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Sample records for experiencing treatment failure

  1. Anxiety and depression after failure of assisted reproductive treatment among patients experiencing infertility.

    Science.gov (United States)

    Maroufizadeh, Saman; Karimi, Elaheh; Vesali, Samira; Omani Samani, Reza

    2015-09-01

    To investigate the impact of the number of previous infertility treatment failures on anxiety and depression. In a cross-sectional study, individuals (men and women, but not couples) aged at least 18 years who had a history of infertility and could read and write in Persian were enrolled at the Royan Institute, Tehran, Iran, between November 1, 2013, and February 28, 2014. Participants provided demographic and infertility information and completed the Persian version of the Hospital Anxiety and Depression Scale (HADS). Overall, 330 patients (122 men, 208 women) were included. Mean scores on the HADS anxiety and depression subscales (HADS-A and HADS-D) were 8.40±4.51 and 5.95±3.54, respectively. In multiple regression analysis, mean HADS-A scores were significantly higher for patients with one treatment failure (9.57±4.58) than for those without a history of treatment (7.79±4.13; P=0.003). HADS-D scores were significantly higher for patients with two failures (6.92±3.69) than for those with no previous treatment (5.59±3.79; P=0.019). Patients with infertility have increased depression and anxiety after infertility treatment failure. Counseling or treatment for these potential psychological effects should be considered after infertility treatment failure. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  2. Prognostic factors in patients with metastatic germ cell tumors who experienced treatment failure with cisplatin-based first-line chemotherapy.

    Science.gov (United States)

    Lorch, Anja; Beyer, Jörg; Bascoul-Mollevi, Caroline; Kramar, Andrew; Einhorn, Lawrence H; Necchi, Andrea; Massard, Christophe; De Giorgi, Ugo; Fléchon, Aude; Margolin, Kim A; Lotz, Jean-Pierre; Germa Lluch, Jose Ramon; Powles, Thomas; Kollmannsberger, Christian K

    2010-11-20

    To develop a prognostic model in patients with germ cell tumors (GCT) who experience treatment failure with cisplatin-based first-line chemotherapy. Data from 1,984 patients with GCT who progressed after at least three cisplatin-based cycles and were treated with cisplatin-based conventional-dose or carboplatin-based high-dose salvage chemotherapy was retrospectively collected from 38 centers/groups worldwide. One thousand five hundred ninety-four (80%) of 1,984 eligible patients were randomly divided into a training set of 1,067 patients (67%) and a validation set of 527 patients (33%). Seminomas were set aside for posthoc analyses. Primary end point was the 2-year progression-free survival after salvage treatment. Overall, 990 patients (62%) relapsed and 604 patients (38%) remained relapse free. Histology, primary tumor location, response, and progression-free interval after first-line treatment, as well as levels of alpha fetoprotein, human chorionic gonadotrophin, and the presence of liver, bone, or brain metastases at salvage were identified as independent prognostic variables and used to build a prognostic model in the training set. Survival rates in the training and validation set were very similar. The estimated 2-year progression-free survival rates in patients not included in the training set was 75% in very low risk, 51% in low risk, 40% in intermediate risk, 26% in high risk, and only 6% in very high-risk patients. Due to missing values in individual variables, 69 patients could not reliably be classified into one of these categories. Prognostic variables are important in patients with GCT who experienced treatment failure with cisplatin-based first-line chemotherapy and can be used to construct a prognostic model to guide salvage strategies.

  3. Effectivity of Dysport in patients with blepharospasm and hemifacial spasm who experienced failure with Botox.

    Science.gov (United States)

    Badarny, Samih; Susel, Zvi; Honigman, Silvia

    2008-07-01

    Long-term therapy with botulinum toxin is sometimes associated with therapy failure following repeated injections of the neurotoxin, presumably due to specific antibody production. Primary therapy failure with botulinum toxin is less common and poorly understood. To examine the effectiveness of the botulinum neurotoxin Dysport in patients with blepharospasm and hemifacial spasm after primary or secondary failure with Botox treatments. In this case series study, eight patients with blepharospasm and hemifacial spasm who experienced primary or secondary therapy failure with Botox were treated with Dysport. In order to render an equivalent Dysport dose, a conversion ratio of 1:3 to 1:4 Botox/Dysport was used. Two patients, one with blepharospasm and the other with hemifacial spasm, who showed primary therapeutic failure with Botox showed good response to Dysport treatments. One patient with tardive blepharospasm did not respond to either drug. Two patients with blepharospasm and three patients with hemifacial spasm who experienced Botox secondary therapy failure responded well to Dysport treatments. Botox and Dysport are both serotype A botulinum toxins but carry different characteristics of biological activity. These differences possibly account for the favorable therapeutic response to Dysport in patients with hemifacial spasm or blepharospasm following failure with Botox treatments.

  4. Stress echocardiography in patients who experienced mechanical ventilation weaning failure.

    Science.gov (United States)

    Ruiz-Bailén, Manuel; Cobo-Molinos, Jesús; Castillo-Rivera, Ana; Pola-Gallego-de-Guzmán, María Dolores; Cárdenas-Cruz, Antonio; Martínez-Amat, Antonio; Sevilla-Martínez, María; Hernández-Caballero, Clara

    2017-06-01

    Critically ill patients may suffer varying degrees of temporary myocardial dysfunction during respiratory weaning that could play an important role in weaning failure. In this study, we tried to assess the existence of temporary diastolic dysfunction during respiratory weaning. Inclusion period is from 2006 to 2015. In this study, we included 181 ventilated patients with cardiogenic shock that were being weaned from mechanical ventilation. Twenty of those patients were successfully weaned from mechanical ventilation, and the rest (161) experienced complications in their weaning process. All patients had a left ventricular ejection fraction >0.45 and E/E' ratio≤8, did not require vasoactive drugs at that time, and did not have remaining significant ischemic disease. We divided our patients into 3 groups, as follows: A, patients who could not tolerate a T-tube and required pressure-support ventilation (82); B, patients who successfully tolerated a T-tube period (20); and C, patients who could not tolerate spontaneous breathing modes of mechanical ventilation and remained on assisted mechanical ventilation. We performed stress echocardiography for the last two groups; using dobutamine to assess diastolic function and using ephedrine to evaluate functional mitral regurgitation (MR). We estimated pulmonary capillary wedge pressure through the E/E' ratio and the flow in the pulmonary veins. In group A (ie, those patients who could not tolerate a T-tube trial), we observed an increase in the E/E' ratio (6.32±0.77 vs 15.2±6.65; P=.0001) and a worsening of strain (S) and strain rate (SR) (-13.6±1.80 vs -11.88±5.6, P=.0001; and -1.3±1.28 vs -0.95±0.38, P=.0001; respectively). We did not observe a change in the E/E' ratio during stress echocardiogram on those patients with successful weaning from mechanical ventilation (7.41±0.43 vs 8.38±4.57, P=.001). However, we did see in this group an increased peak velocity of the S wave and of SR (-16.11±08.72 vs -19.89±5

  5. Risky Business: condom failures as experienced by female sex workers in Mombasa, Kenya.

    Science.gov (United States)

    Bradburn, Caitlyn K; Wanje, George; Pfeiffer, James; Jaoko, Walter; Kurth, Ann E; McClelland, R Scott

    2017-03-01

    Limited research exists about condom failure as experienced by female sex workers. We conducted a qualitative study to examine how female sex workers in Mombasa, Kenya contextualise and explain the occurrence of condom failure. In-depth, semi-structured interviews were conducted with thirty female sex workers to ascertain their condom failure experiences. We qualitatively analysed interview transcripts to determine how the women mitigate risk and cope with condom failure. Condom failure was not uncommon, but women mitigated the risk by learning about correct use, and by supplying and applying condoms themselves. Many female sex workers felt that men intentionally rupture condoms. Few women were aware of or felt empowered to prevent HIV, STIs, and pregnancy after condom failure. Interventions to equip female sex workers with strategies for minimising the risk of HIV, STIs, and pregnancy in the aftermath of a condom failure should be investigated.

  6. System Reliability Evaluation in Water Distribution Networks with the Impact of Valves Experiencing Cascading Failures

    Directory of Open Access Journals (Sweden)

    Qing Shuang

    2017-06-01

    Full Text Available Water distribution networks (WDNs represent a class of critical infrastructure networks. When a disaster occurs, component failures in a WDN may trigger system failures that result in larger-scale reactions. The aim of the paper is to evaluate the evolution of system reliability and failure propagation time for a WDN experiencing cascading failures, and find the critical pipes which may reduce system reliability dramatically. Multiple factors are considered in the method such as network topology, the balance of water supply and demand, demand multiplier, and pipe break isolation. The pipe-based attack with multiple failure scenarios is simulated in the paper. A case WDN is used to illustrate the method. The results show that the lowest capacity gets stronger when a WDN is short of supply, becoming the dominant factor that decides the evolution of system reliability and failure propagation time. The valve ratio (VR and system reliability present a flattened S curve relationship, and there are two turning points in VR. The critical pipes can be identified. With the fixed 5% valves, a WDN can improve system reliability and resist cascading failures effectively. The findings provide insights into the system reliability and failure propagation time for WDNs experiencing cascading failures. It is proven to be useful in future studies focused on the operation and management of water services.

  7. Pharmacokinetics of Unboosted Atazanavir in Treatment-experienced HIV-infected Children, Adolescents and Young Adults.

    Science.gov (United States)

    Cressey, Tim R; Hazra, Rohan; Wiznia, Andrew; Foca, Marc; Jean-Philippe, Patrick; Graham, Bobbie; King, Jennifer R; Britto, Paula; Carey, Vincent J; Acosta, Edward P; Yogev, Ram

    2016-12-01

    HIV protease inhibitor use in pediatrics is challenging due to the poor palatability and/or toxicity of concomitant low-dose ritonavir. Atazanavir without ritonavir (unboosted) is not recommended for patients with prior virologic failure, a common problem for perinatally-infected adolescents. Atazanavir 400 mg once-daily provided suboptimal exposure. Higher unboosted doses or splitting the daily dose to twice-daily warrants investigation in this treatment-experienced population.

  8. Detection of resistance mutations and CD4 slopes in individuals experiencing sustained virological failure

    DEFF Research Database (Denmark)

    Schultze, Anna; Paredes, Roger; Sabin, Caroline

    2014-01-01

    mutations on CD4 slopes in patients undergoing episodes of viral failure. MATERIALS AND METHODS: Patients from the EuroSIDA and UK CHIC cohorts undergoing at least one episode of virological failure (>3 consecutive RNA measurements >500 on ART) with at least three CD4 measurements and a resistance test...... during the episode were included. Mutations were identified using the IAS-US (2013) list, and were presumed to be present from detection until the end of an episode. Multivariable linear mixed models with a random intercept and slope adjusted for age, baseline CD4 count, hepatitis C, drug type, RNA (log......-scale), risk group and subtype were used to estimate CD4 slopes. Individual mutations with a population prevalence of >10% were tested for their effect on the CD4 slope. RESULTS: A total of 2731 patients experiencing a median of 1 (range 1-4) episodes were included in this analysis. The prevalence of any...

  9. Treatment failure in humanistic and experiential psychotherapy.

    Science.gov (United States)

    Watson, Jeanne C

    2011-11-01

    In this article, treatment failure in humanistic experiential psychotherapy is defined and explored. I outline several markers that indicate when treatment is not going well. Factors that contribute to failure include client factors, for example, emotional processing capacities, shame, and impoverished narratives, as well as therapist factors including lack of empathic attunement and inflexibility. Treatment failure is illuminated with a case example drawn from humanistic/experiential psychotherapy, and clinical strategies for dealing with failures are recommended. © 2011 Wiley Periodicals, Inc.

  10. [Clinical, microbiological and evolutionary profile of patients experiencing failures and relapses of tuberculosis in Ivory Coast].

    Science.gov (United States)

    Kouamé-N'Takpé, N; Horo, K; Koné, A; N'guessan, K R; Touré, K; Kouadio, C; Assi, D; Coulibaly, I; Kouakou, A

    2015-02-01

    Multidrug-resistant tuberculosis (MDR-TB) is a major obsession for TB control. The main risk factor for MDR-TB remains a history of TB treatment especially bad conduct. The objective of this study is to describe the profile of patients in situations of failure and relapse of tuberculosis. We performed a retrospective survey of the analysis of records of patients starting TB retreatment for failure or relapse of tuberculosis. We used 193 cases with results of culture-sensitivity. The proportion of failure is 59/193 (30.6 %) and cases of relapse are 134/193 (69.4 %). The proportion of married life is 23.4 % (11/47) in chess against 41.5 % (51/123) in relapse of TB [P=0.021, OR=0.431 (0.201 to 0.927)]. Patients failing therapy have more chest pain [5.8 % (3/52) versus 0 % (0/126) with P=0.024]. The proportion of MDR-TB was 61.4 (38/59) in case of failure against 41 % (55/134) in case of relapse [P=0.002, OR=2.599 (1.378 to 4.902)]. The evolution is the same whatever the indication of reprocessing. The proportion of MDR-TB is very important in case of reprocessing failure and relapse of tuberculosis. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  11. Perfectionism, fear of failure, and affective responses to success and failure: The central role of fear of experiencing shame and embarrassment\\ud

    OpenAIRE

    Sagar, S.S.; Stoeber, Joachim

    2009-01-01

    This study investigated how different aspects of perfectionism in athletes (N = 388) related to the different fears of failure proposed by Conroy et al. (2002), and how perfectionism and fears of failure predicted positive and negative affect after imagined success and failure in sports competitions. Results showed that perfectionistic personal standards showed a negative relationship with fear of experiencing shame and embarrassment and a positive relationship with positive affect after succ...

  12. Perfectionism, fear of failure, and affective responses to success and failure: the central role of fear of experiencing shame and embarrassment.

    OpenAIRE

    Sagar, SS; Stoeber, J

    2009-01-01

    This study investigated how aspects of perfectionism in athletes (N = 388) related to the fears of failure proposed by Conroy et al. (2002), and how perfectionism and fears of failure predicted positive and negative affect after imagined success and failure in sports competitions. Results showed that perfectionistic personal standards showed a negative relationship with fear of experiencing shame and embarrassment and a positive relationship with positive affect after success, whereas perfect...

  13. Perfectionism, fear of failure, and affective responses to success and failure: the central role of fear of experiencing shame and embarrassment.

    Science.gov (United States)

    Sagar, Sam S; Stoeber, Joachim

    2009-10-01

    This study investigated how aspects of perfectionism in athletes (N = 388) related to the fears of failure proposed by Conroy et al. (2002), and how perfectionism and fears of failure predicted positive and negative affect after imagined success and failure in sports competitions. Results showed that perfectionistic personal standards showed a negative relationship with fear of experiencing shame and embarrassment and a positive relationship with positive affect after success, whereas perfectionistic concern over mistakes and perceived parental pressure showed a positive relationship with fear of experiencing shame and embarrassment and with negative affect after failure. Moreover, fear of experiencing shame and embarrassment fully mediated the relationship between perfectionistic concern and negative affect and between coach pressure and negative affect. The findings demonstrate that fear of experiencing shame and embarrassment is central in the relationship between perfectionism and fear of failure, and that perfectionistic concern about mistakes and perceived coach pressure are aspects of perfectionism that predict fear of experiencing shame and embarrassment and negative affect after failure.

  14. Vulnerabilidades presentes no percurso vivenciado pelos pacientes com HIV/AIDS em falha terapêutica Vulnerabilidades presentes en la ruta vivida por pacientes con VIH / SIDA en falla terapéutica Vulnerabilities present in the path experienced by patients with HIV / AIDS in treatment failure

    Directory of Open Access Journals (Sweden)

    Petra Kelly Rabelo de Sousa

    2013-04-01

    study aimed to analyze the vulnerabilities of patients with HIV / AIDS in treatment failure. It is a qualitative study, involving seven users with AIDS considered in treatment failure in an Outpatient Service Unit on HIV / AIDS, in Fortaleza-CE. To interpret the data, it was used the technique of content analysis. In the speeches, it was realized that the deponents faced conflicts in the family and, difficult relationships with people and stigma at work. It was observed that patients had experienced various situations that made them more susceptible to HIV infection and illness.

  15. Diuretics as pathogenetic treatment for heart failure

    Science.gov (United States)

    Guglin, Maya

    2011-01-01

    Increased intracardiac filling pressure or congestion causes symptoms and leads to hospital admissions in patients with heart failure, regardless of their systolic function. A history of hospital admission, in turn, predicts further hospitalizations and morbidity, and a higher number of hospitalizations determine higher mortality. Congestion is therefore the driving force of the natural history of heart failure. Congestion is the syndrome shared by heart failure with preserved and reduced systolic function. These two conditions have almost identical morbidity, mortality, and survival because the outcomes are driven by congestion. A small difference in favor of heart failure with preserved systolic function comes from decreased ejection fraction and left ventricular remodeling which is only present in heart failure with decreased systolic function. The magnitude of this difference reflects the contribution of decreased systolic function and ventricular remodeling to the progression of heart failure. The only treatment available for congestion is fluid removal via diuretics, ultrafiltration, or dialysis. It is the only treatment that works equally well for heart failure with reduced and preserved systolic function because it affects congestion, the main pathogenetic feature of the disease. Diuretics are pathogenetic therapy for heart failure. PMID:21403798

  16. Paediatric HIV treatment failure: a silent epidemic

    Directory of Open Access Journals (Sweden)

    Jonathan M Bernheimer

    2015-07-01

    Full Text Available Paediatric antiretroviral treatment (ART failure is an under-recognized issue that receives inadequate attention in the field of paediatrics and within HIV treatment programmes. With paediatric ART failure rates ranging from 19.3% to over 32% in resource limited settings, a comprehensive evaluation of the causes of failure along with approaches to address barriers to treatment adherence are urgently needed.In partnership with the local Department of Health, a pilot programme has been established by Medecins Sans Frontieres (MSF in Khayelitsha, South Africa, to identify and support paediatric HIV patients with high viral loads and potential treatment failure. Through detailed clinical and psychosocial evaluations and adherence support with an innovative counselling model, treatment barriers are identified and addressed.Demographic and clinical characteristics from the cohort show a delayed median start date for ART, prolonged viraemia including a large number of patients who have never achieved viral load (VL suppression, a low rate of regimen changes despite failure, and a high percentage of pre-adolescent and adolescent patients who have not gone through the disclosure process.Stemming this epidemic of paediatric treatment failure requires programmatic responses to high viral loads in children, starting with improved “case finding” of previously undiagnosed HIV-infected children and adolescents. Viral load testing needs to be prioritized over CD4 count monitoring, and flagging systems to identify high VL results should be developed in clinics. Clinicians must understand that successful treatment begins with good adherence, and that simple adherence support strategies can often dramatically improve adherence. Moreover, appropriate adherence counselling should begin not when the child fails to respond to treatment. Establishing good adherence from the beginning of treatment, and supporting ongoing adherence during the milestones in these

  17. Problems Experienced by Ovarian Cancer Survivors During Treatment.

    Science.gov (United States)

    Keim-Malpass, Jessica; Mihalko, Shannon L; Russell, Greg; Case, Doug; Miller, Brigitte; Avis, Nancy E

    To identify problems at different treatment points (early treatment, mid-treatment, early posttreatment, and late posttreatment) among women with ovarian cancer. Longitudinal and cross-sectional study design. An academic and community clinical cancer center in the Southeastern United States. Sixty-eight women with Stage I to IV ovarian cancer. Variables assessed included reported problems (physical, psychosocial, pain, marital, medical interaction), social support, optimism, and responses to open-ended questions. Analysis involved mixed models for longitudinal repeated measures and unpaired t tests and content analysis to describe responses to open-ended questions. Physical and psychosocial problems were greatest during early treatment and decreased throughout the treatment trajectory. Women with greater levels of social support and optimism at baseline had fewer problems over time. Women who did not have trouble paying for basics had fewer problems related to pain and psychological problems. Problems across all domains must be addressed throughout the treatment trajectory, even after chemotherapy has ended. Nurses are well positioned to refer women appropriately to social workers and clinical navigators across all domains of care and should consider systematic assessment of patient-reported problems as a routine form of practice. Copyright © 2017 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

  18. Treatment of respiratory failure in COPD

    Directory of Open Access Journals (Sweden)

    Stephan Budweiser

    2008-12-01

    Full Text Available Stephan Budweiser1, Rudolf A Jörres2, Michael Pfeifer1,31Center for Pneumology, Hospital Donaustauf, Donaustauf, Germany; 2Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-University, Munich, Germany; 3Department of Internal Medicine II, Division of Respirology, University of Regensburg, Regensburg, GermanyAbstract: Patients with advanced COPD and acute or chronic respiratory failure are at high risk for death. Beyond pharmacological treatment, supplemental oxygen and mechanical ventilation are major treatment options. This review describes the physiological concepts underlying respiratory failure and its therapy, as well as important treatment outcomes. The rationale for the controlled supply of oxygen in acute hypoxic respiratory failure is undisputed. There is also a clear survival benefit from long-term oxygen therapy in patients with chronic hypoxia, while in mild, nocturnal, or exercise-induced hypoxemia such long-term benefits appear questionable. Furthermore, much evidence supports the use of non-invasive positive pressure ventilation in acute hypercapnic respiratory failure. It application reduces intubation and mortality rates, and the duration of intensive care unit or hospital stays, particularly in the presence of mild to moderate respiratory acidosis. COPD with chronic hypercapnic respiratory failure became a major indication for domiciliary mechanical ventilation, based on pathophysiological reasoning and on data regarding symptoms and quality of life. Still, however, its relevance for long-term survival has to be substantiated in prospective controlled studies. Such studies might preferentially recruit patients with repeated hypercapnic decompensation or a high risk for death, while ensuring effective ventilation and the patients’ adherence to therapy.Keywords: respiratory failure, COPD, mechanical ventilation, non-invasive ventilation long-term oxygen therapy, chronic

  19. [Efficacy of dolutegravir in treatment-experienced patients: the SAILING and VIKING trials].

    Science.gov (United States)

    Moreno, Santiago; Berenguer, Juan

    2015-03-01

    Dolutegravir is an HIV integrase inhibitor with a high genetic barrier to resistance and is active against raltegravir- and/or elvitegravir-resistant strains. The clinical development of dolutegravir for HIV infection rescue therapy is based on 3 clinical trials. In the SAILING trial, dolutegravir (5 mg once daily) in combination with 2 other antiretroviral agents was well tolerated and showed greater virological effect than raltegravir (400 mg twice daily) in the treatment of integrase inhibitor-naïve adults with virological failure infected with HIV strains with at least two-class drug resistance. The VIKING studies were designed to evaluate the efficacy of dolutegravir as rescue therapy in treatment-experienced patients infected with HIV strains with resistance mutations to raltegravir and/or elvitegravir. VIKING-1-2 was a dose-ranging phase IIb trial. VIKING-3 was a phase III trial in which dolutegravir (50 mg twice daily) formed part of an optimized regimen and proved safe and effective in this difficult-to-treat group of patients. Dolutegravir is the integrase inhibitor of choice for rescue therapy in multiresistant HIV infection, both in integrase inhibitor-naïve patients and in those previously treated with raltegravir or elvitegravir. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  20. Treatment Methods for Kidney Failure: Peritoneal Dialysis

    Science.gov (United States)

    ... for health care based on financial need. Your renal social worker can help you locate resources for financial assistance. More information is provided in the NIDDK health topic, Financial Help for Treatment of Kidney Failure . Eating, Diet, and Nutrition Eating the right foods can help you feel ...

  1. Efficacy and safety of rilpivirine-based regimens in treatment-experienced HIV-1 infected patients: a prospective cohort study

    Directory of Open Access Journals (Sweden)

    Sandrine Gazaignes

    2014-11-01

    Full Text Available Introduction: Rilpivirine (RPV is a new once-daily, non-nucleoside, reverse transcriptase inhibitor (NNRTI. In treatment-naïve patients, RPV has shown non-inferior antiviral activity to efavirenz but data in treatment-experienced patients are more limited. We assessed the efficacy and safety of RPV in treatment-experienced patients switching to a RPV-based regimen. Methods: Between September 2012 and June 2013, all antiretroviral therapy (ART experienced HIV-1 infected patients with a plasma HIV-RNA level <50 cp/mL, and switching to a RPV-based regimen, were enrolled in this prospective monocentric cohort study. Clinical and laboratory data were collected every 3 months to assess safety and efficacy. The primary endpoint was the proportion of patients with virologic success (HIV-RNA load <50 cp/mL at 12 months using the FDA snapshot algorithm. Results: A total of 281 patients (76% male, median age: 47 years, 56% MSM were enrolled in this study. Median lymphocyte CD4 count at baseline was 640/mm3. Patients have received ART for a median of 7 years and viral replication was fully suppressed for a median of 3 years. Before the switch, 39% patients were treated with NNRTI, 52% with protease inhibitor and 7% with integrase inhibitor-based regimens. Reasons for switch were simplification (176 cases, adverse events (AEs (93 cases and others (12 cases. At month 12 (database frozen on June 2014 in the snapshot analysis, 56% of patients met virologic success, 5% experienced virologic failure (n=14 and 39% had no data in the window period. In the LOCF analysis (using data from the previous available visit before month 12, 89% patients were suppressed, 5% had virologic failure and 6% had no data. Genotypic resistance analysis was performed in 7/14 patients at the time of virologic failure (3 of whom had previous NRTI/NNRTI resistance-associated mutations (RAMs, and new NNRTI and NRTI RAMs emerged in 4 patients. RPV-based regimen was generally well

  2. Efficacy and safety of rilpivirine-based regimens in treatment-experienced HIV-1 infected patients: a prospective cohort study

    Science.gov (United States)

    Gazaignes, Sandrine; Resche-Rigon, Matthieu; Yang, Chloe; Gatey, Caroline; Munier, Anne-Lise; Desseaux, Kristell; Rozenbaum, Willy; Molina, Jean-Michel

    2014-01-01

    Introduction Rilpivirine (RPV) is a new once-daily, non-nucleoside, reverse transcriptase inhibitor (NNRTI). In treatment-naïve patients, RPV has shown non-inferior antiviral activity to efavirenz but data in treatment-experienced patients are more limited. We assessed the efficacy and safety of RPV in treatment-experienced patients switching to a RPV-based regimen. Methods Between September 2012 and June 2013, all antiretroviral therapy (ART) experienced HIV-1 infected patients with a plasma HIV-RNA level <50 cp/mL, and switching to a RPV-based regimen, were enrolled in this prospective monocentric cohort study. Clinical and laboratory data were collected every 3 months to assess safety and efficacy. The primary endpoint was the proportion of patients with virologic success (HIV-RNA load <50 cp/mL) at 12 months using the FDA snapshot algorithm. Results A total of 281 patients (76% male, median age: 47 years, 56% MSM) were enrolled in this study. Median lymphocyte CD4 count at baseline was 640/mm3. Patients have received ART for a median of 7 years and viral replication was fully suppressed for a median of 3 years. Before the switch, 39% patients were treated with NNRTI, 52% with protease inhibitor and 7% with integrase inhibitor-based regimens. Reasons for switch were simplification (176 cases), adverse events (AEs) (93 cases) and others (12 cases). At month 12 (database frozen on June 2014) in the snapshot analysis, 56% of patients met virologic success, 5% experienced virologic failure (n=14) and 39% had no data in the window period. In the LOCF analysis (using data from the previous available visit before month 12), 89% patients were suppressed, 5% had virologic failure and 6% had no data. Genotypic resistance analysis was performed in 7/14 patients at the time of virologic failure (3 of whom had previous NRTI/NNRTI resistance-associated mutations (RAMs)), and new NNRTI and NRTI RAMs emerged in 4 patients. RPV-based regimen was generally well tolerated and

  3. Experienced and anticipated discrimination reported by individuals in treatment for substance use disorders within the Netherlands

    NARCIS (Netherlands)

    van Boekel, L.C.; Brouwers, E.P.M.; van Weeghel, J.; Garretsen, H.F.L.

    2016-01-01

    Experiences and expectations of discrimination (anticipated discrimination) may delay treatment seeking among people with substance use disorders. In addition, experienced and anticipated discrimination can be a barrier to successful recovery and rehabilitation. The aim of this study was to study

  4. Prevalence of anti-retroviral treatment failure and salvage therapy in ...

    African Journals Online (AJOL)

    With long term therapy with ARVs however, problems arise due to poor adherence. The concept of “salvage therapy” was conceived subsequent to experiencing multiple treatment failures to ARV combinations. It implies a final attempt, in the battle against HIV/AIDS. Objective: To determine the prevalence of treatment ...

  5. Disruption of Existing Mental Health Treatments and Failure to Initiate New Treatments After Hurricane Katrina

    Science.gov (United States)

    Wang, Philip S.; Gruber, Michael J.; Powers, Richard E.; Schoenbaum, Michael; Speier, Anthony H.; Wells, Kenneth B.; Kessler, Ronald C.

    2008-01-01

    Objective: To examine disruption of ongoing treatments among pre-existing cases and failure to initiate treatments among cases with new onset disorders in the aftermath of hurricane Katrina. Methods: A telephone survey was administered to a probability sample of 1,043 English-speaking adult Katrina survivors between January 19 and March 31, 2006. The survey assessed post-hurricane treatment of emotional problems and barriers to treatment among respondents with self-reported pre-hurricane mental disorders and those with post-hurricane onsets of mental disorders. Results: Among respondents who had pre-existing mental disorders and used services in the year before the hurricane, 22.9% experienced reductions or terminations of their treatments after Katrina. Among those without pre-hurricane disorders who developed new-onset ones, 18.5% received some form of treatment for emotional problems since the disaster. Reasons for failing to continue treatments among pre-existing cases largely involved structural barriers to treatment, while reasons for failing to seek treatment among new-onset cases largely involved low perceived needs for treatment. The majority (64.5%) of respondents using post-Katrina treatments received them from general medical providers and received medication but no psychotherapy. Treatment of new-onset cases was positively related to age and income, while continued treatment of pre-existing cases was positively related to being Non-Hispanic White and having health insurance. Conclusions: Hurricane Katrina survivors with mental disorders experienced large unmet needs for treatment, including frequent disruptions of existing care and widespread failure to initiate treatments among those with new onset disorders. Future disaster management plans should anticipate both types of need. PMID:18086749

  6. Prevalence and evolution of low frequency HIV drug resistance mutations detected by ultra deep sequencing in patients experiencing first line antiretroviral therapy failure.

    Science.gov (United States)

    Vandenhende, Marie-Anne; Bellecave, Pantxika; Recordon-Pinson, Patricia; Reigadas, Sandrine; Bidet, Yannick; Bruyand, Mathias; Bonnet, Fabrice; Lazaro, Estibaliz; Neau, Didier; Fleury, Hervé; Dabis, François; Morlat, Philippe; Masquelier, Bernard

    2014-01-01

    Clinical relevance of low-frequency HIV-1 variants carrying drug resistance associated mutations (DRMs) is still unclear. We aimed to study the prevalence of low-frequency DRMs, detected by Ultra-Deep Sequencing (UDS) before antiretroviral therapy (ART) and at virological failure (VF), in HIV-1 infected patients experiencing VF on first-line ART. Twenty-nine ART-naive patients followed up in the ANRS-CO3 Aquitaine Cohort, having initiated ART between 2000 and 2009 and experiencing VF (2 plasma viral loads (VL) >500 copies/ml or one VL >1000 copies/ml) were included. Reverse transcriptase and protease DRMs were identified using Sanger sequencing (SS) and UDS at baseline (before ART initiation) and VF. Additional low-frequency variants with PI-, NNRTI- and NRTI-DRMs were found by UDS at baseline and VF, significantly increasing the number of detected DRMs by 1.35 fold (p<0.0001) compared to SS. These low-frequency DRMs modified ARV susceptibility predictions to the prescribed treatment for 1 patient at baseline, in whom low-frequency DRM was found at high frequency at VF, and 6 patients at VF. DRMs found at VF were rarely detected as low-frequency DRMs prior to treatment. The rare low-frequency NNRTI- and NRTI-DRMs detected at baseline that correlated with the prescribed treatment were most often found at high-frequency at VF. Low frequency DRMs detected before ART initiation and at VF in patients experiencing VF on first-line ART can increase the overall burden of resistance to PI, NRTI and NNRTI.

  7. Prevalence and evolution of low frequency HIV drug resistance mutations detected by ultra deep sequencing in patients experiencing first line antiretroviral therapy failure.

    Directory of Open Access Journals (Sweden)

    Marie-Anne Vandenhende

    Full Text Available OBJECTIVES: Clinical relevance of low-frequency HIV-1 variants carrying drug resistance associated mutations (DRMs is still unclear. We aimed to study the prevalence of low-frequency DRMs, detected by Ultra-Deep Sequencing (UDS before antiretroviral therapy (ART and at virological failure (VF, in HIV-1 infected patients experiencing VF on first-line ART. METHODS: Twenty-nine ART-naive patients followed up in the ANRS-CO3 Aquitaine Cohort, having initiated ART between 2000 and 2009 and experiencing VF (2 plasma viral loads (VL >500 copies/ml or one VL >1000 copies/ml were included. Reverse transcriptase and protease DRMs were identified using Sanger sequencing (SS and UDS at baseline (before ART initiation and VF. RESULTS: Additional low-frequency variants with PI-, NNRTI- and NRTI-DRMs were found by UDS at baseline and VF, significantly increasing the number of detected DRMs by 1.35 fold (p<0.0001 compared to SS. These low-frequency DRMs modified ARV susceptibility predictions to the prescribed treatment for 1 patient at baseline, in whom low-frequency DRM was found at high frequency at VF, and 6 patients at VF. DRMs found at VF were rarely detected as low-frequency DRMs prior to treatment. The rare low-frequency NNRTI- and NRTI-DRMs detected at baseline that correlated with the prescribed treatment were most often found at high-frequency at VF. CONCLUSION: Low frequency DRMs detected before ART initiation and at VF in patients experiencing VF on first-line ART can increase the overall burden of resistance to PI, NRTI and NNRTI.

  8. HIV-1 resistance patterns to integrase inhibitors in antiretroviral-experienced patients with virological failure on raltegravir-containing regimens.

    Science.gov (United States)

    da Silva, Daniel; Van Wesenbeeck, Liesbeth; Breilh, Dominique; Reigadas, Sandrine; Anies, Guerric; Van Baelen, Kurt; Morlat, Philippe; Neau, Didier; Dupon, Michel; Wittkop, Linda; Fleury, Hervé; Masquelier, Bernard

    2010-06-01

    Our aim was to study the in vivo viral genetic pathways for resistance to raltegravir, in antiretroviral-experienced patients with virological failure (VF) on raltegravir-containing regimens. We set up a prospective study including antiretroviral-experienced patients receiving raltegravir-based regimens. Integrase (IN) genotypic resistance analysis was performed at baseline. IN was also sequenced at follow-up points in the case of VF, i.e. plasma HIV-1 RNA>400 copies/mL at month 3 and/or >50 copies/mL at month 6. For phenotyping, the IN region was recombined with an IN-deleted HXB2-based HIV-1 backbone. A titrated amount of IN recombinant viruses was used for antiviral testing against raltegravir and elvitegravir. Among 51 patients, 11 (21.6%) had VF. Four different patterns of IN mutations were observed: (i) emergence of Q148H/R with secondary mutations (n=5 patients); (ii) emergence of N155H, then replaced by a pattern including Y143C/H/R (n=3); (iii) selection of S230N (n=1); and (iv) no evidence of selection of IN mutations (n=2). The median raltegravir and elvitegravir fold changes (FCs) were 244 (154-647) and 793 (339-892), respectively, for the Q148H/R pattern, while the median raltegravir and elvitegravir FCs were 21 (6-52) and 3 (2-3), respectively, with Y143C/H/R. The median plasma raltegravir Cmin was lower in patients with selection of the N155H mutation followed by Y143C/H/R compared with patients with Q148H/R and with patients without emerging mutations or without VF. Diverse genetic profiles can be associated with VF on raltegravir-containing regimens, including the dynamics of replacement of mutational profiles. Pharmacokinetic parameters could be involved in this genetic evolution.

  9. Grazoprevir, Ruzasvir, and Uprifosbuvir for HCV After NS5A Treatment Failure

    DEFF Research Database (Denmark)

    Wyles, David; Wedemeyer, Heiner; Ben-Ari, Ziv

    2017-01-01

    a single dose of grazoprevir, ruzasvir, and uprifosbuvir plus ribavirin due to serious adverse events of vomiting and tachycardia. The presence of baseline resistance-associated substitutions had no impact on SVR12. No participant who completed treatment in either study experienced virologic failure...

  10. Difficulties experienced by families following unsuccessful treatment of Pediculosis capitis: the mothers' perspective.

    Science.gov (United States)

    Ozkan, Ozlem; Sikar-Aktürk, Aysun; Mert, Kader; Bilen, Nilgün; Mumcuoğlu, Kosta Y

    2012-01-01

    The study aimed to determine the psychological and social difficulties faced by primary school children and their families, particularly from the mothers' perspective, when treatment for Pediculosis capitis fails. This descriptive study comprised 14 mothers of 19 children in the primary school in Kocaeli. The children and families were infested with lice and nits and were unsuccessfully treated with pediculicides. Data were collected by a semi-structured questionnaire with in-depth individual interviews with a qualitative approach from mothers. Seven social difficulties were experienced by children and families during treatment from the mothers' perspective, lack of support from other family members; children's exposure to verbal and physical violence; exclusion from the school and society due to stigma; children's refusal to be treated; difficulties in the physical removal of the nits; inability to pay for the pediculicide; and inappropriate physical conditions of the house. Eight psychological difficulties were experienced by children and their families: worry, upheaval, embarrassment/shame, guilt, being overwhelmed, disgust, scorn and despair. Parents and children, whose treatment for Pediculosis capitis failed, experienced many psychological and social difficulties. Further studies should be conducted to determine the relation to pediculosis management and their difficulties of chidren and families from different socio-economic levels.

  11. Heart failure in hypertension: prevention and treatment.

    Science.gov (United States)

    Georgiopoulou, Vasiliki V; Kalogeropoulos, Andreas P; Butler, Javed

    2012-07-09

    The heart failure epidemic calls for urgent prevention efforts. Hypertension is present in the majority of individuals who develop heart failure and carries the highest population-attributable risk for heart failure together with coronary heart disease. Therefore, hypertension is a natural prime target for prevention interventions. However, a substantial proportion of heart failure develops among individuals with a systolic BP (SBP) level below current therapeutic target recommendations (140 mmHg or 130 mmHg for high-risk groups), which are accepted as 'normal' levels, underlining the importance of prehypertension for heart failure development. Prevalence and incidence of both hypertension and prehypertension are high. Efforts to prevent or attenuate BP rise could lead to a substantial reduction of complications, including heart failure development. Lifestyle modifications play a crucial role in preventing elevation of BP levels and better control of high BP. Weight loss, control of sodium intake and diet, and physical activity are essential steps towards this direction. However, when medications are needed to reduce BP levels, the selection of the appropriate agent is important not only for effective control of BP but also to reduce hypertension-related complications. Diuretics and renin-angiotensin system modulators seem to be the most effective agents for heart failure prevention according to the existing evidence. Patients with heart failure and hypertension should be treated for hypertension based on the same principles, although medication selection should take into account concomitant medications, other risk factors and type of heart failure (reduced vs preserved left ventricular ejection fraction).

  12. Incidence, mode, and location of acute proximal junctional failures after surgical treatment of adult spinal deformity.

