatment but failed to treat the systemic (bacteremic) phase of anthrax. Furthermore, we evaluate the contribution of combined treatment of clindamycin and ciprofloxacin, which demonstrated improvement in efficacy compared to ciprofloxacin alone. Copyright © 2015, American Society for Microbiology. All Rights Reserved.

  20. [Outcomes of patients with combined methylmalonic acidemia and homocystinuria after treatment].

    Science.gov (United States)

    Huang, Zhuo; Han, Lian-shu; Ye, Jun; Qiu, Wen-juan; Zhang, Hui-wen; Gao, Xiao-lan; Wang, Yu; Ji, Wen-jun; Li, Xiao-yan; Gu, Xue-fan

    2013-03-01

    Combined methylmalonic acidemia with homocystinuria is a common form of methylmalonic acidemia in China. Patients with this disease can progress to death without timely and effective treatment. This study aimed to analyze the treatment outcomes of patients with combined methylmalonic acidemia and homocystinuria. From September 2004 to April 2012, 58 patients with combined methylmalonic acidemia and homocystinuria (34 males and 24 females) were diagnosed and treated in our hospital. Fifty cases were from clinical patients including 42 early-onset cases and 8 late-onset cases. Their age when they were diagnosed ranged from 18 days to 30.8 years. The other 8 cases were from newborn screening. All the patients were treated with vitamin B12, betaine, folic acid, vitamin B6, and L-carnitine. The physical and neuropsychological development, general laboratory tests, the levels of amino acids, acylcarnitines, and homocysteine in blood, and organic acids in urine were followed up. The follow-up period ranged from 1 month to 7.1 years. Three cases died (all were early-onset cases). In the other patients after treatment, the symptoms such as recurrent vomiting, seizures, lethargy, and poor feeding disappeared, muscle strength and muscle tension were improved, and general biochemical abnormalities such as anemia and metabolic acidosis were corrected. Among the surviving 55 cases, 49 had neurological impairments such as developmental delay and mental retardation. The median levels of blood propionylcarnitine and its ratio with acetylcarnitine, serum homocysteine, and urine methylmalonic acid were significantly decreased (P < 0.01), from 7.73 µmol/L (ranged from 1.5 to 18.61 µmol/L), 0.74 (ranged from 0.29 to 2.06), 97.3 µmol/L (ranged from 25.1 to 250 µmol/L) and 168.55 (ranged from 3.66 to 1032.82) before treatment to 2.74 µmol/L (ranged from 0.47 to 12.09 µmol/L), 0.16 (ranged from 0.03 to 0.62), 43.8 µmol/L (ranged from 17 to 97.8 µmol/L) and 6.81 (ranged from 0 to

  1. The Effect of UV and Combined Chlorine/UV Treatment on Coliphages in Drinking Water Disinfection

    Directory of Open Access Journals (Sweden)

    Alyaa M. Zyara

    2016-04-01

    Full Text Available Ultraviolet (UV irradiation is a common way to disinfect drinking water, but some viruses are very resistant to UV. Drinking water was disinfected with UV after spiking with MS2 and 18 different coliphages isolated from municipal wastewater effluent. In addition, some coliphages were disinfected with combined treatment of chlorine/UV or vice versa with UV/chlorine. A UV-dose of 22 mWs/cm2 caused less than 2 Log10-reductions of 10 UV-resistant strains, while it caused up to 7 Log10-reductions for 9 UV-sensitive or intermediate strains. The high dose (117 mWs/cm2 caused only 3 Log10-reductions in some UV-resistant coliphages, including MS2, which proved to be a good indicator for viruses in UV-disinfection tests. The combined treatment with 0.1 or 0.5 mg Cl/L (free Cl-dosage 0.04 or 0.2 mg/L, respectively for 10 min followed by UV irradiation of 22 mWs/cm2 inactivated all coliphages tested by >3.6 Log10-units. Synergy was obtained for most coliphages tested by using a Cl/UV combination, and the inactivation using first low Cl-dosages followed by low UV-dosages was higher than if using high Cl- or UV-dosages alone. The opposite treatment with UV/Cl was less effective. Therefore, the combination treatment using first chlorine and then UV can be recommended as a disinfection method for viruses.

  2. The Effects of Combined Treatment with Naringin and Treadmill Exercise on Osteoporosis in Ovariectomized Rats

    OpenAIRE

    Sun, Xiaolei; Li, FengBo; Ma, Xinlong; MA, JIANXIONG; ZHAO Bin; Zhang, Yang; Li, Yanjun; Lv, Jianwei; MENG, Xinmin

    2015-01-01

    Osteoporosis is a disease characterized by low bone mass and progressive destruction of bone microstructure, resulting in increased the risk of fracture. Previous studies have demonstrated the effect of naringin (NG) or treadmill exercise (EX) on osteoporosis, however, reports about effects of NG plus EX on osteoporosis are limited. This study was designed to investigate the impact of combined treatment with naringin and treadmill exercise on osteoporosis in ovariectomized (OVX) rats. Three m...

  3. Sex differences in attenuation of nicotine reinstatement after individual and combined treatments of progesterone and varenicline

    Science.gov (United States)

    Swalve, Natashia; Smethells, John R.; Carroll, Marilyn E.

    2016-01-01

    Tobacco use is the largest cause of preventable mortality in the western world. Even after treatment, relapse rates for tobacco are high, and more effective pharmacological treatments are needed. Progesterone (PRO), a female hormone used in contraceptives, reduces stimulant use but its effects on tobacco addiction are unknown. Varenicline (VAR) is a commonly used medication that reduces tobacco use. The present study examined sex differences in the individual vs. combined effects of PRO and VAR on reinstatement of nicotine-seeking behavior in a rat model of relapse. Adult female and male Wistar rats self-administered nicotine (NIC, 0.03 mg/kg/infusion) for 14 days followed by 21 days of extinction when no cues or drug were present. Rats were then divided into 4 treatment groups: control (VEH+SAL), PRO alone (PRO+SAL), VAR alone (VEH+VAR) and the combination (PRO+VAR). Reinstatement of nicotine-seeking behavior induced by priming injections of NIC or caffeine (CAF), presentation of cues (CUES), and the combination of drugs and cues (e.g. NIC+CUES, CAF+CUES) was tested after extinction. Male and female rats did not differ in self-administration of nicotine or extinction responding, and both showed elevated levels of responding to the CAF+CUES condition. However, males, but not females, reinstated active lever-pressing to the NIC+CUES condition, and that was attenuated by both VAR and VAR+PRO treatment. Thus, males were more sensitive to NIC+CUE-induced reinstatement than females, and VAR alone and VAR combined with PRO effectively reduced nicotine relapse. PMID:27091301

  4. Sex differences in attenuation of nicotine reinstatement after individual and combined treatments of progesterone and varenicline.

    Science.gov (United States)

    Swalve, Natashia; Smethells, John R; Carroll, Marilyn E

    2016-07-15

    Tobacco use is the largest cause of preventable mortality in the western world. Even after treatment, relapse rates for tobacco are high, and more effective pharmacological treatments are needed. Progesterone (PRO), a female hormone used in contraceptives, reduces stimulant use but its effects on tobacco addiction are unknown. Varenicline (VAR) is a commonly used medication that reduces tobacco use. The present study examined sex differences in the individual vs. combined effects of PRO and VAR on reinstatement of nicotine-seeking behavior in a rat model of relapse. Adult female and male Wistar rats self-administered nicotine (NIC, 0.03mg/kg/infusion) for 14days followed by 21days of extinction when no cues or drug were present. Rats were then divided into 4 treatment groups: control (VEH+SAL), PRO alone (PRO+SAL), VAR alone (VEH+VAR) and the combination (PRO+VAR). Reinstatement of nicotine-seeking behavior induced by priming injections of NIC or caffeine (CAF), presentation of cues (CUES), and the combination of drugs and cues (e.g. NIC+CUES, CAF+CUES) were tested after extinction. Male and female rats did not differ in self-administration of nicotine or extinction responding, and both showed elevated levels of responding to the CAF+CUES condition. However, males, but not females, reinstated active lever-pressing to the NIC+CUES condition, and that was attenuated by both VAR and VAR+PRO treatment. Thus, males were more sensitive to NIC+CUE-induced reinstatement than females, and VAR alone and VAR combined with PRO effectively reduced nicotine relapse.

  5. Combination Immunotherapy for the Treatment of High-Risk HER2-Positive Breast Cancer

    Science.gov (United States)

    2015-10-01

    have withdrawn. Blood samples for immunologic monitoring are being collected in support of specific aims 2 and 3. 15. SUBJECT TERMS Breast cancer ...inflammatory breast cancer (MD Anderson Cancer Center Morgan Welch Inflammatory Breast Cancer Program Seed Grant)  New active grant o Immunologic ...1 AWARD NUMBER: W81XWH-14-1-0109 TITLE: Combination Immunotherapy for the Treatment of High-Risk HER2-Positive Breast Cancer PRINCIPAL

  6. CONCEPTUAL BASES OF THE ENERGY EFFICIENT SYSTEM OF MANAGEMENT OF COMBINED UNITS OF WASTEWATER TREATMENT

    Directory of Open Access Journals (Sweden)

    V. N. Shtepa

    2016-01-01

    Full Text Available A critical analysis of the shortcomings of the existing water purification systems is conducted. In order to ensure environmental safety and energy savings it is proposed to use the combined units, including physical, chemical, physical-and-chemical and biological methods. The attention is driven to the fact that the most effective way to maintain current water purification is an adaptive control system. The shortcomings of the management of water treatment units were revealed and it was proposed to produce their synthesis based on the mathematical apparatus of artificial intelligence systems. Taking into account the requirements of the environmental safety and the need in the energy savings, the energy efficiency criteria of combined system functioning has been developed. At an industrial plant (slaughterhouse wastewater treatment the compliance of the production conditions of the criterion has been undertaken that confirmed the criterion relevance and usefulness as applied to the synthesis of energy-efficient control systems. A synthetic control system combined the water treatment plants. Having based on the preliminary research and analysis of the current work in the subject area the architecture of a control system of combined water treatment units that use intelligent technology was developed. The key functional of the unit – information-analytical subsystem of the formation control actions including: multilayer perceptrons self-organization Kohonen network, fuzzy cognitive map. The basic difference between the developed design and its analogues is the ability to adjust the settings of equipment adaptively on the basis of processing sensor data, information on the price of consumables, volley discharges of pollutants, a sudden change in the flow and other force majeure. Adjustment of the parameters of the control system is carried out with the use of experimental and analytical data stored in the knowledge base of technological

  7. Effectiveness of medication / auricular therapy / phyto-therapy combination in the treatment of hypertensive patients

    Directory of Open Access Journals (Sweden)

    José Ramón Martínez Pérez

    2015-10-01

    Full Text Available Background: hypertension is one of the main cardiovascular risk factors, so its control improves the life expectancy of patients.Objective: to assess the effects of a treatment combining medication with auricular therapy and phyto-therapy in hypertensive patients assisted at the health area of ”Romárico Oro” Polyclinic, in Puerto Padre, Las Tunas province.Methods: an intervention study was carried out in 68 hypertensive patients of the health area of “Romárico Oro” Polyclinic in Puerto Padre from April, 2013 to April, 2014. The patients were distributed at random into two equal groups; the first received medication combined with auricular therapy and phyto-therapy, while the second one received only medication. The statistical analysis was done by means of Statistic system, t-student and Chi-Square tests were used and p< or =0.05 was considered as level of statistical significance.Results: by the end of the intervention, 73, 53% of the patients of the group with the combination of drug treatment and auricular therapy and phyto-therapy were controlled. In this group, the diastolic filling pressure diminished to 2, 2 mm Hg and the systolic gradient to 3, 66 mm, regarding the group treated only with drugs. Only one patient, representing the 2, 94% showed adverse reaction to the natural and traditional treatment.Conclusions: the combination of medication with auricular therapy and phyto-therapy proved to be effective, corroborated by a significant decrease of quantity of crisis, diastolic and systolic filling pressure values and increase of number of patients with their disease controlled; the report of only one complication shows the innocuousness of the auricular therapy and phyto-therapy treatment.

  8. Combination of Linagliptin and Metformin for the Treatment of Patients with Type 2 Diabetes

    OpenAIRE

    Thomas Haak

    2015-01-01

    Type 2 diabetes mellitus (T2DM) is a progressive condition requiring long-term treatment. Most patients with T2DM are unable to maintain normoglycemia using metformin alone; thus, combination therapy is a pivotal part of disease management. Addition of the dipeptidyl peptidase-4 inhibitor linagliptin, with its proven efficacy, low propensity for hypoglycemia, and weight neutrality, has been shown to improve glycemic control for patients who are not well controlled with metformin. As patients ...

  9. Effect and Prognostic Analysis of Treatment for Acute Myeloid Leukemia Using Chinese Drugs Combined with Chemotherapy

    Institute of Scientific and Technical Information of China (English)

    胡晓梅; 刘锋; 郑春梅; 李柳; 刘池; 张姗姗; 肖海燕; 杨晓红; 王洪志; 许勇钢; 胡乃平; 麻柔

    2009-01-01

    Objective:To observe the clinical efficacy of Chinese drugs combined with chemotherapy in the treatment of acute myeloid leukemia(AML) and to investigate the prognostic relevance of the main parameters in AML treated with integrative medicine.Methods:Forty AML patients hospitalized at the authors' hospital were treated with Chinese drugs and chemotherapy.The routine examination,immunophenotype and karyotype analyses were carried out.The clinical efficacy was observed and the prognostic factors were analy...

  10. Combining Mindfulness Meditation with Cognitive-Behavior Therapy for Insomnia: A Treatment-Development Study

    OpenAIRE

    Ong, Jason C.; Shapiro, Shauna L.; Manber, Rachel

    2007-01-01

    This treatment-development study is a Stage I evaluation of an intervention that combines mindfulness meditation with cognitive-behavior therapy for insomnia (CBT-I). Thirty adults who met research diagnostic criteria for Psychophysiological Insomnia (Edinger et al., 2004) participated in a 6-week, multi-component group intervention using mindfulness meditation, sleep restriction, stimulus control, sleep education, and sleep hygiene. Sleep diaries and self-reported pre-sleep arousal were asse...

  11. Diagnosis and surgical treatment of terminal syringomyelia within spinal cord combined with tethered cord syndrome

    OpenAIRE

    Jing-cheng XIE; Wang, Zhen-Yu; Chen, Xiao-Dong

    2016-01-01

    Objective To summarize the clinical manifestations, imaging characteristics and experience of surgical treatment of spinal cord terminal syringomyelia with tethered cord syndrome (TCS).  Methods and Results Clinical data of 10 patients with spinal cord syringomyelia combined with TCS surgically treated under microscope from January 1999 to March 2014 in our hospital were retrospectively analyzed. There were 3 males and 7 females with average age of 15.06 years old (ranged from 2 to 35 y...

  12. Clinical Effects of Acupuncture Combined with Nimodipine for Treatment of Vascular Dementia in 30 Cases

    Institute of Scientific and Technical Information of China (English)

    ZHONG Xiu-yan; SU Xue-xu; LIU Jie

    2009-01-01

    Objective:To study the therapeutic effects of acupuncture combined with nimodipine for vascular dementia.Methods:Acupuncture was applied at Baihui (GV 20), Shenshu (BL 23), Geshu (BL 17), and the points selected according to the midnight-noon, ebb-flow eight methods of the intelligent turtle, combined with the drug nimodipine.The treatment was continued for 8 consecutive weeks.Results:Of the 30 cases treated, 6 cases were cured, 21 cases improved, and 3 cases failed, with a total effective rate of 90%.Conclusion:Acupuncture at Baihui (GV 20), Shenshu (BL 23), Geshu (BL 17), and the points selected according to the midnight-noon, ebb-flow eight methods of the intelligent turtle combined with the drug nimodipine can yield definite therapeutic effects for vascular dementia.