    Science.gov (United States)

    Hostin, Richard; McCarthy, Ian; OʼBrien, Michael; Bess, Shay; Line, Breton; Boachie-Adjei, Oheneba; Burton, Doug; Gupta, Munish; Ames, Christopher; Deviren, Vedat; Kebaish, Khaled; Shaffrey, Christopher; Wood, Kirkham; Hart, Robert

    2013-05-20

    Multicenter, retrospective series. To analyze the incidence, mode, and location of acute proximal junctional failures (APJFs) after surgical treatment of adult spinal deformity. Early proximal junctional failures above adult deformity constructs are a serious clinical problem; however, the incidence and nature of early APJFs remain unclear. A total of 1218 consecutive adult spinal deformity surgeries across 10 deformity centers were retrospectively reviewed to evaluate the incidence and nature of APJF, defined as any of the following within 28 weeks of index procedure: minimum 15° post-operative increase in proximal junctional kyphosis, vertebral fracture of upper instrumented vertebrae (UIV) or UIV + 1, failure of UIV fixation, or need for proximal extension of fusion within 6 months of surgery. Sixty-eight APJF cases were identified out of 1218 consecutive surgeries (5.6%). Patients had a mean age of 63 years (range, 26-82 yr), mean fusion levels of 9.8 (range, 4-18), and mean time to APJF of 11.4 weeks (range, 1.5-28 wk). Fracture was the most common failure mode (47%), followed by soft-tissue failure (44%). Failures most often occurred in the thoracolumbar region (TL-APJF) compared with the upper thoracic region (UT-APJF), with 66% of patients experiencing TL-APJF compared with 34% experiencing UT-APJF. Fracture was significantly more common for TL-APJF relative to UT-APJF (P = 0.00), whereas soft-tissue failure was more common for UT-APJF (P failures occurring primarily in the TL region of the spine. There is evidence that the mode of failure differs depending on the location of UIV, with TL failures more likely due to fracture and UT failures more likely due to soft-tissue failures.

  13. Patient-experienced burden of treatment in patients suffering from multimorbidity data

    DEFF Research Database (Denmark)

    Rosbach, Michael; Andersen, John Sahl

    2017-01-01

    multimorbid. The treatment burden components, experienced by patients, were identified for each study. The components financial burden, lack of knowledge, diet and exercise, medication burden and frequent healthcare reminding patients of their health problem were found to attract additional attention from......) and the context (structure of healthcare and social support). Patients seem to use strategies such as prioritizing between treatments to diminish the workload and mobilizing and coordinating resources to improve their ability to manage the burden of treatment. They try to routinize and integrate the treatment...... the multimorbid patients. In studies conducted in the US and Australia the financial burden and the time and travel burden were found most straining to patients with deprived socioeconomic status. The burden of treatment was found to be a complex concept consisting of many different components and factors...

  14. High levels of pre-treatment HIV drug resistance and treatment failure in Nigerian children

    Directory of Open Access Journals (Sweden)

    Ragna S Boerma

    2016-11-01

    Full Text Available Introduction: Pre-treatment HIV drug resistance (PDR is an increasing problem in sub-Saharan Africa. Children are an especially vulnerable population to develop PDR given that paediatric second-line treatment options are limited. Although monitoring of PDR is important, data on the paediatric prevalence in sub-Saharan Africa and its consequences for treatment outcomes are scarce. We designed a prospective paediatric cohort study to document the prevalence of PDR and its effect on subsequent treatment failure in Nigeria, the country with the second highest number of HIV-infected children in the world. Methods: HIV-1-infected children ≤12 years, who had not been exposed to drugs for the prevention of mother-to-child transmission (PMTCT, were enrolled between 2012 and 2013, and followed up for 24 months in Lagos, Nigeria. Pre-antiretroviral treatment (ART population-based pol genotypic testing and six-monthly viral load (VL testing were performed. Logistic regression analysis was used to assess the effect of PDR (World Health Organization (WHO list for transmitted drug resistance on subsequent treatment failure (two consecutive VL measurements >1000 cps/ml or death. Results: Of the total 82 PMTCT-naïve children, 13 (15.9% had PDR. All 13 children harboured non-nucleoside reverse transcriptase inhibitor (NNRTI mutations, of whom seven also had nucleoside reverse transcriptase inhibitor resistance. After 24 months, 33% had experienced treatment failure. Treatment failure was associated with PDR and a higher log VL before treatment initiation (adjusted odds ratio (aOR 7.53 (95%CI 1.61–35.15 and 2.85 (95%CI 1.04–7.78, respectively. Discussion: PDR was present in one out of six Nigerian children. These high numbers corroborate with recent findings in other African countries. The presence of PDR was relevant as it was the strongest predictor of first-line treatment failure. Conclusions: Our findings stress the importance of implementing fully

  15. Cost-effectiveness of maraviroc for antiretroviral treatment-experienced HIV-infected individuals in Mexico.

    Science.gov (United States)

    Contreras-Hernandez, Iris; Becker, Debbie; Chancellor, Jeremy; Kühne, Felicitas; Mould-Quevedo, Joaquin; Vega, Gabriela; Marfatia, Shalaka

    2010-12-01

    Maraviroc is the first approved drug in a new class of antiretrovirals, the CCR5 antagonists. The objective of this study was to predict the long-term clinical impact and cost-effectiveness of maraviroc in treatment-experienced adults with HIV/AIDS in Mexico. The AntiRetroviral Analysis by Monte Carlo Individual Simulation (ARAMIS) model was adapted to the Mexican context to predict clinical and economic outcomes of treating with optimized background therapy (OBT) versus testing for viral tropism status and treating with OBT ± maraviroc accordingly in treatment-experienced adults in Mexico. Baseline characteristics and efficacy were from the MOTIVATE trials' screening cohort. Costs and population mortality data were specific to Mexico. Results were reported from the perspective of health care payers in 2008 Mexican pesos (converted to 2008 US$ in parentheses). Compared to treatment with OBT alone, treatment with OBT ± maraviroc contingent on tropism test result increased projected undiscounted life expectancy and discounted quality-adjusted life expectancy from 7.54 to 8.71 years and 4.42 to 4.92 quality-adjusted life years (QALYs), respectively, at an incremental cost of $228,215 (US$21,329). The resultant incremental cost-effectiveness ratio (ICER) was $453,978 (US$42,429) per QALY gained. The ICER was somewhat lower when maraviroc was modeled in individuals susceptible to ≤ 2 components of OBT ($407,329; US$38,069), while the ICER was higher in individuals susceptible to ≥3 OBT components ($718,718; US$67,171). In treatment-experienced individuals with HIV/AIDS in Mexico, maraviroc may be cost-effective, particularly in individuals with limited options for active antiretroviral therapy (ART). © 2010, International Society for Pharmacoeconomics and Outcomes Research (ISPOR).

  16. Tenofovir treatment in an unselected cohort of highly antiretroviral experienced HIV positive patients

    DEFF Research Database (Denmark)

    Lerbaek, A; Kristiansen, Thomas Birk; Katzenstein, TL

    2004-01-01

    Tenofovir treatment in an unselected cohort of highly antiretroviral experienced HIV positive patients.Lerbaek A, Kristiansen TB, Katzenstein TL, Mathiesen L, Gerstoft J, Nielsen C, Larsen K, Nielsen JO, Obel N, Laursen AL, Nielsen SD. Department of Infectious Diseases, Hvidovre Hospital......, HIV-RNA levels and genotypic resistance were determined at baseline and after 3 and 6 months. After initiation of tenofovir treatment, a mean decrease in HIV-RNA for all 34 patients was observed (-0.43 log1o copies/ml (+/- 1.22) and -0.49 log10 copies/ml (+/- 1.36) after 3 and 6 months, respectively......, respectively). After initiation of tenofovir treatment, no significant increases in CD4 count were observed. All new NRTI-associated mutations could be explained by the background treatment. In conclusion, we observed a significant decrease in HIV-RNA only when tenofovir was prescribed, in conjunction...

  17. Cost effectiveness of darunavir/ritonavir in highly treatment-experienced, HIV-1-infected adults in the USA.

    Science.gov (United States)

    Mauskopf, Josephine; Brogan, Anita; Martin, Silas; Smets, Erik

    2010-01-01

    Darunavir is a new protease inhibitor (PI) that is co-administered with low-dose ritonavir and has demonstrated substantial efficacy in clinical trials of highly treatment-experienced patients when combined with an optimized background regimen (with or without enfuvirtide). This study estimates the cost effectiveness of darunavir with ritonavir (DRV/r) in this population over 5-year and lifetime time horizons in the USA. A Markov model was used to follow a treatment-experienced HIV-1 cohort through six health states, based on CD4 cell count: greater than 500, 351-500, 201-350, 101-200, 51-100 and 0-50 cells/mm³, and death. The magnitude of the CD4 cell count increase and duration of increasing and stable periods were derived from week 48 DRV/r clinical trial results (POWER 1 and 2). The treatment pathway assumed one regimen switch following treatment failure on the initial regimen. The use of antiretroviral drugs was based on usage in DRV/r clinical trials. US daily wholesale acquisition costs were calculated using the recommended daily doses. For each CD4 cell count range, utility values, HIV-1-related mortality rates and costs for medical resources (other than antiretroviral drug costs) were obtained from published literature. Non-HIV-1-related mortality rates were calculated by applying a relative risk value to the US general population age and gender-specific mortality rates. Costs and outcomes were discounted at 3% per year. One-way and probabilistic sensitivity analyses and variability analysis were performed. In a 5-year analysis, patients receiving DRV/r experienced 3.80 quality-adjusted life-years (QALYs) and incurred total medical costs of US$217,288, while those receiving control PIs experienced 3.60 QALYs and incurred costs of US$218,962. DRV/r was both more effective and less costly than control PIs. For the lifetime analysis, the QALYs and lifetime medical costs with DRV/r were 10.03 and US$565,358, compared with 8.76 and US$527,287 with control PIs

  18. Mechanical circulatory treatment of advanced heart failure

    DEFF Research Database (Denmark)

    Løgstrup, Brian B; Vase, Henrik; Gjedsted, Jakob

    2016-01-01

    Heart failure is one of the most common causes of morbidity and mortality worldwide. When patients cease to respond adequately to optimal medical therapy mechanical circulatory support has been promising. The advent of mechanical circulatory support devices has allowed significant improvements...... in patient survival and quality of life for those with advanced or end-stage heart failure. We provide a general overview of current mechanical circulatory support devices encompassing options for both short- and long-term ventricular support....

  19. Tipranavir in highly antiretroviral treatment-experienced patients: Results from a French prospective cohort.

    Science.gov (United States)

    Allavena, Clotilde; Flandre, Philippe; Pugliese, Pascal; Valantin, Marc-Antoine; Poizot-Martin, Isabelle; Cabié, André; Melliez, Hugues; Cuzin, Lise; Duvivier, Claudine; Dellamonica, Pierre; Raffi, François

    2012-01-01

    In highly antiretroviral-experienced patients with a multidrug-resistant human immunodeficiency virus (HIV) infection, recommended regimens should preferentially contain 3 active components, including a ritonavir-boosted protease inhibitor (PI/r). Tipranavir/r (TPV/r), a non-peptidic PI, has been specifically developed for patients resistant to the usual antiretroviral classes including PIs. This paper discusses the role of TPV/r in patients experiencing multiple PI resistance. Virological, immunological, and safety outcomes were collected between 2003 and 2007 at 7 clinical units. Virus resistance assessment was based on 3 different genotypic tests. The 207 patients evaluated had previously received nucleoside reverse transcriptase inhibitors (NRTIs) and PIs. The main drugs co-administered with TPV/r were 1 or 2 NRTIs associated, in half of the patients, with enfuvirtide. After 12 weeks, viral load was <50 copies/ml in 38% of the patients (44% with enfuvirtide), while median CD4 counts had increased from 150 to 250 cells/mm³. Genotypic testing suggested that most of the patients had viruses susceptible to TPV. Lipid and transaminase levels were slightly modified, and less than 10% of treatment discontinuations were due to gastrointestinal events. A regimen including TPV/r associated with at least 1 active component is a valuable option in highly ARV-experienced patients with multi-resistance to the usual ARV classes including PIs.

  20. MARS treatment in posthepatectomy liver failure

    NARCIS (Netherlands)

    van de Kerkhove, Maarten-Paul; de Jong, Koert P.; Rijken, Arjen M.; de Pont, Anne-Cornélie J. M.; van Gulik, Thomas M.

    2003-01-01

    Posthepatactomy liver failure (PHLF) is a dramatic complication following extensive liver resection or liver resection in a compromised liver, leading to death in 80% of cases. Molecular Adsorbent Recirculating System (MARS) is able to extract water and protein bound toxins out of the blood in liver

  1. Genetic causes and treatment of spermatogenic failure

    NARCIS (Netherlands)

    Nickkholgh, B.

    2015-01-01

    The vast majority of cases of spermatogenic failure, defined as no sperm in semen or low semen quality, are idiopathic, although several genetic factors have been identified. In this thesis, we focused on the effect of Y-chromosome variation including TSPY copy number and AZFc deletions on semen

  2. The successful treatment of hypercapnic respiratory failure with oral modafinil

    Directory of Open Access Journals (Sweden)

    Parnell H

    2014-04-01

    Full Text Available Helen Parnell,1 Ginny Quirke,1 Sally Farmer,1 Sumbo Adeyemo,2 Veronica Varney11Respiratory Department, 2Pharmacy Department, St Helier Hospital, Carshalton, Surrey, UKAbstract: Hypercapnic respiratory failure is common in advanced chronic obstructive pulmonary disease and is usually treated by nasal ventilation. Not all patients requiring such ventilation can tolerate it, with anxiety and phobia influencing their reaction, along with treatment failure. We report the case histories of six patients with hypercapnic respiratory failure who were at risk of death due to refusal of nasal ventilation or its failure despite ongoing treatment. We report their improvement with oral modafinil 200 mg tablets used as a respiratory stimulant, which led to discharge, improved arterial blood gases, and offset further admissions with hypercapnic respiratory failure. This drug is licensed for narcolepsy and is said to stimulate the respiratory system via the central nervous system. Its use in respiratory failure is an unlicensed indication, and there are no case reports or studies of such use in the literature. Its respiratory stimulant effects appear better than those with protriptyline, which was a drug previously used until its production was discontinued. Our findings suggest that a study of modafinil in hypercapnic respiratory failure would be warranted, especially for patients with treatment failure or intolerance to nasal ventilation. This may offer a way of shortening hospital stay, improving outcome and quality of life, and reducing death and readmissions.Keywords: COPD, chronic obstructive pulmonary disease, nasal ventilation, acidosis, modafinil, hypercapnic respiratory failure

  3. Lack of awareness of treatment failure among HIV-1-infected patients in Guinea-Bissau - a retrospective cohort study.

    Science.gov (United States)

    Jespersen, Sanne; Hønge, Bo Langhoff; Medina, Candida; da Silva Té, David; Correira, Faustino Gomes; Laursen, Alex Lund; Erikstrup, Christian; Østergaard, Lars; Wejse, Christian

    2015-01-01

    With more people receiving antiretroviral treatment (ART), the need to detect treatment failure and switch to second-line ART has also increased. We assessed CD4 cell counts (as a marker of treatment failure), determined the rate of switching to second-line treatment and evaluated mortality related to treatment failure among HIV-infected patients in Guinea-Bissau. In this retrospective cohort study, adult patients infected with HIV-1 receiving ≥6 months of ART at an HIV clinic in Bissau were included from June 2005 to July 2014 and followed until January 2015. Treatment failure was defined as 1) a fall in CD4 count to baseline (or below) or 2) CD4 levels persistently below 100 cells/µL after ≥6 months of ART. Cox hazard models, with time since six months of ART as the time-varying coefficient, were used to estimate the hazard ratio for death and loss to follow-up. We assessed 1,591 HIV-1-infected patients for immunological treatment failure. Treatment failure could not be determined in 594 patients (37.3%) because of missing CD4 cell counts. Among the remaining 997 patients, 393 (39.4%) experienced failure. Only 39 patients (9.9%) with failure were switched from first- to second-line ART. The overall switching rate was 3.1 per 100 person-years. Mortality rate was higher in patients with than without treatment failure, with adjusted hazard rate ratios (HRRs) 10.0 (95% CI: 0.9-107.8), 7.6 (95% CI: 1.6-35.5) and 3.1 (95% CI: 1.5-6.3) in the first, second and following years, respectively. During the first year of follow-up, patients experiencing treatment failure had a higher risk of being lost to follow-up than patients not experiencing treatment failure (adjusted HRR 4.4; 95% CI: 1.7-11.8). We found a high rate of treatment failure, an alarmingly high number of patients for whom treatment failure could not be assessed, and a low rate of switching to a second-line therapy. These factors could lead to an increased risk of resistance development and excess

  4. Lack of awareness of treatment failure among HIV-1-infected patients in Guinea-Bissau – a retrospective cohort study

    Science.gov (United States)

    Jespersen, Sanne; Hønge, Bo Langhoff; Medina, Candida; da Silva Té, David; Correira, Faustino Gomes; Laursen, Alex Lund; Erikstrup, Christian; Østergaard, Lars; Wejse, Christian

    2015-01-01

    Introduction With more people receiving antiretroviral treatment (ART), the need to detect treatment failure and switch to second-line ART has also increased. We assessed CD4 cell counts (as a marker of treatment failure), determined the rate of switching to second-line treatment and evaluated mortality related to treatment failure among HIV-infected patients in Guinea-Bissau. Methods In this retrospective cohort study, adult patients infected with HIV-1 receiving ≥6 months of ART at an HIV clinic in Bissau were included from June 2005 to July 2014 and followed until January 2015. Treatment failure was defined as 1) a fall in CD4 count to baseline (or below) or 2) CD4 levels persistently below 100 cells/µL after ≥6 months of ART. Cox hazard models, with time since six months of ART as the time-varying coefficient, were used to estimate the hazard ratio for death and loss to follow-up. Results We assessed 1,591 HIV-1-infected patients for immunological treatment failure. Treatment failure could not be determined in 594 patients (37.3%) because of missing CD4 cell counts. Among the remaining 997 patients, 393 (39.4%) experienced failure. Only 39 patients (9.9%) with failure were switched from first- to second-line ART. The overall switching rate was 3.1 per 100 person-years. Mortality rate was higher in patients with than without treatment failure, with adjusted hazard rate ratios (HRRs) 10.0 (95% CI: 0.9–107.8), 7.6 (95% CI: 1.6–35.5) and 3.1 (95% CI: 1.5–6.3) in the first, second and following years, respectively. During the first year of follow-up, patients experiencing treatment failure had a higher risk of being lost to follow-up than patients not experiencing treatment failure (adjusted HRR 4.4; 95% CI: 1.7–11.8). Conclusions We found a high rate of treatment failure, an alarmingly high number of patients for whom treatment failure could not be assessed, and a low rate of switching to a second-line therapy. These factors could lead to an increased

  5. Clinical Investigation of Treatment Failure in Type 2 Diabetic ...

    African Journals Online (AJOL)

    HP

    contributory factors in treatment failure in type 2 diabetic patients taking metformin and glibenclamide in ... study from the Department of Medicine Ethical .... failure in diabetes. Most of these factors were reported in a prospective cohort study done by. Ishikawa-Takata et al [7]. Lack of exercise and physically inactive jobs are ...

  6. diagnosis and treatment of heart failure in the community

    African Journals Online (AJOL)

    Enrique

    hydralazine if tolerated. ACE inhibitor. + temporary inotropic beta-blockade or ACE inhibitor + ARB if beta- support spironolactone blocker intolerant. Adapted from the Task force report: ESC: Guidelines for the diagnosis and treatment of heart failure.

  7. Radiographic study of the problems and failures of endodontic treatment.

    Science.gov (United States)

    Akbar, Iftikhar

    2015-04-01

    The aim of the present study was to determine radiographically the different reasons and problems of endodontic treatment failure. The periapical radiographs of 100 patients with one hundred teeth (130 root canals) were examined to identify the problems and failures of endodontic treatment. The various reasons of failure that is under filling, poor filling, over filling and presence of procedural errors were recorded for each root filled canal. Chi square test was used to determine statistical significance between different parameters. Under fillings were found in 46.9% of the root canals. The percentage of poor fillings and over fillings were 28.5% and 13% respectively. Separated instruments and strip perforations were present in 4% and 3% of the teeth, while the presence of furcal perforation and coronal leakage was observed in one case each (1%).Endodontic problems and failures were most commonly observed in molars compare to anterior and premolar teeth. Mesiobuccal, mesiolingual and distobuccal root canals were the most frequently canals with endodontic problems and failures. The relationship between mesiobuccal, mesiolingual and distal canals in mandibular molars and mesiobuccal, distobuccal and palatal canals in maxillary molars in terms of endodontic failures were statistically significant by chi square analysis (P≤0.05). The most common cause of endodontic treatment failure was under filling followed by poor filling and over filling and first molar was the most frequently involved tooth with endodontic problems and failures.

  8. Factors influencing treatment failure in HIV positive adult patients on ...

    African Journals Online (AJOL)

    Results: Factors associated with higher odds of treatment failure were severe depression [OR 3.7; p-value 0.002; 95% Cl 1.6-8.5] and discontinuing ART [OR 4.4; p-value 0.02; 95% Cl 1.3-14.7]. Factors associated with lower odds of treatment failure were age >42 [OR 0.3; p-value 0.007; 95% Cl 0.1-0.7], taking ART on time ...

  9. Contrast Enhancement on CT Following Renal Cryoablation – Does It Represent Treatment Failure?

    DEFF Research Database (Denmark)

    Nielsen, Tommy Kjærgaard; Østraat, Øyvind; Andersen, Gratien

    Aim: Renal cryoablation is a valid treatment option for localized pT1a renal cancer. Treatment success is typically defined as absence of contrast enhancement (CE) on follow-up imaging. We investigate the development of lesions that demonstrate CE on follow-up CT after renal cryoablation. Materials...... not uncommon. As there are no clear-cut criteria for monitoring treatment failure, careful evaluation by an experienced radiologist and urologist is recommend. The significance of delayed contrast enhancement is not clearly evident and needs further investigation....

  10. Treatment of central sleep apnea in heart failure.

    Science.gov (United States)

    Javaheri, S

    2000-06-15

    Recent studies show that central sleep apnea occur in about 40% of patients with heart failure and systolic dysfunction. The pathophysiological consequences of central sleep apnea may contribute to morbidity and mortality of heart failure. Three treatment modalities, oxygen, continuous positive airway pressure and theophylline have been shown to decrease periodic breathing modestly with considerable improvement in arterial oxyhemoglobin desaturation, and variable effects on sleep characteristics. However, long-term effects of central sleep apnea and its treatment on the natural history of heart failure remain to be determined.

  11. Maraviroc in treatment-experienced patients with HIV-1 infection - experience from routine clinical practice

    Directory of Open Access Journals (Sweden)

    Reuter S

    2010-06-01

    Full Text Available Abstract Objective Few data are available about the efficacy of maraviroc (MVC during routine use. We characterized indications for MVC use and the efficacy of MVC in clinical practice. Methods Thirty-two patients treated with MVC at our institution between 2006 and 2009 were included. Genotypic (n = 31 and phenotypic (n = 13 tropism analysis was performed. We determined indications for MVC use, characteristics of antiretroviral combination partners and treatment outcome. Results Complete suppression of viral replication was achieved in 78% after 6 months. A median increase of 124 CD4+ cells/μl after 6 months was observed. Concordance between phenotypic and genotypic tropism was found in 75%. Indications for MVC treatment included treatment failure (n = 15, intolerance to previous antiretrovirals (n = 6 and add-on MVC for intensification without changing the current regimen (n = 11. The add-on strategy was used in patients with a relatively low viremia in order to achieve complete viral load suppression or in situations with suppressed viral load but judged as unstable due to an extensive resistance pattern. Salvage drugs most frequently combined with MVC were darunavir (n = 14 and raltegravir (n = 14. The genotypic assay had predicted CXCR4 tropism in 5 patients, using a false positive rate (FPR of 20%. Lowering the FPR to 5% predicted CCR5 tropism in 4 cases, still resulting in sustained complete viral response under MVC use. Conclusions MVC containing salvage regimens achieve relevant CD4 cell increases and high viral response rates. In patients with few remaining treatment options it may be justified to lower the FPR-cutoff to 5% when predicting the coreceptor usage. Hereby, MVC could still be applied in selected patients with otherwise limited treatment options.

  12. Somatic experiencing treatment with social service workers following Hurricanes Katrina and Rita.

    Science.gov (United States)

    Leitch, M Laurie; Vanslyke, Jan; Allen, Marisa

    2009-01-01

    In a disaster, social service workers are often survivors themselves.This study examines whether somatic intervention using a brief (one to two session) stabilization model now called the Trauma Resiliency Model (TRM), which uses the skills of Somatic Experiencing (SE), can reduce the postdisaster symptoms of social service workers involved in postdisaster service delivery.The study was implemented with a nonrandom sample of 142 social service workers who were survivors of Hurricanes Katrina and Rita in New Orleans and Baton Rouge, Louisiana, two to three months after the disasters. Ninety-one participants received SE/TRM and were compared with a matched comparison group of 51 participants through the use of propensity score matching. All participants first received group psychoeducation. Results support the benefits of the brief intervention inspired by SE. The treatment group showed statistically significant gains in resiliency indicators and decreases in posttraumatic stress disorder symptoms. Although psychological symptoms increased in both groups at the three to four month follow-up, the treatment group's psychological symptoms were statistically lower than those of the comparison group.

  13. Tensions in relation: How peer support is experienced and received in a hepatitis C treatment intervention.

    Science.gov (United States)

    Bonnington, Oliver; Harris, Magdalena

    2017-09-01

    Peer support and involvement is recognised as a vital component of hepatitis C (HCV) treatment provision for marginalised populations, such as people who inject drugs (PWID). Developments in HCV treatments enable increased provision in community settings - expanding the possibilities for meaningful peer involvement in HCV treatment plans. To date, HCV peer support has generally been viewed as a positive intervention, with little critical reflection on the ways social structures, policies, health and drug services and social identity impact on how peer support is experienced and received. We report on the qualitative component of a UK-based intervention designed to increase HCV diagnosis and treatment in primary care and drug treatment settings. Data were collected between 2014 and 2016. Pre-intervention, a total of 35 PWID clients took part in nine in-depth interviews and four focus groups. In addition, 22 drug services and intervention providers took part in two focus groups and nine interviews. Post-intervention, one focus group and eight interviews were conducted with 13 PWID clients, and four focus groups and ten interviews were conducted with 26 drug services and intervention providers. Our data generation and thematic analysis focused on the peer education and buddy support component of the intervention. Participants had common expectations of the peer role (to 'just be there') and its occupants' attributes (empathy, trustworthy, etc.). However, in practice, peers faced constraints on realising these expectations. A 'recovery' dominated drug treatment ethos in the UK appeared to influence the selection of 'recovery champions' as peers for the intervention. This created tensions in relations with clients, particularly when risk-adverse discourses were internalised by the peers. Peers were poorly integrated and supported within the service, affecting opportunities to relate and build trust with clients. Thus, the scope for peer support to impact on the nature

  14. Tolvaptan for the treatment of hyponatremia and congestive heart failure.

    Science.gov (United States)

    Orlandi, Cesare; Zimmer, Christopher A; Gheorghiade, Mihai

    2006-11-01

    Tolvaptan is an oral, once-daily nonpeptide arginine vasopressin V(2)-receptor antagonist under development for the treatment of hyponatremia and congestive heart failure. In Phase II clinical trials, tolvaptan, in addition to standard therapy, increased fluid loss, resulting in decreased body weight and improved edema and serum sodium without affecting blood pressure, heart rate or renal function in patients with heart failure. The compound appeared to be well tolerated and dose-dependent adverse events were generally realated to its pharmacological activity, such as thirst and dry mouth. In patients with hyponatremia, tolvaptan appears to be more effective than fluid restriction at improving sodium levels without an increase in adverse events. An international Phase III outcome study; Efficacy of Vasopressin antagonism in hEaRt failurE outcome Study with Tolvaptan (EVEREST), evaluating the long-term efficacy and safety of tolvaptan in patients hospitalized with worsening heart failure, is currently ongoing.

  15. Current treatments for acute heart failure: focus on serelaxin

    Directory of Open Access Journals (Sweden)

    Bennett RG

    2014-07-01

    Full Text Available Robert G BennettVA Nebraska-Western Iowa Health Care System and Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USAAbstract: Acute heart failure remains an enormous health concern worldwide, and is a major cause of death and hospitalization. In spite of this, the treatment strategies for acute heart failure have remained largely unchanged for the past 2 decades. Several large randomized, placebo-controlled clinical trials have recently been conducted to attempt to improve the treatment and outcomes of acute decompensated heart failure. Some studies, including the EVEREST (tolvaptan and ASCEND (nesiritide showed efficacy at relieving early symptoms, but failed to improve long-term outcomes. Others, including PROTECT (rolofylline and ASTRONAUT (aliskiren showed little benefit in the relief of early symptoms or long-term outcomes. The recent RELAX-AHF studies using serelaxin, a recombinant form of relaxin, have shown considerable promise. Importantly, serelaxin improved congestion (dyspnea and other early targets of acute decompensated heart failure treatment, but also improved mortality at 180 days. The purpose of this review is to provide an overview of current treatment strategies for acute decompensated heart failure, and a discussion of the recent clinical trials, with an emphasis on the serelaxin studies.Keywords: acute heart failure, dyspnea, relaxin, serelaxin

  16. Drug susceptibility to etravirine and darunavir among Human Immunodeficiency Virus Type 1-derived pseudoviruses in treatment-experienced patients with HIV/AIDS in South Korea.

    Science.gov (United States)

    Kwon, Oh-Kyung; Kim, Sung Soon; Rhee, Jee Eun; Kee, Mee-Kyung; Park, Mina; Oh, Hye-Ri; Choi, Ju-Yeon

    2015-04-09

    In South Korea, about 20 types of antiretroviral drugs are used in the treatment of patients with human immunodeficiency virus/acquired immune deficiency syndrome. Since 2010, raltegravir, etravirine, and darunavir have been spotlighted as new drugs for highly active antiretroviral therapy (HAART)-experienced adults with resistant HIV-1 in South Korea. In this study, we investigated potential susceptibility of pseudoviruses derived from treatment-experienced Korean patients to etravirine vs efavirenz and to darunavir vs amprenavir and indinavir using a modified single-round assay. Pseudoviruses derived from nine treatment-experienced patients infected with HIV-1 were investigated by comparison with the wild-type strain pNL4-3. The 50% inhibitory concentration (IC50) values were calculated and drug susceptibility was compared. The intensity of genotypic drug resistance was classified based on the 'SIR' interpretation of the Stanford data base. Drug susceptibility was generally higher for etravirine and darunavir compared with efavirenz, amprenavir, and indinavir in pseudoviruses derived from treatment-experienced patients. Pseudoviruses derived from patients KRB4025 and KRB8014, who exhibited long-term use of protease inhibitors, showed an outside of tested drug concentration, especially for amprenavir and indinavir. However, they exhibited a lower fold-change in resistance to darunavir. Etravirine and darunavir have been used in HAART since 2010 in South Korea. Therefore, these antiretroviral drugs together with other newly introduced antiretroviral drugs are interesting for the optimal treatment of patients with treatment failure. This study may help to find a more effective HAART in the case of HIV-1 infected patients that have difficulty being treated.

  17. [Failures of antibiotic treatment in Lyme arthritis].

    Science.gov (United States)

    Grygorczuk, Sambor; Zajkowska, Joanna; Kondrusik, Maciej; Moniuszko, Anna; Pancewicz, Sławomir; Pawlak-Zalewska, Wioletta

    2008-01-01

    Antibiotic treatment has been proven to be effective in about 90% of patients with Lyme arthritis in controlled studies. Overt arthritis persisting in spite of antibiotic therapy is rare and most likely has an autoimmune background. More frequently, patients with history of Lyme borreliosis present with non-specific articular and musculosceletal symptoms, which seem to be permanent sequelae of arthritis or constitute part of so called post-Lyme disease syndrome, of unclear pathogenesis. As persistence of active infection after proper antibiotic therapy is unlikely, repeated treatment seems of no benefit in most of the patients. No more than 2-3 attempts of antibiotic therapy should be undertaken; if symptoms persist, symptomatic and anti-inflammatory treatment should be introduced. Lack of response to antibiotics should also point to co-existing musculoskeletal morbidity or to improper diagnosis of Lyme borreliosis, which is frequent due to common occurrence of false-positive serologic tests results.

  18. Unanswered questions in the treatment of heart failure

    NARCIS (Netherlands)

    van Veldhuisen, DJ

    2003-01-01

    Chronic heart failure (CHF) is a large medical problem, but in recent years significant progress has been made in its treatment. Angiotensin converting enzyme (ACE) inhibitors and beta-blockers are now the cornerstones in the treatment of CHF, usually in combination with diuretics digoxin. Many

  19. [Treatment of intestinal failure in adults. I. Dietary measures

    NARCIS (Netherlands)

    Wanten, G.J.A.; Sauerwein, H.P.; Broek, P. van den; Kristinsson, J.O.

    2007-01-01

    Patients with intestinal failure, predominantly caused by short-bowel syndrome, have impaired quality of life due to the frequent development of complications. Dietary modifications have an established role in the treatment of short-bowel syndrome. Treatment of short-bowel syndrome includes

  20. Treatment failures after antibiotic therapy of uncomplicated urinary tract infections

    DEFF Research Database (Denmark)

    Bjerrum, Lars; Dessau, Ram B; Hallas, Jesper

    2002-01-01

    OBJECTIVES: The efficacy of sulfamethizole and pivmecillinam in the treatment of urinary tract infections (UTI) has been questioned because of an increase in the prevalence of resistant strains. The aim of this study was to describe the risk of treatment failures over the last 10 years. DESIGN: R...

  1. Treatment Failure in Dialectical Behavior Therapy

    Science.gov (United States)

    Rizvi, Shireen L.

    2011-01-01

    Dialectical behavior therapy (DBT) has become a widely used treatment model for individuals with borderline personality disorder (BPD) and other individuals with significant emotion dysregulation problems. Despite its strong empirical support, DBT obviously does not have positive outcomes for all individuals. It is critical that cases of DBT…

  2. Choosing a Treatment for Kidney Failure

    Science.gov (United States)

    ... to 2½ hours. Many people feel that their quality of life improves with this method of dialysis because they sleep better and have better control ... the transplant. Many patients prefer a transplant over dialysis because it ... the quality and length of life. A kidney transplant is a treatment, not a ...

  3. Mechanical circulatory treatment of advanced heart failure

    DEFF Research Database (Denmark)

    Rujic, Dragana; Sundbøll, Jens; Tofig, Bawer Jalal

    2016-01-01

    The paroxysmal supraventricular tachycardias (SVT) are commonly encountered arrhythmias and include atrioventricular nodal re-entrant tachycardia, atrioventricular reciprocating tachycardia, and focal atrial tachycardia. These tachycardias share several clinical features as well as similar...... management strategies. The probable mechanism of paroxysmal SVT can often be diagnosed from the clinical findings and a 12-lead ECG. This review describes the initial evaluation and treatment of patients with paroxysmal SVT, including distinctive features from the most important differential diagnoses....

  4. Characteristics of male and female students who experienced success or failure in their first college science course

    Science.gov (United States)

    Deboer, George E.

    The purpose of this study was to identify correlates of success for male and female students in their first collegiate science course. The factors that were examined included the personality variables of persistence, future orientation, and the tendency toward reckless and rash behavior, as well as cognitive attributions for success and failure. In addition, two scales from the Omnibus Personality Inventory that focused on the direction of a student's academic orientation were examined for their relationship to science achievement. Level of success x gender ANOV As showed no interactions for cognitive attributions or for the direction of academic orientation. Interactions for persistence, reckless and rash behavior, and future orientation indicated that these factors were more important to the science success of women than to that of men.

  5. Risk of virological failure in HIV-1-infected patients experiencing low-level viraemia under active antiretroviral therapy (ANRS C03 cohort study).

    Science.gov (United States)

    Vandenhende, Marie-Anne; Perrier, Adélaïde; Bonnet, Fabrice; Lazaro, Estibaliz; Cazanave, Charles; Reigadas, Sandrine; Chêne, Geneviève; Morlat, Philippe

    2015-01-01

    We assessed the association of persistent low-level viraemia between 50-199 copies/ml (LLV) with the risk of virological failure (VF) among HIV-1-infected patients receiving combination antiretroviral therapy (ART). ART-naive and ART-experienced patients followed up in the ANRS-CO3 Aquitaine Cohort were included if they started two nucleoside reverse transcriptase inhibitors (NRTIs) with either one non-nucleoside reverse transcriptase inhibitor (NNRTI) or one protease inhibitor boosted with ritonavir (PI/r) between 2000 and 2011 and achieved viral load (VL)<200 copies/ml 4-8 months after initiating ART. VF was defined as either two consecutive VL≥200 copies/ml or one VL≥200 followed by a modification of ART. LLV was defined as at least two consecutive VLs between 50-199 copies/ml for at least one month. We used Cox models to estimate the association of LLV with VF. Among 2,374 patients with a median follow-up of 3 years, 205 (8.6%) experienced LLV. LLV was strongly associated with further VF (adjusted hazard ratio [aHR] 2.30, 95% CI 1.65, 3.20). LLV was associated with VF in ART-experienced patients (aHR 3.02, 95% CI 2.10, 4.33) but not in ART-naive patients. Neither type of ART regimen (PI/r- versus NNRTI-based regimen) nor cumulative duration of LLV was associated with VF. Persistent LLV between 50-199 copies/ml was associated with VF among ART-experienced patients under ART. LLV between 50-199 copies/ml in ART-experienced patients should lead, after assessing patient's adherence and checking for drug interactions, to a closer monitoring and to consider ART optimization.

  6. The client "experiencing" scale as a predictor of treatment outcomes: A meta-analysis on psychotherapy process.

    Science.gov (United States)

    Pascual-Leone, Antonio; Yeryomenko, Nikita

    2017-11-01

    The experiencing scale (EXP) is an often used measure of client's depth of processing and meaning-making in-session. While research suggests that "client experiencing" predicts psychotherapy outcomes, this relationship has never been summarized in a meta-analysis. We examine this specific client factor as an in-session process predictor of good treatment outcomes. A meta-analysis quantified the relationship between client experiencing and therapy outcomes using a total of 10 studies and 406 clients. Analysis indicated that client experiencing is a small to medium predictor of standardized symptom improvements at final treatment outcomes with an effect of r = -.19 (95% CI -.10 to -.29), which we consider a "best estimate" for robustly quantifying the association between EXP and self-reported clinical outcomes. However, effects were higher (i.e., r = -.25) when observational measures of outcome were also included: Subgroup analyses indicated that EXP effects were moderated by the modality of outcome measurement (i.e., symptom reports vs. observational measures). On the other hand, statistical index, treatment phase, or treatment approach did not have significant impacts, which addresses some perennial questions in the EXP literature. Client experiencing is a small to medium predictor of treatment outcomes and a probable common factor.

  7. Factors influencing treatment failure in HIV positive adult patients on ...

    African Journals Online (AJOL)

    Results: Factors associated with higher odds of treatment failure were severe depression [OR 3.7; p-value 0.002; 95% CI 1.6-8.5] and discontinuing ART [OR 4.4; p-value 0.02; 95% CI 1.3-14.7]. Factors associated with lower odds of treatment failure were age ≥42 [OR 0.3; p-value 0.007; 95% CI 0.1-0.7], taking ART on time ...

  8. Microbiological Epidemiology in Patients Experiencing Microbiological or Clinical Failure Following Reimplantation After a Two-Stage Exchange Strategy for Hip or Knee Prosthetic Joint Infection (PJI)

    Science.gov (United States)

    Ferry, Tristan; Serrier, Hassan; Laurent, Frederic; Mabrut, Eugenie; Fessy, Michel-Henri; Chidiac, Christian; Huot, Laure; Lustig, Sébastien; Valour, Florent

    2017-01-01

    Abstract Background Patients with late PJI are at risk for superinfection at the time of reimplantation. Different commercially available antibiotic-loaded cements (gentamicin, vancomycin, gentamicin+clindamycin [G+C], gentamicin+vancomycin [G+V]) could be used for the fixation of the new prosthesis and could be effective to treat or prevent superinfection. We aim to determine the microbiological epidemiology in patients experiencing failure following reimplantation to establish, based on the drug susceptibilities, which cement could be the most active. Methods Prospective cohort study including all patients with a two-stage exchange in 2013–2015. Microbiological failure was defined by positive culture at the time of reimplantation. Clinical failure was defined by patients with clinical signs of infection requiring a new surgery. Results We included 117 patients (median age 70 years). Fourteen patients (12%) experienced a failure: seven patients with microbiological failure (four CoNS, one P. acnes, one corynebacterium, and three Candida albicans); seven patients with a clinical relapse requiring a new surgery (three Enterobacteriaceae, two P. aeruginosa, one streptococcus spp., one CoNS, one P. acnes, one E. faecalis). Considering the use of a vancomycin-loaded cement, this antibiotic was inactive on Candida (n = 3) and Gram-negative isolates (n = 5). Considering the use of gentamicin, this antibiotic was inactive on Candida (n = 3) and five bacterial isolates. These five letter isolates were also not susceptible to Clindamycin. Considering the use of G+V, this combination was inactive on Candida (n = 3) and only one bacterial isolate (a gentamicin-resistant K. pneumonia). Consequently, the vancomycin-, gentamicin- and G+C-loaded cements may effectively treat or prevent 42.9% of superinfections, only. Conversely, the G+V-loaded cement may effectively treat or prevent 71.4% of them. Conclusion Considering the commercially available antibiotic loaded

  9. Failure of radioactive iodine in the treatment of hyperthyroidism.

    Science.gov (United States)

    Schneider, David F; Sonderman, Philip E; Jones, Michaela F; Ojomo, Kristin A; Chen, Herbert; Jaume, Juan C; Elson, Diane F; Perlman, Scott B; Sippel, Rebecca S

    2014-12-01

    Persistent or recurrent hyperthyroidism after treatment with radioactive iodine (RAI) is common and many patients require either additional doses or surgery before they are cured. The purpose of this study was to identify patterns and predictors of failure of RAI in patients with hyperthyroidism. We conducted a retrospective review of patients treated with RAI from 2007 to 2010. Failure of RAI was defined as receipt of additional dose(s) and/or total thyroidectomy. Using a Cox proportional hazards model, we conducted univariate analysis to identify factors associated with failure of RAI. A final multivariate model was then constructed with significant (p hyperthyroidism are at risk for failing RAI treatment. Higher doses of RAI or surgical referral may prevent the need for repeat RAI in selected patients.

  10. FAILURE OF RADIOACTIVE IODINE IN TREATMENT OF HYPERTHYROIDISM

    Science.gov (United States)

    Schneider, David F.; Sonderman, Philip E.; Jones, Michaela F.; Ojomo, Kristin A.; Chen, Herbert; Jaume, Juan C.; Elson, Diane F.; Perlman, Scott B.; Sippel, Rebecca S.

    2015-01-01

    Introduction Persistent or recurrent hyperthyroidism after treatment with radioactive iodine (RAI) is common, and many patients require either additional doses or surgery before they are cured. The purpose of this study was to identify patterns and predictors of failure of RAI in patients with hyperthyroidism. Methods We conducted a retrospective review of patients treated with RAI from 2007–2010. Failure of RAI was defined as receipt of additional dose(s) and/or total thyroidectomy. Using a Cox proportional hazards model, we conducted univariate analysis to identify factors associated with failure of RAI. A final multivariate model was then constructed with significant (p hyperthyroidism are at risk for failing RAI treatment. Higher doses of RAI or surgical referral may prevent the need for repeat RAI in selected patients. PMID:25001092

  11. Prognostic Factors for Treatment Failure in Acute Otitis Media.

    Science.gov (United States)

    Tähtinen, Paula A; Laine, Miia K; Ruohola, Aino

    2017-09-01

    Antimicrobial treatment is effective in the management of acute otitis media (AOM), but approximately half of the children may recover without antimicrobial agents. By identifying patients who may not require antimicrobial treatment for the management of AOM, the use of antimicrobial agents could be substantially reduced. Our aim was to identify subgroups of children with AOM who would benefit most from antimicrobial treatment and children who could be suitable for initial observation. This is a secondary analysis of randomized, double-blind, placebo-controlled trial. Children 6 to 35 months of age with AOM (N = 319) were randomly allocated to receive amoxicillin-clavulanate (40/5.7 mg/kg per day) or placebo for 7 days. Our primary outcome was time until treatment failure. Treatment failure occurred in 31.7% of all children. Older age (24-35 months) and peaked tympanogram at entry decreased the hazard for treatment failure (hazard ratio, 0.53; 95% confidence interval [CI], 0.29 to 0.96; P = .04; and hazard ratio, 0.43; 95% CI, 0.21 to 0.88; P = .02, respectively). The rate difference for treatment failure between antimicrobial treatment and placebo groups was highest among children with severe bulging of the tympanic membrane (11.1% vs 64.1%; rate difference -53.0%; 95% CI, -73.5% to -32.4%), resulting in a number needed to treat of 1.9. Children with severe bulging of the tympanic membrane seem to benefit most from antimicrobial treatment of AOM. On the other hand, children with peaked tympanogram (A and C curves) may be optimal candidates for initial observation. Copyright © 2017 by the American Academy of Pediatrics.

  12. Relaxin, a pleiotropic vasodilator for the treatment of heart failure

    NARCIS (Netherlands)

    Teichman, Sam L.; Unemori, Elaine; Dschietzig, Thomas; Conrad, Kirk; Voors, Adriaan A.; Teerlink, John R.; Felker, G. Michael; Metra, Marco; Cotter, Gad

    2009-01-01

    Relaxin is a naturally occurring peptide hormone that plays a central role in the hemodynamic and renovascular adaptive changes that occur during pregnancy. Triggering similar changes could potentially be beneficial in the treatment of patients with heart failure. The effects of relaxin include the

  13. Creatine kinase is associated with failure of hypertension treatment

    NARCIS (Netherlands)

    Oudman, Inge; Kewalbansingh, Preschana V.; van Valkengoed, Irene; Zwinderman, Aeilko H.; Clark, Joseph F.; van Montfrans, Gert A.; Brewster, Lizzy M.

    2013-01-01

    Failure of hypertension treatment is a major clinical issue because of the high prevalence and the associated mortality risk. We have reported evidence that creatine kinase increases blood pressure through greater sodium retention and cardiovascular contractility, by rapidly providing ATP for these

  14. TREATMENT OF CHRONIC HEART FAILURE: FOCUS ON METOPROLOL SUCCINATE

    Directory of Open Access Journals (Sweden)

    O. D. Ostroumova

    2012-01-01

    Full Text Available Advantages of metoprolol succinate in patients with chronic heart failure (CHF are covered. Results of MERIT-HF study are taken as the main evidences. Patterns of the metoprolol succinate use in the treatment of different categories of patients with CHF (women, the elderly , severe CHF forms, CHF with concomitant hypertension or diabetes are considered.

  15. Treatment failure among patients on self medication for malaria ...

    African Journals Online (AJOL)

    . We report the outcome of a follow-up study conducted to investigate the claim of treatment failure. Methods: One hundred and four patients who said they were not cured after home management of malaria were studied. Giemsa stained blood ...

  16. Clinical Investigation of Treatment Failure in Type 2 Diabetic ...

    African Journals Online (AJOL)

    HP

    pharmacogenetics as a possible cause of treatment failure in diabetes, which affects patients' response to anti-diabetic agents. Genetic variation in Transcription Factor 7 Like-2. (TF7L-2) was shown by Pearson et al [9] to result in clinically significant difference in the therapeutic response to sulphonylurea leading to.

  17. Ovarian failure due to cancer treatment and fertility preservation options

    Directory of Open Access Journals (Sweden)

    Soheila Aminimoghaddam

    2016-04-01

    Full Text Available Primary ovarian insufficiency (POI, commonly referred to premature ovarian failure, is defined as ovarian failure before the age of 40 years. It is the loss of ovarian function caused by a process directly affecting ovaries. Cancer therapy which includes surgery, radiotherapy, and chemotherapy influence ovarian function, leading to premature menopause and loss of fertility. POI is idiopathic in most cases (74-90%. The known causes, in addition to anticancer treatment, are other processes like chromosomal abnormalities, autoimmunity, and natural aging can result in secondary ovarian failure, which is detected by an increase in serum gonadotropin levels (FSH and LH. There are evident risks of POI in women treated for cancer. Those who receive anticancer treatments have an increased risk of developing POI. There by, anticancer drugs and radiation therapy are considered as the most common toxins of ovaries. Although cancer incidence rates in women less than 50 years old continue to increase during recent years, mortality rates are dramatically decreasing due to modern advances in treatment. Increasing numbers of survivors are now confronted with the long-term consequences of exposure to these treatments. The pool of primordial follicles in the ovary is fixed and any injury to the ovary can potentially reduce this ovarian reserve, effectively advancing the patient’s reproductive age, thus narrowing the window of reproductive opportunity. Ovarian failure occurs in a significant percentage of childhood cancer survivors and many of them will seek care for reproductive dysfunction. Nevertheless, Embryo cryopreservation, oocyte cryopreservation, ovary tissue cryopreservation, ovarian suppression and oophoro-pexy are some options to preserve fertility in these groups. As a result, having foreknowledge of potential treatment related ovarian failure will allow the physician to give a better counsel to patients and their family regarding the importance and

  18. Transcatheter Interatrial Shunt Device for the Treatment of Heart Failure

    DEFF Research Database (Denmark)

    Feldman, Ted; Komtebedde, Jan; Burkhoff, Daniel

    2016-01-01

    UNLABELLED: Heart failure with preserved ejection fraction (HFpEF), a major public health problem with high morbidity and mortality rates, remains difficult to manage because of a lack of effective treatment options. Although HFpEF is a heterogeneous clinical syndrome, elevated left atrial pressure...... the rationale for a therapeutic transcatheter interatrial shunt device in HFpEF, and we describe the design of REDUCE Elevated Left Atrial Pressure in Heart Failure (REDUCE LAP-HF I), the first randomized controlled trial of a device-based therapy to reduce left atrial pressure in HFpEF. CLINICAL TRIAL...

  19. Effects of unplanned treatment interruptions on HIV treatment failure - results from TAHOD.

    Science.gov (United States)

    Jiamsakul, Awachana; Kerr, Stephen J; Ng, Oon Tek; Lee, Man Po; Chaiwarith, Romanee; Yunihastuti, Evy; Van Nguyen, Kinh; Pham, Thuy Thanh; Kiertiburanakul, Sasisopin; Ditangco, Rossana; Saphonn, Vonthanak; Sim, Benedict L H; Merati, Tuti Parwati; Wong, Wingwai; Kantipong, Pacharee; Zhang, Fujie; Choi, Jun Yong; Pujari, Sanjay; Kamarulzaman, Adeeba; Oka, Shinichi; Mustafa, Mahiran; Ratanasuwan, Winai; Petersen, Boondarika; Law, Matthew; Kumarasamy, Nagalingeswaran

    2016-05-01

    Treatment interruptions (TIs) of combination antiretroviral therapy (cART) are known to lead to unfavourable treatment outcomes but do still occur in resource-limited settings. We investigated the effects of TI associated with adverse events (AEs) and non-AE-related reasons, including their durations, on treatment failure after cART resumption in HIV-infected individuals in Asia. Patients initiating cART between 2006 and 2013 were included. TI was defined as stopping cART for >1 day. Treatment failure was defined as confirmed virological, immunological or clinical failure. Time to treatment failure during cART was analysed using Cox regression, not including periods off treatment. Covariables with P 30 days were associated with failure (31-180 days HR = 2.66, 95%CI (1.70-4.16); 181-365 days HR = 6.22, 95%CI (3.26-11.86); and >365 days HR = 9.10, 95% CI (4.27-19.38), all P treatment failure. If TI is unavoidable, its duration should be minimised to reduce the risk of failure after treatment resumption. © 2016 John Wiley & Sons Ltd.

  20. New Insights in the Diagnosis and Treatment of Heart Failure

    Science.gov (United States)

    Agnetti, Giulio; Piepoli, Massimo F.; Siniscalchi, Giuseppe

    2015-01-01

    Cardiovascular disease is the leading cause of mortality in the US and in westernized countries with ischemic heart disease accounting for the majority of these deaths. Paradoxically, the improvements in the medical and surgical treatments of acute coronary syndrome are leading to an increasing number of “survivors” who are then developing heart failure. Despite considerable advances in its management, the gold standard for the treatment of end-stage heart failure patients remains heart transplantation. Nevertheless, this procedure can be offered only to a small percentage of patients who could benefit from a new heart due to the limited availability of donor organs. The aim of this review is to evaluate the safety and efficacy of innovative approaches in the diagnosis and treatment of patients refractory to standard medical therapy and excluded from cardiac transplantation lists. PMID:26634204

  1. New Insights in the Diagnosis and Treatment of Heart Failure

    Directory of Open Access Journals (Sweden)

    Giulio Agnetti

    2015-01-01

    Full Text Available Cardiovascular disease is the leading cause of mortality in the US and in westernized countries with ischemic heart disease accounting for the majority of these deaths. Paradoxically, the improvements in the medical and surgical treatments of acute coronary syndrome are leading to an increasing number of “survivors” who are then developing heart failure. Despite considerable advances in its management, the gold standard for the treatment of end-stage heart failure patients remains heart transplantation. Nevertheless, this procedure can be offered only to a small percentage of patients who could benefit from a new heart due to the limited availability of donor organs. The aim of this review is to evaluate the safety and efficacy of innovative approaches in the diagnosis and treatment of patients refractory to standard medical therapy and excluded from cardiac transplantation lists.

  2. Risk factors for treatment failure in surgery for primary hyperparathyroidism

    DEFF Research Database (Denmark)

    Madsen, Anders Rørbæk; Rasmussen, Lars; Godballe, Christian

    2016-01-01

    of focused surgery was combined with training of new surgeons. The objective of this study was to identify possible risk factors for treatment failure with special focus on surgical strategy and training of new surgeons. A 6-year prospective and consecutive series of 567 pHPT patients operated at Odense...... University hospital, Denmark, was analyzed. A shift in strategy was made in 2006 and at the same time new surgeons started training in parathyroid surgery. Biochemical-, clinical- and follow-up data were analyzed. Overall cure-rate was 90.7 %. Complication rates were 1.1 % for hemorrhage, 1.1 % for wound...... infection and 0.9 % for recurrent nerve paralysis. The only significant predictor of treatment failure at 6 months was histology of hyperplasia (OR 4.3). Neither the introduction of minimal invasive surgical strategy nor the training of new surgeons had a significant influence on the rate of treatment...

  3. A phase IIIb study of ledipasvir/sofosbuvir fixed-dose combination tablet in treatment-naïve and treatment-experienced Korean patients chronically infected with genotype 1 hepatitis C virus.

    Science.gov (United States)

    Lim, Young-Suk; Ahn, Sang Hoon; Lee, Kwan Sik; Paik, Seung Woon; Lee, Youn-Jae; Jeong, Sook-Hyang; Kim, Ju-Hyun; Yoon, Seung Kew; Yim, Hyung Joon; Tak, Won Young; Han, Sang-Young; Yang, Jenny C; Mo, Hongmei; Garrison, Kimberly L; Gao, Bing; Knox, Steven J; Pang, Phillip S; Kim, Yoon Jun; Byun, Kwan-Soo; Kim, Young Seok; Heo, Jeong; Han, Kwang-Hyub

    2016-11-01

    The standard-of-care regimen for chronic hepatitis C virus (HCV) infection in Korea, pegylated-interferon-alpha plus ribavirin, is poorly tolerated. Ledipasvir/sofosbuvir is a two-drug, fixed-dose combination tablet approved in the USA, European Union, and Japan for chronic genotype 1 HCV infection. This single-arm, phase IIIb study (NCT02021656) investigated the efficacy and safety of ledipasvir/sofosbuvir fixed-dose combination tablet for 12 weeks in treatment-naïve and treatment-experienced Korean patients chronically infected with genotype 1 HCV with or without compensated cirrhosis. The proportion of patients with sustained virologic response 12 weeks after treatment discontinuation (SVR12) was 99 % (92/93), with rates of 100 % (46/46) and 98 % (46/47) in treatment-naïve and treatment-experienced patients, respectively. There were no on-treatment failures. One patient relapsed after the end of treatment. The most common treatment-emergent adverse events were headache (8 %, 7/93) and fatigue (6 %, 6/93). There were no grade 3 or 4 adverse events, seven grade 3 laboratory abnormalities, and one premature discontinuation of study treatment (due to nonserious mouth ulceration). None of the three reported serious adverse events were related to treatment. These data suggest that 12 weeks of ledipasvir/sofosbuvir is effective and well tolerated in treatment-naïve and treatment-experienced Korean patients with chronic genotype 1 HCV infection.

  4. Ceftibuten resistance and treatment failure of Neisseria gonorrhoeae infection.

    Science.gov (United States)

    Lo, Janice Y C; Ho, K M; Leung, Anna O C; Tiu, Felisa S T; Tsang, Grand K L; Lo, Angus C T; Tapsall, John W

    2008-10-01

    Neisseria gonorrhoeae infections have been empirically treated in Hong Kong with a single oral 400-mg dose of ceftibuten since 1997. Following anecdotal reports of the treatment failure of gonorrhea with oral extended-spectrum cephalosporins, the current study was undertaken to determine the antimicrobial susceptibility pattern and molecular characteristics of isolates of N. gonorrhoeae among patients with putative treatment failure in a sexually transmitted disease clinic setting. Between October 2006 and August 2007, 44 isolates of N. gonorrhoeae were studied from patients identified clinically to have treatment failure with empirical ceftibuten. The ceftibuten MICs for three strains were found to have been 8 mg/liter. These strains were determined by N. gonorrhoeae multiantigen sequence typing to belong to sequence type 835 (ST835) or the closely related ST2469. The testing of an additional eight archived ST835 strains revealed similarly elevated ceftibuten MICs. The penA gene sequences of these 11 isolates all had the mosaic pattern previously described as pattern X. Of note is that the ceftriaxone susceptibility results of these strains all fell within the susceptible range. It is concluded that ceftibuten resistance may contribute to the empirical treatment failure of gonorrhea caused by strains harboring the mosaic penA gene, which confers reduced susceptibility to oral extended-spectrum cephalosporins. Screening for such resistance in the routine clinical laboratory may be undertaken by the disk diffusion test. The continued monitoring of antimicrobial resistance and molecular characteristics of N. gonorrhoeae isolates is important to ensure that control and prevention strategies remain effective.

  5. Ceftibuten Resistance and Treatment Failure of Neisseria gonorrhoeae Infection▿

    Science.gov (United States)

    Lo, Janice Y. C.; Ho, K. M.; Leung, Anna O. C.; Tiu, Felisa S. T.; Tsang, Grand K. L.; Lo, Angus C. T.; Tapsall, John W.

    2008-01-01

    Neisseria gonorrhoeae infections have been empirically treated in Hong Kong with a single oral 400-mg dose of ceftibuten since 1997. Following anecdotal reports of the treatment failure of gonorrhea with oral extended-spectrum cephalosporins, the current study was undertaken to determine the antimicrobial susceptibility pattern and molecular characteristics of isolates of N. gonorrhoeae among patients with putative treatment failure in a sexually transmitted disease clinic setting. Between October 2006 and August 2007, 44 isolates of N. gonorrhoeae were studied from patients identified clinically to have treatment failure with empirical ceftibuten. The ceftibuten MICs for three strains were found to have been 8 mg/liter. These strains were determined by N. gonorrhoeae multiantigen sequence typing to belong to sequence type 835 (ST835) or the closely related ST2469. The testing of an additional eight archived ST835 strains revealed similarly elevated ceftibuten MICs. The penA gene sequences of these 11 isolates all had the mosaic pattern previously described as pattern X. Of note is that the ceftriaxone susceptibility results of these strains all fell within the susceptible range. It is concluded that ceftibuten resistance may contribute to the empirical treatment failure of gonorrhea caused by strains harboring the mosaic penA gene, which confers reduced susceptibility to oral extended-spectrum cephalosporins. Screening for such resistance in the routine clinical laboratory may be undertaken by the disk diffusion test. The continued monitoring of antimicrobial resistance and molecular characteristics of N. gonorrhoeae isolates is important to ensure that control and prevention strategies remain effective. PMID:18663018

  6. Hepatitis C treatment failure is associated with increased risk of hepatocellular carcinoma.

    Science.gov (United States)

    Lu, Mei; Li, Jia; Rupp, Loralee B; Holmberg, Scott D; Moorman, Anne C; Spradling, Philip R; Teshale, Eyasu H; Zhou, Yueren; Boscarino, Joseph A; Schmidt, Mark A; Lamerato, Lois E; Trinacty, Connie; Trudeau, Sheri; Gordon, Stuart C

    2016-09-01

    Sustained virological response (SVR) to antiviral therapy for hepatitis C (HCV) reduces risk of hepatocellular carcinoma (HCC), but there is little information regarding how treatment failure (TF) compares to lack of treatment. We evaluated the impact of treatment status on risk of HCC using data from the Chronic Hepatitis Cohort Study (CHeCS-an observational study based in four large US health systems, with up to 7 years of follow-up on patients). Multivariable analyses were used to adjust for bias in treatment selection, as well as other covariates, followed by sensitivity analyses. Among 10 091 HCV patients, 3681 (36%) received treatment, 2099 (57%) experienced treatment failure (TF), and 1582 (43%) of these achieved sustained virological response (SVR). TF patients demonstrated almost twice the risk of HCC than untreated patients [adjusted hazard ratio (aHR) = 1.95, 95% confidence interval (CI) 1.50-2.53]; this risk persisted across all stages of fibrosis. Several sensitivity analyses validated these results. Although African Americans were at increased risk of treatment failure, they were at lower risk for HCC and all-cause mortality compared to White patients. SVR patients had lower risk of HCC than TF patients (aHR = 0.48, CI 0.31-0.73), whereas treatment - regardless of outcome - reduced all-cause mortality (aHR = 0.45, CI 0.34-0.60 for SVR patients; aHR = 0.78, CI 0.65-0.93 for TF patients). © 2016 John Wiley & Sons Ltd.

  7. Treatment failure in patients with chronic Blastocystis infection.

    Science.gov (United States)

    Roberts, Tamalee; Ellis, John; Harkness, John; Marriott, Deborah; Stark, Damien

    2014-02-01

    This article reports long-term infection and treatment failure in 18 symptomatic individuals infected with Blastocystis spp. Patients were initially treated with either metronidazole, iodoquinol or triple combination therapy consisting of nitazoxanide, furazolidone and secnidazole. Following treatment, resolution of clinical symptoms did not occur and follow-up testing revealed ongoing infection with the same subtype. Patients then underwent secondary treatment with a variety of antimicrobial agents but remained symptomatic with Blastocystis spp. still present in faeces. Sequencing of the SSU rDNA was completed on all isolates and four subtypes were identified in this group: ST1, ST3, ST4 and ST5. This study highlights the lack of efficacy of several commonly used antimicrobial regimens in the treatment of Blastocystis and the chronic nature of some infections. It also demonstrates the need for further research into treatment options for Blastocystis infection.

  8. Risk Factors of Treatment Failure in Diabetic Foot Ulcer Patients

    Directory of Open Access Journals (Sweden)

    Kyung Mook Lee

    2013-03-01

    Full Text Available BackgroundSome diabetic feet heal without complication, but others undergo amputation due to progressive wounds. This study investigates the risk factors for amputation of diabetic feet.MethodsA total of 55 patients who visited our institution from 2008 to 2012 were included in the study. The patients with abnormal fasting blood sugar levels, lower leg vascularity, and poor nutrition were excluded from the study group, and the wound states were unified. The patients were categorized into a treatment success group (n=47 and a treatment failure group (n=8, and their hemoglobin A1C (HgA1C, C-reactive protein (CRP, white blood cell count (WBC, and serum creatinine levels were analyzed.ResultsThe initial CRP, WBC, and serum creatinine levels in the treatment failure group were significantly higher than that of the treatment success group, and the initial HgA1C level was significantly higher in the treatment success group. The CRP and WBC levels of both groups changed significantly as time passed, but their serum creatinine levels did not.ConclusionsThe initial CRP, WBC, and serum creatinine levels were considered to be risk factors for amputation. Among them, the serum creatinine level was found to be the most important predictive risk factor. Because serum creatinine represents the renal function, thorough care is needed for the feet of diabetic patients with renal impairment.

  9. A prostate MRI atlas of biochemical failures following cancer treatment

    Science.gov (United States)

    Rusu, Mirabela; Kurhanewicz, John; Tewari, Ashutosh; Madabhushi, Anant

    2014-03-01

    Radical prostatectomy (RP) and radiation therapy (RT) are the most common treatment options for prostate cancer (PCa). Despite advancements in radiation delivery and surgical procedures, RP and RT can result in failure rates as high as 40% and >25%, respectively. Treatment failure is characterized by biochemical recurrence (BcR), which is defined in terms of prostate specific antigen (PSA) concentrations and its variation following treatment. PSA is expected to decrease following treatment, thereby its presence in even small concentrations (e.g 0.2 ng/ml for surgery or 2 ng/ml over the nadir PSA for radiation therapy) is indicative of treatment failure. Early identification of treatment failure may enable the use of more aggressive or neo-adjuvant therapies. Moreover, predicting failure prior to treatment may spare the patient from a procedure that is unlikely to be successful. Our goal is to identify differences on pre-treatment MRI between patients who have BcR and those who remain disease-free at 5 years post-treatment. Specifically, we focus on (1) identifying statistically significant differences in MRI intensities, (2) establishing morphological differences in prostatic anatomic structures, and (3) comparing these differences with the natural variability of prostatic structures. In order to attain these objectives, we use an anatomically constrained registration framework to construct BcR and non-BcR statistical atlases based on the pre-treatment magnetic resonance images (MRI) of the prostate. The patients included in the atlas either underwent RP or RT and were followed up for at least 5 years. The BcR atlas was constructed from a combined population of 12 pre-RT 1.5 Tesla (T) MRI and 33 pre-RP 3T MRI from patients with BcR within 5 years of treatment. Similarly, the non-BcR atlas was built based on a combined cohort of 20 pre-RT 1.5T MRI and 41 pre-RP 3T MRI from patients who remain disease-free 5 years post treatment. We chose the atlas framework as it

  10. Tenofovir treatment in an unselected cohort of highly antiretroviral experienced HIV positive patients

    DEFF Research Database (Denmark)

    Lerbaek, Anne; Kristiansen, Thomas B; Katzenstein, Terese L

    2004-01-01

    The aim of the present study was to explore the treatment effect of tenofovir as implemented in clinical practice. Data are presented on 34 patients. 11 patients had tenofovir added to a stable anti-retroviral treatment (ART) and 23 patients had drugs other than tenofovir. CD4 counts, HIV......-RNA levels and genotypic resistance were determined at baseline and after 3 and 6 months. After initiation of tenofovir treatment, a mean decrease in HIV-RNA for all 34 patients was observed (-0.43 log1o copies/ml (+/- 1.22) and -0.49 log10 copies/ml (+/- 1.36) after 3 and 6 months, respectively, (p = 0...... initiation of tenofovir treatment, no significant increases in CD4 count were observed. All new NRTI-associated mutations could be explained by the background treatment. In conclusion, we observed a significant decrease in HIV-RNA only when tenofovir was prescribed, in conjunction with other anti...

  11. Limits and possibilities experienced by nurses in the treatment of women with chronic venous ulcers

    Directory of Open Access Journals (Sweden)

    Marcelo Henrique da Silva

    2014-08-01

    Full Text Available Objective To understand the experiences and expectations of nurses in the treatment of women with chronic venous ulcers. Method Phenomenological research was based on Alfred Schütz, whose statements were obtained in January, 2012, through semi-structured interviews with seven nurses. Results The nurse reveals the difficulties presented by the woman in performing self-care, the perceived limitations in the treatment anchored in motivation, and the values and beliefs of women. It showed professional frustration because venous leg ulcer recurrence, lack of inputs, interdisciplinary work and training of nursing staff. There was an expected adherence to the treatment of women, and it emphasized the need for ongoing care, supported self-care and standard practices in treatment. Conclusion That treatment of chronic venous leg ulcers constitutes a challenge that requires collective investment, involving women, professionals, managers and health institutions.

  12. Recognition and Treatment of BCG Failure in Bladder Cancer

    Directory of Open Access Journals (Sweden)

    Andrew J. Lightfoot

    2011-01-01

    Full Text Available Patients with high-grade Ta, T1, or carcinoma in situ non–muscle-invasive bladder cancer (NMIBC are at high risk for recurrence and, more importantly, progression. Thus, both the American Urological Association and European Association of Urology recommend initial intravesical treatment with bacillus Calmette-Guerin(BCG followed by maintenance therapy for a minimum of 1 year. The complete response rate to BCG therapy in patients with high-risk NMIBC can be as high as ∼80%; however, most patients with high-risk disease suffer from recurrence. BCG failure can be further characterized into BCG refractory, BCG resistant, BCG relapsing, and BCG intolerant. Current recommendations include one further course of BCG or cystectomy. In patients who continue to fail conservative treatment and who refuse surgical therapy or are not surgical candidates, treatment options become even more complicated. In this setting, treatment options are limited and include repeat BCG treatment, an alternate immunotherapy regimen, chemotherapy, or device-assisted therapy. To date, however, further research is necessary for all secondary treatment options in order to determine which might be the most efficacious. All conservative treatments should be considered investigational. Currently, cystectomy remains the standard of care for high-risk patients who have failed BCG therapy.

  13. Role of Peritoneal Ultrafiltration in Heart Failure Treatment

    Directory of Open Access Journals (Sweden)

    Tuba Elif Şenel

    2017-09-01

    Full Text Available Cardiorenal syndrome (CRS is a general term that can reflect different clinical conditions in which cardiac and renal dysfunctions coexist. The main pathogenetic mechanisms playing a role in heart failure (HF and CRS are neurohumoral adaptation, right ventricular dilatation and dysfunction and systemic inflammation. Persistence of these factors cause focal and segmental glomerulosclerosis, and tubulointerstitial fibrosis in the renal parenchyma. Diuretics, beta blockers, renin-angiotensin-aldosterone system inhibitors, and vasodilators are the main medical treatments besides conventional approach, such as salt and water restriction and quitting smoking, in HF treatment. Diuretic resistance is the main problem emerging during diuretic treatments. Two renal replacement treatments have become prominent for removal of excess fluids via ultrafiltration in HF patients with diuretic resistance extracorporeal ultrafiltration with hemodialysis and peritoneal dialysis (PD. Herein, the role of these two ultrafiltration modalities, especially peritoneal ultrafiltration (PUF in the treatment of HF is discussed. The main studies and advantages of PUF in HF treatment were discussed. Moreover, effects of PD on glomerular filtration rate, hospitalization and mortality were investigated. In conclusion, PD is an alternative cheap, practical and convenient therapy in reducing cardiac volume burden in HF patients who do not respond well to standard treatments and/or require frequent hospitalization.

  14. Treatment options after sorafenib failure in patients with hepatocellular carcinoma.

    Science.gov (United States)

    Dika, Imane El; Abou-Alfa, Ghassan K

    2017-12-01

    Second line therapy after failure of sorafenib continues to be under study. Prognosis of hepatocellular carcinoma is measured in months, with median overall survival reaching 10.7 months with sorafenib. Because of the modest net benefit sorafenib has contributed, and rising incidence of hepatocellular carcinoma in the world, continued efforts are ongoing to look for efficient upfront, second line, or combination therapies. Herein we review the most relevant to date published literature on treatment options beyond sorafenib, reported studies, ongoing investigational efforts, and possibilities for future studies in advanced hepatocellular carcinoma.

  15. Advances in the treatment of acute liver failure

    Directory of Open Access Journals (Sweden)

    LUO Ling

    2018-02-01

    Full Text Available Acute liver failure (ALF is a rare life-threatening disease with rapid progression and a low survival rate and affects the function of multiple organ systems. Early identification of cause and protection of vital organs are critical for patients' survival. With the development in artificial liver, stem cell transplantation, and liver transplantation in recent years, the outcome of ALF has been greatly improved. This article elaborates on the treatment of ALF from the aspects of the etiology of ALF and major organ systems involved and introduces the latest advances in artificial liver and stem cell transplantation.

  16. Meaning of leprosy for people who have experienced treatment during the sulfonic and multidrug therapy periods

    Directory of Open Access Journals (Sweden)

    Karen da Silva Santos

    2015-08-01

    Full Text Available AbstractObjective: to analyze the meanings of leprosy for people treated during the sulfonic and multidrug therapy periods.Method: qualitative nature study based on the Vigotski's historical-cultural approach, which guided the production and analysis of data. It included eight respondents who have had leprosy and were submitted to sulfonic and multidrug therapy treatments. The participants are also members of the Movement for Reintegration of People Affected by Leprosy.Results: the meanings were organized into three meaning cores: spots on the body: something is out of order; leprosy or hanseniasis? and leprosy from the inclusion in the Movement for Reintegration of People Affected by Leprosy.Conclusion: the meanings of leprosy for people submitted to both regimens point to a complex construction thereof, indicating differences and similarities in both treatments. Health professionals may contribute to the change of the meanings, since these are socially constructed and the changes are continuous.

  17. Risk Factors for Montelukast Treatment Failure in Step-Down Therapy for Controlled Asthma

    Science.gov (United States)

    Drummond, M. Bradley; Peters, Stephen P.; Castro, Mario; Holbrook, Janet T.; Irvin, Charles G.; Smith, Lewis J.; Wise, Robert A.; Sugar, Elizabeth A.

    2014-01-01

    Background Leukotriene receptor antagonists including montelukast are an option for step-down therapy for mild asthmatics controlled on low-dose inhaled corticosteroids (ICS). Because some patients fail montelukast step-down therapy, it would be helpful for clinicians to be able to predict the risk of treatment failure. Objectives To determine patient characteristics associated with montelukast treatment failure and develop a clinical index to predict the risk of montelukast treatment failure. Methods Using the 165 participants in the Leukotriene or Corticosteroid or Corticosteroid-Salmeterol Study (LOCCS) trial who were stepped down from low-dose ICS to montelukast, we determined associations between enrollment variables and treatment failure. We constructed a montelukast failure index to predict the risk of montelukast treatment failure during step-down. To assess its specificity for montelukast, index performance was evaluated in the other LOCCS treatment groups. Results Characteristics independently associated with montelukast treatment failure included age of asthma onset montelukast failure index was generated from these three variables (range: −5 to 7 points). Scores 5 predicted high risk (>0.60) of treatment failure. Conclusion Early asthma onset, worse asthma control in the last year, and lower pre-bronchodilator FEV1 are associated with montelukast treatment failure. A montelukast failure index is proposed to quantify the risk of failure prior to treatment initiation. PMID:22029858

  18. Treatment of hypertension in heart failure with preserved ejection fraction.

    Science.gov (United States)

    Asrar ul Haq, Muhammad; Hare, David L; Wong, Chiew; Hayat, Umair; Barlis, Peter

    2014-01-01

    Prevalence of Heart Failure with Preserved Ejection (HFPEF) has been rising steadily in the recent past. Studies have shown that at least half of patients presenting with symptoms and signs of heart failure (HF) have preserved left ventricular ejection fraction, i.e. HFPEF, and that this portion of the HF population consists predominantly of women, older age group, and people with hypertension and other cardiovascular risk factors. The morbidity and mortality associated with HFPEF are much higher than the normal population. Chronic hypertension is the most common cause in addition to age, with suggestion of up to 60% of patients with HFPEF being hypertensive. Addressing the specific aetiology and aggressive risk factor modification remain the mainstay in the treatment of HFPEF. Current guidelines recommend the management should involve treatment of hypertension, control of heart rate, venous pressure reduction, and prevention of myocardial ischemia. This review aims to discuss the role of hypertension in the pathophysiology, risk stratification and prognosis of HFPEF, as well as the current available data on various antihypertensive options in this population.

  19. [Endodontically treated teeth. Success--failure. Endorestorative treatment plan].

    Science.gov (United States)

    Zabalegui, B

    1990-01-01

    More and more often the general dentist is finding the presence of endodontically treated teeth during his treatment planning procedure. He has to ask himself if the endo-treated tooth functions and will continue to function function successfully, when deciding which final endo-restorative procedure to apply. For this reason the dentist or the endodontist with whom he works should clinically evaluate these teeth, establish a diagnostic criteria of their success or failure and a treatment plan according to the prognosis. The purpose of this article is to offer an organized clinical view of the steps to follow when evaluating an endodontically treated tooth and how to establish a final endo-restorative plan.

  20. Stigma and discrimination experienced by people living with severe and persistent mental illness in assertive community treatment settings.

    Science.gov (United States)

    Ye, Jing; Chen, Timothy F; Paul, Diane; McCahon, Rebecca; Shankar, Sumitra; Rosen, Alan; O'Reilly, Claire L

    2016-09-01

    To describe the perceived experiences of stigma and discrimination among people living with severe and persistent mental illness in assertive community treatment (ACT teams) settings in New South Wales (NSW), Australia. The Discrimination and Stigma Scale (DISC) was used in this cross-sectional study with people living with severe and persistent mental illness. The DISC is a reliable and valid, quantitative and qualitative instrument used to explore and measure levels of negative, anticipated and positive discrimination. Relevant clinical history and socio-demographic information were also collected. A total of 50 clients participated, with 40 (80%) reporting experienced negative discrimination in at least one life area. Negative discrimination was most commonly experienced in being avoided or shunned (n=25, 50%), by neighbours (n=24, 48%) and family (n=23, 46%). Anticipated discrimination was common, with half of participants (n=25, 50%) feeling the need to conceal their mental health diagnosis. Discrimination was highly prevalent in everyday aspects of life. While healthcare professionals often tend to increase perceived stigma and discrimination, this was only experienced in interactions with general health professionals, while interactions with ACT team members decreased perceived stigma and increased positive discrimination. This indicates that healthcare professionals potentially have a significant role in reducing stigma and discrimination in mental health and that such an effect may be optimised in an ACT team setting. © The Author(s) 2016.

  1. Risk Factors of Treatment Failure in Diabetic Foot Ulcer Patients

    Directory of Open Access Journals (Sweden)

    Kyung Mook Lee

    2013-03-01

    Full Text Available Background Some diabetic feet heal without complication, but others undergo amputation dueto progressive wounds. This study investigates the risk factors for amputation of diabetic feet.Methods A total of 55 patients who visited our institution from 2008 to 2012 were includedin the study. The patients with abnormal fasting blood sugar levels, lower leg vascularity, andpoor nutrition were excluded from the study group, and the wound states were unified. Thepatients were categorized into a treatment success group (n=47 and a treatment failuregroup (n=8, and their hemoglobin A1C (HgA1C, C-reactive protein (CRP, white blood cellcount (WBC, and serum creatinine levels were analyzed.Results The initial CRP, WBC, and serum creatinine levels in the treatment failure group weresignificantly higher than that of the treatment success group, and the initial HgA1C level wassignificantly higher in the treatment success group. The CRP and WBC levels of both groupschanged significantly as time passed, but their serum creatinine levels did not.Conclusions The initial CRP, WBC, and serum creatinine levels were considered to be riskfactors for amputation. Among them, the serum creatinine level was found to be the mostimportant predictive risk factor. Because serum creatinine represents the renal function,thorough care is needed for the feet of diabetic patients with renal impairment.

  2. Treatment failure of gentamicin in pediatric patients with oropharyngeal tularemia

    Science.gov (United States)

    Kaya, Ali; Uysal, İsmail Önder; Güven, Ahmet Sami; Engin, Aynur; Gültürk, Abdulaziz; İçağasıoğlu, Füsun Dilara; Cevit, Ömer

    2011-01-01

    Summary Background Tularemia is a zoonotic infection, and the causative agent is Francisella tularensis. A first-line therapy for treating tularemia is aminoglycosides (streptomycin or, more commonly, gentamicin), and treatment duration is typically 7 to 10 days, with longer courses for more severe cases. Material/Methods We evaluated 11 patients retrospectively. Failure of the therapy was defined by persistent or recurrent fever, increased size or appearance of new lymphadenopathies and persistence of the constitutional syndrome with elevation of the levels of the proteins associated with the acute phase of infection. Results We observed fluctuating size of lymph nodes of 4 patients who were on the 7th day of empirical therapy. The therapy was switched to streptomycin alone and continued for 14 days. The other 7 patients, who had no complications, were on cefazolin and gentamycin therapy until the serologic diagnosis. Then we evaluated them again and observed that none of their lymph nodes regressed. We also switched their therapy to 14 days of streptomycin. After the 14 days on streptomycin therapy, we observed all the lymph nodes had recovered or regressed. During a follow-up 3 weeks later, we observed that all their lymph nodes had regressed to the clinically non-significant dimensions (<1 cm). Conclusions All patients were first treated with gentamicin, but were than given streptomycin after failure of gentamicin. This treatment was successful in all patients. The results of our study suggest that streptomycin is an effective choice of first-line treatment for pediatric oropharyngeal tularemia patients. PMID:21709631

  3. The hypertension of autonomic failure and its treatment

    Science.gov (United States)

    Shannon, J.; Jordan, J.; Costa, F.; Robertson, R. M.; Biaggioni, I.