  13. Treatment for severe craniocerebral trauma combined with transtentorial hernia in children

    Institute of Scientific and Technical Information of China (English)

    梁艺湖; 麦洁文; 李林繁

    2004-01-01

    Objective: To explore the treating method for severe craniocerebral trauma combined with transtentorial hernia in children.Methods: We treated 58 children with severe craniocerebral trauma combined with transtentorial hernia through evacuating the hematomas, incising the tentorium but preserving the floating bone flap between January 1996 and January 2002.Results: GCS was 3-5 in 17 cases and 6-8 in 41 cases. After treatment, 46 patients (79.30%) recovered well, 6 (10.30%) suffered from mild disability, 1 (1.72%) suffered from severe disability, 1 (1.72%) was in vegetative state, and 4 (6.90%) died.Conclusions: Evacuating hematomas and incising tentorium can effectively treat the child patients with severe craniocerebral trauma combined with transtentorial hernia, which can decrease the disability and mortality rates greatly, preserve the skull, exempt reoperation for cranioplasty and relieve the psychologic and physiologic burden of the child patients.

  14. Severe hyperpigmentation and scarring following glycolic acid peel treatment in combination with low-dose isotretinoin.

    Science.gov (United States)

    Gerber, Peter Arne; Kukova, Gabriela; Bölke, Edwin; Homey, Bernhard; Diedrichson, Evelyn

    2014-11-07

    The application of systemic isotretinoin in the treatment of cutaneous photoaging has been well investigated. In addition, well-recognized topical antiaging therapies such as superficial chemical peeling (CP) with α-hydroxy acids have been shown to be more helpful when combined with low-dose oral isotretinoin. Even though the combination of systemic isotretinoin and medium to deep CP has been associated with serious side effects such as delayed wound healing and enlarged incidence of scarring, to date superficial CP and concomitant systemic isotretinoin have been considered safe. In this report, we present the case of a patient receiving low-dose oral isotretinoin therapy who developed severe painful erythema and erosions that led to permanent hyperpigmentation and scarring of her face and neck after undergoing superficial CP with glycolic acid. There is a potential risk of hyperpigmentation and scarring with the use of a combination of low-dose oral isotretinoin and glycolic acid peeling.

  15. [The combination of extracorporeal lithotripsy and percutaneous nephrostomy in the treatment of obstructive ureteral urate calculi].

    Science.gov (United States)

    Del Boca, C; Ferrari, C; Dotti, E; Corsi, G; Guardamagna, A; Giuberti, A C; Colloi, D

    1994-04-01

    The authors report their experience with combined percutaneous nephrostomy and extracorporeal shock-wave lithotripsy to treat obstructive uratic ureteral stones. The role of nephrostomy is stressed as a diagnosis and treatment method before, during and after lithotripsy. Thus, the method proved especially useful to drain obstructed kidneys and restore peristalsis, to evacuate septic urine, to facilitate the elimination of lithiasic fragments, to perform anterograde pyelography before, during and after lithotripsy and finally to allow pharmacological litholysis. Fourteen patients were successfully treated with combined extracorporeal lithotripsy and percutaneous nephrostomy and the results compared with those obtained with other techniques--e.g., ureteroscopy, whose value appears lower because the method requires general anesthesia and is more traumatic to the ureter. The authors conclude that combined extracorporeal lithotripsy and percutaneous nephrostomy make the best technique to treat obstructive uric acid stones thanks to their positive results, low invasiveness and to patients compliance.

  16. Multiple treatment comparisons in a series of anti-malarial trials with an ordinal primary outcome and repeated treatment evaluations

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    Youdom Solange

    2012-05-01

    Full Text Available Abstract Background Artemisinin-based combination therapies (ACT are widely used in African countries, including Cameroon. Between 2005 and 2007, five randomized studies comparing different treatment arms among artesunate-amodiaquine and other ACT were conducted in Cameroonian children aged two to 60 months who had uncomplicated Plasmodium falciparum malaria. In these studies, the categorical criterion proposed by the World Health Organization (WHO to assess the relative effectiveness of anti-malarial drugs was repeatedly evaluated on Days 14, 21 and 28 after treatment initiation. The aim of the present study was to compare the effects of different treatments on this repeated ordinal outcome, hence using the fully available information. Methods The quantitative synthesis was based on individual patient data. Due to the incomplete block design concerning treatment arms between different trials, a mixed treatment comparison (MTC meta-analysis approach was adopted. The repeated ordinal outcome was modelled through a latent variable, as a proportional odds mixed model with trial, period and treatment arms as covariates. The model was further complexified to account for the variance heterogeneity, and the individual log-residual variance was modelled as a linear mixed model, as well. The effects of individual covariates at inclusion, such as parasitaemia, fever, gender and weight, were also tested. Model parameters were estimated using a Bayesian approach via the WinBUGS software. After selecting the best model using Deviance Information Criterion (DIC, mixed treatment comparisons were based on the estimated treatment effects. Results Modeling the residual variance improved the model ability to adjust the data. The results showed that, compared to artesunate-amodiaquine (ASAQ, dihydroartemisinin-piperaquine (DHPP was significantly more efficacious. Artesunate-chlorproguanil-dapsone (ASCD was less efficacious than artesunate

  17. [Treatment of bedsores--combination of therapies depended the experimental design method].

    Science.gov (United States)

    Miyaji, Hiroko; Sakurai, Hirofumi; Kikawada, Masayuki; Yamaguchi, Katsuhiko; Kimura, Akihiro; Fujiwara, Takayuki; Imada, Nobuo; Imai, Mihoko; Iwamoto, Toshihiko; Takasaki, Masaru

    2005-01-01

    The treatment of bedsores is a particular problem in geriatric medicine. We selected standard drugs that may be effective for the decubitus ulcer, and investigated combination therapy to develop efficient treatment The subjects were 16 patients in whom the grade of the bedsore was evaluated as II to IV according to the Shea's depth classification. Treatment was performed while all patients were on air mats. We selected drugs and treatment methods based on the previously established experimental design of Taguchi. Based on this, we created and adapted 16 different component combination treatment programs in accordance with the L16 rectangular cross table. The following component factors were adopted: A: types of covering substances on the wound surface (Elase ointment, isodine sugar, isodine gel solcoseryl ointment); B: Isalopan powder; C: Spray of 10 ml physiological saline containing 500 microg of prostaglandin (concentration 0.005%); D: daily number of treatments; and F: presence or absence of tapping. We serially measured the wound surface area as an index of the speed of wound healing, and measured the interval (day) until the area decreased to one half of the original size (T1/2, half life). We analyzed data on one combination treatment each in 16 patients. Analysis of variance of the above factors showed significant F values for factors A, B, D and F. The contribution rates for factors A, B, D and F were 37.84%, 8.47%, 14.98% and 13.81%, respectively. The error term (e) was 16.37%. Optimal results were seen in the groups in which solcoseryl ointment had been applied twice a day. In this study, prostaglandin, which had been anticipated to be effective, did not show any effects. The error term (e) suggests the presence of other healing factors including individual differences. Concerning this point, it well be necessary to examine a larger number of patients in the future. With ointment treatment alone, without using an air mat, it was confirmed that bedsore