    1997-01-01

    We studied the incidence and severity of supine hypertension in 117 patients with severe primary autonomic failure presenting to a referral center over a 9-year period. Patients were uniformly characterized by disabling orthostatic hypotension, lack of compensatory heart rate increase, abnormal autonomic function tests, and unresponsive plasma norepinephrine. Fifty-four patients had isolated autonomic impairment (pure autonomic failure). Sixty-three patients had central nervous system involvement in addition to autonomic impairment (multiple-system atrophy). Patients were studied off medications, in a metabolic ward, and on a controlled diet containing 150 mEq of sodium. Fifty-six percent of patients had supine diastolic blood pressure > or =90 mm Hg. The prevalence of hypertension was slightly greater in females (63%) than in males (52%). Potential mechanisms responsible for this hypertension were investigated. No correlation was found between blood volume and blood pressure. Similarly, plasma norepinephrine (92+/-15 pg/mL) and plasma renin activity (0.3+/-0.05 ng/mL per hour) were very low in the subset of patients with pure autonomic failure and supine hypertension (mean systolic/diastolic pressure, 177 +/- 6/108 +/- 2 mm Hg, range 167/97 to 219/121). Supine hypertension represents a challenge in the treatment of orthostatic hypotension. We found these patients to be particularly responsive to the hypotensive effects of transdermal nitroglycerin. Doses ranging from 0.025 to 0.1 mg/h decreased systolic blood pressure by 36+/-7 mm Hg and may effectively treat supine hypertension overnight, but the dose should be individualized and used with caution.

  4. [TREATMENT COMPLIANCE IN PATIENTS WITH CHRONIC HEART FAILURE AND COMORBIDITIES].

    Science.gov (United States)

    Efremova, E V; Menzorov, M V; Sabitov, L A

    2015-01-01

    Treatment compliance determines to a large degree the effectiveness of therapy of chronic heart failure (CHF). However; individual characteristics of a patient, such as comorbidities and personality status are frequently disregarded. This work was aimed to study clinical and psychological peculiarities of patients with CHF determining treatment compliance taking account of comorbidity. The study included 203 patients (130 men and 73 women) of mean age 61.8 ± 9.6 yr. The following features were evaluated: comorbidity psychological status, compliance with medicamental and non-medicamental treatment of CHF. Charlson comorbidity index corrected for age was 5.0 ± 2.1. Compliance with non-medicamental (recommendations on self-control and changes in the lifestyle) and medicamental therapy was documented in 37 (18.2%) and 61 (30%) patients respectively. Patients with poor compliance were characterised by disadaptive type of responsiveness, emotional lability and indecisiveness (p < 0.04). Poor treatment compliance is to a large extent determined by peculiarities of the personality status.

  5. Increasing and decreasing factors of hope in infertile women with failure in infertility treatment: A phenomenology study.

    Science.gov (United States)

    Mosalanejad, Leili; Parandavar, Nehle; Gholami, Morteza; Abdollahifard, Sareh

    2014-02-01

    Assisted reproductive technology (ART) provide the hope of pregnancy for infertile women, but do not always turn this hope into reality. The purpose of this study was to explore the lived experience of infertile women from increasing and decreasing factors of hope in infertile women with failure in infertility treatment. Using a qualitative research design (Phenomenology study), 23 subjects were selected who had experienced infertility failure visited by gynecologist (Rasekh Infertility center) in 2012. The data were collected through semi structured interviews and analyzed using interpretive research strategies of phenomenology by Collizi's seven-stage method. Totally 96 codes were identified. The data arranged in two categories. The factors decreasing and increasing hope in infertility treatments. Totally 5 themes and 20 sub themes were extracted. The increasing factors which emerged from the data contain "spiritual source", "family interaction and support" and "information through the media", and decreasing factors contain "nature of treatments" and "negatively oriented mind".

  6. Failures in the treatment of pseudoarthroses; Problem niepowodzen w leczeniu stawow rzekomych

    Energy Technology Data Exchange (ETDEWEB)

    Konarski, K.; Piotrowski, W.; Trubisz, L.; Michalski, S. [Szpital im. J. Jonstona, Lublin (Poland)

    1993-12-31

    Failure analysis in the treatment of pseudoarthroses has been presented. It was noted that ankylosis within adjacent joints may lead to nonunion or refracture. Vascular disorders of various origins remain the dominant cause of failure. (author). 5 refs, 10 figs.

  7. Pill Properties that Cause Dysphagia and Treatment Failure

    Directory of Open Access Journals (Sweden)

    Jeremy Fields, MD

    2015-12-01

    Conclusions: Our survey results suggest that 4 out of 5 adult Americans take several pills daily, and do so without undue effort. It also suggests that half of today’s Americans encounter pills that are hard to swallow. Up to 4% of our participants gave up on treatments because they could not swallow the prescribed pills. Up to 7% categorically rejected taking pills that are hard to swallow. Specific material properties are widely blamed for making pills hard to swallow; extra-large capsules and tablets are universally feared, whereas medium-sized pills with a smooth coating are widely preferred. Our findings suggest that health care providers could minimize treatment failures and complications by prescribing and dispensing pills that are easy to swallow. Industry and regulatory bodies may facilitate this by making swallowability an essential criterion in the design and licensing of oral medications. Such policies could lessen the burden of pill taking for Americans and improve the adherence with prescribed treatments.

  8. Successful treatment of early implant failure: a case series.

    Science.gov (United States)

    AlGhamdi, Ali Saad Thafeed

    2012-06-01

    The aim of this longitudinal study was to evaluate the effect of combined treatment on early progressive bone loss around dental implants. The study sample consisted of 18 implants presenting at 4-6 weeks postplacement with early progressive bone loss. Clinical examination indicated the presence of a fistula in the soft tissue covering the implants in most cases. Defects around the implants were curetted, exposed implant surfaces were mechanically debrided and treated with tetracycline solution, and the defects were filled with bone graft and doxycycline powder. Bioabsorbable membranes were used. Final crowns were placed after 6 months. The patients were followed for an average of 30 months. The surgical sites healed without complication. At the time of loading, the defects were completely restored. At 12 months postloading, there was crestal bone loss to the level of the first thread (average, 1.3 mm). Pocket depths ranged from 3 to 5 mm (average, 3.6 mm) with no bleeding. No further changes were noticed throughout the remaining follow-up visits. All implants were successful according to the criteria proposed by Albrektsson and colleagues. Early detection and treatment of early progressive bone loss around dental implants are the key to saving early failing implants. The author recommends reevaluation visits 4-6 weeks postimplant placement to detect any signs of early failure so that immediate treatment can be undertaken if needed. © 2010 Wiley Periodicals, Inc.

  9. Characterization and treatment of persistent hepatocellular secretory failure

    NARCIS (Netherlands)

    van Dijk, Remco; Kremer, Andreas E.; Smit, Wouter; van den Elzen, Bram; van Gulik, Thomas; Gouma, Dirk; Lameris, Johan S.; Bikker, Hennie; Enemuo, Valentine; Stokkers, Pieter C. F.; Feist, Mark; Bosma, Piter; Jansen, Peter L. M.; Beuers, Ulrich

    2015-01-01

    Hepatocellular secretory failure induced by drugs, toxins or transient biliary obstruction may sometimes persist for months after removal of the initiating factor and may then be fatal without liver transplantation. We characterized patients with severe persistent hepatocellular secretory failure

  10. Treatment of anemia with darbepoetin alfa in systolic heart failure

    DEFF Research Database (Denmark)

    Swedberg, Karl; Young, James B; Anand, Inder S

    2013-01-01

    Patients with systolic heart failure and anemia have worse symptoms, functional capacity, and outcomes than those without anemia. We evaluated the effects of darbepoetin alfa on clinical outcomes in patients with systolic heart failure and anemia.......Patients with systolic heart failure and anemia have worse symptoms, functional capacity, and outcomes than those without anemia. We evaluated the effects of darbepoetin alfa on clinical outcomes in patients with systolic heart failure and anemia....

  11. Trends in antibiotic treatment of acute otitis media and treatment failure in children, 2000-2011.

    Directory of Open Access Journals (Sweden)

    Leah J McGrath

    Full Text Available Guidelines to treat acute otitis media (AOM were published in 2004. Initial declines in prescribing were shown, but it's unknown if they were sustained. We examine trends in antibiotic dispensing patterns to treat AOM among a large population of children. We also document trends in antibiotic failure.Children aged 3 months to 12 years with an AOM diagnosis, enrolled in a commercial claims database between January 1, 2000-December 31, 2011 were included. Pharmacy claims within 7 days of diagnosis were searched for antibiotic prescriptions. Antibiotic failure was defined as a dispensing of a different antibiotic class within 2-18 days after the first prescription. We analyzed trends in antibiotic use and failure by class of antibiotic and year.We identified over 4 million children under 13 years with AOM. The proportion of antibiotic dispensing decreased from 66.0% in 2005 to 51.9% in 2007, after which the instances of dispensing rebounded to pre-guideline levels. However, levels began decreasing again in 2010 and the antibiotic use rate in 2011 was 57.6%. Cephalosporin prescriptions increased by 41.5% over eleven years. Antibiotic failure decreased slightly, and macrolides had the lowest proportion of failures, while all other classes had failure rates around 10%.In recent years, antibiotic dispensing to treat AOM remains high. In addition, the use of broad-spectrum antibiotics is increasing despite having a high rate of treatment failure. Overprescribing of antibiotics and use of non-penicillin therapy for AOM treatment could lead to the development of antibiotic-resistant infections.

  12. Experiencing control

    NARCIS (Netherlands)

    Monaci, G.; Braspenning, R.A.C.; Meerbeek, B.W.; Bingley, P.; Rajagopalan, R.; Triki, M.

    2009-01-01

    This report describes the activities carried out in the first part of the Experiencing Control project (2008-324). The guiding idea of the project is to make control part of the experience, exploring new interaction solutions for complex, engaging interactions with Philips devices in the living

  13. Multicentre analysis of second-line antiretroviral treatment in HIV-infected children: adolescents at high risk of failure.

    Science.gov (United States)

    Boerma, Ragna S; Bunupuradah, Torsak; Dow, Dorothy; Fokam, Joseph; Kariminia, Azar; Lehman, Dara; Kityo, Cissy; Musiime, Victor; Palumbo, Paul; Schoffelen, Annelot; Sophan, Sam; Zanoni, Brian; Rinke de Wit, Tobias F; Calis, Job C J; Sigaloff, Kim C E

    2017-09-15

    The number of HIV-infected children and adolescents requiring second-line antiretroviral treatment (ART) is increasing in low- and middle-income countries (LMIC). However, the effectiveness of paediatric second-line ART and potential risk factors for virologic failure are poorly characterized. We performed an aggregate analysis of second-line ART outcomes for children and assessed the need for paediatric third-line ART. We performed a multicentre analysis by systematically reviewing the literature to identify cohorts of children and adolescents receiving second-line ART in LMIC, contacting the corresponding study groups and including patient-level data on virologic and clinical outcomes. Kaplan-Meier survival estimates and Cox proportional hazard models were used to describe cumulative rates and predictors of virologic failure. Virologic failure was defined as two consecutive viral load measurements >1000 copies/ml after at least six months of second-line treatment. We included 12 cohorts representing 928 children on second-line protease inhibitor (PI)-based ART in 14 countries in Asia and sub-Saharan Africa. After 24 months, 16.4% (95% confidence interval (CI): 13.9-19.4) of children experienced virologic failure. Adolescents (10-18 years) had failure rates of 14.5 (95% CI 11.9-17.6) per 100 person-years compared to 4.5 (95% CI 3.4-5.8) for younger children (3-9 years). Risk factors for virologic failure were adolescence (adjusted hazard ratio [aHR] 3.93, p 48 months, respectively, compared to failure rates. However, adolescents showed exceptionally poor virologic outcomes in LMIC, and optimizing their HIV care requires urgent attention. In addition, 16% of children and adolescents failed PI-based treatment and will require integrase inhibitors to construct salvage regimens. These drugs are currently not available in LMIC.

  14. Management of sepsis during MARS treatment in acute on chronic liver failure.

    Science.gov (United States)

    Novelli, G; Morabito, V; Pugliese, F; Ferretti, G; Novelli, S; Ianni, S; Lai, Q; Rossi, M; Berloco, P B

    2011-05-01

    The aim of our study was a 30-day follow-up of the use of early detection of endotoxin by the endotoxin activity assay (EAA) for patients with acute liver failure superimposed on chronic liver disease (AoCLF) and treated with polymyxin-B hemoperfusion-based (PMX-DHP) treatment and albumin dialysis in the molecular adsorbent recirculating system (MARS). From February 2008 to July 2010, we evaluated 10 AoCLF patients experiencing systemic inflammatory response syndrome (SIRS) in association with suspected infection and an EAA-positive test (>0.60). These patients awaiting liver transplantation (OLT) showed similar Model End-Stage Liver Disease (MELD) scores (range, 19-25) and encephalopathy grade ≤ 2. Five patients received therapy to remove endotoxins with PMX-DHP with MARS treatment for liver failure (group A); the other 5 patients received MARS treatment only (group B). Two PMX-DHP treatments were performed in 4 group A patients (average EA=0.66 [range, 0.61-0.70]) and 3 treatments for 1 patient (EA=0.92). All 5 subjects underwent an average of 4 MARS treatments (range, 3-5). At the end of therapy, the median EA level was 0.42 (range, 0.37-0.48). As reported in the literature, we achieved a significant improvement in liver and kidney functions using MARS. Measurements of lactate, interleukin (IL)-6, and tumor necrosis factor (TNF)-α were significantly improved among patients treated with the extracorporeal therapies. At 30 days of observation, all 5 patients treated with MARS plus PMX-DHP are alive. In group B, a mean of 7.5 MRAS treatments were performed. We observed an improvement in hemodynamic and liver functions with reduced levels of proinflammatory cytokines and lactates in 4 patients. One patient showed no improvement in clinical status with the development of sepsis and subsequent multiorgan failure after 24 days. The possibility of an early diagnosis using the EAA in AoCLF patients could prevent the progression of the sepsis cascade. The use of PMX

  15. Causes and Treatment of Acute Renal Failure in Children

    Directory of Open Access Journals (Sweden)

    O. I. Andriyanova

    2007-01-01

    Full Text Available Objective: to study the causes of acute renal failure (ARF in children and to substantiate recommendations on its treatment. Fifty-nine children with ARF were followed up in 1979 to 2004. In 90% of the patients, ARF was established to be caused by hemolytic uremic syndrome (HUS, acute intestinal infection (AII, acute glomerulonephritis, and acute intravascular hemolysis. The major cause of ARF was AII in two thirds (66.1% of the children. In the past decade, the incidence of HUS has decreased from 55 to 40%. The authors identified the following predictors of poor ARF outcome: early age, anuria, impaired consciousness progressing to spoor and coma. A combination of these symptoms is most frequently observed in patients with HUS in which the kidneys are the major target organ and the possibilities of more than 7-day treatment for anuria without dialysis are limited. In other etiology of ARF, water deprivation, antihypertensive therapy, and exchange plasmapheresis allow patients to survive until renal function restores without renal replacement therapy, by preventing serious complications. 

  16. Screening, brief intervention, and referral to treatment for military spouses experiencing alcohol and substance use disorders: a literature review.

    Science.gov (United States)

    Ahmadi, Halima; Green, Scott L

    2011-06-01

    This paper provides an overview of alcohol and substance use issues in military spouses, and explore how the screening, brief intervention, and referral to treatment (SBIRT) model may enable health care providers to identify individuals at risk for developing substance use related disorders. The information presented is based on a broad literature scan relating to the characteristics of the military lifestyle, health infrastructure, screening and intervention processes, and the uses of SBIRT in military and civilian settings. Current literature suggests that military spouses, and families, tend to be at different points in their life course than civilian families of similar ages. Marrying earlier and having children sooner coupled with military lifestyle stressors place them at increased risk for developing adverse coping mechanisms, particularly during deployment. SBIRT has been recognized as an effective method among civilian patients although there is limited research on the efficacy of SBIRT for military spouses at risk of or experiencing substance use problems.

  17. Calendar time trends in the incidence and prevalence of triple-class virologic failure in antiretroviral drug-experienced people with HIV in Europe

    DEFF Research Database (Denmark)

    Nakagawa, Fumiyo; Lodwick, Rebecca; Costagliola, Dominique

    2012-01-01

    Despite the increasing success of antiretroviral therapy (ART), virologic failure of the 3 original classes [triple-class virologic failure, (TCVF)] still develops in a small minority of patients who started therapy in the triple combination ART era. Trends in the incidence and prevalence of TCVF...

  18. Experiencing variation

    DEFF Research Database (Denmark)

    Kobayashi, Sofie; Berge, Maria; Grout, Brian William Wilson

    2017-01-01

    This study contributes towards a better understanding of learning dynamics in doctoral supervision by analysing how learning opportunities are created in the interaction between supervisors and PhD students, using the notion of experiencing variation as a key to learning. Empirically, we have bas...... were discussed, created more complex patterns of variation. Both PhD students and supervisors can learn from this. Understanding of this mechanism that creates learning opportunities can help supervisors develop their competences in supervisory pedagogy....

  19. Art therapy improves experienced quality of life among women undergoing treatment for breast cancer: a randomized controlled study.

    Science.gov (United States)

    Svensk, A-C; Oster, I; Thyme, K E; Magnusson, E; Sjödin, M; Eisemann, M; Aström, S; Lindh, J

    2009-01-01

    Women with breast cancer are naturally exposed to strain related to diagnosis and treatment, and this influences their experienced quality of life (QoL). The present paper reports the effect, with regard to QoL aspects, of an art therapy intervention among 41 women undergoing radiotherapy treatment for breast cancer. The women were randomized to an intervention group with individual art therapy sessions for 1 h/week (n = 20), or to a control group (n = 21). The WHOQOL-BREF and EORTC Quality of Life Questionnaire-BR23, were used for QoL assessment, and administrated on three measurement occasions, before the start of radiotherapy and 2 and 6 months later. The results indicate an overall improvement in QoL aspects among women in the intervention group. A significant increase in total health, total QoL, physical health and psychological health was observed in the art therapy group. A significant positive difference within the art therapy group was also seen, concerning future perspectives, body image and systemic therapy side effects. The present study provides strong support for the use of art therapy to improve QoL for women undergoing radiotherapy treatment for breast cancer.

  20. Geotechnical problems experienced during the construction of the sludge treatment unit of the main wastewater treatment plant in antalya

    Energy Technology Data Exchange (ETDEWEB)

    Acar, Mustafa H. [Akdeniz University, Faculty of Engineering, Department of Civil Engineering, Antalya (Turkey)

    2007-12-15

    The treatment and disposal of wastewater still is a big problem of Antalya. The wastewater produced in the residential areas is biologically treated, the produced sludge, however, remains untreated. At the moment more than 60 t/day of dewatered sludge are buried at a landfill area located directly above the main groundwater resources of the city. As the area does not have any drainage and liner systems, it is believed that this kind of disposal constitutes a threat to the groundwater resources. Therefore, Antalya Metropolitan Municipality decided to add anaerobic sludge digestion units to the wastewater treatment plant. The sludge digestion tanks are considered to be built within the wastewater treatment plant area which is less than 1 km away from the beaches along the Mediterranean Sea. The purpose of this study is to examine the foundation soil in terms of its bearing capacity, consolidation settlement, and earthquake risks and to find out whether this construction site is suitable for building the sludge digestion tanks or not. (Abstract Copyright [2007], Wiley Periodicals, Inc.)

  1. Clinical Holistic Medicine (Mindful,Short-Term Psychodynamic Psychotherapy Complemented with Bodywork in the Treatment of Experienced Mental Illness

    Directory of Open Access Journals (Sweden)

    Søren Ventegodt

    2007-01-01

    Full Text Available Short-term psychodynamic psychotherapy (STPP complemented with bodywork improved 31 of 54 patients (57.4%, 95% CI: 43.21–70.77% who rated themselves mentally ill before treatment. Calculated from this we find 1.41 500. Of the 54 patients, 40% had already had traditional treatment that did not help them. Bodywork helped the patients to confront repressed painful feelings from childhood and this seemingly accelerated and improved the therapy. The patients received in average 20 sessions over 14 months at a cost of 1600 EURO. For the treatment responders, all measured aspects of life (on a five point Likert Scale improved significantly, simultaneously, and radically: somatic health (from 2.9 to 2.3, self-esteem/relationship to self (from 3.5 to 2.3, relationship to partner (from 4.7 to 2.9 [no partner was rated as “6”], relationship to friends (from 2.5 to 2.0, ability to love (from 3.8 to 2.4, self-assessed sexual ability (from 3.5 to 2.4, self-assessed social ability (from 3.2 to 2.1, self-assessed working ability (from 3.3 to 2.4, and self-assessed quality of life (from 4.0 to 2.3. Quality of life as measured with QOL5 improved (from 3.6 to 2.3 on a scale from 1 to 5; p < 0.001. This general improvement strongly indicated that the patient had healed existentially, i.e., had experienced what Aaron Antonovsky (1923–1994 called “salutogenesis”, defined as the process exactly the opposite of pathogenesis. For the treatment responders, the treatment provided lasting benefits, without the negative side effects of drugs. A lasting, positive effect might also prevent many different types of problems in the future.

  2. Tumor-derived exosomes in cancer progression and treatment failure

    Science.gov (United States)

    Shen, Bo; Feng, Jifeng

    2015-01-01

    Exosomes have diameter within the range of 30-100nm and spherical to cup-shaped nanoparticles with specific surface molecular characteristics, such as CD9 and CD63. These vesicles are present in nearly all human body fluids, including blood plasma/serum, saliva, breast milk, cerebrospinal fluid, urine, semen, and particularly enriched in tumor microenvironment. Exosomes contain multiple proteins, DNA, mRNA, miRNA, long non-coding RNA, and even genetic materials of viruses/prions. These materials are biochemically and functionally distinct and can be transferred to a recipient cell where they regulate protein expression and signaling pathways. Recently, exosomes are demonstrated to have a close relationship with tumor development and metastasis. Exosomes influence therapeutic effect in cancer patients. In this review, we describe the biogenesis, composition, and function of exosomes. The mechanism on how tumor-derived exosomes contribute to cancer progression and clinical treatment failure is also described, with special focus on their potential applications in cancer therapy. PMID:26452221

  3. Characteristics of adherence to methadone maintenance treatment over a 15-year period among homeless adults experiencing mental illness

    Directory of Open Access Journals (Sweden)

    Milad Parpouchi

    2017-12-01

    Full Text Available Background: Methadone maintenance treatment (MMT has important protective effects related to reduced illicit opioid use, infectious disease transmission, and overdose mortality. Adherence to MMT has not been examined among homeless people. We measured MMT adherence and reported relevant characteristics among homeless adults experiencing mental illness in Vancouver, British Columbia, Canada. Material and methods: Homeless adults living with mental illness who had received MMT prior to the baseline interview of the Vancouver At Home study (n=78 were included in analyses. The medication possession ratio (MPR was used to estimate MMT adherence from retrospective administrative pharmacy and public health insurance data collected across 15years. Independent sample t tests and one-way ANOVA were used to test for significant differences in MMT MPR by participant characteristics. Results: Mean MMT MPR was 0.47. A large proportion of participants reported blood-borne infectious disease, three or more chronic physical health conditions, and substance use. Being single and never married was associated with significantly lower MMT MPR (0.40 vs. 0.55, p=0.036, while living with schizophrenia, bipolar disorder, or a mood disorder with psychotic features was associated with significantly higher MMT MPR (0.54 vs. 0.37, p=0.022. Daily drug use (excluding alcohol was associated with significantly lower MMT MPR (0.39 vs. 0.54, p=0.051. Conclusions: The level of adherence to MMT was very low among homeless adults experiencing mental illness. Efforts are needed to improve adherence to MMT as a means of reducing illicit substance use, preventing overdose deaths, and attenuating infectious disease transmission. Keywords: Adherence, Medication possession ratio, Methadone, Opioid dependence, Homeless, Mental illness

  4. Treatment of patients with heart failure and preserved ejection fraction.

    Science.gov (United States)

    Deswal, Anita; Bozkurt, Biykem

    2008-12-01

    Of the more than 5 million Americans who have heart failure (HF), 30% to 50% have HF with preserved ejection fraction (HF-PEF). HF-PEF commonly occurs in elderly patients, especially women, with comorbidities of hypertension, left ventricular hypertrophy, diabetes, myocardial ischemia, and obesity. HF-PEF is associated with high morbidity and mortality. Although two large multicenter randomized, placebo-controlled trials evaluating an angiotensin-converting enzyme inhibitor (ACEI) and an angiotensin receptor blocker (ARB) in patients with HF-PEF did not demonstrate any statistically significant benefit in their primary end points, they did suggest that these agents may have a modest role in reducing HF hospitalizations. Although calcium channel blockers and beta-blockers may be of benefit in patients with HF-PEF, large clinical trial data are not available to support their routine use in all patients with HF-PEF. Subgroup analysis does not support the use of digoxin in patients with HF-PEF in sinus rhythm. Current therapeutic recommendations for HF-PEF are aimed at 1) management of HF symptoms with sodium and fluid restriction along with diuretics for volume overload and 2) treatment of concomitant comorbidities, especially hypertension, rate and possibly rhythm control of atrial fibrillation, and evaluation and treatment of myocardial ischemia and anemia. ACEIs, ARBs, calcium channel blockers, and beta-blockers are recommended for HF-PEF patients who have other established indications for their use. Results are awaited from ongoing clinical trials with another ARB, irbesartan, and an aldosterone blocker, spironolactone.

  5. Anemia in chronic heart failure : etiology and treatment options

    NARCIS (Netherlands)

    Westenbrink, B. Daan; de Boer, Rudolf A.; Voors, Adriaan A.; van Gilst, Wiek H.; van Veldhuisen, Dirk J.

    Purpose of review Anemia is common in patients with chronic heart failure, and is related to increased morbidity and mortality. The etiology of anemia in heart failure is complex and still not fully resolved. The review will describe current advances in the understanding of the pathophysiology of

  6. Treatment of Anemia with Darbepoetin Alfa in Systolic Heart Failure

    NARCIS (Netherlands)

    Swedberg, Karl; Young, James B.; Anand, Inder S.; Cheng, Sunfa; Desai, Akshay S.; Diaz, Rafael; Maggioni, Aldo P.; McMurray, John J. V.; O'Connor, Christopher; Pfeffer, Marc A.; Solomon, Scott D.; Sun, Yan; Tendera, Michal; van Veldhuisen, Dirk J.

    2013-01-01

    BACKGROUND Patients with systolic heart failure and anemia have worse symptoms, functional capacity, and outcomes than those without anemia. We evaluated the effects of darbepoetin alfa on clinical outcomes in patients with systolic heart failure and anemia. METHODS In this randomized, double-blind

  7. Etravirine combined with antiretrovirals other than darunavir/ritonavir for HIV-1-infected, treatment-experienced adults: Week 48 results of a phase IV trial

    Directory of Open Access Journals (Sweden)

    Eduardo Arathoon

    2017-01-01

    Full Text Available Objective: VIOLIN (TMC125IFD3002; NCT01422330 evaluated the safety, tolerability, and pharmacokinetics of etravirine with antiretrovirals other than darunavir/ritonavir in HIV-1-infected patients. Methods: In a 48-week, phase IV, single-arm, multicenter study, patients on prior antiretroviral therapy (⩾8 weeks who needed to change regimen for virologic failure (viral load ⩾ 500 copies/mL or simplification/adverse events (viral load < 50 copies/mL received etravirine 200 mg bid with ⩾1 other active antiretroviral, excluding darunavir/ritonavir or only nucleoside/tide reverse transcriptase inhibitors. Results: Of 211 treated patients, 73% (n = 155 had baseline viral load ⩾ 50 copies/mL and 27% (n = 56 had baseline viral load < 50 copies/mL. Protease inhibitors were the most common background antiretrovirals (83%. Diarrhea was the most frequent adverse event (17%. Serious adverse events (no rash occurred in 5% of patients; none were etravirine related. Overall, median etravirine AUC12h was 5390 ng h/mL and C0h was 353 ng/mL (N = 199. Week 48 virologic response rates (viral load < 50 copies/mL; Food and Drug Administration Snapshot algorithm were 48% (74/155 (baseline viral load ⩾ 50 copies/mL and 75% (42/56 (baseline viral load < 50 copies/mL. Virologic failure rates were 42% and 13%, respectively. The most frequently emerging etravirine resistance-associated mutations in virologic failures were Y181C, E138A, and M230L. Virologic response rates for patients with baseline viral load ⩾ 50 copies/mL were 38% (30/79 (non-adherent versus 64% (44/69 (adherent subset. Conclusion: Etravirine 200 mg bid in combination with antiretrovirals other than darunavir/ritonavir was well tolerated in the studied treatment-experienced HIV-1-infected population. The overall etravirine safety and tolerability profile and pharmacokinetics (specifically in those patients who were adherent

  8. Clinical features and treatment of organ failure in severe acute pancreatitis

    Directory of Open Access Journals (Sweden)

    CUI Lijian

    2014-08-01

    Full Text Available Organ failure is an important factor causing death in patients with severe acute pancreatitis (SAP. In recent years, thanks to the further study of pathophysiology of SAP and the continuous accumulation of experience and technology, substantial progress has been made in the diagnosis and treatment of SAP complicated by organ failure. The clinical features of SAP complicated by organ failure and the measures to be strengthened in the treatment of SAP are summarized. Currently, it is thought that organ failure tends to appear once SAP occurs, so timely, standardized treatment can shorten the course of disease and significantly reduce mortality.

  9. Treatment Failure and Mortality amongst Children with Severe Acute Malnutrition Presenting with Cough or Respiratory Difficulty and Radiological Pneumonia.

    Directory of Open Access Journals (Sweden)

    Mohammod Jobayer Chisti

    Full Text Available Appropriate intervention is critical in reducing deaths among under-five, severe acutely malnourished (SAM children with danger signs of severe pneumonia; however, there is paucity of data on outcome of World Health Organisation (WHO recommended interventions of SAM children with severe pneumonia. We sought to evaluate outcome of the interventions in such children.We prospectively enrolled SAM children aged 0-59 months, admitted to the Intensive Care Unit (ICU or Acute Respiratory Infection (ARI ward of the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b, between April 2011 and June 2012 with cough or respiratory difficulty and radiological pneumonia. All the enrolled children were treated with ampicillin and gentamicin, and micronutrients as recommended by the WHO. Comparison was made among pneumonic children with (n = 111 and without WHO defined danger signs of severe pneumonia (n = 296. The outcomes of interest were treatment failure (if a child required changing of antibiotics and deaths during hospitalization. Further comparison was also made among those who developed treatment failure and who did not and among the survivors and deaths.SAM children with danger signs of severe pneumonia more often experienced treatment failure (58% vs. 20%; p<0.001 and fatal outcome (21% vs. 4%; p<0.001 compared to those without danger signs. Only 6/111 (5.4% SAM children with danger signs of severe pneumonia and 12/296 (4.0% without danger signs had bacterial isolates from blood. In log-linear binomial regression analysis, after adjusting for potential confounders, danger signs of severe pneumonia, dehydration, hypocalcaemia, and bacteraemia were independently associated both with treatment failure and deaths in SAM children presenting with cough or respiratory difficulty and radiological pneumonia (p<0.01.The result suggests that SAM children with cough or respiratory difficulty and radiologic pneumonia who

  10. Treatment Failure and Mortality amongst Children with Severe Acute Malnutrition Presenting with Cough or Respiratory Difficulty and Radiological Pneumonia.

    Science.gov (United States)

    Chisti, Mohammod Jobayer; Salam, Mohammed Abdus; Bardhan, Pradip Kumar; Faruque, Abu S G; Shahid, Abu S M S B; Shahunja, K M; Das, Sumon Kumar; Hossain, Md Iqbal; Ahmed, Tahmeed

    2015-01-01

    Appropriate intervention is critical in reducing deaths among under-five, severe acutely malnourished (SAM) children with danger signs of severe pneumonia; however, there is paucity of data on outcome of World Health Organisation (WHO) recommended interventions of SAM children with severe pneumonia. We sought to evaluate outcome of the interventions in such children. We prospectively enrolled SAM children aged 0-59 months, admitted to the Intensive Care Unit (ICU) or Acute Respiratory Infection (ARI) ward of the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), between April 2011 and June 2012 with cough or respiratory difficulty and radiological pneumonia. All the enrolled children were treated with ampicillin and gentamicin, and micronutrients as recommended by the WHO. Comparison was made among pneumonic children with (n = 111) and without WHO defined danger signs of severe pneumonia (n = 296). The outcomes of interest were treatment failure (if a child required changing of antibiotics) and deaths during hospitalization. Further comparison was also made among those who developed treatment failure and who did not and among the survivors and deaths. SAM children with danger signs of severe pneumonia more often experienced treatment failure (58% vs. 20%; ppneumonia and 12/296 (4.0%) without danger signs had bacterial isolates from blood. In log-linear binomial regression analysis, after adjusting for potential confounders, danger signs of severe pneumonia, dehydration, hypocalcaemia, and bacteraemia were independently associated both with treatment failure and deaths in SAM children presenting with cough or respiratory difficulty and radiological pneumonia (ppneumonia who had WHO-defined danger signs of severe pneumonia more often had treatment failure and fatal outcome compared to those without the danger signs. In addition to danger signs of severe pneumonia, other common causes of both treatment failure and deaths

  11. ACE inhibitors and calcium antagonists in the treatment of congestive heart failure

    DEFF Research Database (Denmark)

    Hansen, J F

    1995-01-01

    The increased mortality after myocardial infarction is related to the risk of reinfarction, sudden death, and the development and progression of heart failure; in congestive heart failure it is due to the progression of heart failure and sudden death. ACE inhibitors have been proven to prevent...... cardiovascular events, especially the progression of heart failure, in postinfarct patients with reduced ejection fraction and heart failure in the SAVE and AIRE trials. In patients with congestive heart failure, ACE inhibitor treatment has prevented cardiovascular death and reduced morbidity due to progressive...... by prevention of reinfarction and sudden death. Combination treatment with both verapamil, which has pronounced antiischemic properties and prevents sudden death and reinfarction, and an ACE inhibitor, which prevents the progression of heart failure, is a possibility for future cardiovascular therapy...

  12. Tritium Waste Treatment System component failure data analysis from June 18, 1984--December 31, 1989

    Energy Technology Data Exchange (ETDEWEB)

    Cadwallader, L.C. (EG and G Idaho, Inc., Idaho Falls, ID (USA)); Stolpe Gavett, M.A. (Los Alamos National Lab., NM (USA))

    1990-09-01

    This document gives the failure rates for the major tritium-bearing components in the Tritium Waste Treatment System at the Tritium Systems Test Assembly, which is a fusion research and technology facility at the Los Alamos National Laboratory. The failure reports, component populations, and operating demands/hours are given in this report, and sample calculations for binomial demand failure rates and poisson hourly failure rates are given in the appendices. The failure rates for tritium-bearing components were on the order of the screening failure rate values suggested for fusion reliability and risk analyses. More effort should be directed toward collecting and analyzing fusion component failure data, since accurate failure rates are necessary to refine reliability and risk analyses. 15 refs., 4 figs., 4 tabs.

  13. Differences in drug treatment of chronic heart failure between European countries

    NARCIS (Netherlands)

    van Veldhuisen, DJ; Charlesworth, A; Crijns, HJGM; Lie, KI; Hampton, [No Value

    Aims A large number of drugs are currently used for the treatment of chronic heart failure. Treatment for other cardiovascular disorders has been shown to differ between countries. In this study we examined whether this would also be true in heart failure. Methods and Results We studied patients

  14. Time-to-Furosemide Treatment and Mortality in Patients Hospitalized With Acute Heart Failure

    NARCIS (Netherlands)

    Matsue, Yuya; Damman, Kevin; Voors, Adriaan A.; Kagiyama, Nobuyuki; Yamaguchi, Tetsuo; Kuroda, Shunsuke; Okumura, Takahiro; Kida, Keisuke; Mizuno, Atsushi; Oishi, Shogo; Inuzuka, Yasutaka; Akiyama, Eiichi; Matsukawa, Ryuichi; Kato, Kota; Suzuki, Satoshi; Naruke, Takashi; Yoshioka, Kenji; Miyoshi, Tatsuya; Baba, Yuichi; Yamamoto, Masayoshi; Murai, Koji; Mizutani, Kazuo; Yoshida, Kazuki; Kitai, Takeshi

    2017-01-01

    BACKGROUND Acute heart failure (AHF) is a life-threatening disease requiring urgent treatment, including a recommendation for immediate initiation of loop diuretics. OBJECTIVES The authors prospectively evaluated the association between time-to-diuretic treatment and clinical outcome. METHODS

  15. Prediction Score for Antimony Treatment Failure in Patients with Ulcerative Leishmaniasis Lesions

    Science.gov (United States)

    Dujardin, Jean Claude; Llanos-Cuentas, Alejandro; Chappuis, François; Zimic, Mirko

    2012-01-01

    Background Increased rates for failure in leishmaniasis antimony treatment have been recently recognized worldwide. Although several risk factors have been identified there is no clinical score to predict antimony therapy failure of cutaneous leishmaniasis. Methods A case control study was conducted in Peru from 2001 to 2004. 171 patients were treated with pentavalent antimony and followed up to at least 6 months to determine cure or failure. Only patients with ulcerative cutaneous leishmaniasis (N = 87) were considered for data analysis. Epidemiological, demographical, clinical and laboratory data were analyzed to identify risk factors for treatment failure. Two prognostic scores for antimonial treatment failure were tested for sensitivity and specificity to predict antimony therapy failure by comparison with treatment outcome. Results Among 87 antimony-treated patients, 18 (21%) failed the treatment and 69 (79%) were cured. A novel risk factor for treatment failure was identified: presence of concomitant distant lesions. Patients presenting concomitant-distant lesions showed a 30.5-fold increase in the risk of treatment failure compared to other patients. The best prognostic score for antimonial treatment failure showed a sensitivity of 77.78% and specificity of 95.52% to predict antimony therapy failure. Conclusions A prognostic score including a novel risk factor was able to predict antimonial treatment failure in cutaneous leishmaniasis with high specificity and sensitivity. This prognostic score presents practical advantages as it relies on clinical and epidemiological characteristics, easily obtained by physicians or health workers, and makes it a promising clinical tool that needs to be validated before their use for developing countries. PMID:22720098

  16. Toward a definition and method of assessment of treatment failure and treatment effectiveness: the case of leflunomide versus methotrexate.