  18. Efficacy of entecavir combined with alprostadil in treatment of hepatitis B-related cirrhotic ascites

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    LI Huili

    2016-02-01

    Full Text Available ObjectiveTo investigate the efficacy of entecavir combined with alprostadil in the treatment of hepatitis B-related cirrhotic ascites. MethodsA total of 100 patients with hepatitis B-related cirrhotic ascites who were admitted to Dezhou Hospital of Traditional Chinese Medicine from May 2012 to February 2014 were selected and randomly divided into treatment group and control group, with 50 patients in each group. The patients in both groups received the liver-protecting treatment, diuretic treatment, and intermittent supplementation of albumin(Alb. Additionally, the patients in the treatment group received oral entecavir 0.5 mg once a day, combined with intravenous infusion of alprostadil 20 μg+5% glucose injection 100 ml once a day, and those in the observation group only received oral entecavir 0.5 mg once a day. The patients were hospitalized and treated for 4 weeks. Ascites regression, changes in the levels of alanine aminotransferase (ALT, total bilirubin (TBil, Alb, blood urea nitrogen (BUN, creatinine (Cr, and hepatitis B virus (HBV DNA, and prothrombin activity (PTA were observed in both groups. After discharge, the patients in both groups continued to take oral entecavir 0.5 mg once a day, and the long-term therapeutic effect was observed through follow-up for 3 months. The t-test was applied for comparison of continuous data between groups, and the chi-square test was applied for comparison of categorical data between groups. ResultsThe patients in both groups had varying degrees of reduction in the amount of ascites after treatment, and the treatment group had a significantly higher overall response rate than the control group (χ2=6.018, P<0.05. The patients in both groups had varying degrees of improvement in each index of liver and renal function (ALT, TBil, Alb, BUN, and Cr and PTA after treatment; the treatment group had a better treatment outcome than the control group, and there were significant differences in each index

  19. Combined Anti-PLGF and Anti-Endostatin Treatments Inhibit Ocular Hemangiomas

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    Hua Jiang

    2015-06-01

    Full Text Available Background/Aims: The degree of neovascularization determines the aggressiveness of ocular hemangiomas (OH. So far, the anti-angiogenic treatments using either antagonists against vascular endothelial growth factor A (VEGF-A, or endostatin, do not always lead to satisfactory therapeutic outcome. Methods: We examined the VEGF receptor 1 (VEGFR1 levels in the OH specimen. We compared the effects of anti-PLGF, endostatin, as well as their combined treatments on the growth of OH in a mouse model, using bioluminescence imaging in living animals. We also examined vascularization by CD31 expression. Results: We detected higher VEGFR1 levels in the OH, compared to paired normal tissue. Thus, we hypothesize that as a major ligand for VEGFR1, placental growth factor (PLGF may also play a role in the neovascularization and tumorigenesis of OH. In an implanted OH model in mice, we found that both anti-PLGF and endostatin significantly decreased OH growth as well as vascularization, while combined treatments had a significantly more pronounced effect. Conclusion: Our data suggest that combined anti-PLGF and endostatin may be a more effective therapy for inhibition of ocular vascularization and the tumor growth in OH.

  20. The effect of chlorine and combined chlorine/UV treatment on coliphages in drinking water disinfection.

    Science.gov (United States)

    Zyara, Alyaa M; Torvinen, Eila; Veijalainen, Anna-Maria; Heinonen-Tanski, Helvi

    2016-08-01

    Chlorine disinfection is a globally used method to ensure the safety of drinking water. However, it has not always been successful against viruses and, therefore, it is important to find new methods to disinfect water. Seventeen different coliphages were isolated from the treated municipal wastewater. These coliphages and MS2 were treated with different dosages of chlorine in drinking water, and a combined chlorine/ultraviolet irradiation treatment for the chlorine-resistant coliphages. Chlorine disinfection with 0.3-0.5 mg/L total chlorine (free Cl-dosage 0.12-0.21 mg/L) for 10 min achieved 2.5-5.7 Log10-reductions for 11 sensitive coliphages. The six most resistant coliphages showed no reduction with these chlorine concentrations. MS2 was intermediate in chlorine resistance, and thus it is not a good indicator for viruses in chlorine disinfection. In the combined treatment total chlorine of 0.05-0.25 mg/L (free Cl-dosage 0.02-0.08 mg/L) and ultraviolet irradiation (14-22 mWs/cm(2)) were more effective than chlorine alone, and 3-5 Log10-reductions were achieved for the chlorine-resistant strains. The chlorination efficiency could be increased by higher dosages and longer contact times, but this could increase the formation of disinfection by-products. Therefore, the combination treatment is a recommended disinfection method.

  1. Clinical Observation on Treatment of Depression by Electro-Acupuncture Combined with Paroxetine

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Objective: To observe the clinical efficacy and adverse reactions of Paroxetine combined with electro-acupuncture (EA) in treating depression. Methods: Forty-two patients with depression were randomly assigned to the observation group (22 patients) treated with EA combined with Paroxetine, and the control group (20 patients) treated with Paroxetine alone, and the therapeutic course for both groups was 6 weeks. The therapeutic efficacy and adverse reactions were evaluated with scores by Hamilton depression scale (HAMD) and treatment emergent symptoms scale (TESS),respectively. Results: HAMD scores determined at the end of the 1st, 2nd, 4th, and 6th week of the treatment course were significantly lower in the observation group than those in the control group (P<0.05). The significant improvement rate evaluated at the end of the 6-week treatment was remarkably higher in the observation group than that in the control group (72.7% vs 40.0%). No significant difference of TESS scores was found between the two groups. Conclusion: EA combined with Paroxetine has better clinical efficacy than that of Paroxetine alone, with milder adverse reaction and quicker initiation of effect.

  2. Treatment of pathologic spinal fractures with combined radiofrequency ablation and balloon kyphoplasty

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    Tzanakakis George

    2009-11-01

    Full Text Available Abstract Background In oncologic patients with metastatic spinal disease, the ideal treatment should be well tolerated, relieve the pain, and preserve or restore the neurological function. The combination of fluoroscopic guided radiofrequency ablation (RFA and kyphoplasty may fulfill these criteria. Methods We describe three pathological vertebral fractures treated with a combination of fluoroscopic guided RFA and kyphoplasty in one session: a 62-year-old man suffering from a painful L4 pathological fracture due to a plasmocytoma, a 68-year-old man with a T12 pathological fracture from metastatic hepatocellular carcinoma, and a 71-year-old man with a Th12 and L1 pathological fracture from multiple myeloma. Results The choice of patients was carried out according to the classification of Tomita. Visual analog score (VAS and Oswestry disability index (ODI were used for the evaluation of the functional outcomes. The treatment was successful in all patients and no complications were reported. The mean follow-up was 6 months. Marked pain relief and functional restoration was observed. Conclusion In our experience the treatment of pathologic spinal fractures with combined radiofrequency ablation and balloon kyphoplasty is safe and effective for immediate pain relief in painful spinal lesions in neurologically intact patients.

  3. Combined treatment of olive mill wastewater by Fenton's reagent and anaerobic biological process.

    Science.gov (United States)

    Amor, Carlos; Lucas, Marco S; García, Juan; Dominguez, Joaquín R; De Heredia, J Beltrán; Peres, José A

    2015-01-01

    This work presents the application of Fenton's reagent process combined with anaerobic digestion to treat an olive mill wastewater (OMW). Firstly, OMW was pre-treated by chemical oxidation in a batch reactor with Fenton's reagent, using a fixed H2O2/COD ratio of 0.20, pH = 3.5 and a H2O2/Fe(2+) molar ratio of 15:1. This advanced oxidation treatment allowed reaching reductions of 17.6 and 82.5% of chemical oxygen demand (COD) and total polyphenols (TP), respectively. Secondly, OMW treatment by anaerobic digestion was performed using previously adapted microorganisms immobilized in Sepiolite. These biological tests were carried out varying the substrate concentration supplied to the reactor and COD conversions from 52 to 74% were obtained. Afterwards, Fenton's reagent followed by anaerobic digestion was applied to OMW treatment. This combined process presented a significant improvement on organic load removal, reaching COD degradations from 64 to 88%. Beyond the pollutant load removal, it was also monitored the yield of methane generated throughout anaerobic experiments. The methane produced ranged from 281 cm(3) to 322 cm(3) of CH4/g COD removed. Additionally, a methane generation kinetic study was performed using the Monod Model. The application of this model allowed observing a kinetic constant increase of the combined process (kFN = 0.036 h(-1)) when compared to the single anaerobic process (kF = 0.017 h(-1)).