    Science.gov (United States)

    Wolfe, Frederick; Michaud, Kaleb; Stephenson, Barbara; Doyle, Joseph

    2003-08-01

    Time to treatment discontinuation (TTD) is an accepted method of assessing treatment effectiveness in the community, but is susceptible to channeling bias and secular and cohort effects. In addition, TTD does not consider the addition of new disease modifying antirheumatic drugs (DMARD) to insufficiently effective therapies. We expand the definition of treatment failure to include discontinuation or addition of a second DMARD (1) to examine leflunomide (LEF) versus methotrexate (MTX) effectiveness in clinical practice; (2) to obtain an estimate of overall clinical effectiveness; and (3) to identify factors associated with treatment successes and failure. In addition, (4) we test the feasibility of performing a clinical trial using a longitudinal data bank. Using the National Data Bank for Rheumatic Diseases longitudinal data bank, 1431 patients with rheumatoid arthritis (RA) who began taking LEF or MTX as part of their routine medical care were followed from 1998 through 2001. None of the 1431 patients had received either treatment previously. Patients were assessed at 6 month intervals for periods up to 36 months by mailed questionnaires concerning DMARD therapy and demographic and RA severity factors. Kaplan-Meier survivor functions and Cox regression analyses were used to assess treatment failure, defined as time to discontinuation or to the addition of a second DMARD. For 756 patients taking LEF, the failure rate was 55.5 per 100 patient-years, and the median time to failure was 15 (95% CI 13, 17) months. For 675 patients taking MTX the failure rate was 57.3 per 100 patient-years, and the median failure time was 14 (95% CI 12, 18) months. These differences were not statistically significant. The overall rate of discontinuation was 68.7% of the failure rate. Discontinuation was predicted by adverse effects [hazard ratio 1.76 (95% CI 1.51, 2.04)] and by clinical status prior to starting DMARD, and these results were not affected by specific DMARD treatment

  17. Treatment failure after uterine artery embolization: prospective cohort study with multifactorial analysis of possible predictors of long-term outcome.

    Science.gov (United States)

    Scheurig-Muenkler, Christian; Koesters, Clemens; Grieser, Christian; Hamm, Bernd; Kroencke, Thomas J

    2012-05-01

    To evaluate the impact of baseline characteristics and residual leiomyoma perfusion after uterine artery embolization (UAE) on clinical long-term outcome. One hundred fifteen patients underwent UAE. All patients were divided into three groups according to achieved infarction rate determined on contrast-enhanced magnetic resonance imaging within 48-72 h after UAE (I: 100%, n=60; II: 90-99%, n=32; and III: 0-89%, n=23). Treatment failure and subsequent re-interventions (surgery, repeat UAE) were assessed for each group and compared using Cox regression analysis (CRA) with respect to the following baseline variables: age, uterine and dominant fibroid volume, number of fibroids, location of largest fibroid, and clinical symptoms. Long-term follow-up was completed after a median of 7.2 years (range 5.1-9.6) with a response rate of 84%. CRA revealed that patients in group III had a 22.2-fold higher risk (pfibroid infarction after UAE is strongly associated with the risk of experiencing treatment failure. Patients with bleeding-related complaints only face the highest likelihood of treatment failure if UAE results in less than 90% fibroid devascularization. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  18. Ivabradine in Heart Failure: The Representativeness of SHIFT (Systolic Heart Failure Treatment With the IF Inhibitor Ivabradine Trial) in a Broad Population of Patients With Chronic Heart Failure.

    Science.gov (United States)

    Das, Debraj; Savarese, Gianluigi; Dahlström, Ulf; Fu, Michael; Howlett, Jonathan; Ezekowitz, Justin A; Lund, Lars H

    2017-09-01

    The sinus node inhibitor ivabradine was approved for patients with heart failure (HF) after the ivabradine and outcomes in chronic HF (SHIFT [Systolic Heart Failure Treatment With the IF Inhibitor Ivabradine Trial]) trial. Our objective was to characterize the proportion of patients with HF eligible for ivabradine and the representativeness of the SHIFT trial enrollees compared with those in the Swedish Heart Failure Registry. We examined 26 404 patients with clinical HF from the Swedish Heart Failure Registry and divided them into SHIFT type (left ventricular ejection fraction 50% of target dose. From those patients who had repeated visits within 6 months (n=5420) and 1 year (n=6840), respectively, 10.2% (n=555) and 10.6% (n=724) of SHIFT-type patients became ineligible, 77.3% (n=4188) and 77.3% (n=5287) remained ineligible, and 4.6% (n=252) and 4.9% (n=335) of non-SHIFT-type patients became eligible for initiation of ivabradine. From the Swedish Heart Failure Registry, 14.2% of patients with HF were eligible for ivabradine. These patients more commonly were not receiving target β-blocker dose. Over time, a minority of patients became ineligible and an even smaller minority became eligible. © 2017 American Heart Association, Inc.

  19. dhfr and dhps genotype and sulfadoxine-pyrimethamine treatment failure in children with falciparum malaria in the Democratic Republic of the Congo

    Science.gov (United States)

    Alker, Alisa P.; Kazadi, Walter M.; Kutelemeni, Albert K.; Bloland, Peter B.; Tshefu, Antoinette K.; Meshnick, Steven R.

    2009-01-01

    Summary OBJECTIVE To determine the relationship between mutations in dhfr and dhps and SP treatment failure in Plasmodium falciparum malaria in the Democratic Republic of the Congo (DRC) METHODS Between June and September 2002, a therapeutic efficacy trial was conducted in Rutshuru, Eastern DRC, comparing sulfadoxine-pyrimethamine (SP), SP plus amodiaquine (AQSP), and artesunate plus SP (ASSP) regimens for treating malaria in children under 5 years old. We genotyped 212 samples for mutations associated with SP resistance and investigated their association with treatment failure. RESULTS In the SP arm, 61% of the subjects experienced treatment failure after 14 days. The failure rate was lower in the combination arms (AQSP: 32%, ASSP: 21%). The dhfr-108 and dhfr-51 mutations were nearly universal while 89% of the samples had at least one additional mutation at dhfr-59, dhps-437, or dhps-540. Dhps mutations had a bigger impact on treatment failure in children with high parasite density: for children with a parasite density less than 45,000 parasites/μl, the risk of treatment failure was 37% for mutations at dhps-437 and dhps-540 mutation and 21% for neither mutation (risk difference (RD) = 17%, 95%CI: −3%, 36%). In children with a parasite density greater than 45,000 parasites/μl, the treatment failure risk was 58% and 8% for children with both mutations or neither mutation, respectively (RD = 51%, 95%CI: 34%, 67%). CONCLUSIONS Dhps-437 and dhps-540 are strongly associated with SP treatment failure and should be evaluated further as a method for surveillance of SP-based therapy in the DRC. PMID:19055622

  20. Somatic Experiencing® Informed Therapeutic Group for the Care and Treatment of Biopsychosocial Effects upon a Gender Diverse Identity

    Directory of Open Access Journals (Sweden)

    Paul C. Briggs

    2018-02-01

    Full Text Available BackgroundSomatic Experiencing® (SE™ is a resiliency-based treatment for autonomic nervous systems dysregulation syndromes, such as posttraumatic stress disorder, anxiety, depression, and physical syndromes like chronic pain, migraines, and fibromyalgia. “Transgender/gender non-conforming/gender variant” describes people whose gender identity/expression is different, at least part of the time, from the sex assigned at birth. Research indicates transgender individuals have a higher incidence of depression, anxiety, victimization, and discrimination. SE™ tools may support transgender/gender non-conforming individuals to increase resilience in the face of discrimination and social injustice.MethodsThis study is a pretest posttest within group (N = 7 pilot study assessing the impact of a 10 session SE™ based group treatment on depression (PHQ-9, anxiety (GAD-7, somatic symptoms (PHQ-15, quality of life (QoL (WHOQoL-BREF, and coping with discrimination (CDS for a cohort of seven individuals identifying as transgender/gender non-conforming. Materials were created in collaboration with members of the LGBTQIA community. Care was taken to be inclusive of gender non-conforming identities and culturally responsive in design.ResultsParticipants described their gender identities as: non-binary, female to male, male to female, and gender fluid. Participants had significant increase in psychological QoL (psychological well-being (WHOQoL-BREF p = 0.004, SD = 2.31, with a modest effect size of d = 0.71. Some likely impacts of historical effect discussed. No other clinical or QoL outcomes were statistically significant. However, one outlier was identified in the dataset. When this outlier was excluded there was a trend toward significant reduction in depression symptoms (PhQ-9 p = 0.097, SD = 3.31 and a modest effect size of d = 0.68; somatic symptoms (PhQ-15 p = 0.093, SD = 3.52 and a modest effect size of d = 0

  1. Heart failure in geriatric outpatients: diagnosis, prognosis and treatment

    NARCIS (Netherlands)

    Oudejans-Mooijaart, I.

    2012-01-01

    The ageing of the population and improved survival following acute cardiac events have led to an increased prevalence of heart failure (HF), especially in the elderly. Establishing the presence of HF based only on signs and symptoms is often inaccurate. Additional investigations (e.g.

  2. Use of Inotropic Agents in Treatment of Systolic Heart Failure.

    Science.gov (United States)

    Tariq, Sohaib; Aronow, Wilbert S

    2015-12-04

    The most common use of inotropes is among hospitalized patients with acute decompensated heart failure, with reduced left ventricular ejection fraction and with signs of end-organ dysfunction in the setting of a low cardiac output. Inotropes can be used in patients with severe systolic heart failure awaiting heart transplant to maintain hemodynamic stability or as a bridge to decision. In cases where patients are unable to be weaned off inotropes, these agents can be used until a definite or escalated supportive therapy is planned, which can include coronary revascularization or mechanical circulatory support (intra-aortic balloon pump, extracorporeal membrane oxygenation, impella, left ventricular assist device, etc.). Use of inotropic drugs is associated with risks and adverse events. This review will discuss the use of the inotropes digoxin, dopamine, dobutamine, norepinephrine, milrinone, levosimendan, and omecamtiv mecarbil. Long-term inotropic therapy should be offered in selected patients. A detailed conversation with the patient and family shall be held, including a discussion on the risks and benefits of use of inotropes. Chronic heart failure patients awaiting heart transplants are candidates for intravenous inotropic support until the donor heart becomes available. This helps to maintain hemodynamic stability and keep the fluid status and pulmonary pressures optimized prior to the surgery. On the other hand, in patients with severe heart failure who are not candidates for advanced heart failure therapies, such as transplant and mechanical circulatory support, inotropic agents can be used for palliative therapy. Inotropes can help reduce frequency of hospitalizations and improve symptoms in these patients.

  3. Saccharomyces cerevisiae colonization associated with fecal microbiota treatment failure

    Science.gov (United States)

    Background: Fecal microbiota therapy (FMT) has emerged as the gold standard for treatment of persistent, symptomatic Clostridium difficile infection (CDI) that does not respond to conventional antimicrobial treatment. Probiotics are commonly recommended in addition to antimicrobial treatment for CD...

  4. Metronomic capecitabine as second-line treatment in hepatocellular carcinoma after sorafenib failure.

    Science.gov (United States)

    Granito, Alessandro; Marinelli, Sara; Terzi, Eleonora; Piscaglia, Fabio; Renzulli, Matteo; Venerandi, Laura; Benevento, Francesca; Bolondi, Luigi

    2015-06-01

    No standard second-line treatments are available for hepatocellular carcinoma patients who fail sorafenib therapy. We assessed the safety and efficacy of metronomic capecitabine after first-line sorafenib failure. Retrospective analysis of consecutive hepatocellular carcinoma patients receiving metronomic capecitabine between January 2012 and November 2014. The primary end-point was safety, secondary end-point was efficacy, including time-to-progression and overall survival. Twenty-six patients (80% Child-Pugh A, 80% Barcelona Clinic Liver Cancer stage C) received metronomic capecitabine (500 mg/bid). Median treatment duration was 3.2 months (range 0.6-31). Fourteen (53%) patients experienced at least one adverse event. The most frequent drug-related adverse events were bilirubin elevation (23%), fatigue (15%), anaemia (11%), lymphoedema (11%), and hand-foot syndrome (7.6%). Treatment was interrupted in 19 (73%) for disease progression, in 4 (15%) for liver deterioration, and in 1 (3.8%) for adverse event. Disease control was achieved in 6 (23%) patients. Median time-to-progression was 4 months (95% confidence interval 3.2-4.7). Median overall survival was 8 months (95% confidence interval 3.7-12.3). Metronomic capecitabine was well tolerated in hepatocellular carcinoma patients who had been treated with sorafenib. Preliminary data show potential anti-tumour activity with long-lasting disease control in a subgroup of patients that warrants further evaluation in a phase III study. Copyright © 2015 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  5. Therapeutic potential of functional selectivity in the treatment of heart failure

    DEFF Research Database (Denmark)

    Christensen, Gitte Lund; Aplin, Mark; Hansen, Jakob Lerche

    2010-01-01

    Adrenergic and angiotensin receptors are prominent targets in pharmacological alleviation of cardiac remodeling and heart failure, but their use is associated with cardiodepressant side effects. Recent advances in our understanding of seven transmembrane receptor signaling show that it is possible...... pursued as next-generation drugs for superior treatment of heart failure....

  6. Risk factors of acute hepatic failure during antituberculosis treatment : two cases and literature review

    NARCIS (Netherlands)

    Smink, F.; van Hoek, B.; Ringers, J.; van Altena, R.; Arend, S. M.

    2006-01-01

    Hepatotoxicity is a well-known side effect of antituberculosis treatment (ATT). If not recognised in time, drug-induced hepatitis can develop, which may rapidly progress to acute liver failure. We describe two patients with acute hepatic failure caused by ATT, whose pretreatment liver function had

  7. Treatment of addison disease and subsequent hypophosphatemic respiratory failure.

    Science.gov (United States)

    Meisterling, Leah; Chawla, Lakhmir S; Seneff, Michael G

    2012-01-01

    A 38-year-old man was found unresponsive with hypoglycemia by emergency medical service (EMS) personnel. He was intubated in the emergency department after reports of seizure activity. With supportive care and empiric steroids, the patient was extubated the next day. He reported a diagnosis of Addison disease and noncompliance with his steroid replacement therapy. Within 12 hours, respiratory failure and altered mental status required reintubation. Laboratory studies revealed rhabdomyolysis and hypophosphatemia. The replacement of glucose likely stimulated glycolysis, formation of phosphorylated glucose compounds, and an intracellular shift of phosphorus. This patient required phosphate replacement and was extubated on hospital day 5. We report a unique case of hypoglycemia due to Addison disease, leading to hypophosphatemic respiratory failure.

  8. Future implications: Compliance and failure with antiretroviral treatment

    Directory of Open Access Journals (Sweden)

    Patel Atul

    2006-01-01

    Full Text Available HIV management is currently in an era of effective, potent antiretroviral therapy. Modern drug discovery and development have transformed HIV-1 disease into a treatable, chronic infectious disease. Complete suppression of viral replication is critical for long-term durability of antiretroviral therapy. Partial suppression, even at very low levels, is likely to lead to virologic failure and ultimately to the appearance of drug resistance. The relationship between adherence and resistance to HIV antiretroviral therapy is more complex than to state ′non-adherence increases the risk of drug resistance.′ In many patients who fail to respond to initial therapy, the primary reason for failure is their inability to take the prescribed drug regimen or nonadherence.

  9. A combined screening platform for HIV treatment failure and resistance.

    Directory of Open Access Journals (Sweden)

    Myres W Tilghman

    Full Text Available To develop a low cost method to screen for virologic failure of antiretroviral therapy (ART and HIV-1 drug resistance, we performed a retrospective evaluation of a screening assay using serial dilutions of HIV-1 RNA-spiked blood plasma and samples from patients receiving >6 months of first-line ART.Serial dilution testing was used to assess sensitivity of a simple PCR-based assay (targeted at ≥1,000 HIV RNA copies/mL. We created blood plasma minipools of five samples, extracted HIV RNA from the pools, PCR amplified the reverse transcriptase (RT coding region of the HIV-1 pol gene from extracted RNA, sequenced PCR product of positive pools, and used sequences to determine drug resistance. Sensitivity, specificity, and predictive values were determined for different levels of virologic failure based on maximum viral loads of individual samples within a pool.Of 295 samples analyzed, 43 (15% had virologic failure at ≥50 copies/mL (range 50-10,500 copies/mL, four at ≥1,000 copies/mL. The assay demonstrated 100% sensitivity to detect virus from these four samples, requiring only one round of PCR, and 56% and 89% sensitivity to detect samples with ≥50 and ≥500 copies/mL using two rounds. Amplified PCR products of all positive pools were successfully sequenced and 30% harbored ≥1 major resistance mutation. This method would have cost 10% of the combined costs of individual viral load and resistance testing.We present a novel method that can screen for both virologic failure of first-line ART and drug resistance. The method is much less expensive than current methods, which may offer sustainability in resource-limited settings.

  10. A combined screening platform for HIV treatment failure and resistance.

    Science.gov (United States)

    Tilghman, Myres W; May, Susanne; Pérez-Santiago, Josué; Ignacio, Caroline C; Little, Susan J; Richman, Douglas D; Smith, Davey M

    2012-01-01

    To develop a low cost method to screen for virologic failure of antiretroviral therapy (ART) and HIV-1 drug resistance, we performed a retrospective evaluation of a screening assay using serial dilutions of HIV-1 RNA-spiked blood plasma and samples from patients receiving >6 months of first-line ART. Serial dilution testing was used to assess sensitivity of a simple PCR-based assay (targeted at ≥1,000 HIV RNA copies/mL). We created blood plasma minipools of five samples, extracted HIV RNA from the pools, PCR amplified the reverse transcriptase (RT) coding region of the HIV-1 pol gene from extracted RNA, sequenced PCR product of positive pools, and used sequences to determine drug resistance. Sensitivity, specificity, and predictive values were determined for different levels of virologic failure based on maximum viral loads of individual samples within a pool. Of 295 samples analyzed, 43 (15%) had virologic failure at ≥50 copies/mL (range 50-10,500 copies/mL, four at ≥1,000 copies/mL). The assay demonstrated 100% sensitivity to detect virus from these four samples, requiring only one round of PCR, and 56% and 89% sensitivity to detect samples with ≥50 and ≥500 copies/mL using two rounds. Amplified PCR products of all positive pools were successfully sequenced and 30% harbored ≥1 major resistance mutation. This method would have cost 10% of the combined costs of individual viral load and resistance testing. We present a novel method that can screen for both virologic failure of first-line ART and drug resistance. The method is much less expensive than current methods, which may offer sustainability in resource-limited settings.

  11. Treatment of acute renal failure due to myeloma kidney.

    OpenAIRE

    Bear, R. A.; Cole, E H; Lang, A; Johnson, M.

    1980-01-01

    Severe renal insufficiency is considered to indicate a poor prognosis in patients with multiple myeloma, their reported median survival being approximately 2 months. In five consecutive patients with severe renal failure secondary to acute myeloma kidney early aggressive therapy, including chemotherapy and peritoneal dialysis, led to a significant improvement in the renal function of four; the fifth patient received a cadaveric renal transplant after 1 year of peritoneal dialysis. After a med...

  12. Characterization and treatment of persistent hepatocellular secretory failure.

    Science.gov (United States)

    van Dijk, Remco; Kremer, Andreas E; Smit, Wouter; van den Elzen, Bram; van Gulik, Thomas; Gouma, Dirk; Lameris, Johan S; Bikker, Hennie; Enemuo, Valentine; Stokkers, Pieter C F; Feist, Mark; Bosma, Piter; Jansen, Peter L M; Beuers, Ulrich

    2015-04-01

    Hepatocellular secretory failure induced by drugs, toxins or transient biliary obstruction may sometimes persist for months after removal of the initiating factor and may then be fatal without liver transplantation. We characterized patients with severe persistent hepatocellular secretory failure (PHSF) and treated them with the pregnane X receptor (PXR) agonist, rifampicin. We also studied the effect of rifampicin on PXR-dependent expression of genes involved in biotransformation and secretion in vitro. Thirteen patients (age 18-81 years, 6 male) with hepatocellular secretory failure that persisted after removal of the inducing factor (drugs/toxin: 9) or biliary obstruction (4) were identified over 6 years. Six of these patients were screened for ATP8B1 or ABCB11 mutations. All were treated with rifampicin (300 mg daily) for 1-10 weeks. Expression of genes involved in biotransformation and secretion was determined by rtPCR in human hepatocytes and intestinal cells incubated with rifampicin (10 μmol/L). Serum bilirubin of patients with PHSF ranged from 264 to 755 μmol/L. Normal γGT was found in 10/13 patients of whom 3/6 tested positive for ATP8B1/ABCB11 mutations. Serum bilirubin declined to hepatocellular secretory failure may develop in carriers of transporter gene mutations. In severe cases, rifampicin may represent an effective therapeutic option of PHSF. PXR-dependent induction of CYP3A4, UGT1A1, MRP2 and OSTβ could contribute to the anticholestatic effect of rifampicin in PHSF. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  13. Newer treatments for decompensated heart failure: focus on levosimendan

    Directory of Open Access Journals (Sweden)

    Ferenc Follath

    2009-03-01

    Full Text Available Ferenc FollathUniversity Hospital Zürich, Steering Group Drug Therapy, Zürich, SwitzerlandAbstract: Acute heart failure (AHF is a major cause of hospitalizations. Severe dyspnea, pulmonary congestion and low cardiac output with peripheral vasoconstriction and renal hypoperfusion is a main form of clinical presentation. Most patients with acute worsening have a pre-existing decompensated chronic heart failure (ADCHF, but AHF may also occur as a first manifestation of a previously unknown heart disease. Myocardial ischemia, cardiac arrhythmias, non-compliance with medication and infections are frequent precipitating factors. Management of AHF depends on the underlying heart disease and cause of decompensation. In patients with ADCHF vasodilators and iv diuretics are first-line drugs for rapid reduction of dyspnea and congestion. In patients with signs of low cardiac output and oliguria, inotropic agents are also often administered to prevent further deterioration. Beta-adrenergic agents and phosphodiesterase inhibitors correct the hemodynamic disturbance, but may also induce arrhythmias and worsen myocardial ischemia. Inotropic therapy therefore remains controversial. A novel class of drugs, the calcium sensitizers, represent a new therapeutic option. Levosimendan was shown to improve myocardial contractility without increasing oxygen requirements and to produce peripheral and coronary vasodilation. Its therapeutic effects and tolerance have been tested in several trials. The present review focuses on the clinical pharmacology and therapeutic utility of levosimendan in patients with ADCHF.Keywords: acute heart failure, inotropic agents, calcium sensitizers, levosimendan

  14. Treatment of chronic heart failure with slow release phentolamine.

    Science.gov (United States)

    Georgopoulos, A J; Valasidis, A; Siourthas, D

    1978-07-30

    Oral medication with phentolamine SR produced subjective and objective improvement in all 45 patients with refractory chronic heart failure of various aetiologies, who were already receiving digitalis and diuretics. This was shown by an increase in pulse-pressure amplitude and urine volume, a decrease in bodyweight and marked reduction in cardiac size and pulmonary congestion, the latter changes being more pronounced in patients with arteriosclerotic heart disease (ASHD). Exercise tolerance tests in a further 34 patients with less severe chronic heart failure demonstrated that phentolamine SR markedly increased physical capacity. This effect was more pronounced in patients with slightly compromised cardiac status (functional Class 2, NYHA) than in those with moderately compromised cardiac status (Class 3). The improvement in clinical condition was attributed mainly to arterial and venous dilatation, as well as to the positive inotropic effect of the drug. The most important side-effects were diarrhoea and, in the patients with ASHD, increased attacks of angina pectoris; The side-effects were well controlled by the anticholinergic agent oxyphenonium bromide (Antrenyl) and a slight increase in the dose of nitrates. It is concluded that oral phentolamine SR may be a valuable therapeutic adjunct in the management of patients with refractory chronic heart failure.

  15. Pharmacologic and nonpharmacologic treatment of ventricular arrhythmias in heart failure.

    Science.gov (United States)

    Stevenson, W G; Sweeney, M O

    1997-05-01

    Ventricular arrhythmias are common in patients with heart failure. The risk and benefits of antiarrhythmic therapies continue to be defined. Class I antiarrhythmic drugs should be avoided due to proarrhythmic and negative inotropic effects that may be responsible for increased mortality in some trials. For patients resuscitated from sustained ventricular tachycardia or ventricular fibrillation, amiodarone or an implantable cardioverter-defibrillator should be considered. Implantable cardioverter-defibrillators markedly reduce sudden death in ventricular tachycardia and ventricular fibrillation survivors, but in advanced heart failure, this may not markedly extend survival. Catheter or surgical ablation can be considered for selected patients with bundle branch reentry ventricular tachycardia or difficult to control monomorphic ventricular tachycardia. For patients who have not had sustained ventricular tachycardia or ventricular fibrillation antiarrhythmic therapy should generally be avoided, but may benefit some high risk patients. Amiodarone may be beneficial in patients with advanced heart failure and rapid resting heart rates. Implantable cardioverter-defibrillators may improve survival in selected patients with depressed ventricular function after myocardial infarction, who also have nonsustained and inducible ventricular tachycardia.

  16. Predictors of Successful Noninvasive Ventilation Treatment for Patients Suffering Acute Respiratory Failure

    Directory of Open Access Journals (Sweden)

    Ming-Shian Lin

    2008-08-01

    Conclusion: APACHE II scores recorded prior to NIV treatment, PImax30, R30, RR60, as well as improvements to RR during the first 30 minutes of NIV treatment and to PEmax during the first 60 minutes of NIV treatment were predictors of successful NIV treatment for patients suffering from acute respiratory failure. Such parameters may be helpful in selecting patients to receive NIV treatment and also for deciding when early termination of the treatment is appropriate.

  17. Risk factors of cellulitis treatment failure with once-daily intravenous cefazolin plus oral probenecid.

    Science.gov (United States)

    Bader, Mazen S; Twells, Laurie; Hawboldt, John

    2011-12-01

    Once-daily intravenous cefazolin with probenecid is used commonly to treat cellulitis. The primary objective of this study was to determine the risk factors of treatment failure with this regimen. This was a retrospective cohort study of adult outpatients with cellulitis who were initially treated with once-daily intravenous cefazolin plus probenecid. Treatment failure is defined as inadequate improvement that necessitates either hospital admission or a change in antibiotic therapy to a different intravenous regimen. A stepwise logistic regression analysis was performed to determine the risk factors for regimen failure. From January 2003 to December 2008, 159 patients with cellulitis were initially treated with once daily intravenous cefazolin plus probenecid. Thirty-five (22%) patients had treatment failure. The treatment for 53% (9/17) of the patients with a history of chronic venous disease (CVD) failed, whereas the treatment for 18% (26/142) of patients without CVD failed (P = 0.001). Multivariate analysis identified the presence of CVD as the only risk factor associated with treatment failure (odds ratio 4.4, 95% confidence interval 1.5-13; P = .007). Patients with cellulitis and CVD who are being treated with once-daily intravenous cefazolin plus probenecid should be monitored closely for treatment failure.

  18. Balloon-Assisted Tracking Use Reduces Radial Artery Access Failure in an Experienced Radial Center and is Feasible During Primary PCI for STEMI.

    Science.gov (United States)

    Obaid, Daniel; Hailan, Ahmed; Chase, Alexander; Dorman, Stephen; Jenkins, Geraint; Raybould, Adrian; Ramsey, Mark; Thomas, Phillip; Smith, David; Ionescu, Adrian

    2017-07-01

    This prospective study assesses balloon-assisted tracking (BAT) in reducing radial access failure during percutaneous coronary intervention (PCI). Arterial spasm prevents PCI from the radial artery in a small percentage of cases. A total of 2223 consecutive patients undergoing PCI from the radial approach were analyzed. Radial access failure mode and requirement for crossover to femoral access during a 12-month run-in period were compared with the following 14-month period with routine BAT usage. During the 14-month study period, 1334 radial PCIs were attempted. Twenty-six patients switched to femoral at an early stage, while 76 encountered radial spasm and underwent successful BAT in 69 cases (91%), giving a total crossover rate to femoral of 33/1334 (2.5%). Utilizing BAT rather than a femoral puncture reduced our institution's radial-femoral crossover rate from 7.6% to 2.5% (P<.01), which is also significantly lower than the radial-femoral crossover rate in the 12 months before BAT implementation (6.1%; P<.01). Mean procedure times were similar for those requiring BAT compared with conventional radial access (51.3 ± 21.3 min vs 47.9 ± 23.7 min; P=.23), and those crossing straight to femoral (BAT not attempted) (60.7 ± 31.9 min; P=.10). Mean first device/balloon time for the BAT-assisted primary PCI cases (22.6 ± 9.4 min) was similar to cases that had radial difficulties and converted to femoral without attempting BAT (25.8 ± 13.4 min; P=.54). BAT allowed catheter passage despite radial spasm in 91% of cases, significantly reducing the institution's rate of femoral crossover. During radial spasm in primary PCI, using BAT did not delay reperfusion compared with femoral crossover.

  19. Antimicrobial treatment failures in patients with community-acquired pneumonia: causes and prognostic implications

    National Research Council Canada - National Science Library

    Arancibia, F; Ewig, S; Martinez, J A; Ruiz, M; Bauer, T; Marcos, M A; Mensa, J; Torres, A

    2000-01-01

    The aim of the study was to determine the causes and prognostic implications of antimicrobial treatment failures in patients with nonresponding and progressive life-threatening, community-acquired pneumonia...

  20. Fertility outcome of laparoscopic treatment in patients with severe endometriosis and repeated in vitro fertilization failures.

    Science.gov (United States)

    Soriano, David; Adler, Iris; Bouaziz, Jerome; Zolti, Matti; Eisenberg, Vered H; Goldenberg, Mordechai; Seidman, Daniel S; Elizur, Shai E

    2016-10-01

    To evaluate fertility outcomes in infertile women with severe endometriosis (The revised American Fertility Society classification [AFS] 3-4) and repeated IVF failures, who underwent surgery due to exacerbation of endometriosis-related symptoms. Retrospective cohort study. University hospital. All women who failed IVF treatment before surgery and who underwent laparoscopic surgery for severe endometriosis between January 2006 and December 2014. All patients were operated by highly skilled surgeons specializing in laparoscopic surgery for advanced endometriosis. Only patients with evidence of endometriosis in the pathology specimens were included in this study. Delivery rate after surgery. Seventy-eight women were included in the present study. All women were diagnosed with severe endometriosis during surgery (AFS 3-4) and all women had experienced failed IVF treatments before surgery. All women were symptomatic before their surgery. After surgical treatment 33 women (42.3%) delivered. Three women (9%) conceived spontaneously and all other women conceived after IVF treatment. Women who delivered were younger (32.5 [±4.1] years vs. 35.5 [±3.8] years), were less often diagnosed with diminished ovarian reserve before surgery (6% vs. 28.8%), and were more often diagnosed with normal uterine anatomy (by preoperative transvaginal ultrasound and during operation). In addition, performing salpingectomy during surgery was associated with a trend of improvement in delivery rates after surgery (70% in women who delivered vs. 51% in women who failed to deliver). Symptomatic women with severe endometriosis and repeated IVF implantation failures may benefit from extensive laparoscopic surgery when performed by an experienced multidisciplinary surgical team to improve IVF outcome. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  1. Efficacy and safety of etravirine in treatment-experienced, HIV-1 patients: pooled 48 week analysis of two randomized, controlled trials

    NARCIS (Netherlands)

    Katlama, Christine; Haubrich, Richard; Lalezari, Jacob; Lazzarin, Adriano; Madruga, José V.; Molina, Jean-Michel; Schechter, Mauro; Peeters, Monika; Picchio, Gaston; Vingerhoets, Johan; Woodfall, Brian; de Smedt, Goedele; Ariza, H. A.; Benetucci, J.; Cahn, P.; Calanni, L. M.; Cassetti, I.; Corral, J.; David, D. O.; Krolewiecki, A.; Losso, M. H.; Patterson, P.; Teijeiro, R. A.; Grinsztejn, B.; da Cunha, C. A.; Kallas, E. G.; Netto, E. M.; Pilotto, J. H.; Suleiman, J.; Timerman, A.; Ballesteros, J.; Northland, R.; Alvilés Montoya, A. A.; Herrera Martinez, G.; Solano Chinchilla, A.; Dupon, M.; Livrozet, J. M.; Morlat, P.; Pialoux, G.; Piketty, C.; Poizot-Martin, I.; Andrade-Villanueva, J.; Reyes-Terán, G.; Sierra-Madero, J.; Canton, A.; Rodriguez, A.; Sosa, N.; Morales Ramirez, J. O.; Santana Bagur, J. L.; Soto-Malave, R.; Anekthananon, T.; Mootsikapun, P.; Ruxrungtham, K.; Albrecht, M.; Bellos, N.; Bolan, R.; Brachman, P.; Brinson, C.; Cruickshank, F.; Elion, R.; Fessel, W. J.; Hawkins, T.; Hodder, S.; Hutcherson, P.; Jefferson, T.; Katner, H.; Kinder, C.; Kozal, M.; Leider, J.; Mills, T.; McDonough, D.; Mounzer, K.; Nadler, J.; Norris, D.; O'Brien, W.; Pierone, G.; Raben, K.; Rashbaum, B.; Rawlings, M.; Rodwick, B.; Ruane, P.; Sampson, J.; Schrader, S.; Scribner, A.; Sension, M.; Sweet, D.; Wade, B.; Wheeler, D.; Wilkin, A.; Wills, T.; Wohlfeiler, M.; Workowski, K.; Chuah, J.; Cooper, D.; Eu, B.; Hoy, J.; Workman, C.; Clumeck, N.; Colebunders, R.; Moutschen, M.; Gill, J.; Gough, K.; Junod, P.; Kilby, D.; Montaner, J.; Rachlis, A.; Trottier, B.; Tsoukas, C. M.; Walmsley, S. L.; Arvieux, C.; Cotte, L.; Delfraissy, J. F.; Girard, P. M.; Marchou, B.; Vittecoq, D.; Yazdanpanah, Y.; Yeni, P.; Arastéh, K.; Esser, S.; Fätkenheuer, G.; Gellermann, H.; Göbels, K.; Goebel, F. D.; Jäger, H.; Moll, A.; Rockstroh, J. K.; Schuster, D.; Staszewski, S.; Stoehr, A.; Antinori, A.; Carosi, G.; Di Perri, G.; Esposito, R.; Mazzotta, F.; Pagano, G.; Raise, E.; Rusconi, S.; Sighinolfi, L.; Suter, F.; Frissen, P. H. J.; Prins, J. M.; Rijnders, B. J. A.; Horban, A.; Antunes, F.; Miranda, M.; Vera, J.; Clotet, B.; Domingo, P.; Garcia, G.; Gatell, J. M.; González-Lahoz, J.; López-Aldeguer, J.; Podzamczer, D.; Easterbrook, P.; Fisher, M.; Johnson, M.; Orkin, C.; Wilkins, E.; Barnett, B.; Baxter, J.; Beatty, G.; Berger, D.; Borkert, C.; Campell, T.; Cohen, C.; Conant, M.; Ernst, J.; Farthing, C.; File, T.; Frank, M.; Gallant, J. E.; Greenberg, R. N.; Hicks, C.; Jayaweera, D. T.; Kerkar, S.; Markowitz, N.; Martorell, C.; McDonald, C.; McMahon, D.; Mogyoros, M.; Myers, R. A.; Richmond, G.; Sathasivam, K.; Schneider, S.; Schrager, H.; Shalit, P.; Siegal, F. P.; Sloan, L.; Smith, K.; Smith, S.; Tebas, P.; Tkatch, L. S.; Towner, W.

    2009-01-01

    OBJECTIVE: To evaluate the efficacy, safety and virologic resistance profile of etravirine (TMC125), a next-generation nonnucleoside reverse transcriptase inhibitor, over 48 weeks in treatment-experienced adults infected with HIV-1 strains resistant to a nonnucleoside reverse transcriptase inhibitor

  2. Delineating sites of failure following post-prostatectomy radiation treatment using (68)Ga-PSMA-PET.

    Science.gov (United States)

    Byrne, Keelan; Eade, Thomas; Kneebone, Andrew; Guo, Linxin; Hsiao, Ed; Schembri, Geoff; Kwong, Carolyn; Hunter, Julia; Emmett, Louise; Hruby, George

    2017-11-10

    To identify sites of failure with (68)Ga-PSMA-PET (PSMA-PET) imaging in patients who have Biochemical Failure (BF) following post-prostatectomy radiotherapy. Between June 2006 and January 2016, 409 men received post prostatectomy intensity modulated radiation treatment (IMRT) with protocolised planning. 310 patients received radiation treatment (RT) to the Prostate Fossa (PF) alone and 99 patients received RT to PF and pelvic lymphatics (PF + LN) usually in combination with androgen deprivation (AD) therapy. Any failure not detected on conventional imaging was delineated with PSMA-PET scanning. Sites of failure were characterised as in-field (PF ± LN), or out of field (nodal alone, distant metastatic alone (visceral or bone) or multi-site failure). Nodal failure was further divided into pelvic failure and/or distant failure. 119 men developed BF, defined as a PSA rise of >0.2 or greater, above post-RT nadir. Freedom from BF was 71% in the PF group and 70% in the PF + LN group, with median follow up of 52 and 44 months respectively. AD was used concomitantly in 13% of the PF group and 92% of the PF + LN group. 81 patients with BF (68%) had PSMA-PET imaging performed as per study intent, 67 (80%) of whom had PSMA avid disease identified. PSMA-PET delineated in-field failure occurred in 2/50 (4%) of the PF group and 1/17 (6%) in the PF + LN group. Nodal failure alone was 33/50 (66%) for the PF group vs 7/17 (41%) for the PF + LN group. For the nodal only failure patients, 18/33 (55%) had pelvic-only nodal failure in the PF group compared to 1/7 (14%) in the PF + LN group (p = 0.03). 16 (32%) of the PSMA avid failures in the PF group would have been encompassed by standard pelvic lymphatic radiotherapy volumes. Post-prostatectomy radiation treatment resulted in excellent in-field control rates. Isolated pelvic nodal failure was rare in those receiving radiotherapy to the prostatic fossa and pelvic nodes but accounted for one third of

  3. Heart Failure: Pathophysiology, Diagnosis, Medical Treatment Guidelines, and Nursing Management.

    Science.gov (United States)

    Rogers, Chad; Bush, Nathania

    2015-12-01

    Heart failure (HF) is a debilitating chronic disease and is expected to increase in upcoming years due to demographic changes. Nurses in all settings have an essential role in supporting patients in managing this disease. This article describes the pathophysiology of HF, diagnosis, medical management, and nursing interventions. It is crucial for nurses to understand the pathophysiology of HF and the importance that nursing actions have on enhancing medical management to alleviate symptoms and to deter the advancement of the pathophysiologic state. Such an understanding can ultimately reduce morbidity and mortality and optimize quality of life in patients with HF. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. Racial/Ethnic Differences in Contemporaneous Use of Mental Health and Substance Use Treatment Among Individuals Experiencing Both Mental Illness and Substance Use Disorders.

    Science.gov (United States)

    Nam, Eunji; Matejkowski, Jason; Lee, Sungkyu

    2017-03-01

    This study examined whether the well-established racial/ethnic differences in mental health service utilization among individuals with mental illness are reflected in the treatment utilization patterns of individuals experiencing both mental illness and substance use disorders, particularly in regards to the use of contemporaneous mental health and substance abuse treatment. Using pooled data from the National Survey on Drug Use and Health (2009-2013), the patterns of mental health and substance use treatment utilization of 8748 White, Black, or Latino individuals experiencing both mental illness and substance use disorders were analyzed. Multinomial logistic regression was conducted to test the relationships among racial/ethnic groups and the receipt of contemporaneous treatment, mental health treatment alone, and substance use treatment alone as compared with no treatment utilization. Results indicated that Black and Latino respondents were less likely to receive contemporaneous treatment than Whites respondents. Also, significantly associated with outcomes were several interactions between race/ethnicity and predisposing, need and enabling factors known to be associated with service utilization. The findings suggest that an underlying mechanism of racial/ethnic differences among individuals with co-occurring mental illness and substance use disorders in the treatment utilization may differ by the specific types of treatment and between Blacks and Latinos. Therefore, efforts to reduce these disparities should consider specialty in each treatment settings and heterogeneity within diverse racial/ethnic groups.