  4. Combination therapies: The next logical Step for the treatment of synucleinopathies?

    Science.gov (United States)

    Valera, Elvira; Masliah, Eliezer

    2016-02-01

    Currently there are no disease-modifying alternatives for the treatment of most neurodegenerative disorders. The available therapies for diseases such as Parkinson's disease (PD), PD dementia (PDD), dementia with Lewy bodies (DLB), and multiple system atrophy (MSA), in which the protein alpha-synuclein (α-Syn) accumulates within neurons and glial cells with toxic consequences, are focused on managing the disease symptoms. However, using strategic drug combinations and/or multi-target drugs might increase the treatment efficiency when compared with monotherapies. Synucleinopathies are complex disorders that progress through several stages, and toxic α-Syn aggregates exhibit prion-like behavior spreading from cell to cell. Therefore, it follows that these neurodegenerative disorders might require equally complex therapeutic approaches to obtain significant and long-lasting results. Hypothetically, therapies aimed at reducing α-Syn accumulation and cell-to-cell transfer, such as immunotherapy against α-Syn, could be combined with agents that reduce neuroinflammation with potential synergistic outcomes. Here we review the current evidence supporting this type of approach, suggesting that such rational therapy combinations, together with the use of multi-target drugs, may hold promise as the next logical step for the treatment of synucleinopathies.

  5. pH- and NIR light responsive nanocarriers for combination treatment of chemotherapy and photodynamic therapy.

    Science.gov (United States)

    Wang, Sheng; Yang, Weitao; Cui, Jing; Li, Xue; Dou, Yan; Su, Lin; Chang, Jin; Wang, Hanjie; Li, Xiaodong; Zhang, Bingbo

    2016-02-01

    The side effects of antitumor drugs and low treatment efficacy are two major challenges of current chemotherapy. To address these issues, we developed a new kind of smart nanocarriers that combine pH-responsive chemotherapy and near-infrared (NIR) light triggered photodynamic therapy. These nanocarriers were based on upconversion nanoparticle (UCN)-loaded folate-conjugated polymeric lipid vesicles (UFPLVs). Merocyanine 540 (MC540), as a photosensitizer, was loaded in the UFPLVs; doxorubicin hydrochloride (DOX), as an antitumor drug, was conjugated to the surfaces of UFPLVs by pH-sensitive hydrazone bonds. The newly developed MC540&DOX-UFPLVs had a nanosized structure with targeting ligand modification, so they had the potential to accumulate into tumor sites via a combination of passive and active targeting effects. An in vitro singlet oxygen test showed that the nanocarriers can generate cytotoxic singlet oxygen successfully under the irradiation of NIR light. In vitro DOX release profiles demonstrated that the nanocarriers can achieve a pH-triggered drug release. It has been demonstrated by a cellular uptake study that the nanocarriers can efficiently deliver drugs and photosensitizers into tumor cells. In vitro and in vivo combination treatments evidenced the high antitumor effects of MC540&DOX-UFPLVs under NIR light irradiation. These results suggest that the MC540&DOX-UFPLVs may be promising nanocarriers for tumor combination therapy applications.

  6. Study of combination treatment effect of the {sup 166}Ho and anticancer agents in-vitro

    Energy Technology Data Exchange (ETDEWEB)

    Jeon, S. M.; Choi, S. J.; Park, K. B. [KAERI, Taejon (Korea, Republic of)

    2003-10-01

    For the development of new controlled drug delivery systems, the application of combination therapy using radioisotopes and tumor static agents has drawn great attention. This study was designed to estimate the treatment effect of the combination therapy with Holmium ({sup 166}Ho) and tumor static agents. Ho-166 was produced at the KAERI using HANARO reactor. The drugs applied were Sunpla, Methotrexate and Doxorubicin. Human glioblastoma (T98G), adenocarcinoma (MKN45), hepatocellular (Hep3B), lung carcinoma (Calu6), ovary adenocarcinoma (NIH:OVCAR- 3) and rat glioma (C6) were used. The cell cytotoxicity on the tumor cell lines determined by MTT assay. In the case where the chemotherapeutic agent was solely applied to the cell lines, the IC{sub 50} values wer e 2.4x10{sup -5}M of the Sunpla for MKN45 and 4.23x10{sup -6}M of the Doxorubicin for Calu6. The radioactivity of Ho-166 occurring 20% apoptosis was 10{mu}Ci. As for Sunpla and Doxorubicin, the value of IC20 was dependent on the cell lines used. The combination treatment of {sup 166}Ho and drug was to improve therapeutic success rate in T98G, MKN45, Hep3B, and Calu6. From this in vitro study it can be concluded that combining 166Ho radionuclide therapy and chemotherapy could enhance the effect of each in eliminating proliferating tumor cells.

  7. COMBINED COMPOST AND VERMICOMPOSTING PROCESS IN THE TREATMENT AND BIOCONVERSION OF SLUDGE

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    H. Alidadi, A. R. Parvaresh and M. R. Shamansouri

    2005-10-01

    Full Text Available Traditional thermophillic composting is commonly for treatment of sludge. A related technique as vermicomposting process, using earthworms to breakdown sludge, is also becoming popular. These two techniques have their inherent advantages and disadvantages. The combined approach suggested in this study to enhance the overall process and improve the products qualities. Two systems,vermicomposting and combined compost vermicomposting processes, have been investigated in this study. The sludge used in this study was obtained from the drying beds of South Isfahan wastewater treatment plant.The sludge mixed with sawdust to provide C/N ratio of 25/1.Eisenia fetida was the species of earthworms used in the vermicomposting processes.The results obtained indicates reduction in the amount of volatile solids,total carbon and C/N ratio with the vermicompost age,which indicates the reduction in the biodegradable organic content and mineralization of sludge. Also increase in phosphorus concentration by the end process because of mineralization of organic matter. The results indicate that, a system that combines the two mentioned processes not only shortens stabilization time, but also improves the products quality. Combining the two systems resulted in a product that was more stable and homogenous; the product could meet the pathogen reduction requirements.

  8. Combined Application of UV Photolysis and Ozonation with Biological Aerating Filter in Tertiary Wastewater Treatment

    Directory of Open Access Journals (Sweden)

    Zhaoqian Jing

    2012-01-01

    Full Text Available To enhance the biodegradability of residual organic pollutants in secondary effluent of wastewater treatment plants, UV photolysis and ozonation were used in combination as pretreatment before a biological aerating filter (BAF. The results indicated that UV photolysis could not remove much COD (chemical oxygen demand, and the performance of ozonation was better than the former. With UV photolysis combined with ozonation (UV/O3, COD removal was much higher than the sum of that with UV photolysis and ozonation alone, which indicated that UV photolysis could efficiently promote COD removal during ozonation. This pretreatment also improved molecular weight distribution (MWD and biodegradability greatly. Proportion of organic compounds with molecular weight (MW <3 kDalton was increased from 51.9% to 85.9%. COD removal rates with BAF and O3/BAF were only about 25% and 38%, respectively. When UV/O3 oxidation was combined with BAF, the average COD removal rate reached above 61%, which was about 2.5 times of that with BAF alone. With influent COD ranging from 65 to 84 mg/L, the effluent COD was stably in the scope of 23–31 mg/L. The combination of UV/O3 oxidation with BAF was quite efficient in organic pollutants removal for tertiary wastewater treatment.

  9. Targeted Therapies in Combination With Immune Therapies for the Treatment of Metastatic Melanoma.

    Science.gov (United States)

    Christiansen, Shelly A; Khan, Shaheer; Gibney, Geoffrey T

    In recent years, the field of oncology has witnessed many breakthroughs in the treatment of advanced malignancies, particularly in patients with advanced melanoma. Targeted and immune checkpoint therapies have emerged as the primary treatment strategies for these patients. Molecular profiling of melanoma is incorporated into routine practice to identify potential therapeutic targets, and patients are offered either a targeted or immune checkpoint inhibitor therapy approach. Both strategies have limitations where not all patients experience durable responses. Preclinical data have demonstrated the ability of targeted therapy to enhance activity of effector T cells, reduce immunosuppressive cytokine production, and increase tumor cell antigen presentation, which can augment antitumor immunity. In vivo models have shown synergy with improved tumor control when targeted and immune checkpoint agents are combined. Therefore, combination strategies with targeted and immune checkpoint therapy may improve patient outcomes. Early clinical data with anti-programmed cell-death protein 1/programmed cell-death ligand 1 agents in combination with targeted inhibitors appear to have acceptable toxicity rates and the potential for enhanced antitumor activity. This review explores the current status of preclinical and clinical development for these combination approaches in patients with advanced melanoma.