  5. Levosimendan as a treatment for acute renal failure associated with cardiogenic shock after hip fracture.

    Science.gov (United States)

    Hinojosa, Fabiola Quinteros; Revelo, Margarita; Salazar, Alexander; Maggi, Genaro; Schiraldi, Renato; Brogly, Nicolas; Gilsanz, Fernando

    Inotropic drugs are part of the treatment of heart failure; however, inotropic treatment has been largely debated due to the increased incidence of adverse effects and increased mortality. Recently levosimendan, an inotropic positive agent, has been proved to be effective in acute heart failure, reducing the mortality and improving cardiac and renal performance. We report the case of a 75-year-old woman with history of heart and renal failure and hip fracture. Levosimendan was used in preoperative preparation as an adjuvant therapy, to improve cardiac and renal function and to allow surgery. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  6. Serum microRNA expression patterns that predict early treatment failure in prostate cancer patients

    Science.gov (United States)

    Singh, Prashant K.; Preus, Leah; Hu, Qiang; Yan, Li; Long, Mark D.; Morrison, Carl D.; Nesline, Mary; Johnson, Candace S.; Koochekpour, Shahriar; Kohli, Manish; Liu, Song; Trump, Donald L.

    2014-01-01

    We aimed to identify microRNA (miRNA) expression patterns in the serum of prostate cancer (CaP) patients that predict the risk of early treatment failure following radical prostatectomy (RP). Microarray and Q-RT-PCR analyses identified 43 miRNAs as differentiating disease stages within 14 prostate cell lines and reflectedpublically available patient data. 34 of these miRNA were detectable in the serum of CaP patients. Association with time to biochemical progression was examined in a cohort of CaP patients following RP. A greater than two-fold increase in hazard of biochemical progression associated with altered expression of miR-103, miR-125b and miR-222 (p <.0008) in the serum of CaP patients. Prediction models based on penalized regression analyses showed that the levels of the miRNAs and PSA together were better at detecting false positives than models without miRNAs, for similar level of sensitivity. Analyses of publically available data revealed significant and reciprocal relationships between changes in CpG methylation and miRNA expression patterns suggesting a role for CpG methylation to regulate miRNA. Exploratory validation supported roles for miR-222 and miR-125b to predict progression risk in CaP. The current study established that expression patterns of serum-detectable miRNAs taken at the time of RP are prognostic for men who are at risk of experiencing subsequent early biochemical progression. These non-invasive approaches could be used to augment treatment decisions. PMID:24583788

  7. Treatment of heart failure with decreased left ventricular ejection fraction.

    Science.gov (United States)

    Aronow, Wilbert S

    2006-01-01

    Class I recommendations for treating patients with current or prior symptoms of heart failure with reduced left ventricular ejection fraction (LVEF) include using diuretics and salt restriction in individuals with fluid retention. Use angiotensin-converting enzyme (ACE) inhibitors, beta blockers, and angiotensin II receptor blockers if intolerant to ACE inhibitors because of cough or angioneurotic edema. Nonsteroidal anti-inflammatory drugs, most antiarrhythmic drugs, and calcium channel blockers should be avoided or withdrawn. Exercise training is recommended. Implant cardioverter-defibrillator (ICD) is recommended in individuals with a history of cardiac arrest, ventricular fibrillation, or hemodynamically unstable ventricular tachycardia. ICD is indicated in patients with ischemic heart disease for at least 40 d post-myocardial infarction or nonischemic cardiomyopathy, an LVEF of 30% or less, New York Heart Association (NYHA) class II or III symptoms on optimal medical therapy, and an expectation of survival of at least 1 yr. Cardiac resynchronization therapy should be used in individuals with an LVEF of 35% or below, NYHA class III or IV symptoms despite optimal therapy, and a QRS duration greater than 120 ms. An aldosterone antagonist can be added in selected patients with moderately severe to severe symptoms of heart failure who can be carefully monitored for renal function and potassium concentration (serum creatinine should be

  8. Characteristics of peripheral blood NK and NKT-like cells in euthyroid and subclinical hypothyroid women with thyroid autoimmunity experiencing reproductive failure.

    Science.gov (United States)

    Miko, Eva; Meggyes, Matyas; Doba, Katalin; Farkas, Nelli; Bogar, Barbara; Barakonyi, Aliz; Szereday, Laszlo; Szekeres-Bartho, Julia; Mezosi, Emese

    2017-11-01

    Thyroid autoimmunity (TAI) appears to play a crucial role in female infertility, recurrent pregnancy loss and IVF failure. Thyroid autoantibodies against thyroid peroxidase and thyroglobulin have been shown to represent an independent risk factor for infertility and miscarriage. Moreover, thyroxin hormone administration reduces the risk of obstetrical complications in TAI positive women. The aim of our present study was to investigate the immunological background of female infertility and recurrent pregnancy loss in euthyroid and subclinical hypothyroid women with TAI focusing on innate immunity. Phenotypic and functional analysis was carried out on peripheral blood mononuclear cells from healthy donors and TAI patients by flow cytometry. Our findings show Th1 oriented changes of innate immunity in the peripheral blood of women suffering from thyroid autoimmunity. Elevated NK and NKT-like cells ratios and enhanced natural cytotoxicity of TAI positive women reveal an altered immune status with possible negative impact on pregnancy outcome. It is important to notice that immune alterations are already established in the euthyroid phase of autoimmune thyroiditis before endocrine dysfunction develops and only the presence of thyroid autoantibodies indicate TAI condition. For this reason, screening of healthy women of reproductive age for the presence of thyroid autoantibodies would be beneficial not only from the endocrinological aspect but from the reproductive point of view since, although yet unexplained, thyroid hormone administration may improve pregnancy outcome. Copyright © 2017 Elsevier B.V. All rights reserved.

  9. Week 48 results of a Phase IV trial of etravirine with antiretrovirals other than darunavir/ritonavir in HIV-1-infected treatment-experienced adults

    Directory of Open Access Journals (Sweden)

    Eduardo Arathoon

    2014-11-01

    Full Text Available Introduction: In DUET, etravirine (ETR 200 mg bid had durable efficacy and a favourable safety profile versus placebo, both arms with an optimised background regimen (BR including darunavir/ritonavir (DRV/r. TMC125IFD3002 (VIOLIN; NCT01422330 investigated ETR plus ARVs other than DRV/r. Materials and Methods: This was a 48 week, Phase IV, open-label, single-arm, multicentre study. HIV-1-infected treatment-experienced adult patients on=8 weeks ARV therapy prior to screening, switching either for virologic failure (VF (viral load [VL] =500 c/mL or regimen simplification/AEs (RS/AE (VL<50 c/mL, received active ETR 200 mg bid with an investigator-selected BR of =1 active ARVs, but excluding DRV/r or NRTIs only. The primary objective was to evaluate safety, tolerability and pharmacokinetics (PK. Results: Of 211 treated patients, 55% were female, 61% black/African American. 155 patients (73% had baseline (BL VL=50 c/mL versus 56 (27% with BL VL<50 c/mL. Between these two latter subgroups, median BL VL was 4.42 versus 1.28 log10 c/mL and CD4+ count 238 versus 410.5 cells/mm3. Overall, 96% previously used <2 NNRTIs and 99% used=5 PIs; median number of BL NNRTI RAMs was 2, PI RAMs 5 and NRTI RAMs 1. Overall, most common BR ARVs were PIs (83%, mostly lopinavir/r (62% and mostly used alone (20% or with 1 or 2 NRTIs (61%. Raltegravir was used in 9% of patients. Most frequent AEs (any cause/grade were diarrhoea (17% and URTI (8%. Incidence of grade 3–4 AEs was 13%, serious AEs 5% (no rashes; none ETR related, AEs leading to discontinuation 4%, AEs possibly related to ETR 23% and AEs of interest: rash (any type 4%, hepatic 6% and neuropsychiatric 3%. At week 48, VF and RS/AE virologic responses (% patients with VL<50 c/mL; FDA Snapshot were: 48% (74/155 and 75% (42/56, respectively. VF rates were 42% and 13%; 10% and 13% had no VL data in the week 48 window. The percentage of patients adherent to treatment (assessed based on PK sampling plus ETR pill count

  10. Hepatitis C viral evolution in genotype 1 treatment-naïve and treatment-experienced patients receiving telaprevir-based therapy in clinical trials.

    Directory of Open Access Journals (Sweden)

    Tara L Kieffer

    Full Text Available In patients with genotype 1 chronic hepatitis C infection, telaprevir (TVR in combination with peginterferon and ribavirin (PR significantly increased sustained virologic response (SVR rates compared with PR alone. However, genotypic changes could be observed in TVR-treated patients who did not achieve an SVR.Population sequence analysis of the NS3•4A region was performed in patients who did not achieve SVR with TVR-based treatment.Resistant variants were observed after treatment with a telaprevir-based regimen in 12% of treatment-naïve patients (ADVANCE; T12PR arm, 6% of prior relapsers, 24% of prior partial responders, and 51% of prior null responder patients (REALIZE, T12PR48 arms. NS3 protease variants V36M, R155K, and V36M+R155K emerged frequently in patients with genotype 1a and V36A, T54A, and A156S/T in patients with genotype 1b. Lower-level resistance to telaprevir was conferred by V36A/M, T54A/S, R155K/T, and A156S variants; and higher-level resistance to telaprevir was conferred by A156T and V36M+R155K variants. Virologic failure during telaprevir treatment was more common in patients with genotype 1a and in prior PR nonresponder patients and was associated with higher-level telaprevir-resistant variants. Relapse was usually associated with wild-type or lower-level resistant variants. After treatment, viral populations were wild-type with a median time of 10 months for genotype 1a and 3 weeks for genotype 1b patients.A consistent, subtype-dependent resistance profile was observed in patients who did not achieve an SVR with telaprevir-based treatment. The primary role of TVR is to inhibit wild-type virus and variants with lower-levels of resistance to telaprevir. The complementary role of PR is to clear any remaining telaprevir-resistant variants, especially higher-level telaprevir-resistant variants. Resistant variants are detectable in most patients who fail to achieve SVR, but their levels decline over time after treatment.

  11. Renal sympathetic denervation for treatment of patients with heart failure: summary of the available evidence.

    Science.gov (United States)

    Nammas, Wail; Koistinen, Juhani; Paana, Tuomas; Karjalainen, Pasi P

    2017-08-01

    Heart failure syndrome results from compensatory mechanisms that operate to restore - back to normal - the systemic perfusion pressure. Sympathetic overactivity plays a pivotal role in heart failure; norepinephrine contributes to maintenance of the systemic blood pressure and increasing preload. Cardiac norepinephrine spillover increases in patients with heart failure; norepinephrine exerts direct toxicity on cardiac myocytes resulting in a decrease of synthetic activity and/or viability. Importantly, cardiac norepinephrine spillover is a powerful predictor of mortality in patients with moderate to severe HF. This provided the rationale for trials that demonstrated survival benefit associated with the use of beta adrenergic blockers in heart failure with reduced ejection fraction. Nevertheless, the MOXCON trial demonstrated that rapid uptitration of moxonidine (inhibitor of central sympathetic outflow) in patients with heart failure was associated with excess mortality and morbidity, despite reduction of plasma norepinephrine. Interestingly, renal norepinephrine spillover was the only independent predictor of adverse outcome in patients with heart failure, in multivariable analysis. Recently, renal sympathetic denervation has emerged as a novel approach for control of blood pressure in patients with treatment-resistant hypertension. This article summarizes the available evidence for the effect of renal sympathetic denervation in the setting of heart failure. Key messages Experimental studies supported a beneficial effect of renal sympathetic denervation in heart failure with reduced ejection fraction. Clinical studies demonstrated improvement of symptoms, and left ventricular function. In heart failure and preserved ejection fraction, renal sympathetic denervation is associated with improvement of surrogate endpoints.

  12. Prehospital use of furosemide for the treatment of heart failure.

    Science.gov (United States)

    Pan, Andy; Stiell, Ian G; Dionne, Richard; Maloney, Justin

    2015-01-01

    The diagnosis and management of acute decompensated heart failure (HF) in the prehospital setting can be challenging. The objectives of this study are to evaluate the appropriateness of furosemide use by Emergency Medical Services (EMS) and its association with adverse outcomes. This study was a multi-centre health records review of EMS patients who received prehospital furosemide or had an emergency department (ED) diagnosis of HF. We included acutely ill patients ≥50 years of age with shortness of breath transported by land EMS. Univariate and logistic regression analyses were performed to determine associations between furosemide use and serious adverse outcomes (acute renal failure, intubation, vasopressors or death). The study population consisted of 330 patients (N=58, furosemide given by EMS but no HF diagnosed in ED; N=110, furosemide given, HF diagnosed; N=162, no furosemide given, HF diagnosed). The median dose of intravenous furosemide was 80 mg (range 20-80 mg). Serious adverse outcomes occurred in 61 patients (19.0%, 23.6% and 14.8% of the three groups, respectively; p=0.18). The adjusted ORs for adverse events with furosemide use was 0.62 (95% CI 0.33 to 1.43) in patients with a diagnosis of HF and 1.14 (95% CI 0.58 to 2.23) in those without. More than a third of patients who received prehospital furosemide did not have an HF diagnosis, suggesting that the prehospital diagnosis of HF can be challenging. Serious adverse outcomes were identified in all patient groups and we found no statistically significant associations between furosemide use and adverse events. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  13. Barriers in Access to the Treatment for People with Gambling Disorders. Are They Different from Those Experienced by People with Alcohol and/or Drug Dependence?

    Science.gov (United States)

    Dąbrowska, Katarzyna; Moskalewicz, Jacek; Wieczorek, Łukasz

    2017-06-01

    A prevalence of gambling disorders is diversified depending on the region of the world. Almost three quarters of pathological gamblers had never sought a professional treatment as well as an assistance in self-help groups. Reasons why they do not initiate a treatment are complex. The aim of the article is to compare barriers to the treatment for people with gambling disorders found in presented study and barriers to alcohol and drug treatment identified in the available literature. The semi structured interviews were applied and conducted with people with gambling disorders, social workers, therapists employed in the addiction treatment facilities, General Practitioners and psychiatrists. Selection of the respondents was based on purposive sampling. In total, 90 interviews were completed. Respondents identified individual barriers as well as structural ones. Individual barriers include internal resistance and a fear of the treatment. In turn structural barriers apply to the organization of the therapy, infrastructure, personnel, and the therapeutic program. A comparison of barriers experienced by people with gambling disorders and substance use disorders showed that they are largely similar, but people with gambling disorders also experience specific barriers. Empirical studies focused specifically on treatment needs of people experiencing gambling disorders may improve an offer of help for them. More adequate treatment options could contribute to the increasing in the number of people who start the treatment. It can result in improving their quality of life and may have positive impact on public health.

  14. Written information material and availability of sexual health care for men experiencing sexual dysfunction after prostate cancer treatment: An evaluation of Dutch urology and radiotherapy departments.

    Science.gov (United States)

    Grondhuis Palacios, L A; Krouwel, E M; Duijn, M; den Oudsten, B L; den Ouden, M E M; Putter, H; Pelger, R C M; Elzevier, H W

    2017-03-01

    Objective was to investigate content of written information material and availability of sexual health care for men experiencing sexual dysfunction (SD) after prostate cancer treatment. A cross-sectional survey was conducted among Dutch urology and radiotherapy departments to evaluate information materials and availability of sexual health care. Out of 71 eligible departments, 34 urology and 15 radiotherapy departments participated in the survey (response rate 69.0%). Fifty-nine brochures corresponding to 31 urology and 11 radiotherapy departments were analysed. In 88.1% of collected information material, sexual health was mentioned. Regarding extensiveness, 20.4% of the brochures contained extensive information, 50.8% moderate amount of information and 28.8% contained little or no information. Urology departments provided pre-treatment nurse consultations more often than radiotherapy departments. Sexual counselling was more frequently provided by urology departments. Urology departments were more aware of adequate referral possibilities. Information material provided by Dutch urology and radiotherapy departments does not address treatment-related SD routinely. Sexual health care is not available everywhere for men experiencing SD. Applying a standard regarding content of sexual health in information material is recommended as well as improved awareness of referral possibilities and enhanced provision of pre-treatment nurse consultations for men experiencing SD after prostate cancer treatment. © 2016 John Wiley & Sons Ltd.

  15. High rate of failure in treatment of imported schistosomiasis

    DEFF Research Database (Denmark)

    Helleberg, Marie; Thybo, Sören

    2011-01-01

    There is an increasing number of imported cases of schistosomiasis in Europe, but there are only few studies on the efficacy of praziquantel for the treatment of schistosomiasis in non-endemic settings.......There is an increasing number of imported cases of schistosomiasis in Europe, but there are only few studies on the efficacy of praziquantel for the treatment of schistosomiasis in non-endemic settings....

  16. Endoscopic lung volume reduction coil treatment in patients with chronic hypercapnic respiratory failure: an observational study.

    Science.gov (United States)

    Simon, Marcel; Harbaum, Lars; Oqueka, Tim; Kluge, Stefan; Klose, Hans

    2017-01-01

    Endoscopic lung volume reduction coil (LVRC) treatment is an option for selected patients with severe emphysema. In the advanced stages, emphysema leads to respiratory failure: hypoxemia and eventually chronic hypercapnic respiratory failure. It can be hypothesized that LVRC treatment, a procedure targeting hyperinflation and thereby reducing ventilatory workload, may be especially beneficial in patients with chronic hypercapnic respiratory failure. This study was conducted to gain first insights into the effects and the safety of LVRC treatment in patients with emphysema and chronic hypercapnic respiratory failure. A retrospective observational study conducted in the Department of Respiratory Medicine at the University Medical Center Hamburg-Eppendorf, Germany on all patients with chronic hypercapnic respiratory failure in whom bilateral LVRC treatment was performed between 1 April 2012 and 30 September 2015. During the study period, bilateral LVRC treatment was performed in 10 patients with chronic hypercapnic respiratory failure. Compared with baseline, bilateral LVRC treatment led to a significant increase in mean forced expiratory volume in one second (FEV1) from 0.5 ± 0.1 l to 0.6 ± 0.2 l ( p = 0.004), a decrease in residual volume (RV) from 6.1 ± 0.9 l to 5.6 ± 1.1 l ( p = 0.02) and a reduction in partial pressure of carbon dioxide in arterial blood (PaCO2) from 53 ± 5 mmHg to 48 ± 4 mmHg ( p = 0.03). One case of hemoptysis requiring readmission to hospital was the only severe adverse event. LVRC treatment was safe and effective in patients with nonsevere chronic hypercapnic respiratory failure. It led not only to an improvement in lung function but also to a significant decrease in PaCO2.

  17. Time to 12-month remission and treatment failure for generalised and unclassified epilepsy

    Science.gov (United States)

    Bonnett, Laura J; Tudur Smith, Catrin; Smith, David; Williamson, Paula R; Chadwick, David; Marson, Anthony G

    2014-01-01

    Objectives To develop prognostic models for time to 12-month remission and time to treatment failure after initiating antiepileptic drug monotherapy for generalised and unclassified epilepsy. Methods We analysed data from the Standard and New Antiepileptic Drug (arm B) study, a randomised trial that compared initiating treatment with lamotrigine, topiramate and valproate in patients diagnosed with generalised or unclassified epilepsy. Multivariable regression modelling was used to investigate how clinical factors affect the probability of achieving 12-month remission and treatment failure. Results Significant factors in the multivariable model for time to 12-month remission were having a relative with epilepsy, neurological insult, total number of tonic-clonic seizures before randomisation, seizure type and treatment. Significant factors in the multivariable model for time to treatment failure were treatment history (antiepileptic drug treatment prior to randomisation), EEG result, seizure type and treatment. Conclusions The models described within this paper can be used to identify patients most likely to achieve 12-month remission and most likely to have treatment failure, aiding individual patient risk stratification and the design and analysis of future epilepsy trials. PMID:24292995

  18. Time to 12-month remission and treatment failure for generalised and unclassified epilepsy.

    Science.gov (United States)

    Bonnett, Laura J; Tudur Smith, Catrin; Smith, David; Williamson, Paula R; Chadwick, David; Marson, Anthony G

    2014-06-01

    To develop prognostic models for time to 12-month remission and time to treatment failure after initiating antiepileptic drug monotherapy for generalised and unclassified epilepsy. We analysed data from the Standard and New Antiepileptic Drug (arm B) study, a randomised trial that compared initiating treatment with lamotrigine, topiramate and valproate in patients diagnosed with generalised or unclassified epilepsy. Multivariable regression modelling was used to investigate how clinical factors affect the probability of achieving 12-month remission and treatment failure. Significant factors in the multivariable model for time to 12-month remission were having a relative with epilepsy, neurological insult, total number of tonic-clonic seizures before randomisation, seizure type and treatment. Significant factors in the multivariable model for time to treatment failure were treatment history (antiepileptic drug treatment prior to randomisation), EEG result, seizure type and treatment. The models described within this paper can be used to identify patients most likely to achieve 12-month remission and most likely to have treatment failure, aiding individual patient risk stratification and the design and analysis of future epilepsy trials.

  19. Treatment of heart failure in Dutch general practice

    Directory of Open Access Journals (Sweden)

    van den Bosch Wil JHM

    2006-07-01

    Full Text Available Abstract Background To study the relation between the prescription rates of selected cardiovascular drugs (ACE-inhibitors and Angiotensin receptor blockers, beta-blockers, diuretics, and combinations, sociodemographic factors (age, gender and socioeconomic class and concomitant diseases (hypertension, coronary heart disease, cerebrovascular accident, heart valve disease, atrial fibrillation, diabetes mellitus and asthma/COPD among patients with heart failure cared for in general practice. Methods Data from the second Dutch National Survey in General Practice, conducted mainly in 2001. In this study the data of 96 practices with a registered patient population of 374.000 were used. Data included diagnosis made during one year by general practitioners, derived from the electronic medical records, prescriptions for medication and sociodemographic characteristics collected via a postal questionnary (response 76% Results A diagnosis of HF was found with 2771 patients (7.1 in 1000. Their mean age was 77.7 years, 68% was 75 years or older, 55% of the patients were women. Overall prescription rates for RAAS-I, beta-blockers and diuretics were 50%, 32%, 86%, respectively, whereas a combination of these three drugs was prescribed in 18%. Variations in prescription rates were mainly related to age and concomitant diseases. Conclusion Prescription is not influenced by gender, to a small degree influenced by socioeconomic status and to a large degree by age and concomitant diseases.

  20. Mineralocorticoid Receptor Antagonists for Treatment of Hypertension and Heart Failure.

    Science.gov (United States)

    Sica, Domenic A

    2015-01-01

    Spironolactone and eplerenone are both mineralocorticoid-receptor antagonists. These compounds block both the epithelial and nonepithelial actions of aldosterone, with the latter assuming increasing clinical relevance. Spironolactone and eplerenone both affect reductions in blood pressure either as mono- or add-on therapy; moreover, they each afford survival benefits in diverse circumstances of heart failure and the probability of renal protection in proteinuric chronic kidney disease. However, as use of mineralocorticoid-blocking agents has expanded, the hazards inherent in taking such drugs have become more apparent. Whereas the endocrine side effects of spironolactone are in most cases little more than a cosmetic annoyance, the potassium-sparing effects of both spironolactone and eplerenone can prove disastrous, even fatal, if sufficient degrees of hyperkalemia emerge. For most patients, however, the risk of developing hyperkalemia in and of itself should not discourage the sensible clinician from bringing these compounds into play. Hyperkalemia should always be considered a possibility in patients receiving either of these medications; therefore, anticipatory steps should be taken to minimize the likelihood of its occurrence if long-term therapy of these agents is being considered.

  1. The use of lisuride in the treatment of multiple system atrophy with autonomic failure (Shy-Drager syndrome).

    Science.gov (United States)

    Lees, A J; Bannister, R

    1981-04-01

    In a controlled trial lisuride, an ergolene derivative with dopamine receptor agonist properties was given maximum tolerated doses (2.4 mg/day) to seven patients with multiple system atrophy with autonomic failure (Shy-Drager syndrome). Improvement in Parkinsonian features occurred in only one patient and another patient who had been deriving marked benefit from levodopa treatment before the study began failed to respond to large doses of lisuride. Psychiatric side effects (including nightmares, isolated visual hallucinations and toxic confusional states) were the dose-limiting factor in six patients. A modest reduction in orthostatic hypotension occurred in two patients, one of whom had experienced an aggravation of this disturbance on levodopa and bromocriptine. Destruction of post-synaptic dopamine receptors and damage to central noradrenergic systems may offer an explanation for the lack of therapeutic effect of lisuride.

  2. Treatment of severe metabolic alkalosis in a patient with congestive heart failure.

    Science.gov (United States)

    Peixoto, Aldo J; Alpern, Robert J

    2013-05-01

    Metabolic alkalosis, isolated or in combination with another abnormality, is the most common acid-base disorder in patients with congestive heart failure. In most cases, it is a result of diuretic therapy, which causes activation of the renin-angiotensin system, chloride depletion, increased distal sodium delivery, hypokalemia, and increased urine acidification, all of which contribute to bicarbonate retention. In addition, the disease state itself results in neurohormonal activation (renin-angiotensin system, sympathetic nervous system, and endothelin) that further amplifies the tendency toward alkalosis. Treatment of metabolic alkalosis is based on the elimination of generation and maintenance factors, chloride and potassium repletion, enhancement of renal bicarbonate excretion (such as acetazolamide), direct titration of the base excess (hydrochloric acid), or, if accompanied by kidney failure, low-bicarbonate dialysis. In congestive heart failure, appropriate management of circulatory failure and use of an aldosterone antagonist in the diuretic regimen are integral to treatment. Published by Elsevier Inc.

  3. Addressing the Challenges of Hepatitis C Virus Resistance and Treatment Failure

    Directory of Open Access Journals (Sweden)

    Che C. Colpitts

    2016-08-01

    Full Text Available Chronic hepatitis C is a major cause of chronic liver disease, including liver cirrhosis and hepatocellular carcinoma. The development of direct-acting antivirals (DAAs revolutionized hepatitis C virus (HCV treatment by offering genuine prospects for the first comprehensive cure of a chronic viral infection in humans. While antiviral resistance is a significant limitation for interferon-based therapies, resistance and treatment failure still appear to be present in a small fraction of patients even in state-of-the-art DAA combination therapies. Therefore, treatment failure and resistance still remain a clinical challenge for the management of patients not responding to DAAs. In this special issue of Viruses on HCV drug resistance, mechanisms of antiviral resistance for different classes of antiviral drugs are described. Furthermore, the detection and monitoring of resistance in clinical practice, the clinical impact of resistance in different patient groups and strategies to prevent and address resistance and treatment failure using complementary antiviral strategies are reviewed.

  4. Erythropoietin treatment does not compromise cardiovascular function in chronic renal failure

    DEFF Research Database (Denmark)

    Haedersdal, C; Mehlsen, J; Stenver, Doris Irene

    1994-01-01

    The anemia in patients with chronic renal failure can be corrected through treatment with recombinant human erythropoietin treatment. This correction is associated with changes in the rheologic variables, which could explain the changes in hemodynamics found by many investigators. The authors have...... followed up 11 patients with chronic renal failure on hemodialysis before and during six months of therapy with erythropoietin. The measurements were made before treatment, after four months of therapy, and after six months of therapy. The measurements included hematocrit, osmotic resistance of the red...

  5. Successful Treatment of Fibrosing Organising Pneumonia Causing Respiratory Failure with Mycophenolic Acid.

    Science.gov (United States)

    Paul, Christina; Lin-Shaw, Ammy; Joseph, Mariamma; Kwan, Keith; Sergiacomi, Gianluigi; Mura, Marco

    2016-01-01

    Organising pneumonia (OP) is usually promptly responsive to corticosteroid treatment. We describe a series of 3 cases of severe, progressive, biopsy-proven fibrosing OP causing respiratory failure. All cases presented with peribronchial and subpleural consolidations, had a fibro-inflammatory infiltrative component in the alveolar septa, and only had a partial and unsatisfactory response to corticosteroids. However, they responded to mycophenolic acid (MPA) treatment with resolution of respiratory failure as well as clinical and functional improvement. MPA as an additional treatment option for aggressive forms of fibrosing OP and interstitial lung disease needs to be further explored. © 2016 S. Karger AG, Basel.

  6. Treatment Failure of Dihydroartemisinin/Piperaquine for Plasmodium falciparum Malaria, Vietnam

    Science.gov (United States)

    Phuc, Bui Quang; Duong, Tran Thanh; Dong, Le Than; Loi, Mai Anh; Ménard, Didier; Tarning, Joel; Bustos, Dorina; Ringwald, Pascal; Galappaththy, Gawrie Loku; Thieu, Nguyen Quang

    2017-01-01

    We conducted a study in Binh Phuoc, Vietnam, in 2015 on the therapeutic efficacy of dihydroartemisinin/piperaquine for Plasmodium falciparum malaria. A high number of treatment failures (14/40) was found, and piperaquine resistance in Vietnam was confirmed. A change in the malaria treatment policy for Vietnam is in process. PMID:28322709

  7. Bed rest and increased diuretic treatment in chronic congestive heart failure

    DEFF Research Database (Denmark)

    Abildgaard, U; Aldershvile, J; Ring-Larsen, H

    1985-01-01

    To elucidate the effect of bed rest used as an adjunct to increased diuretic treatment, twelve patients with chronic congestive heart failure (CHF) had a 50% increase in loop diuretic dosage and were allocated to either continuous bed rest or bed rest during nights only. The 24-hour bed rest group...... is a reasonable adjunct to diuretic treatment in patients with CHF....

  8. Successful treatment of thyroid storm presenting as recurrent cardiac arrest and subsequent multiorgan failure by continuous renal replacement therapy

    Directory of Open Access Journals (Sweden)

    Han Soo Park

    2017-03-01

    Full Text Available Thyroid storm is a rare and potentially life-threatening medical emergency. We experienced a case of thyroid storm associated with sepsis caused by pneumonia, which had a catastrophic course including recurrent cardiac arrest and subsequent multiple organ failure (MOF. A 22-year-old female patient with a 10-year history of Graves’ disease was transferred to our emergency department (ED. She had a cardiac arrest at her home and a second cardiac arrest at the ED. Her heart recovered after 20 min of cardiac resuscitation. She was diagnosed with thyroid storm associated with hyperthyroidism complicated by pneumonia and sepsis. Although full conventional medical treatment was given, she had progressive MOF and hemodynamic instability consisting of hyperthermia, tachycardia and hypotension. Because of hepatic and renal failure with refractory hypotension, we reduced the patient’s dose of beta-blocker and antithyroid drug, and she was started on continuous veno-venous renal replacement therapy (CRRT with intravenous albumin and plasma supplementation. Subsequently, her body temperature and pulse rate began to stabilize within 1 h, and her blood pressure reached 120/60 mmHg after 6 h. We discontinued antithyroid drug 3 days after admission because of aggravated hyperbilirubinemia. The patient exhibited progressive improvement in thyroid function even after cessation of antithyroid drug, and she successfully recovered from thyroid storm and MOF. This is the first case of thyroid storm successfully treated by CRRT in a patient considered unfit for antithyroid drug treatment.

  9. Pathophysiology and potential treatments of pulmonary hypertension due to systolic left heart failure.

    Science.gov (United States)

    Lundgren, J; Rådegran, G

    2014-06-01

    Pulmonary hypertension (PH) due to left heart failure is becoming increasingly prevalent and is associated with poor outcome. The precise pathophysiological mechanisms behind PH due to left heart failure are, however, still unclear. In its early course, PH is caused by increased left ventricular filling pressures, without pulmonary vessel abnormalities. Conventional treatment for heart failure may partly reverse such passive PH by optimizing left ventricular function. However, if increased pulmonary pressures persist, endothelial damage, excessive vasoconstriction and structural changes in the pulmonary vasculature may occur. There is, at present, no recommended medical treatment for this active component of PH due to left heart failure. However, as the vascular changes in PH due to left heart failure may be similar to those in pulmonary arterial hypertension (PAH), a selected group of these patients may benefit from PAH treatment targeting the endothelin, nitric oxide or prostacyclin pathways. Such potent pulmonary vasodilators could, however, be detrimental in patients with left heart failure without pulmonary vascular pathology, as selective pulmonary vasodilatation may lead to further congestion in the pulmonary circuit, resulting in pulmonary oedema. The use of PAH therapies is therefore currently not recommended and would require the selection of suitable patients based on the underlying causes of the disease and careful monitoring of their progress. The present review focuses on the following: (i) the pathophysiology behind PH resulting from systolic left heart failure, and (ii) the current evidence for medical treatment of this condition, especially the role of PAH-targeted therapies in systolic left heart failure. © 2014 Scandinavian Physiological Society. Published by John Wiley & Sons Ltd.

  10. Clinical Investigation of Treatment Failure in Type 2 Diabetic ...

    African Journals Online (AJOL)

    HP

    triple oral therapy or a switch from metformin and glibenclamide therapy [6,13]. A total of 276 type. 2 diabetic patients were identified to have failed treatment with a combination of metformin and glibenclamide at their maximum doses while 244 type 2 diabetic patients receiving similar drugs but considered responding to ...

  11. Cost effectiveness of darunavir/ritonavir 600/100 mg bid in treatment-experienced, lopinavir-naive, protease inhibitor-resistant, HIV-infected adults in Belgium, Italy, Sweden and the UK.

    Science.gov (United States)

    Moeremans, Karen; Hemmett, Lindsay; Hjelmgren, Jonas; Allegri, Gabriele; Smets, Erik

    2010-01-01

    Using data from the phase IIb POWER trials, darunavir boosted with low-dose ritonavir (DRV/r; 600/100 mg twice daily; bid)-based highly active antiretroviral therapy (HAART) was shown to be significantly more efficacious and cost effective than other protease inhibitor (PI)-based therapy in highly treatment-experienced, HIV-1-infected adults. Furthermore, in the phase III TITAN trial (TMC114-C214), DRV/r 600/100 mg bid-based HAART generated a superior 48-week virological response rate compared with standard-of-care lopinavir/ritonavir (LPV/r; 400/100 mg bid)-based therapy in treatment-experienced, lopinavir-naive patients, and in particular those with one or more International AIDS Society - USA (IAS-USA) primary PI resistance-associated mutations at baseline. These patients had a broader degree of previous PI use/failure (0 - ≥ 2) than the POWER patients. To determine whether DRV/r 600/100 mg bid-based HAART is cost effective compared with LPV/r-based therapy, from the perspective of Belgian, Italian, Swedish and UK reimbursement authorities, when used in treatment-experienced patients similar to TITAN patients with one or more IAS-USA primary PI mutations at baseline. An existing Markov model containing health states defined by CD4 cell count ranges (>500, 351-500, 201-350, 101-200, 51-100 and 0-50 cells/mm³) and an absorbing state of death was adapted for use in the above-mentioned healthcare settings. Baseline demographics, CD4 cell count distribution, antiretroviral drug usage, virological/immunological response rates and matching transition probabilities were based on data collected during the first 48 weeks of therapy in the modelled subgroup of TITAN patients and the published literature. After treatment failure, patients were assumed to switch to a follow-on combination regimen. For each health state, utility values and mortality rates were obtained from the published literature. Data from local observational studies (Belgium, Sweden and Italy) or the

  12. Current treatments and novel pharmacologic treatments for hyponatremia in congestive heart failure.

    Science.gov (United States)

    Goldsmith, Steven R

    2005-05-02

    Hyponatremia in congestive heart failure (CHF) is associated with increased morbidity and mortality, underlining the importance of adequate assessment and treatment of this electrolyte imbalance in patients with CHF. Current treatment options for hyponatremia in CHF include hypertonic saline solution, loop diuretics, fluid restriction, and other pharmacologic agents, such as demeclocycline, lithium carbonate, and urea. Hypertonic saline solution must be administered with extreme caution because excessively slow or rapid sodium correction can lead to severe neurologic adverse effects. Loop diuretics are useful for reducing the water retention caused by CHF. However, the potent diuresis induced by agents such as furosemide results in loss of sodium and other essential electrolytes, which may exacerbate hyponatremia. Fluid restriction is only moderately effective and often difficult to implement in the hospital setting. Agents such as demeclocycline and lithium have potentially serious renal and cardiovascular side effects. The arginine vasopressin (AVP) receptor antagonists are a promising new class of aquaretic agents that increase free-water excretion while maintaining levels of sodium and other essential electrolytes. Tolvaptan (OPC-41061), lixivaptan (VPA-985), and conivaptan (YM-087) are currently under development for the treatment of hyponatremia. Although tolvaptan and lixivaptan are selective for the vasopressin-2 (V(2)) receptor responsible for the antidiuretic actions of AVP, conivaptan demonstrates activity at both the V(2) receptor and the V(1a) receptor responsible for the vasoconstricting properties of AVP. This dual receptor activity may be particularly useful in patients with CHF. These patients may benefit from the increased cardiac output, reduced total peripheral resistance, and reduced mean arterial blood pressure that results from V(1a) receptor blockade as well as the reduced congestion, reduced cardiac preload, and increased sodium

  13. [Treatment of type II diabetic patients with chronic renal failure].

    Science.gov (United States)

    Gin, Henri; Perlemoine, Caroline; Raffaitin, Christelle; Rigalleau, Vincent

    2006-01-01

    Glycaemic control is a key element in the management of patients with chronic renal insufficiency, associated of course with treatment of all the other associated factors. Dietary management should not merely be wishful thinking but a reality, involving the control of body weight, the maintenance of lean body mass, the observance of a sufficient carbohydrate intake and the control of protein intake, which, always tends to be excessive in diabetics. Drug treatment with oral antidiabetics may be given without risk of iatrogenic effects: glitazone has no effect on renal metabolism but may increase water retention; glinides are insulin secretagogues without renal metabolism so there is no risk of hypoglycaemia in the event of impaired renal function; if not insulin remains an excellent alternative with, however, a change in its half-life with the elevated creatinine clearance. In all cases, the goal remains the control of glycosylated haemoglobin without iatrogenic effects.

  14. New Heart Failure Treatment Capability for Remote Environments

    Science.gov (United States)

    2013-06-01

    Packer DL, Anstadt MP, Plunkett MD, Lowe JE. Surgical Treatment of Automatic Atrial Tachycardia . Presented at the 25th Anniversary Meeting of the...Subsequent Tolerance to Global Myocardial Ischemia. Surgical Forum XLII, peripheral pulses are equal and adequate throughout, no significant JVD or edema...Jr., Wolfe WG, Lowe JE: Depletion of the Ventricular Mitochondrial Oxygen Store: The Etiology of Tachycardia -Induced Cardiomyopathy. Surgical Forum

  15. Infected primary knee arthroplasty: Risk factors for surgical treatment failure

    Directory of Open Access Journals (Sweden)

    Joao Gabriel Duarte Paes Pradella

    2013-09-01

    Full Text Available OBJECTIVE: To present epidemiological data and risk factors associated with surgical out-comes favorable or unfavorable for the treatment of infection in infected total knee arthroplasty. METHODS: We reviewed medical records of 48 patients who underwent treatment of primary total knee arthroplasty for infection between January 1994 and December 2008, in the Orthopedics and Traumatology Department of the Santa Casa de Misericórdia de São Paulo. The variables associated with favorable outcome of surgical treatment (debridement and retention or exchange arthroplasty in two days or unfavorable (arthrodesis or death infection. RESULTS: A total of 39 cases of infection after primary total knee arthroplasty, 22 progressed to 17 for a favorable outcome and unfavorable outcome. Early infections (OR: 14.0, 95% CI 1.5-133.2, p = 0.016 and diabetes (OR: 11.3, 95% CI 1.4-89.3, p = 0.032 were associated with arthrodesis joint and death respectively. CONCLUSION: Patients with early infection had a higher risk of developing surgical procedure with unfavorable outcome (arthrodesis and diabetics had higher odds of death after infection of primary knee arthroplasties.