  10. Effect of combined treatment with cyclophosphamidum and allicin on neuroblastoma-bearing mice

    Institute of Scientific and Technical Information of China (English)

    Xiang-Yang Gao; Xian-Jie Geng; Wen-Long Zhai; Xian-Wei Zhang; Yuan Wei; Guang-Jun Hou

    2015-01-01

    Objective:To evaluate the efficacy of allicin combined with cyclophosphamide on neuroblastoma (NB)-bearing mice and explore the immunological mechanism in it.Methods:A total of30 NB-bearing mice were equally randomized into model group, cyclophosphamide group and combined therapy group,10 nudemice were set as normal saline(NS) group.Cyclophosphamide group and combined therapy group were weekly injected with60 mg/kg cyclophosphamide for four weeks; besides, combined therapy group was given with allicin(10 mg/kg/d) by gastric perfusion for4 weeks; model group and NS group were given with the same volume of NS.Serum VEGF content was detected byELISA pre-treating(0 d) and on the3rd d,14th d and28th d; on 29th d, all mice were sacrificed and the tumor, liver, spleen and thymic tissues were weighted. Tumors were made into paraffin section for detecting tumor cell apoptosis and proliferation by TUNEL and BrdU method, respectively.Survival curves were drawn byKaplan-Meier method. Results:After treatment, both treatment groups relieved on viscera indexes,VEGF level,T cell subsets distribution and tumor growth and each index of combined therapy group was better than cyclophosphamide group(P<0.05 or0.01); only combined therapy group could significantly increase the lifetime of NB-bearing mice(χ²=5.667,P=0.017).Conclusions:Allicin can improve T cell subsets distribution and inhibitVEGF expression through its immunomodulatory activity, thereby improve the efficiency onNB in coordination with cyclophosphamide.

  11. Treatment of heavy menstrual bleeding with a new combination of estradiol valerate and dienogest

    Directory of Open Access Journals (Sweden)

    Luis Bahamondes

    2010-11-01

    Full Text Available Luis Bahamondes, Ilza Monteiro, Arlete FernandesHuman Reproduction Unit, Department of Obstetrics and Gynecology, School of Medical Sciences and National Institute of Hormones and Women’s Health, University of Campinas, Campinas, BrazilAbstract: The first combined oral contraceptive (OC was launched in the US 50 years ago and was followed by another formulation introduced in Germany one year later. The most common estrogen component in current formulations is ethinylestradiol; however, many concerns have been raised with respect to this estrogen. Although the natural estrogen produced by the ovary, 17-beta estradiol, is the most potent of the estrogens, it is poorly absorbed orally, and previous attempts to use it in combined OCs have been unsuccessful due to the occurrence of irregular bleeding. Recently, a new combined OC was developed containing a natural estrogen, estradiol valerate, and a new progestin, dienogest, in a dynamic 26-day, four-phasic (estrogen stepdown and progestin stepup scheme of administration. In clinical trials, its contraceptive performance was excellent, with good cycle control and bleeding patterns compared with other combined OCs or with placebo. This review focuses predominantly on the use of an estradiol valerate-dienogest combined OC for the treatment of heavy menstrual bleeding. The findings of two large, randomized, controlled trials have shown that this combined OC constitutes an effective treatment for women with heavy menstrual bleeding, representing a new therapeutic option to reduce menstrual blood loss. Further studies are necessary to confirm these data.Keywords: dienogest, estradiol valerate, heavy menstrual bleeding, menorrhagia, contraception

  12. LOW POWER BRACHYTHERAPY IN COMBINED TREATMENT IN PATIENTS WITH INTERMEDIATE RISK OF LOCALIZED PROST ATE CANCER

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    V. A. Biryukov

    2014-01-01

    Full Text Available Objective. Estimation of the effectiveness of low power brachytherapy sources I-125 in the combined treatment in group of patients of intermediate risk of localized prostate cancer.Material and methods. The study included 126 patients with prostate cancer of intermediate risk. 104 patients (83,9% were conducted low power brachytherapy I‑125 in combination with hormone therapy by analogues of LHWG. 22 patients (16.1% received external beam irradiation in combination with brachytherapy I‑125 and hormonal treatment. Relapse-free survival of patients was evaluated in accordance with the criteria Phoenix (Nadir PSA + ng/ml. Evaluation of side effects of radiation treatment were carried out according to the RTOG criteria.Results. PSA relapse-free survival in the group of brachytherapy and hormone treatment at the time of observation 5 years amounted to 97.1%. In the group of combined radiation therapy with brachytherapy, and hormonal treatment PSA relapse-free survival rate was 95.5%.In both groups, relapse-free survival was noted in 96,8% of cases. Tumor-specific and overall survival in bothgroups was 100%. The major complications of treatment in both groups were radiation urethritis 1 to 2 degrees in 9.5% of cases (12 patients, urethral stricture in 5 patients (3.9% of cases, acute urinary retention in 1 patient (0.8% of cases and late radiation rectitis of 2 degree in 1.58% of cases (2 patients.Conclusions. It is possible to draw tentative conclusions about the high rate of survival without progression in both treatment groups on the background of the relatively low frequency of adverse reactions. It is necessary further follow-up for patients with estimating of survival for a longer period.

  13. Profile of lumacaftor/ivacaftor combination: potential in the treatment of cystic fibrosis

    Directory of Open Access Journals (Sweden)

    Arends AM

    2015-08-01

    Full Text Available Alexandria M Arends,1 Rebecca S Pettit2 1Department of Pharmacy, Indiana University Health, 2Department of Pharmacy, Riley Hospital for Children, Indianapolis, IN, USA Objective: To review the cystic fibrosis transmembrane conductance regulator (CFTR modulator ivacaftor in combination with lumacaftor for the treatment of cystic fibrosis (CF. Data sources: Literature was accessed through MEDLINE (1977–June 2015 and national conference abstracts. Search terms included ivacaftor, VX-770, lumacaftor, VX-809, CFTR modulator, and CF. Data synthesis: CF is an autosomal recessive genetic disease that affects chloride transport into and out of cells, causing the body to produce a thick, sticky mucus. There are over 1,800 CFTR mutations that have been identified and classified into six groups. CFTR modulators lumacaftor and ivacaftor are being studied in combination for the treatment of CF patients. This combination has proved beneficial for CF patients who are homozygous for the F508del mutation. In patients 12 years of age and older, the lumacaftor/ivacaftor combination demonstrated modest improvements in lung function with decreases in pulmonary exacerbation rate. There were clinically significant reductions in exacerbations, hospitalizations, and intravenous antibiotic requirement. Body mass index and Cystic Fibrosis Questionnaire-Revised scores were also positively impacted by therapy. A Phase I study evaluated the pharmacokinetics, safety, and tolerability of lumacaftor/ivacaftor in CF patients 6–11 years old. The combination is being further studied in this age group for clinical efficacy. The combination was generally well tolerated among all age groups, with the most common adverse events including headache and cough. Conclusion: The use of lumacaftor in combination with ivacaftor in CF patients homozygous for the F508del mutation has shown improvement in percent predicted forced expiratory volume in 1 second and a decrease in the number of

  14. Quantifying and Valuing Community Health Worker Time in Improving Access to Malaria Diagnosis and Treatment.

    Science.gov (United States)

    Castellani, Joëlle; Mihaylova, Borislava; Ajayi, IkeOluwapo O; Siribié, Mohamadou; Nsungwa-Sabiiti, Jesca; Afonne, Chinenye; Sermé, Luc; Balyeku, Andrew; Kabarungi, Vanessa; Kyaligonza, Josephine; Evers, Silvia M A A; Paulus, Aggie T G; Petzold, Max; Singlovic, Jan; Gomes, Melba