  16. Adherence to the ESC Heart Failure Treatment Guidelines in Spain: ESC Heart Failure Long-term Registry.

    Science.gov (United States)

    Crespo-Leiro, María G; Segovia-Cubero, Javier; González-Costello, José; Bayes-Genis, Antoni; López-Fernández, Silvia; Roig, Eulàlia; Sanz-Julve, Marisa; Fernández-Vivancos, Carla; de Mora-Martín, Manuel; García-Pinilla, José Manuel; Varela-Román, Alfonso; Almenar-Bonet, Luis; Lara-Padrón, Antonio; de la Fuente-Galán, Luis; Delgado-Jiménez, Juan

    2015-09-01

    To estimate the percentage of heart failure patients in Spain that received the European Society of Cardiology recommended treatments, and in those that did not, to determine the reasons why. The study included 2834 consecutive ambulatory patients with heart failure from 27 Spanish hospitals. We recorded general information, the treatment indicated, and the reasons why it was not prescribed in some cases. In patients who met the criteria to receive a certain drug, true undertreatment was defined as the percentage of patients who, without justification, did not receive the drug. In total, 92.6% of ambulatory patients with low ejection fraction received angiotensin converting enzyme inhibitors or angiotensin receptor blockers, 93.3% beta-blockers, and 74.5% mineralocorticoid receptor antagonists. The true undertreatment rates were 3.4%, 1.8%, and 19.0%, respectively. Target doses were reached in 16.2% of patients receiving angiotensin converting enzyme inhibitors, 23.3% of those with angiotensin receptor blockers, 13.2% of those prescribed beta-blockers, and 23.5% of those with mineralocorticoid receptor antagonists. Among patients who could benefit from ivabradine, 29.1% received this drug. In total, 36% of patients met the criteria for defibrillator implantation and 90% of them had received the device or were scheduled for implantation, whereas 19.6% fulfilled the criteria for resynchronization therapy and 88.0% already had or would soon have the device. In patients who met the criteria, but did not undergo device implantation, the reasons were not cost-related. When justified reasons for not administering heart failure drugs were taken into account, adherence to the guideline recommendations was excellent. Exclusive use of the percentage of treated patients is a poor indicator of the quality of healthcare in heart failure. Measures should be taken to improve the attainment of optimal dosing in each patient. Copyright © 2015 Sociedad Española de Cardiolog

  17. The politics of despair: AIDS and the failure of treatment.

    Science.gov (United States)

    Mackie, I D

    1995-01-01

    The recent AIDS-related death of a friend forced Dr. Iain Mackie to think about the disease and the lack of positive news about it. Despite a flood of recent studies that brought pessimistic news about the treatments now in use, Mackie tries to remain optimistic. "I may be treating only myself as I feed off the politics of optimism," he says, "but at least I will not be feeding off the politics of despair." The article appears as Canada marks another National AIDS Week Oct. 2-8. PMID:7553499

  18. Factors related to the local treatment failure of γ knife surgery for metastatic brain tumors.

    Science.gov (United States)

    Woo, Hyun Jin; Hwang, Sung Kyoo; Park, Seong Hyun; Hwang, Jeong Hyun; Hamm, In Suk

    2010-11-01

    Radiosurgery (RS) is regarded as a standard therapy for metastatic brain tumors, but local failure requiring repeated therapy for the same lesion remains an unsolved problem. The authors analyzed outcomes of gamma knife surgery (GKS) for metastatic lesions to identify factors of local treatment failure. The hospital records of 103 patients with a metastatic brain tumor and monitored for more than 6 months were analyzed. Lesion response to RS was analyzed in 77 patients with available gamma plan data. Local treatment failure was defined as lesion regrowth or repeat GKS within 6 months. In cases with multiple lesions, largest masses were evaluated. Primary sites, metastatic location, Karnofsky scale, tumor size, number of metastatic lesions, and various radiosurgical prescription parameters, namely, Paddick's conformity index (CI), Radiation Therapy Oncology Group (RTOG)-CI, and gradient index, were analyzed. Of the 103 study subjects, 58 were male and 45 were female. Primary sites were lung (n = 58), breast (n = 12), colon (n = 6), kidney (n = 7), rectum (n = 6), and others (n = 14). Median survival duration from the diagnosis of brain metastasis was 25 months. Local treatment failure occurred in 14 of 77 the patients (77 lesions) with available gamma plan data. A lung cancer primary site was found to have a lower GKS failure rate than a breast or a renal site (p < 0.05). Lesions with a high Paddicks' CI or a low RTOG-CI had a higher rate of treatment failure (p < 0.05). Multivariate analysis revealed that primary tumor site and Paddick's CI were related to treatment failure (p < 0.05). Brain metastases from renal and breast cancers had higher rates of local GKS treatment failure than those from lung cancer. Furthermore, high Paddick's CI revealed higher rate of local recurrence, and was not contributory to prevent local treatment failure. However, the enlargement of the diameter of the tumor after RS in the early follow

  19. Hybrid approach to treatment of patients with severe heart failure and arrhythmia

    Directory of Open Access Journals (Sweden)

    O. V. Sapelnikov

    2017-07-01

    Full Text Available Management of patients with terminal heart failure is one of the most serious ongoing problems in cardiac surgery. In addition, the clinical progression of heart failure is often characterized by cardiac rhythm disturbances, with atrial fibrillation and atrial flutter being the most common types of these disorders. The prognosis may be extremely unfavorable if inappropriate tactics of treatment is used. Development of interventional and minimally invasive surgery expanded the possibilities of treatment of such patients. The article looks at some application features of a hybrid approach to treatment of a patient with atrial flutter and a terminal stage of chronic heart failure.Received 3 May 2017. Accepted 24 June 2017.Funding: The study did not have sponsorship.Conflict of interest: The authors declare no conflict of interest.

  20. Antibiotic treatment failure when consulting patients with respiratory tract infections in general practice

    DEFF Research Database (Denmark)

    Bordado Sköld, Margrethe; Aabenhus, Rune; Guassora, Ann Dorrit

    2017-01-01

    Background: Prescribing antibiotics for acute respiratory tract infections (RTIs) is common in primary healthcare although most of these infections are of viral origin and antibiotics may not be helpful. Some of these prescriptions will not be associated with a quick recovery, and might be regarded...... definition of ATF. Studies describing patients’ views are still missing. General practitioners’ experiences and views on antibiotic treatment failure in acute respiratory infections or its effects on the doctor–patient relationship have not been studied previously....... as cases of antibiotic treatment failure (ATF). Objectives: We studied antibiotic treatment failure in patients with acute RTIs from a general practitioner (GP) perspective, aiming to explore (i) GPs’ views of ATF in primary care; (ii) how ATF influences the doctor-patient relationship; and (iii) GPs...

  1. EFFECTS OF TREATMENT INTEGRITY FAILURES DURING DIFFERENTIAL REINFORCEMENT OF ALTERNATIVE BEHAVIOR: A TRANSLATIONAL MODEL

    Science.gov (United States)

    Peter Pipkin, Claire St; Vollmer, Timothy R; Sloman, Kimberly N

    2010-01-01

    Differential reinforcement of alternative behavior (DRA) is used frequently as a treatment for problem behavior. Previous studies on treatment integrity failures during DRA suggest that the intervention is robust, but research has not yet investigated the effects of different types of integrity failures. We examined the effects of two types of integrity failures on DRA, starting with a human operant procedure and extending the results to children with disabilities in a school setting. Human operant results (Experiment 1) showed that conditions involving reinforcement for problem behavior were more detrimental than failing to reinforce appropriate behavior alone, and that condition order affected the results. Experiments 2 and 3 replicated the effects of combined errors and sequence effects during actual treatment implementation. PMID:20808495

  2. Autoimmune Gastrointestinal Paralysis: Failure of Conventional Treatment without Immunomodulation

    Directory of Open Access Journals (Sweden)

    Craig Weinkauf

    2014-01-01

    Full Text Available The treatment of the rare enteric nervous system (ENS manifestations of paraneoplastic syndromes, which are most frequently associated with small cell lung cancer (SCLC, is poorly understood and described. Patients with neuroendocrine-derived tumors can develop B-cell reactivity towards the tumor with cross-reactivity for neurons located in the submucosal and myenteric ganglia of the ENS. The ensuing autoimmune neuritis causes aperistalsis and severe gastrointestinal (GI dysfunction. Immune-directed therapy is not the standard of care but may be paramount for patient recovery. Our patient, a 63-year-old man with recent symptoms of esophageal dysmotility and newly diagnosed SCLC was hospitalized with nausea, emesis, and constipation. After an extensive work-up that included laparoscopy and celiotomy with bowel resection, we diagnosed what we refer to as Autoimmune Paraneoplastic Chronic Intestinal Pseudoobstruction (AP-CIPO. Unlike the few clinically similar reports, SCLC and AP-CIPO were diagnosed in our patient within weeks of each other, which presented the dilemma of treating the two processes simultaneously. In this report, we review the relevant literature and describe our patient’s course. We believe standard chemotherapy is not effective treatment for AP-CIPO. Based on evidence discussed herein, we suggest initiating autoimmune-directed therapy before or simultaneous with cancer-directed therapy.

  3. The promise and failures of epigenetic therapies for cancer treatment.

    Science.gov (United States)

    Bojang, Pasano; Ramos, Kenneth S

    2014-02-01

    Genetic mutations and gross structural defects in the DNA sequence permanently alter genetic loci in ways that significantly disrupt gene function. In sharp contrast, genes modified by aberrant epigenetic modifications remain structurally intact and are subject to partial or complete reversal of modifications that restore the original (i.e. non-diseased) state. Such reversibility makes epigenetic modifications ideal targets for therapeutic intervention. The epigenome of cancer cells is extensively modified by specific hypermethylation of the promoters of tumor suppressor genes relative to the extensive hypomethylation of repetitive sequences, overall loss of acetylation, and loss of repressive marks at microsatellite/repeat regions. In this review, we discuss emerging therapies targeting specific epigenetic modifications or epigenetic modifying enzymes either alone or in combination with other treatment regimens. The limitations posed by cancer treatments elicit unintended epigenetic modifications that result in exacerbation of tumor progression are also discussed. Lastly, a brief discussion of the specificity restrictions posed by epigenetic therapies and ways to address such limitations is presented. Copyright © 2013 Elsevier Ltd. All rights reserved.

  4. Risk factors for treatment failure of CO2 laser vaporization in cervical intraepithelial neoplasia 2.

    Science.gov (United States)

    Yoon, Bo Sung; Seong, Seok Ju; Song, Taejong; Kim, Mi-La; Kim, Mi Kyoung

    2014-07-01

    The aim of our study was to evaluate the risk factors for treatment failure of CO2 laser vaporization in patients with cervical intraepithelial neoplasia 2 (CIN2). Medical records of patients who received either shallow or deep CO2 laser vaporization with biopsy-proven CIN2 during March 2007 to April 2011 were reviewed retrospectively. After laser vaporization, liquid-based cytology and human papilloma virus (HPV) DNA testing were checked in every follow-up visit. Treatment failure was defined when the follow-up biopsy was more than CIN2, needing secondary surgical treatment. During that period, 141 patients with CIN2 underwent CO2 laser vaporization. After laser ablation, 14 of 141 women needed the secondary treatment, a success rate of laser vaporization of 90.1 %. In multivariate analysis, the previous loop electrosurgical excision procedure (LEEP) history (adjusted OR = 13.649; P value = 0.025) and the ablation depth (adjusted OR = 11.279; P value = 0.006) were independent factors associated with treatment failure. Both ablation depth and previous LEEP history were the important factors increasing the risk for the treatment failure of CO2 laser vaporization in CIN2.

  5. Bioartificial liver and liver transplantation: new modalities for the treatment of liver failure

    Directory of Open Access Journals (Sweden)

    DING Yitao

    2017-09-01

    Full Text Available The main features of liver failure are extensive necrosis of hepatocytes, rapid disease progression, and poor prognosis, and at present, there are no effective drugs and methods for the treatment of liver failure. This article summarizes four treatment methods for liver failure, i.e., medical treatment, cell transplantation, liver transplantation, and artificial liver support therapy, and elaborates on the existing treatment methods. The current medical treatment regimen should be optimized; cell transplantation has not been used in clinical practice; liver transplantation is the most effective method, but it is limited by donor liver shortage and high costs; artificial liver can effectively remove toxic substances in human body. Therefore, this article puts forward artificial liver as a transition for liver transplantation; artificial liver can buy time for liver regeneration or liver transplantation and prolong patients′ survival time and thus has a promising future. The new treatment modality of bioartificial liver combined with liver transplantation may bring good news to patients with liver failure.

  6. [The role of liver transplantation in the treatment of acute liver failure following Amanita phalloides poisoning].

    Science.gov (United States)

    Beckurts, K T; Hölscher, A H; Heidecke, C D; Zilker, T R; Natrath, W; Siewert, J R

    1997-03-21

    To formulate the indications for liver transplantation in the treatment of acute liver failure after Amanita phalloides poisoning and to determine the results of this treatment. In 1994 twelve patients with acute Amanita phalloides poisoning were treated in the intensive care unit of our hospital's toxicology department. Three of them developed irreversible signs of poisoning and were given orthotopic liver transplants. The findings and course of this group of patients were analysed retrospectively and prognostic criteria defined on the basis of this personal experience and published data. Amanita phalloides poisoning differs from other causes of acute liver failure in several respects. The following criteria make it possible reliably to distinguish a lethal from a non-lethal course: a Quick value 1.4 mg%, even after correcting water and electrolyte abnormalities, serum bilirubin > 4.6 mg%, and progressive encephalopathy indicate a lethal course. Two of three patients survived severe poisoning by being given a liver transplant. Renal failure, pancreatitis and bone marrow suppression, in addition to liver failure, were signs relevant to treatment decisions. Liver transplantation is the procedure of choice in the treatment of acute Amanita phalloides poisoning, if the criteria for a probably lethal course under conservative treatment have been met. This should be taken into account when poisoned patients are to be transferred to a centre for treatment.

  7. Seminoma at Roswell Park, 1970 to 1979. An analysis of treatment failures.

    Science.gov (United States)

    Huben, R P; Williams, P D; Pontes, J E; Panahon, A M; Murphy, G P

    1984-04-01

    A retrospective study of all cases of seminoma treated at Roswell Park Memorial Institute from 1970 through 1979 was conducted. Fifty-six evaluable patients treated initially with radiation therapy were seen during this period, and the overall survival rate at an average follow-up period of 52 months was 82%. The survival rate in patients with bulky abdominal or supradiaphragmatic metastases was only 33% (4 of 12 patients). Treatment failures were analyzed to determine their apparent causes and the implication of such failures to the future management of seminoma. The use of combination chemotherapy as the initial treatment modality in advanced seminoma is discussed in light of these results.

  8. Recent advances in treatment of heart failure [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Takeshi Kitai

    2015-12-01

    Full Text Available With the total cases and economic burden of heart failure continuing to rise, there is an overwhelming need for novel therapies. Several drugs for heart failure have succeeded in preclinical and early-phase clinical trials, but most of them failed to show the real benefit in pivotal clinical trials. Meanwhile, the US Food and Drug Administration recently approved two promising new drugs to treat heart failure: ivabradine and sacubitril/valsartan. Furthermore, some of the newer agents in testing offer the potential for significant progress in addition to these drugs. Patiromer and zirconium cyclosilicate are attractive agents that are expected to prevent hyperkalemia during renin-angiotensin-aldosterone system inhibition, and serelaxin and urodilatin are promising drugs in the treatment of acute heart failure. Future clinical trials with more appropriate study designs, optimal clinical endpoints, and proper patient selection are mandatory to assess the true efficacy of these attractive compounds in clinical practice.

  9. Severe hypertriglyceridemia with a history of treatment failure.

    Science.gov (United States)

    Capell, Warren H; Eckel, Robert H

    2005-11-01

    Background A 53-year-old man with a history of hypertension and gout was referred to our clinic for severe hypertriglyceridemia, diagnosed 3 years previously. He was asymptomatic and had no history of abdominal pain, pancreatitis or diabetes, but consumed six cans of beer per night. Over the previous 2 years, he had been treated unsuccessfully with multiple medications; during this period his fasting triglycerides ranged from 5.41 mM to 55.04 mM (479 to 4,871 mg/dl). Investigations Physical examination including fundoscopy, medication review, and laboratory tests.Diagnosis Severe hypertriglyceridemia due to a genetic combined hyperlipidemia, exacerbated by persistent excessive alcohol intake and metabolic syndrome. Management Cessation of alcohol intake, initiation of a fat-restricted diet, and fibrate therapy, with close follow-up. Once serum triglycerides were controlled, attention was turned to lowering LDL-cholesterol concentration according to The National Cholesterol Education Program, Adult Treatment Panel III guidelines.

  10. Endogenous cardiac stem cells for the treatment of heart failure

    Directory of Open Access Journals (Sweden)

    Fuentes T

    2013-03-01

    Full Text Available Tania Fuentes, Mary Kearns-Jonker Department of Pathology and Human Anatomy, Loma Linda University School of Medicine, Loma Linda, CA, USA Abstract: Stem cell-based therapies hold promise for regenerating the myocardium after injury. Recent data obtained from phase I clinical trials using endogenous cardiovascular progenitors isolated directly from the heart suggest that cell-based treatment for heart patients using stem cells that reside in the heart provides significant functional benefit and an improvement in patient outcome. Methods to achieve improved engraftment and regeneration may extend this therapeutic benefit. Endogenous cardiovascular progenitors have been tested extensively in small animals to identify cells that improve cardiac function after myocardial infarction. However, the relative lack of large animal models impedes translation into clinical practice. This review will exclusively focus on the latest research pertaining to humans and large animals, including both endogenous and induced sources of cardiovascular progenitors. Keywords: Isl1, iPSC, large animal, c-kit, cardiosphere

  11. Central sleep apnea-hypopnea syndrome in heart failure: prevalence, impact, and treatment.

    Science.gov (United States)

    Javaheri, S

    1996-12-01

    Despite recent advances in its treatment, congestive heart failure associated with depressed left ventricular function continues to be associated with excess morbidity and mortality. Multiple factors may contribute to the progressively declining course of heart failure. Nocturnal arterial oxyhemoglobin desaturation caused by sleep-disordered breathing could be a contributing factor, particularly because it has been associated with excess mortality in patients with chronic obstructive pulmonary disease. Cheyne and Stokes were the first to observe periodic breathing in patients with heart failure (Cheyne-Stokes respiration). However, relatively large-scale systematic studies have been performed only recently. We studied 42 patients with stable, optimally treated heart failure, without other co-morbid disorders: 19 patients (45%) had an apnea-hypopnea index of more than 20/hour. These episodes were associated with an excess number of arousals and arterial oxyhemoglobin desaturation. Treatment options include nocturnal administration of oxygen, continuous positive airway pressure (CPAP), and medications such as theophylline. Large-scale studies are needed to evaluate the efficacy of these treatment options on quality of life, morbidity, and mortality of patients with heart failure.

  12. Current Treatment Strategies for Heart Failure: Role of Device Therapy and LV Reconstruction.

    Science.gov (United States)

    Janaswamy, Praneeth; Walters, Tomos E; Nazer, Babak; Lee, Randall J

    2016-09-01

    Medical care of heart failure (HF) begins with the determination of the cause of the heart failure and diagnosing potential reversible causes (i.e., coronary heart disease, hyperthyroidism, etc.). Medical therapy includes pharmacological and nonpharmacological strategies that limit and/or reverse the signs and symptoms of HF. Initial behavior modification includes dietary sodium and fluid restriction to avoid weight gain; and encouraging physical activity when appropriate. Optimization of medical therapy is the first line of treatment that includes the use of diuretics, vasodilators (i.e., ACE inhibitors or ARBs), beta blockers, and potentially inotropic agents and anticoagulation depending on the patient's severity of heart failure and LV dysfunction. As heart failure advances despite optimized medical management, cardiac resynchronization therapy (CRT), and implantable cardioverter defibrillators (ICDs) are appropriate device therapies. The development of progressive end-stage HF, despite maximal medical therapy, necessitates the consideration of mechanical circulatory devices such as ventricular assist devices (VADs) either as a bridge to heart transplantation or as destination therapy. Despite the advances in the treatment of heart failure, there is still a large morbidity and mortality associated with HF, thus the need to develop newer strategies for the treatment of HF.

  13. A review of economic evaluations of darunavir boosted by low-dose ritonavir in treatment-experienced persons living with HIV infection.

    Science.gov (United States)

    Mauskopf, Josephine; Annemans, Lieven; Hill, Andrew M; Smets, Erik

    2010-01-01

    Darunavir boosted by low-dose ritonavir (DRV/r), at a daily dose of 600/100 mg twice a day (bid), has been shown to be superior to alternative highly active antiretroviral therapy (HAART) regimens for the management of treatment-experienced, HIV-infected adults in the phase IIb POWER trials and the phase III TITAN trial. Economic analyses of different types that have been performed for several countries to investigate the cost effectiveness and budgetary impact of DRV/r 600/100 mg bid for treatment-experienced people living with HIV (PLHIV) based on the clinical data gathered in the POWER and TITAN trials are reviewed for consistency and their value to different decision-makers is assessed. Cost-utility analyses for the USA and several European countries indicate that DRV/r-based HAART is cost effective compared with other standard of care protease inhibitor (PI)-based regimens in PLHIV with evidence of PI resistance. For all of these countries, the estimated cost-utility ratio is well below typical benchmark values and these ratios are robust, as demonstrated by one-way sensitivity and variability analyses and multi-way probabilistic sensitivity analyses. Studies using other metrics including the average 1-year drug cost per patient with a plasma HIV-RNA level less than 50 copies/mL at 48 weeks, the incremental drug cost per additional patient with a plasma HIV-RNA level less than 50 copies/mL at 48 weeks, the total (antiretroviral and non-antiretroviral) costs during the first year of treatment, and the total healthcare budget impact during the first 5 years of treatment provided further evidence of the positive economic outcomes with the use of DRV/r in treatment-experienced PLHIV. Different measures of economic outcomes are useful for different types of decision-makers and different types of decisions. In general, the results of these different types of analyses will be consistent with each other. For darunavir, the economic analyses reviewed in this paper

  14. Effect of molecular adsorbents recirculating system treatment in children with acute liver failure caused by Wilson disease.

    Science.gov (United States)

    Rustom, Najla; Bost, Muriel; Cour-Andlauer, Fleur; Lachaux, Alain; Brunet, Anne-Sophie; Boillot, Olivier; Bordet, Fabienne; Valla, Frederic; Richard, Nathalie; Javouhey, Etienne

    2014-02-01

    Because fulminant Wilson disease (WD) has an extremely poor prognosis, the use of liver support that can bridge patients to liver transplantation is lifesaving. We report the experience of albumin dialysis in acute liver failure (ALF) caused by WD in children. Chart review of children admitted for ALF secondary to acute WD and treated by the molecular adsorbents and recirculating system. Measures of copper level in blood and within the circuit during molecular adsorbents recirculating system (MARS) sessions were performed. Clinical and biological assessments after MARS session were reported. Four children, with a median age of 12.3 years, were treated from 2004 to 2009 for a severe ALF associated with acute renal failure, haemolysis, and severe cholestasis. All of the children had a new Wilson index >12. A total of 14 MARS sessions were performed, for a median duration of 7.5 hours. Tolerance was good, except for 1 child who experienced haemorrhage because of vascular injury following insertion of the dialysis catheter. A neurological improvement or stabilisation was noted in all of the children along with an improvement in the Fisher index and ammonia level after MARS treatment. MARS was able to remove copper, to decrease the serum copper level of 28% in mean, and to decrease the bilirubin and creatinin levels >25%. All of the children were subsequently underwent liver transplants with a good outcome without disability. MARS is able to remove copper and to stabilise children with ALF secondary to WD, allowing bridging to LT.

  15. Voice problems of group fitness instructors: diagnosis, treatment, perceived and experienced attitudes and expectations of the industry.

    Science.gov (United States)

    Rumbach, Anna F

    2013-11-01

    To determine the anatomical and physiological nature of voice problems and their treatment in those group fitness instructors (GFIs) who have sought a medical diagnosis; the impact of voice disorders on quality of life and their contribution to activity limitations and participation restrictions; and the perceived attitudes and level of support from the industry at large in response to instructor's voice disorders and need for treatment. Prospective self-completion questionnaire design. Thirty-eight individuals (3 males and 35 females) currently active in the Australian fitness industry who had been diagnosed with a voice disorder completed an online self-completion questionnaire administered via SurveyMonkey. Laryngeal pathology included vocal fold nodules (N = 24), vocal fold cysts (N = 2), vocal fold hemorrhage (N = 1), and recurrent chronic laryngitis (N = 3). Eight individuals reported vocal strain and muscle tension dysphonia without concurrent vocal fold pathology. Treatment methods were variable, with 73.68% (N = 28) receiving voice therapy alone, 7.89% (N = 3) having voice therapy in combination with surgery, and 10.53% (N = 4) having voice therapy in conjunction with medication. Three individuals (7.89%) received no treatment for their voice disorder. During treatment, 82% of the cohort altered their teaching practices. Half of the cohort reported that their voice problems led to social withdrawal, decreased job satisfaction, and emotional distress. Greater than 65% also reported being dissatisfied with the level of industry and coworker support during the period of voice recovery. This study identifies that GFIs are susceptible to a number of voice disorders that impact their social and professional lives, and there is a need for more proactive training and advice on voice care for instructors, as well as those in management positions within the industry to address mixed approaches and opinions regarding the importance of voice care. Copyright © 2013

  16. The anxiety of Taiwanese women with or without continuity treatment after previous in vitro fertilisation failure.

    Science.gov (United States)

    Su, Tsann-Juu; Tzeng, Ya-Ling; Kuo, Pi-Chao

    2011-08-01

    To compare the anxiety levels of Taiwanese women who continued with in vitro fertilisation treatment and those who discontinued treatment post-in vitro fertilisation failure. In vitro fertilisation is perceived as the last resort of infertility treatment. The impact of unsuccessful in vitro fertilisation treatment on psychological function has been documented; however, research comparing the levels of anxiety of women who cease and those who continue in vitro fertilisation post-failure is scant. A cross-sectional comparative study design was used. Fifty-eight women in whom in vitro fertilisation had failed within the previous year were recruited to this study from a medical centre in northern Taiwan; 34 women continued treatment and 24 discontinued treatment. The State-Trait Anxiety Inventory was used to assess their levels of anxiety. Women in the group who continued treatment exhibited higher state and trait anxiety (TA) than women in the group who discontinued treatment (p fertilisation cycles were significantly higher in the group who continued treatment than in those who did not. A strong positive correlation between state and TA (r = 0·8, p fertilisation treatment had higher levels of anxiety than those who discontinued treatment. The level of anxiety of women who decide to continue in vitro fertilisation treatment should be assessed as early as possible and counselling services provided to women who experience in vitro fertilisation failure should concentrate more on relieving psychological distress. One year after discontinuing treatment, some women still experience considerable anxiety; therefore, the care and assistance provided to these women need to be continually evaluated. © 2011 Blackwell Publishing Ltd.

  17. Therapeutic effects of blood purification in treatment of fulminant hepatic failure

    Directory of Open Access Journals (Sweden)

    Yunchuan Pu

    Full Text Available OBJECTIVES: To evaluate the clinical effects of blood purification for treating fulminant hepatic failure (FHF. METHODS: Thirty-three severe FHF patients with hepatic encephalopathy (HE above grade III were subjected to a combined blood purification treatment in addition to the comprehensive liver protection therapy. Patients underwent continuous hemofiltration on a daily basis during the daytime followed by sequential treatment with plasma exchange or hemodialysis every 2-3 days. The therapeutic effects of this treatment were evaluated. RESULTS: After treatment with blood purification, restoration of consciousness (those who abandoned the treatment without restoration of consciousness were excluded was achieved in 6 of 8 cases (75% in acute liver failure (ALF group, 3 of 3 cases (100% in subacute liver failure (SALF group, and 9 of 14 cases (64.29% in acute/subacute on chronic liver failure (A/SCLF group. Of all cases, 11 patients restored consciousness after 7 days in a coma. The rate of long-term survival (those who abandoned the treatment were excluded was 3/7 (42.86% for ALF group, 2/2 (100% for SALF group, and 1/11 (9.09% for A/SCLF group. The levels of hemoglobin and platelet in peripheral blood were significantly reduced after blood purification. CONCLUSIONS: Treatment of FHF patients with daily continuous hemofiltration during the daytime is effective in treating HE and in improving health status in the early stages of the disease. Long-term prognosis also benefits from this treatment. The rate of consciousness recovery and long-term survival is highest in SALF group followed by ALF group. This treatment is less effective in A/SCLF patients. It should be noted that blood purification procedure may cause damage to blood cells.

  18. Treatment Options Available for Bacillus Calmette-Guerin Failure in Non-muscle-invasive Bladder Cancer

    NARCIS (Netherlands)

    Yates, D.R.; Brausi, M.A.; Catto, J.W.; Dalbagni, G.; Roupret, M.; Shariat, S.F.; Sylvester, R.J.; Witjes, J.A.; Zlotta, A.R.; Palou-Redorta, J.

    2012-01-01

    CONTEXT: Intravesical bacillus Calmette-Guerin (BCG) is a standard conservative treatment for patients with high-risk non-muscle-invasive bladder cancer (NMIBC). Many patients will experience recurrence or progression following BCG and are termed BCG failures. OBJECTIVE: To summarise the current

  19. Eradication of carriage with methicillin-resistant Staphylococcus aureus: determinants of treatment failure

    NARCIS (Netherlands)

    Ammerlaan, Heidi S. M.; Kluytmans, Jan A. J. W.; Berkhout, Hanneke; Buiting, Anton; de Brauwer, Els I. G. B.; van den Broek, Peterhans J.; van Gelderen, Paula; Leenders, Sander A. C. A. P.; Ott, Alewijn; Richter, Clemens; Spanjaard, Lodewijk; Spijkerman, Ingrid J. B.; van Tiel, Frank H.; Voorn, G. Paul; Wulf, Mireille W. H.; van Zeijl, Jan; Troelstra, Annet; Bonten, Marc J. M.; van de Berg, C. M. F.; Bosman, J.; Bremer, A.; Bril, W.; Commeren, D.; van Essen, G.; Gigengack-Baars, A.; van Kasteren, M. M. E.; Lommerse, E. J. M.; Mascini, E.; Renders, N. H. M.; van Rijen, M.; Schellekens, J.; Smeets, E.; Sprangers, T.; Vandenbroucke-Grauls, C. M. J. E.; Verbon, A.; Verduin, K.; Wagenvoort, J. H. T.; van Wijngaarden, P.

    2011-01-01

    Using data from an observational study in which the effectiveness of a guideline for eradication of methicillin-resistant Staphylococcus aureus (MRSA) carriage was evaluated, we identified variables that were associated with treatment failure. A multivariate logistic regression model was performed

  20. Nebivolol: Its role in the treatment of hypertension and chronic heart failure

    NARCIS (Netherlands)

    Voors, Adriaan; Van Veldhuisen, D.J.

    2006-01-01

    (beta)-blockers are standard therapy in patients with cardiovascular disease, and have become a cornerstone in the treatment of both hypertension and chronic heart failure. However, two meta-analyses have recently raised doubts about the use of (beta)-blockers in patients with essential

  1. Risk factors associated with failure of treatment for cesarean scar pregnancy.

    Science.gov (United States)

    Chiang, Ying-Cheng; Tu, Yi-An; Yang, Jehn-Hsiahn; Lin, Shin-Yu; Lee, Chien-Nan; Shih, Jin-Chung

    2017-07-01

    To identify risk factors associated with treatment failure among women with cesarean scar pregnancy (CSP). In a retrospective study, the medical records of patients with CSP treated at National Taiwan University Hospital, Taipei, Taiwan, from 1994 to 2015 were reviewed. The women were managed primarily with hysterotomy, evacuation, or methotrexate. Receiver operating characteristic (ROC) curve analysis and logistic regression analysis were used to evaluate the factors associated with treatment failure. Among 90 patients, 44 underwent hysterotomy, 18 underwent evacuation, and 28 received methotrexate. The success rates were 100% (44/44) for hysterotomy, 83% (15/18) for evacuation, and 57% (16/28) for methotrexate (Ptreatment by primary evacuation and methotrexate. In multivariate logistic regression analysis, an MSD of 4 cm or more was the only independent risk factor for treatment failure (odds ratio 68.99, 95% confidence interval 6.27-759.60; P=0.001). Primary hysterotomy was suitable for treatment of CSP of any size. Failure of primary evacuation or methotrexate usually occurred when the MSD was larger than 4 cm. © 2017 International Federation of Gynecology and Obstetrics.

  2. Effects of chronic treprostinil treatment on experimental right heart hypertrophy and failure.

    Science.gov (United States)

    Axelgaard, Sofie; Holmboe, Sarah; Ringgaard, Steffen; Hillgaard, Thomas K; Andersen, Stine; Hansen, Mona S; Andersen, Asger; Nielsen-Kudsk, Jens E

    2017-01-01

    Right heart function is an important predictor of morbidity and mortality in pulmonary arterial hypertension and many CHD. We investigated whether treatment with the prostacyclin analogue treprostinil could prevent pressure overload-induced right ventricular hypertrophy and failure. Male Wistar rats were randomised to severe pulmonary trunk banding with a 0.5-mm banding clip (n=41), moderate pulmonary trunk banding with a 0.6-mm banding clip (n=36), or sham procedure (n=10). The banded rats were randomised to 6 weeks of treatment with a moderate dose of treprostinil (300 ng/kg/minute), a high dose of treprostinil (900 ng/kg/minute), or vehicle. Pulmonary trunk banding effectively induced hypertrophy, dilatation, and decreased right ventricular function. The severely banded animals presented with decompensated heart failure with extracardial manifestations. Treatment with treprostinil neither reduced right ventricular hypertrophy nor improved right ventricular function. In the pulmonary trunk banding model of pressure overload-induced right ventricular hypertrophy and failure, moderate- and high-dose treatment with treprostinil did not improve right ventricular function neither in compensated nor in decompensated right heart failure.

  3. Metabolic effects of short-term GLP-1 treatment in insulin resistant heart failure patients

    DEFF Research Database (Denmark)

    Nielsen, R.; Wiggers, Henrik; Halbirk, Mads

    2012-01-01

    We studied the metabolic effects of 48-h GLP-1 treatment in insulin resistant heart failure patients.In a randomized placebo-controlled double-blinded cross-over study, 11 non-diabetic HF patients with IHD received 48-h GLP-1 and placebo-infusion. We applied OGTT, hyperinsulinemic clamp, indirect...

  4. A systems biology study to tailored treatment in chronic heart failure

    NARCIS (Netherlands)

    Ouwerkerk, W.

    2017-01-01

    This thesis was part of the The BIOlogy STudy to TAilored Treatment in Chronic Heart Failure (BIOSTAT-CHF) project. BIOSTAT-CHF was a European, multicenter, multinational, prospective, observational study that was especially designed to find biological mechanisms involved with response to ESC

  5. Early treatment with tolvaptan improves diuretic response in acute heart failure with renal dysfunction

    NARCIS (Netherlands)

    Matsue, Yuya; ter Maaten, Jozine M.; Suzuki, Makoto; Torii, Sho; Yamaguchi, Satoshi; Fukamizu, Seiji; Ono, Yuichi; Fujii, Hiroyuki; Kitai, Takeshi; Nishioka, Toshihiko; Sugi, Kaoru; Onishi, Yuko; Noda, Makoto; Kagiyama, Nobuyuki; Satoh, Yasuhiro; Yoshida, Kazuki; van der Meer, Peter; Damman, Kevin; Voors, Adriaan A.; Goldsmith, Steven R.

    2017-01-01

    Background: Poor response to diuretics is associated with worse prognosis in patients with acute heart failure (AHF). We hypothesized that treatment with tolvaptan improves diuretic response in patients with AHF. Methods: We performed a secondary analysis of the AQUAMARINE open-label randomized

  6. Volume control in treatment-resistant congestive heart failure : role for peritoneal dialysis

    NARCIS (Netherlands)

    Broekman, K. E.; Sinkeler, S. J.; Waanders, F.; Bartels, G. L.; Navis, G.; Janssen, W. M. T.

    2014-01-01

    Chronic congestive heart failure (HF) has a rising prevalence and increasing impact on health care systems. Current treatment consists of diuretics, renin-angiotensin-aldosterone system blockers, and restriction of salt and fluids. This strategy is often hampered by a drop in effective circulating

  7. Bilateral pelvic discontinuity: a unique condition characterized by high failure rates of current treatment

    Directory of Open Access Journals (Sweden)

    John R. Martin, MD

    2016-12-01

    Conclusions: Bilateral pelvic discontinuity is rare but presents the surgeon with a major reconstructive challenge. Only 1 patient went on to radiographic healing with current treatment strategies. Continued motion of the contralateral pelvic dissociation may account for the high failure rates. Surgeons should be aware of the challenges presented by this diagnosis and develop strategies to improve outcomes.

  8. Long-Term Compliance With Nonpharmacologic Treatment of Patients With Heart Failure

    NARCIS (Netherlands)

    Nieuwenhuis, Maurice M. W.; Jaarsma, Tiny; van Veldhuisen, Dirk J.; Postmus, Douwe; van der Wal, Martje H. L.

    2012-01-01

    The aim of this study was to examine long-term compliance with nonpharmacologic treatment of patients with heart failure (HF) and its associated variables. Data from 648 hospitalized patients with HF (mean age 69 +/- 12 years, 38% women, mean left ventricular ejection fraction 33 +/- 14%) were

  9. 9 CFR 113.499 - Products for treatment of failure of passive transfer.

    Science.gov (United States)

    2010-01-01

    ... passive transfer. 113.499 Section 113.499 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION... STANDARD REQUIREMENTS Antibody Products § 113.499 Products for treatment of failure of passive transfer. A... antibody origin. A product for oral administration shall not be recommended for use in animals more than 24...

  10. NS5A resistance leading to failure of 24-week therapy with sofosbuvir/ledipasvir and ribavirin for the treatment of hepatitis C genotype 1a infection in a HIV-1 co-infected patient.

    Science.gov (United States)

    Sevastianova, Ksenia; Dean, Jonathan; Bannan, Ciaran; Coghlan, Miriam; Farrell, Gillian; Murray, Catherine; De Gascun, Cillian F; Bergin, Colm

    2016-09-01

    Herein we report a previously undescribed case of treatment-emergent non-structural protein 5A (NS5A) resistance mutations, Q30H and Y93C, leading to a failure of 24-week course of sofosbuvir/ledipasvir+ribavirin therapy for the treatment of hepatitis C virus (HCV) genotype 1a in interferon-experienced, human immunodeficiency virus type 1 (HIV-1) co-infected patient with cirrhosis. Copyright © 2016 Elsevier B.V. All rights reserved.

  11. Obesity Is Not Associated with Antimicrobial Treatment Failure for Intra-Abdominal Infection.

    Science.gov (United States)

    Dietch, Zachary C; Duane, Therese M; Cook, Charles H; O'Neill, Patrick J; Askari, Reza; Napolitano, Lena M; Namias, Nicholas; Watson, Christopher M; Dent, Daniel L; Edwards, Brandy L; Shah, Puja M; Guidry, Christopher A; Davies, Stephen W; Willis, Rhett N; Sawyer, Robert G

    2016-08-01

    Obesity and commonly associated comorbidities are known risk factors for the development of infections. However, the intensity and duration of antimicrobial treatment are rarely conditioned on body mass index (BMI). In particular, the influence of obesity on failure of antimicrobial treatment for intra-abdominal infection (IAI) remains unknown. We hypothesized that obesity is associated with recurrent infectious complications in patients treated for IAI. Five hundred eighteen patients randomized to treatment in the Surgical Infection Society Study to Optimize Peritoneal Infection Therapy (STOP-IT) trial were evaluated. Patients were stratified by obese (BMI ≥30) versus non-obese (BMI≥30) status. Descriptive comparisons were performed using Chi-square test, Fisher exact test, or Wilcoxon rank-sum tests as appropriate. Multivariable logistic regression using a priori selected variables was performed to assess the independent association between obesity and treatment failure in patients with IAI. Overall, 198 (38.3%) of patients were obese (BMI ≥30) versus 319 (61.7%) who were non-obese. Mean antibiotic d and total hospital d were similar between both groups. Unadjusted outcomes of surgical site infection (9.1% vs. 6.9%, p = 0.36), recurrent intra-abdominal infection (16.2% vs. 13.8, p = 0.46), death (1.0% vs. 0.9%, p = 1.0), and a composite of all complications (25.3% vs. 19.8%, p = 0.14) were also similar between both groups. After controlling for appropriate demographics, comorbidities, severity of illness, treatment group, and duration of antimicrobial therapy, obesity was not independently associated with treatment failure (c-statistic: 0.64). Obesity is not associated with antimicrobial treatment failure among patients with IAI. These results suggest that obesity may not independently influence the need for longer duration of antimicrobial therapy in treatment of IAI versus non-obese patients.