    2016-12-15

     Community health workers (CHWs) are members of a community who are chosen by their communities as first-line, volunteer health workers. The time they spend providing healthcare and the value of this time are often not evaluated. Our aim was to quantify the time CHWs spent on providing healthcare before and during the implementation of an integrated program of diagnosis and treatment of febrile illness in 3 African countries.  In Burkina Faso, Nigeria, and Uganda, CHWs were trained to assess and manage febrile patients in keeping with Integrated Management of Childhood Illness recommendations to use rapid diagnostic tests, artemisinin-based combination therapy, and rectal artesunate for malaria treatment. All CHWs provided healthcare only to young children usually <5 years of age, and hence daily time allocation of their time to child healthcare was documented for 1 day (in the high malaria season) before the intervention and at several time points following the implementation of the intervention. Time spent in providing child healthcare was valued in earnings of persons with similar experience.  During the high malaria season of the intervention, CHWs spent nearly 50 minutes more in daily healthcare provision (average daily time, 30.2 minutes before the intervention vs 79.5 minutes during the intervention; test for difference in means P < .01). On average, the daily time spent providing healthcare during the intervention was 55.8 minutes (Burkina Faso), 77.4 minutes (Nigeria), and 72.2 minutes (Uganda). Using the country minimum monthly salary, CHWs' time allocated to child healthcare for 1 year was valued at US Dollars (USD) $52 in Burkina Faso, USD $295 in Nigeria, and USD $141 in Uganda.  CHWs spend up to an hour and a half daily on child healthcare in their communities. These data are informative in designing reward systems to motivate CHWs to continue providing good-quality services.  ISRCTN13858170. © 2016 World Health Organization; licensee

  15. Decontamination of collagen biomatrices with combined pulsed electric field and nisin treatment.

    Science.gov (United States)

    Griffiths, Sarah; Maclean, Michelle; Macgregor, Scott J; Anderson, John G; Helen Grant, M

    2011-02-01

    Pulsed electric field (PEF) treatment has been proposed as a decontamination method for labile matrices used in tissue engineering applications. Through the application of PEF, a non-thermal treatment that causes bacterial inactivation through the irreversible rupture of microbial cell membranes, inactivation is achieved without loss of scaffold structure and function. However, some microorganisms are less susceptible to PEF treatment. This study shows that treatment with PEF and nisin, a food preservative bacteriocin, has a synergistic effect on the inactivation of Staphylococcus epidermidis in collagen gels. Almost complete inactivation of a 10(3) -10(4) CFU/mL S. epidermidis population was achieved when treated with a combination of PEF and 500 IU/mL nisin, with results demonstrating a 3.4 log(10) reduction, compared with 0.66 log(10) reduction with PEF alone. Nisin, at concentrations up to 3000 IU/mL, had no discernable toxicity to mammalian 3T3 cells when added to the culture medium or incorporated into the collagen gels. This combined decontamination method, involving PEF plus nisin, may provide a non-destructive process for inactivation of PEF-resistant bacteria in labile tissue engineering scaffolds.

  16. Urate crystal degradation for treatment of gout: a nanoparticulate combination therapy approach.

    Science.gov (United States)

    Tiwari, Sanjay; Dwivedi, Harinath; Kymonil, Koshy M; Saraf, Shubhini A

    2015-06-01

    The objective of the present work was to develop polymeric nanoparticles of uricase and aceclofenac (NSAID) and to incorporate them into gel, for delivering drugs to synovial joints, for effective treatment of Gout. Nanoparticles containing uricase and aceclofenac were prepared by double emulsion solvent evaporation method and emulsion solvent evaporation, using PLGA (50:50) as carrier, respectively. Process parameters were optimized using Taguchi L4 orthogonal array and L9 array, respectively. The formulations were characterized for particle size, entrapment efficiency, surface charge, in vitro drug release, ex vivo drug permeation, and urate crystal degradation activity. The particle size and entrapment efficiency for optimized batch was found to be 228.8 nm and 81.26% for uricase nanoparticles and 288.5 nm and 85.36% for aceclofenac nanoparticles, respectively. The developed nanoparticles formulations displayed zero order and Higuchi release kinetics with non-Fickian diffusion, respectively. The in vivo studies were performed in rabbit model. Topical application of gel containing polymeric uricase nanoparticles alone and a combination of both, uricase nanoparticles and aceclofenac nanoparticles in rabbit model test groups, provided complete removal of urate crystals and inflammation within 40 and 25 days of treatment, respectively. The combination treatment therapy resulted in effective treatment of gout due to degradation of crystals and anti-inflammatory response.

  17. Aspirin in combination with TACE in treatment of unresectable HCC: a matched-pairs analysis

    Science.gov (United States)

    Li, Jing-Huan; Wang, Yan; Xie, Xiao-Ying; Yin, Xin; Zhang, Lan; Chen, Rong-Xin; Ren, Zheng-Gang

    2016-01-01

    Transarterial chemoembolization (TACE) is the principal therapy for unresectable hepatocellular carcinoma (HCC). However, its efficacy is currently limited owing to tumor progression or treatment failure. It has been shown that aspirin reduces the incidence of multiple malignant tumors including HCC and plays a synergistic role with chemotherapy in the treatment of colon cancer. Therefore, we aimed to investigate the adjuvant effect of aspirin on patients with unresectable HCC who underwent TACE therapy. A retrospective matched-pairs analysis was performed to evaluate the efficacy of aspirin in combination with TACE therapy. A total of 120 patients with HCC, including 60 patients treated with aspirin for treatment of cardiovascular disease, transient ischemic attack, and arthritis, and 60 paired matching HCC patients without aspirin treatment in the same period, were enrolled. Compared with non-aspirin users, patients treated with aspirin showed improved OS (P = 0.050). Specifically, patients treated with a full dose of aspirin showed prolonged OS (P = 0.027), which was an independent factor associated with OS in multivariate analysis (hazard ratio 0.498, 95% confidence interval 0.280-0.888, P = 0.018). Aspirin in combination with TACE might improve OS in patients with unresectable HCC. Thus, the impact of aspirin on patients with HCC warrants further investigation prospectively. PMID:27725915

  18. Combined cisplatin and aurora inhibitor treatment increase neuroblastoma cell death but surviving cells overproduce BDNF.

    Science.gov (United States)

    Polacchini, Alessio; Albani, Clara; Baj, Gabriele; Colliva, Andrea; Carpinelli, Patrizia; Tongiorgi, Enrico

    2016-07-15

    Drug-resistance to chemotherapics in aggressive neuroblastoma (NB) is characterized by enhanced cell survival mediated by TrkB and its ligand, brain-derived neurotrophic factor (BDNF); thus reduction in BDNF levels represent a promising strategy to overcome drug-resistance, but how chemotherapics regulate BDNF is unknown. Here, cisplatin treatment in SK-N-BE neuroblastoma upregulated multiple BDNF transcripts, except exons 5 and 8 variants. Cisplatin increased BDNF mRNA and protein, and enhanced translation of a firefly reporter gene flanked by BDNF 5'UTR exons 1, 2c, 4 or 6 and 3'UTR-long. To block BDNF translation we focused on aurora kinases inhibitors which are proposed as new chemotherapeutics. NB cell survival after 24 h treatment was 43% with cisplatin, and 22% by cisplatin+aurora kinase inhibitor PHA-680632, while the aurora kinases inhibitor alone was less effective; however the combined treatment induced a paradoxical increase of BDNF in surviving cells with strong translational activation of exon6-3'UTR-long transcript, while translation of BDNF transcripts 1, 2C and 4 was suppressed. In conclusion, combined cisplatin and aurora kinase inhibitor treatment increases cell death, but induces BDNF overproduction in surviving cells through an aurora kinase-independent mechanism.

  19. Investigation of a combined platinum and electron lifetime control treatment for silicon

    Science.gov (United States)

    Jia, Yunpeng; Cui, Zhihang; Yang, Fei; Zhao, Bao; Zou, Shikai; Liang, Yongsheng

    2017-02-01

    In silicon, the effect of Combined Lifetime Treatment (CLT) involving platinum diffusion and subsequent electron irradiation is different from the separate treatments of platinum diffusion and electron irradiation, even the treatment of electron irradiation followed by platinum diffusion. In this paper, we investigated the experimental behavior of different kinds of lifetime treated samples. We found that the reverse leakage current (Irr) increases with the increasing platinum diffusion temperature or electron irradiation dose in the separate treatments. Conversely, Irr of the CLT samples decreased with rising platinum diffusion temperature at the same dose of subsequent electron irradiation. By deep-level transient spectroscopy (DLTS), a new energy level E7 (Ec -0.376 eV) was found in our CLT samples. The new level E7 suppresses the dominance of the deeper level E8 (Ec -0.476 eV), which is caused by electron irradiation directly and results in Irr's increase. The formation of the level E7 comes from the complex defect-combined effect between platinum atoms and silicon vacancies, and it affects device's characteristics finally. These research will be helpful to the development of platinum-diffused devices used in intense electron irradiation environments.

  20. Combined treatment of xenon and hypothermia in newborn rats--additive or synergistic effect?

    Directory of Open Access Journals (Sweden)

    Hemmen Sabir

    Full Text Available Breathing the inert gas Xenon (Xe enhances hypothermic (HT neuroprotection after hypoxia-ischemia (HI in small and large newborn animal models. The underlying mechanism of the enhancement is not yet fully understood, but the combined effect of Xe and HT could either be synergistic (larger than the two effects added or simply additive. A previously published study, using unilateral carotid ligation followed by hypoxia in seven day old (P7 rats, showed that the combination of mild HT (35°C and low Xe concentration (20%, both not being neuroprotective alone, had a synergistic effect and was neuroprotective when both were started with a 4 h delay after a moderate HI insult. To examine whether another laboratory could confirm this finding, we repeated key aspects of the study.After the HI-insult 120 pups were exposed to different post-insult treatments: three temperatures (normothermia (NT NT37°C, HT35°C, HT32°C or Xe concentrations (0%, 20% or 50% starting either immediately or with a 4 h delay. To assess the synergistic potency of Xe-HT, a second set (n = 101 of P7 pups were exposed to either HT35°C+Xe0%, NT+Xe20% or a combination of HT35°C+Xe20% starting with a 4 h delay after the insult. Brain damage was analyzed using relative hemispheric (ligated side/unligated side brain tissue area loss after seven day survival.Immediate HT32°C (p = 0.042, but not HT35°C significantly reduced brain injury compared to NT37°C. As previously shown, adding immediate Xe50% to HT32°C increased protection. Neither 4 h-delayed Xe20%, nor Xe50% at 37°C significantly reduced brain injury (p>0.050. In addition, neither 4 h-delayed HT35°C alone, nor HT35°C+Xe20% reduced brain injury. We found no synergistic effect of the combined treatments in this experimental model.Combining two treatments that individually were ineffective (delayed HT35°C and delayed Xe20% did not exert neuroprotection when combined, and therefore did not show a synergistic

  1. The Differential Effects of Exercise,Brace and Combined Rehabilitation Treatment in Patients with Adolescent Idiopathic Scoliosis%The Differential Effects of Exercise, Brace and Combined Rehabilitation Treatment in Patients with Adolescent Idiopathic Scoliosis

    Institute of Scientific and Technical Information of China (English)

    DU Qing; ZHOU Xuan; LI Jianan; ZHAO Li; TAO Quan; CHEN Ting; CHEN Peijie

    2013-01-01

    Objective:To compare the effects of different conservative managements on patients with adolescent idiopathic scoliosis (AIS).Method:One hundred and four AIS patients were recruited for this study.The patients were divided into 3groups:exercise (E group),brace (B group) and combined rehabilitation treatment (brace treatment combined with exercise,CR group).Radiological parameter were used to assess AIS patients before and after treatment.The Chinese version of scoliosis research society-22(SRS-22) patient questionnaires were filled out by patients after treatment.The SRS-22 scores were compared among management groups.Result:The maximal Cobb angles were smaller in E group than in B group or CR group both before and after treatment.The maximal Cobb angles were significantly smaller after treatment than before treatment in B group and CR group.Function/activity was better in E group than in B group or CR group.Self-image/appearance and satisfaction with management were better in E group and CR group than in B group.There was no significant difference among treatment groups in pain and mental health.Conclusion:Both brace and combined rehabilitation treatment can reduce the spinal curve of AIS patients.Both exercise and combined rehabilitation treatment have positive influence on self-image/appearance and satisfaction with management.We support preference of combined rehabilitation treatment above brace treatment.

  2. Treatment of Aluminium Phosphide Poisoning with a Combination of Intravenous Glucagon, Digoxin and Antioxidant Agents

    Science.gov (United States)

    Oghabian, Zohreh; Mehrpour, Omid

    2016-01-01

    Aluminium phosphide (AlP) is used to protect stored grains from rodents. It produces phosphine gas (PH3), a mitochondrial poison thought to cause toxicity by blocking the cytochrome c oxidase enzyme and inhibiting oxidative phosphorylation, which results in cell death. AlP poisoning has a high mortality rate among humans due to the rapid onset of cardiogenic shock and metabolic acidosis, despite aggressive treatment. We report a 21-year-old male who was referred to the Afzalipour Hospital, Kerman, Iran, in 2015 after having intentionally ingested a 3 g AlP tablet. He was successfully treated with crystalloid fluids, vasopressors, sodium bicarbonate, digoxin, glucagon and antioxidant agents and was discharged from the hospital six days after admission in good clinical condition. For the treatment of AlP poisoning, the combination of glucagon and digoxin with antioxidant agents should be considered. However, evaluation of further cases is necessary to optimise treatment protocols. PMID:27606117

  3. Treatment of Aluminium Phosphide Poisoning with a Combination of Intravenous Glucagon, Digoxin and Antioxidant Agents

    Directory of Open Access Journals (Sweden)

    Zohreh Oghabian

    2016-08-01

    Full Text Available Aluminium phosphide (AlP is used to protect stored grains from rodents. It produces phosphine gas (PH3, a mitochondrial poison thought to cause toxicity by blocking the cytochrome c oxidase enzyme and inhibiting oxidative phosphorylation, which results in cell death. AlP poisoning has a high mortality rate among humans due to the rapid onset of cardiogenic shock and metabolic acidosis, despite aggressive treatment. We report a 21-yearold male who was referred to the Afzalipour Hospital, Kerman, Iran, in 2015 after having intentionally ingested a 3 g AlP tablet. He was successfully treated with crystalloid fluids, vasopressors, sodium bicarbonate, digoxin, glucagon and antioxidant agents and was discharged from the hospital six days after admission in good clinical condition. For the treatment of AlP poisoning, the combination of glucagon and digoxin with antioxidant agents should be considered. However, evaluation of further cases is necessary to optimise treatment protocols.

  4. Treatment of trauma-affected refugees with venlafaxine versus sertraline combined with psychotherapy

    DEFF Research Database (Denmark)

    Sonne, Charlotte; Lohmann, Jessica Mariana Carlsson; Bech, Per

    2016-01-01

    Background: The prevalence of trauma-related psychiatric disorders is high among refugees. Despite this, little is known about the effect of pharmacological treatment for this patient group. The objective of the present study was therefore to examine differences in the effects of venlafaxine...... and sertraline on Post-Traumatic Stress Disorder (PTSD), depression and functional impairment in trauma-affected refugees. Methods: The study was a randomised pragmatic trial comparing venlafaxine and sertraline in combination with psychotherapy and social counselling. PTSD symptoms were measured on the Harvard......: Two hundred seven adult refugee patients were included in the trial (98 in the venlafaxine and 109 in the sertraline group). Of these, 195 patients were eligible for intention-to-treat analyses. Small but significant pre-treatment to post-treatment