  12. New less invasive ventricular reconstruction technique in the treatment of ischemic heart failure.

    Science.gov (United States)

    Faria, Rita; Melica, Bruno; Pires-Morais, Gustavo; Rodrigues, Alberto; Ribeiro, José; Guerra, Miguel; Gama, Vasco; Vouga, Luís

    2014-01-01

    Ischemic cardiomyopathy is the leading cause of heart failure. In patients with left ventricular (LV) dilatation, low ejection fraction, and transmural scar in an anteroseptal distribution, surgical ventricular reconstruction (SVR) is a treatment option. We describe our first experience with the Less Invasive Ventricular Enhancement (LIVE) technique using the Revivent™ system (Bioventrix Inc., San Ramon, CA), in the treatment of a large anteroapical aneurysm. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  13. Implant failure and history of failed endodontic treatment: A retrospective case-control study.

    Science.gov (United States)

    Chatzopoulos, Georgios S; Wolff, Larry F

    2017-11-01

    Residual bacterial biofilm and/or bacteria in planktonic form may be survived in the bone following an extraction of an infected tooth that was endodontically treated unsuccessfully Failed endodontic treatment may be associated with failure of implants to osseointegrate in the same sites. Therefore, the aim of this retrospective case-control study is to examine the risk of implant failure in previous failed endodontic sites. This retrospective case-control study is based on 94 dental records of implants placed at the University of Minnesota School of Dentistry. Dental records of patients who received an implant in sites with previously failed endodontic therapy in the dental school were identified from the electronic database, while control subjects were obtained from the same pool of patients with the requirement to have received an implant in a site that was not endodontically treated. The mean age of the population was 62.89±14.17 years with 57.4% of the sample being females and 42.6% of them being males. In regards to the socio-economic status and dental insurance, 84.0% of this population was classified as low socio-economic status and 68.1% had dental insurance. Tobacco use was self-reported by 9.6% and hypercholesterolemia was the most prevalent systemic medical condition. Dental implant failure was identified in two of the included records (2.1%), both of which were placed in sites with a history of failed endodontic treatment. Within the limitations of this retrospective case-control study, further investigation with a larger population group into implant failure of sites that previously had unsuccessful endodontic treatment would be warranted. Implant failure may be associated with a history of failed endodontic treatment. Key words:Implantology, endodontics, osseointegration, treatment outcome, case-control study.

  14. Evaluation of the Prevalence of Different Treatment Failure Modes after Crown Lengthening Surgical Procedures

    Directory of Open Access Journals (Sweden)

    Amirreza Babaloo

    2016-07-01

    and a lack of sufficient keratinized gingiva around the tooth was the most frequent reason for early failures of such procedures.   Key words: Crown lengthening surgical procedures; treatment failure; keratinized gingiva;

  15. Time-to-Furosemide Treatment and Mortality in Patients Hospitalized With Acute Heart Failure.

    Science.gov (United States)

    Matsue, Yuya; Damman, Kevin; Voors, Adriaan A; Kagiyama, Nobuyuki; Yamaguchi, Tetsuo; Kuroda, Shunsuke; Okumura, Takahiro; Kida, Keisuke; Mizuno, Atsushi; Oishi, Shogo; Inuzuka, Yasutaka; Akiyama, Eiichi; Matsukawa, Ryuichi; Kato, Kota; Suzuki, Satoshi; Naruke, Takashi; Yoshioka, Kenji; Miyoshi, Tatsuya; Baba, Yuichi; Yamamoto, Masayoshi; Murai, Koji; Mizutani, Kazuo; Yoshida, Kazuki; Kitai, Takeshi

    2017-06-27

    Acute heart failure (AHF) is a life-threatening disease requiring urgent treatment, including a recommendation for immediate initiation of loop diuretics. The authors prospectively evaluated the association between time-to-diuretic treatment and clinical outcome. REALITY-AHF (Registry Focused on Very Early Presentation and Treatment in Emergency Department of Acute Heart Failure) was a prospective, multicenter, observational cohort study that primarily aimed to assess the association between time to loop diuretic treatment and clinical outcome in patients with AHF admitted through the emergency department (ED). Door-to-furosemide (D2F) time was defined as the time from patient arrival at the ED to the first intravenous furosemide injection. Patients with a D2F time furosemide within 24 h of ED arrival, the median D2F time was 90 min (IQR: 36 to 186 min), and 481 patients (37.3%) were categorized as the early treatment group. These patients were more likely to arrive by ambulance and had more signs of congestion compared with the nonearly treatment group. In-hospital mortality was significantly lower in the early treatment group (2.3% vs. 6.0% in the nonearly treatment group; p = 0.002). In multivariate analysis, earlier treatment remained significantly associated with lower in-hospital mortality (odds ratio: 0.39; 95% confidence interval: 0.20 to 0.76; p = 0.006). In this prospective multicenter, observational cohort study of patients presenting at the ED for AHF, early treatment with intravenous loop diuretics was associated with lower in-hospital mortality. (Registry focused on very early presentation and treatment in emergency department of acute heart failure syndrome; UMIN000014105). Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  16. 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.

  17. Virologic Effectiveness of Abacavir/Lamivudine with Darunavir/Ritonavir Versus Other Protease Inhibitors in Treatment-Experienced HIV-Infected Patients in Clinical Practice.

    Science.gov (United States)

    Lackey, Philip; Mills, Anthony; Carpio, Felix; Hsu, Ricky; DeJesus, Edwin; Pierone, Gerald; Henegar, Cassidy; Fusco, Jennifer; Fusco, Gregory; Wohlfeiler, Mike

    2017-01-01

    The standard of care for HIV treatment is a three-drug regimen consisting of two nucleoside reverse transcriptase inhibitors (NRTIs) and either a non-nucleoside reverse transcriptase inhibitor, a protease inhibitor (PI) or an integrase strand transfer inhibitor. Darunavir boosted with ritonavir (DRV/r) is the only preferred PI in the US Department of Health and Human Services (DHHS) HIV treatment guidelines for antiretroviral-naïve patients, recommended in combination with tenofovir/emtricitabine for antiretroviral-naïve patients. For treatment-experienced and certain antiretroviral-naïve patients, abacavir and lamivudine (ABC/3TC) in combination with DRV/r is considered an effective and tolerable alternative, despite limited research on the effectiveness of this particular combination. This study evaluated virologic outcomes in treatment-experienced patients taking ABC/3TC + DRV/r compared to treatment-experienced patients taking ABC/3TC with any other PI. Treatment-experienced HIV-infected patients initiating their first regimen containing ABC/3TC in combination with any PI in the year 2005 or later were selected from the Observational Pharmaco-Epidemiology Research and Analysis (OPERA®) cohort, a prospective observational cohort reflecting routine medical care. Viral load measurements taken during follow-up were compared between patients taking ABC/3TC + DRV/r and ABC/3TC with a PI other than DRV/r. Logistic regression models were fit to assess the association between regimen exposure and viral load suppression. A total of 151 patients initiating ABC/3TC + DRV/r and 525 patients initiating ABC/3TC + a non-darunavir PI were included. Patients in both treatment groups had comparable clinical indicators (viral load, CD4) at baseline. A regimen of ABC/3TC + DRV/r was more likely to be prescribed in the later years of the study period, leading to a shorter median follow-up in the DRV/r treatment group (as-treated analysis: 14 vs. 17 months, p = 0

  18. Clinical Holistic Medicine (Mindful, Short-Term Psychodynamic Psychotherapy Complemented with Bodywork in the Treatment of Experienced Impaired Sexual Functioning

    Directory of Open Access Journals (Sweden)

    Søren Ventegodt

    2007-01-01

    Full Text Available In this clinical follow-up study, we examined the effect of clinical holistic medicine (psychodynamic short-term therapy complemented with bodywork on patients with poor self-assessed sexual functioning and found that this problem could be solved in 41.67% of the patients ((95% CI: 27.61–56.7%; 1.75 < NNT < 3.62, p = 0.05. The bodywork was inspired by the Marion Rosen method and helped the patients to confront painful emotions from childhood trauma(s, and thus accelerated and deepened the therapy. The goal of therapy was the healing of the whole life of the patient through Antonovsky-salutogenesis. In this process, rehabilitation of the character and purpose of life of the patient was essential, and assisted the patient to recover his or her sense of coherence (existential coherence. We conclude that clinical holistic medicine is the treatment of choice if the patient is ready to explore and assume responsibility for his or her existence (true self, and willing to struggle emotionally in the therapy to reach this important goal. When the patient heals existentially, quality of life, health, and ability to function in general are improved at the same time. The therapy was “mindful” in its focus on existential and spiritual issues. The patients received in average 14.8 sessions at the cost of 1,188 EURO.

  19. Biologically effective dose and definitive radiation treatment for localized prostate cancer: treatment gaps do affect the risk of biochemical failure.

    Science.gov (United States)

    Sanpaolo, P; Barbieri, V; Genovesi, D

    2014-08-01

    It is not clear if prolongation of definitive external radiation therapy for prostate cancer has an effect on biochemical failure. The aim of this work was to evaluate whether the biologically effective dose (BED), and in particular the duration of radiotherapy, intended as overall treatment time, has an effect on biochemical failure rates and to develop a nomogram useful to predict the 6-year probability of biochemical failure. A total of 670 patients with T1-3 N0 prostate cancer were treated with external beam definitive radiotherapy, to a total dose of 72-79.2 Gy in 40-44 fractions. The computed BED values were treated with restricted cubic splines. Variables were checked for colinearity using Spearman's test. The Kaplan-Meier method was used to calculate freedom from biochemical relapse (FFBR) rates. The Cox regression analysis was used to identify prognostic factors of biochemical relapse in the final most performing model and to create a nomogram. Concordance probability estimate and calibration methods were used to validate the nomogram. Neoadjuvant and concomitant androgen deprivation was administered to 475 patients (70%). The median follow-up was 80 months (range 20-129 months). Overall, the 6-year FFBR rate was 88.3%. BED values were associated with higher biochemical failure risk. Age, iPSA, risk category, and days of radiotherapy treatment were independent variables of biochemical failure. A prolongation of RT (lower BED values) is associated with an increased risk of biochemical failure. The nomogram may be helpful in decision making for the individual patient.

  20. An Effective Treatment for Heart Failure Caused by Valvular Heart Diseases: Thoracic Sympathetic Block.

    Science.gov (United States)

    Li, Dan; Liu, Wei; Ma, Dan; Yun, Fengxiang; Li, Shu; Liu, Fengqi

    2017-02-27

    The pilot study is designed to investigate the effect of continuous thoracic sympathetic block (TSB) on cardiac function, reconstruction, and hemodynamic parameters in patients with heart failure resulting from valvular heart disease. The cardiac function parameters, including left ventricle ejection fraction (LVEF), left ventricle end-diastole diameter (LVEDD), fractional shortening (FS), and N-terminal prohormone of brain natriuretic peptide (NT-proBNP), were measured in 19 patients before and after TSB treatment. The patients were also classified on the basis of NYHA classification system. 4 weeks of TSB administration improved cardiac function in 18 of 19 patients (94.74%). The patients' LVEF, LVEDD, and NT-proBNP were all improved significantly after treatment. The favorable clinical outcome of TSB administration suggests an alternative treatment for the patients with heart failure caused by valvular dysfunctions.

  1. Successful treatment of a child with fulminant liver failure and coma due to Amanita phalloides poisoning using urgent liver transplantation.

    Science.gov (United States)

    Araz, C; Karaaslan, P; Esen, A; Zeyneloglu, P; Candan, S; Torgay, A; Haberal, M

    2006-03-01

    Intoxication due to eating wild mushrooms presents with a variety of signs, ranging from mild diarrhea to severe organ failure. We present the case of an 11-year-old boy with fulminant liver failure and hepatic coma due to Amanita phalloides poisoning treated with an urgent pediatric orthotopic liver transplantation. Successful treatment of patients with fulminant liver failure and hepatic coma caused by Amanita phalloides poisoning is possible using urgent orthotopic liver transplantation when conservative medical treatment modalities are ineffective.

  2. Treatment Failure With Rhythm and Rate Control Strategies in Patients With Atrial Fibrillation and Congestive Heart Failure: An AF-CHF Substudy.

    Science.gov (United States)

    Dyrda, Katia; Roy, Denis; Leduc, Hugues; Talajic, Mario; Stevenson, Lynne Warner; Guerra, Peter G; Andrade, Jason; Dubuc, Marc; Macle, Laurent; Thibault, Bernard; Rivard, Lena; Khairy, Paul

    2015-12-01

    Rate and rhythm control strategies for atrial fibrillation (AF) are not always effective or well tolerated in patients with congestive heart failure (CHF). We assessed reasons for treatment failure, associated characteristics, and effects on survival. A total of 1,376 patients enrolled in the AF-CHF trial were followed for 37  ±  19 months, 206 (15.0%) of whom failed initial therapy leading to crossover. Rhythm control was abandoned more frequently than rate control (21.0% vs. 9.1%, P CHF. The most common reasons for treatment failure are inefficacy for rhythm control and worsening heart failure for rate control. Changing strategies does not impact survival. © 2015 Wiley Periodicals, Inc.

  3. Cardiac Resynchronization Therapy Defibrillator Treatment in a Child with Heart Failure and Ventricular Arrhythmia

    Directory of Open Access Journals (Sweden)

    Hak Ju Kim

    2016-08-01

    Full Text Available Cardiac resynchronization therapy (CRT is a new treatment for refractory heart failure. However, most patients with heart failure treated with CRT are adults, middle-aged or older with idiopathic or ischemic dilated cardiomyopathy. We treated a 12-year-old boy, who was transferred after cardiac arrest, with dilated cardiomyopathy, left bundle-branch block, and ventricular tachycardia. We performed cardiac resynchronization therapy with a defibrillator (CRT-D. After CRT-D, left ventricular ejection fraction improved from 22% to 4 4% a ssessed by e chocardiog ram 1 year p ostoperatively. On e lectrocardiog ram, Q RS d uration was shortened from 206 to 144 ms. The patient’s clinical symptoms also improved. For pediatric patients with refractory heart failure and ventricular arrhythmia, CRT-D could be indicated as an effective therapeutic option.

  4. The fascial system and exercise intolerance in patients with chronic heart failure: hypothesis of osteopathic treatment

    Science.gov (United States)

    Bordoni, Bruno; Marelli, F

    2015-01-01

    Chronic heart failure is a progressive, debilitating disease, resulting in a decline in the quality of life of the patient and incurring very high social economic costs. Chronic heart failure is defined as the inability of the heart to meet the demands of oxygen from the peripheral area. It is a multi-aspect complex disease which impacts negatively on all of the body systems. Presently, there are no texts in the modern literature that associate the symptoms of exercise intolerance of the patient with a dysfunction of the fascial system. In the first part of this article, we will discuss the significance of the disease, its causes, and epidemiology. The second part will explain the pathological adaptations of the myofascial system. The last section will outline a possible osteopathic treatment for patients with heart failure in order to encourage research and improve the general curative approach for the patient. PMID:26586951

  5. The fascial system and exercise intolerance in patients with chronic heart failure: hypothesis of osteopathic treatment.

    Science.gov (United States)

    Bordoni, Bruno; Marelli, F

    2015-01-01

    Chronic heart failure is a progressive, debilitating disease, resulting in a decline in the quality of life of the patient and incurring very high social economic costs. Chronic heart failure is defined as the inability of the heart to meet the demands of oxygen from the peripheral area. It is a multi-aspect complex disease which impacts negatively on all of the body systems. Presently, there are no texts in the modern literature that associate the symptoms of exercise intolerance of the patient with a dysfunction of the fascial system. In the first part of this article, we will discuss the significance of the disease, its causes, and epidemiology. The second part will explain the pathological adaptations of the myofascial system. The last section will outline a possible osteopathic treatment for patients with heart failure in order to encourage research and improve the general curative approach for the patient.

  6. HIV-1 Drug-Resistance Surveillance among Treatment-Experienced and -Naïve Patients after the Implementation of Antiretroviral Therapy in Ghana

    Science.gov (United States)

    Ishikawa, Koichi; Brandful, James A. M.; Ofori, Sampson B.; Yamaoka, Shoji; Ampofo, William K.; Sugiura, Wataru

    2013-01-01

    Background Limited HIV-1 drug-resistance surveillance has been carried out in Ghana since the implementation of antiretroviral therapy (ART). This study sought to provide data on the profile of HIV-1 drug resistance in ART-experienced and newly diagnosed individuals in Ghana. Methods Samples were collected from 101 HIV-1-infected patients (32 ART-experienced cases with virological failure and 69 newly diagnosed ART-naïve cases, including 11 children), in Koforidua, Eastern region of Ghana, from February 2009 to January 2010. The pol gene sequences were analyzed by in-house HIV-1 drug-resistance testing. Results The most prevalent HIV-1 subtype was CRF02_AG (66.3%, 67/101) followed by unique recombinant forms (25.7%, 26/101). Among 31 ART-experienced adults, 22 (71.0%) possessed at least one drug-resistance mutation, and 14 (45.2%) had two-class-resistance to nucleoside and non-nucleoside reverse-transcriptase inhibitors used in their first ART regimen. Importantly, the number of accumulated mutations clearly correlated with the duration of ART. The most prevalent mutation was lamivudine-resistance M184V (n = 12, 38.7%) followed by efavirenz/nevirapine-resistance K103N (n = 9, 29.0%), and zidovudine/stavudine-resistance T215Y/F (n = 6, 19.4%). Within the viral protease, the major nelfinavir-resistance mutation L90M was found in one case. No transmitted HIV-1 drug-resistance mutation was found in 59 ART-naïve adults, but K103N and G190S mutations were observed in one ART-naïve child. Conclusions Despite expanding accessibility to ART in Eastern Ghana, the prevalence of transmitted HIV-1 drug resistance presently appears to be low. As ART provision with limited options is scaled up nationwide in Ghana, careful monitoring of transmitted HIV-1 drug resistance is necessary. PMID:23977189

  7. LCZ696 (Valsartan/Sacubitril)--A Possible New Treatment for Hypertension and Heart Failure.

    Science.gov (United States)

    Andersen, Mathilde Borring; Simonsen, Ulf; Wehland, Markus; Pietsch, Jessica; Grimm, Daniela

    2016-01-01

    The aim of this MiniReview was to introduce the newly invented dual-acting drug valsartan/sacubitril (LCZ696), which combines an angiotensin receptor blocker (valsartan) with sacubitril, a specific inhibitor of the neutral endopeptidase (NEP) that degrades vasoactive peptides, including natriuretic peptides ANP and BNP, but also glucagon, enkephalins and bradykinin, among others. The MiniReview presents the data of four available trials NCT01193101, NCT00549770, NCT00887588 and NCT01035255 and provides the current knowledge about LCZ696 effects in patients with hypertension and heart failure. Presently, patients suffering from hypertension and heart failure are treated with ACE inhibitors or angiotensin receptor antagonists often in combination with other drugs. These current medications lead to a reduction in blood pressure in hypertensive patients and a decreased mortality and morbidity in patients with heart failure with reduced ejection fraction, but not in patients with heart failure with preserved ejection fraction. LCZ696 had been tested to utilize the beneficial properties of natriuretic peptides in combination with angiotensin receptor antagonism. It induces even greater blood pressure reductions and decreased mortality and morbidity in patients with heart failure with reduced ejection fraction, while patients with heart failure with preserved ejection fraction show lowered blood pressure and decreased NT-pro-BNP levels. Although long-term studies remain to be performed, these initial data suggest that there is a potential clinical benefit of LCZ696 in the treatment of hypertension and heart failure. © 2015 Nordic Association for the Publication of BCPT (former Nordic Pharmacological Society).

  8. [Clinical experience of supplying sodium chloride for the treatment of patients with severe heart failure].

    Science.gov (United States)

    He, Li-xia; Sun, Lu-lu; Yang, Yue-jin; Zhang, Jian; Zhang, Yu-hui; Song, Wei-hua; Huang, Yan; Lü, Rong; Ji, Shi-ming

    2012-09-01

    To observe the effect and safety of supplying sodium chloride in the treatment of patients with severe heart failure. Consecutive 51 hospitalized patients with severe heart failure and cardiac edema were included in this study. Normal diet (6 g NaCl/d) was supplied to all patients. On the basis of controlling fluid intake and treating related etiological factors as well as standard medications including furosemide for severe heart failure, patients with mild hyponatremia (serum sodium level 130 - 134 mmol/L) ate additional salted vegetables, patients with moderate hyponatremia (serum sodium level 125 - 129 mmol/L) and severe hyponatremia (serum sodium level salted vegetables and were received additionally intravenous 3%NaCl hypertonic saline infusion (10 ml/h) until reaching normal serum sodium level. On admission, 37.25% (19/51) patients had hyponatremia. During the first two weeks hospitalization period, 88.24% (45/51) patients were treated with intravenous diuretics and total incidence of hyponatremia was 64.71% (33/51), mild hyponatremia was 50.98% (26/51), middle and severe hyponatremia was 13.73% (7/51); among them, hyponatremia lasted less than 3 d in 57.58% (19/33) patients and ≥ 3 d in 42.42% (14/33) patients. Heart failure exacerbation and hypernatremia were not observed in patients receiving additional sodium chloride therapy. Hospitalization time was similar among patients with different blood natrium levels [average (16 ± 12) d]. Fifty out of 51 (98%) patients discharged from the hospital with improved heart failure symptoms and signs. Supplying additional sodium chloride could rapid correct hyponatremia in heart failure patients with or without intravenous diuretics therapy which might contribute to a favorable prognosis in hospitalized heart failure patients.

  9. Elevated CD8 counts during HAART are associated with HIV virologic treatment failure.

    Science.gov (United States)

    Krantz, Elizabeth M; Hullsiek, Katherine Huppler; Okulicz, Jason F; Weintrob, Amy C; Agan, Brian K; Crum-Cianflone, Nancy F; Ganesan, Anuradha; Ferguson, Tomas M; Hale, Braden R

    2011-08-15

    To evaluate whether elevated CD8 counts are associated with increased risk of virologic treatment failure in HIV-infected individuals. Retrospective cohort study. US Military HIV Natural History Study participants who initiated highly active antiretroviral therapy (HAART) in 1996-2008 had 6- and 12-month post-HAART HIV RNA start of HAART, virologic failure (VF) was defined as confirmed HIV RNA ≥ 400 copies per milliliter, and CD8 counts ≥ 1200 cells per cubic millimeter were considered elevated. Cox models were used to examine the effect of baseline and time-updated CD8 counts on VF. There were 216 failures for a rate of 5.6 per 100 person-years [95% confidence interval (CI): 4.9 to 6.4]. Among those initiating HAART in 2000-2008, the participants with elevated baseline CD8 counts had significantly greater risk of VF compared with those with baseline CD8 counts ≤ 600 cells per cubic millimeter [hazard ratio (HR) = 2.68, 95% CI: 1.13 to 6.35]. The participants with elevated CD8 counts at >20% of previous 6-month follow-up visits had a greater risk of failure at the current visit than those who did not (HR = 1.53, 95% CI: 1.14 to 2.06). Those with CD8 counts that increased after the start of HAART had a greater risk of failure than those with CD8 counts that decreased or remained the same (HR = 1.59, 95% CI: 1.19 to 2.13). Initial or serial elevated CD8 counts while on HAART or an increase in CD8 counts from HAART initiation may be early warnings for future treatment failure.

  10. Profile and determinants of treatment failure among smear-positive pulmonary tuberculosis patients in Ebonyi, Southeastern Nigeria

    Directory of Open Access Journals (Sweden)

    Isaac Alobu

    2014-01-01

    Conclusion: This study showed that the treatment failure rate among smear-positive TB patients is low in Nigeria. Education and improved clinical and laboratory interventions for the identified at-risk groups may reduce TB treatment failure in resource-limited settings.

  11. The psychological impact more cycles of IVF with a treatment strategy of IVF failure after two or mild versus standard

    NARCIS (Netherlands)

    de Klerk, C.; Macklon, N. S.; Heijnen, E. M. E. W.; Eijkemans, M. J. C.; Fauser, B. C. J. M.; Passchier, J.; Hunfeld, J. A. M.

    BACKGROUND: Failure of IVF treatment after a number of cycles can be devastating for couples. Although mild IVF strategies reduce the psychological burden of treatment, failure may cause feelings of regret that a more aggressive approach, including the transfer of two embryos, was not employed. In

  12. Endometrial scratching for women with previous IVF failure undergoing IVF treatment.

    Science.gov (United States)

    Gibreel, Ahmed; El-Adawi, Noha; Elgindy, Eman; Al-Inany, Hesham; Allakany, Nasser; Tournaye, Herman

    2015-04-01

    The purpose of this study was to find out whether endometrial scratching could improve live birth rate in women with previous IVF failure undergoing fresh IVF cycle. In a randomized controlled trial, 387 women with previous IVF failure were divided into two groups. Group A (193 women) was subjected to endometrial biopsy procedure twice. Group B (194 women) was subjected to a placebo procedure. Our results showed no difference in live birth rate between the two groups of women (47.2% versus 38.1%, p = 0.08). However, regression analysis revealed that endometrial scratching was an independent predictor of live birth in the subgroup of women with two or more previous failure after control of other independent predictors (odds ratio (OR) 3.4, p = 0.005). We conclude that endometrial scratching does not improve live birth rate in women undergoing IVF treatment with previous one IVF failure. Nevertheless, it may improve live birth in women with two or more previous IVF failures.

  13. [The prevention and treatment of post-resectional live failure for hepatocellular carcinoma].

    Science.gov (United States)

    Ding, Yi-tao; Jiang, Chun-ping; Qiu, Yu-dong; Wu, Ya-fu; Zhou, Jian-xin; Liu, Ren-qing

    2010-02-01

    To investigate the cause of liver failure after hepatectomy for hepatocellular carcinoma and explore its prevention and treatment. The clinical data of 1000 patients with hepatocellular carcinoma undergone hepatectomy from July 2000 to June 2008 were retrospectively analyzed. There were 922 male and 78 female, aging from 21 to 89 years old. Among the 1000 patients, there were 18 patients with liver failure after hepatectomy (1.8%). Among the 18 patients with liver failure, 13 patients were more than 65 years old, 14 patients were with more than 20% of indocyanine green retention rate at 15 minutes, 14 patients were with more than 1000 ml blood loss during operation, 6 patients were with F4/F3 liver fibrosis (Metavir Scores), and 9 patients were with less than 40.0% liver volume of residue liver. Patients with hepatocellular carcinoma with less than volume of residue liver, much more blood loss or transfusion, more than 20% of ICGR15, F4/F3 liver cirrhosis are prone to be with liver failure after hepatectomy. Artificial liver or liver transplantation may be the important alternative for liver failure after hepatectomy.

  14. Type 2 Diabetes Mellitus Is Associated with Strongyloides stercoralis Treatment Failure in Australian Aboriginals.

    Directory of Open Access Journals (Sweden)

    Russell Hays

    Full Text Available To explore the efficacy of ivermectin in the treatment of serologically diagnosed cases of Strongyloides stercoralis (S. stercoralis infection in an Aboriginal community and to describe factors that may influence the outcome of treatment.Longitudinal study of a group of 92 individuals with serologically diagnosed S. stercoralis treated with ivermectin and followed up over a period of approximately 6 months. Main outcomes were serological titers pre and post treatment, diabetic status, and duration of follow up.Treatment success was achieved in 62% to 79% of cases dependent on the methods employed for the diagnosis of infection and assessment of treatment outcome. Type 2 Diabetes Mellitus (T2DM was found to be significantly associated with treatment failure in this group for two of the three methods employed.Ivermectin has been confirmed as an effective treatment for S stercoralis infection in this setting. T2DM appears to be an independent risk factor for treatment failure in this population, and plausible mechanisms to explain this observation are presented.

  15. B-type natriuretic peptide-guided treatment for heart failure.

    Science.gov (United States)

    McLellan, Julie; Heneghan, Carl J; Perera, Rafael; Clements, Alison M; Glasziou, Paul P; Kearley, Karen E; Pidduck, Nicola; Roberts, Nia W; Tyndel, Sally; Wright, F Lucy; Bankhead, Clare

    2016-12-22

    Heart failure is a condition in which the heart does not pump enough blood to meet all the needs of the body. Symptoms of heart failure include breathlessness, fatigue and fluid retention. Outcomes for patients with heart failure are highly variable; however on average, these patients have a poor prognosis. Prognosis can be improved with early diagnosis and appropriate use of medical treatment, use of devices and transplantation. Patients with heart failure are high users of healthcare resources, not only due to drug and device treatments, but due to high costs of hospitalisation care. B-type natriuretic peptide levels are already used as biomarkers for diagnosis and prognosis of heart failure, but could offer to clinicians a possible tool to guide drug treatment. This could optimise drug management in heart failure patients whilst allaying concerns over potential side effects due to drug intolerance. To assess whether treatment guided by serial BNP or NT-proBNP (collectively referred to as NP) monitoring improves outcomes compared with treatment guided by clinical assessment alone. Searches were conducted up to 15 March 2016 in the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library; MEDLINE (OVID), Embase (OVID), the Database of Abstracts of Reviews of Effects (DARE) and the NHS Economic Evaluation Database in the Cochrane Library. Searches were also conducted in the Science Citation Index Expanded, the Conference Proceedings Citation Index on Web of Science (Thomson Reuters), World Health Organization International Clinical Trials Registry and ClinicalTrials.gov. We applied no date or language restrictions. We included randomised controlled trials of NP-guided treatment of heart failure versus treatment guided by clinical assessment alone with no restriction on follow-up. Adults treated for heart failure, in both in-hospital and out-of-hospital settings, and trials reporting a clinical outcome were included. Two review authors

  16. Failure pattern and salvage treatment after radical treatment of head and neck cancer

    DEFF Research Database (Denmark)

    Pagh, Anja; Grau, Cai; Overgaard, Jens

    2016-01-01

    recordings of recurrent disease in 567 patients with primary tumors of the larynx, pharynx, oral cavity, nasal cavity, paranasal sinuses and salivary glands. A review of medical records was performed in order to update and supplement the database. Results Failures of the 567 patients were primarily in T...

  17. Advantages, Disadvantages, and Trend of Integrative Medicine in the Treatment of Heart Failure.

    Science.gov (United States)

    Zhang, PeiYing

    2015-06-01

    Integrative medicine therapy using traditional Chinese medicine (TCM) combined with western medicine has shown some advantages in treating heart failure (HF), such as holistic concept; multi-target treatment; dialectical logic; personalized therapy; formulae compatibility; and reduction of side effects of western medicine. However, problems still exist in TCM treatment of HF, including non-uniformed categorization of TCM, lack of standardized syndrome differentiation and lack of an evidence base. The future of treatment of HF seems to be focused on reversing ventricular remodeling, improving cardiac rehabilitation, and accelerating experimental research and drug discovery in TCM.

  18. Immunity as a predictor of anti-malarial treatment failure: a systematic review.

    Science.gov (United States)

    O'Flaherty, Katherine; Maguire, Julia; Simpson, Julie A; Fowkes, Freya J I

    2017-04-20

    Naturally acquired immunity can reduce parasitaemia and potentially influence anti-malarial treatment outcomes; however, evidence for this in the current literature provides conflicted results. The available evidence was synthesized to determine and quantify the association between host immunity and anti-malarial treatment failure. Four databases were searched to identify studies investigating malaria antibody levels in patients receiving anti-malarial treatment for symptomatic malaria with treatment failure recorded according to the World Health Organization classification. Odds ratios or hazard ratios were extracted or calculated to quantify the association between malarial antibody levels and treatment failure, and findings from different studies were visualized using forest plots. Eight studies, including patients with falciparum malaria treated with mono- and combination therapy of artemisinin derivatives, sulfadoxine, pyrimethamine and chloroquine, were identified. Reported and calculated effect estimates varied greatly between studies, even those assessing the same antigens and treatments. An association between blood-stage IgG responses and treatment efficacy was observed. The greatest magnitudes of effect were observed for artemisinin [OR/HR (95% CI) range 0.02 (0.00, 0.45)-1.08 (0.57, 2.06)] and chloroquine [0.24 (0.04, 1.37)-0.32 (0.05, 1.96)] treatments, and larger magnitudes of effect were observed for variant surface antigen responses [0.02 (0.00, 0.45)-1.92 (0.94, 3.91)] when compared with merozoite specific responses [0.24 (0.04, 1.37)-2.83 (1.13, 7.09)]. Naturally acquired malarial immunity is associated with reduced anti-malarial treatment failure in malaria endemic populations. Anti-malarial IgG effects treatment outcome differently for different anti-malarial drugs and antigen targets, and had the greatest impact during treatment with the current first-line treatments, the artemisinins. This has implications for the assessment of the therapeutic

  19. Safety and Effectiveness of Ledipasvir and Sofosbuvir, With or Without Ribavirin, in Treatment-Experienced Patients with Genotype 1 Hepatitis C Virus Infection and Cirrhosis.

    Science.gov (United States)

    Lim, Joseph K; Liapakis, Ann Marie; Shiffman, Mitchell L; Lok, Anna S; Zeuzem, Stefan; Terrault, Norah A; Park, James S; Landis, Charles S; Hassan, Mohamed; Gallant, Joel; Kuo, Alexander; Pockros, Paul J; Vainorius, Monika; Akushevich, Lucy; Michael, Larry; Fried, Michael W; Nelson, David R; Ben-Ari, Ziv

    2018-01-03

    We aimed to evaluate the safety and effectiveness of 12 or 24 weeks treatment with ledipasvir and sofosbuvir, with or without ribavirin, in treatment-experienced patients with hepatitis C virus (HCV) genotype 1 infection and cirrhosis in routine clinical practice. Patients were followed in a multi-center, prospective, observational cohort study (HCV-TARGET). We collected data from 667 treatment-experienced adults with chronic genotype 1 HCV infection who began treatment with ledipasvir and sofosbuvir, with or without ribavirin, from 2011 through September 15, 2016, according to the regional standards of care, at academic (n=39) and community (n=18) centers in the United States, Canada, Germany, and Israel. Information was collected from medical records and abstracted into a unique centralized data core. Independent monitors systematically reviewed data entries for completeness and accuracy. Demographic, clinical, adverse event, and virologic data were collected every 12 weeks during treatment and during the follow-up period. The primary efficacy endpoint was sustained virologic response, defined as a level of HCV RNA below the lower limit of quantification or undetectable at a minimum 64 days after the end of treatment (SVR12). The per-protocol population (n=610) was restricted to patients who completed 12 or 24 weeks of treatment (±2 weeks) and had final virologic outcomes available. The per-protocol analysis revealed that 579 patients (93.8%) achieved an SVR12, including 50/51 patients who received ledipasvir and sofosbuvir for 12 weeks (98%), 384/408 patients who received ledipasvir and sofosbuvir for 24 weeks (94.1%), 68/70 patients who received ledipasvir and sofosbuvir with ribavirin for 12 weeks (97.1%), and 57/60 patients who received ledipasvir and sofosbuvir with ribavirin for 24 weeks (95%). On multivariate analysis, neither treatment duration nor the addition of ribavirin was associated with SVR12. Compensated cirrhosis (odds ratio [OR] compared to

  20. Bone growth during daily or intermittent calcitriol treatment during renal failure with advanced secondary hyperparathyroidism.

    Science.gov (United States)

    Sanchez, C P; He, Y Z

    2007-09-01

    Calcitriol is a standard therapy for secondary hyperparathyroidism in chronic renal failure. We evaluated whether the effect of daily or intermittent calcitriol administration is more efficient in enhancing bone growth in renal failure with advanced secondary hyperparathyroidism in weanling 5/6 nephrectomized rats loaded with phosphorus to induce severe secondary hyperparathyroidism. The animals were treated daily or three times weekly with calcitriol for 4 weeks but the total weekly dose of calcitriol was the same. Although calcitriol increased the serum calcium, it did not lower parathyroid hormone (PTH) or improve tibia and body length. Animals with renal failure and advanced secondary hyperparathyroidism had decreased PTH/PTHrP, which was accompanied by an increase in the cyclin kinase inhibitor p57(Kip2). Calcitriol treatment upregulated the PTH/PTHrP receptor but also increased inhibitors of cell proliferation such as p21(Waf1/Cip1), IGFBP3, and FGFR3. Calcitriol also enhanced markers of chondrocyte differentiation, such as IGF1, Vitamin D receptor, FGF23, and bone morphogenetic protein-7. Receptor activator of nuclear factor-kappabeta ligand levels improved with calcitriol treatment but without changes in osteoprotegerin suggesting an enhancement of osteo/chondroclastogenesis and mineralization. Overall, both daily and intermittent calcitriol had similar effects on endochondral bone growth in phosphorus-loaded rats with renal failure.

  1. First-drug treatment failures in 42 Turkish children with idiopathic childhood occipital epilepsies

    Directory of Open Access Journals (Sweden)

    Faruk Incecik

    2015-01-01

    Full Text Available Background: The early and late benign occipital epilepsies of childhood (BOEC are described as two discrete electro-clinical syndromes, eponymously known as Panayiotopoulos and Gastaut syndromes. The purpose of this study was to identify predictors of failure to respond to the initial antiepileptic drug (AED. Materials and Methods: A total of 42 children with BOEC were enrolled. Predictive factors were analyzed by survival methods. Results: Among the 42, 25 patients (59.5% were boys and 17 (40.5% were girls and the mean age at the seizure onset was 7.46 ± 2.65 years (4-14 years. Of the 42 patients, 34 (81.0% were treated relatively successfully with the first AED treatment, and 8 (19.0% were not responded initial AED treatment. There was no correlation between response to initial AED treatment and sex, consanguinity, epilepsy history of family, age of seizure onset, frequency of seizures, history of status epilepticus, duration of starting first treatment, findings on electroencephalogram. However, history of febrile seizure and type of BOEC were significantly associated with failure risk. Conclusions: Factors predicting failure to respond to the AED were history of febrile seizure and type of BOEC in children with BOEC.

  2. Medical treatment of hypertension in patients with heart failure with preserved ejection fraction.

    Science.gov (United States)

    Kiel, Richard G; Deedwania, Prakash

    2013-12-01

    Heart failure with preserved ejection fraction (HFPEF) has become an increasingly common problem, accounting for as many as half of all diagnoses of heart failure. Hypertension has been shown to be a major risk factor for the development of HPEF, and the treatment of hypertension is key to both preventing the development of HFPEF as well as mitigating its impact on our health care system. While numerous studies have looked at using various classes of antihypertensive medications to treat HFPEF, there are still no well validated treatment strategies which have shown a significant mortality benefit. As a result, when choosing an antihypertensive medication to treat or prevent HFPEF, it is important to tailor the choice of antihypertensive medication to an individual patient's specific symptoms and comorbidities.

  3. An atypical presentation of mechanical failure of eruption of a mandibular permanent molar: diagnosis and treatment case report.

    LENUS (Irish Health Repository)

    Smith, C P

    2012-06-01

    Failure of eruption of mandibular permanent molars occurs infrequently but is a difficult clinical problem. It can be due to local or systemic factors or failure of the eruption process. Primary failure of eruption (PFE) is a rare condition that can result in severe posterior open bite, requires complex treatment strategies and has unfavourable outcomes. Mechanical failure of eruption (MFE) is more unusual but can respond positively to treatment. Differentiating between the two is crucial in making the correct diagnosis and managing the case successfully.

  4. New formulation of Botox: complete antibody-induced treatment failure in cervical dystonia

    OpenAIRE

    Dressler, D; Saberi, F Adib

    2009-01-01

    Botulinum toxin is used with remarkable success to treat various muscle and exocrine gland hyperactivity syndromes. Rarely, treatment failure due to formation of botulinum toxin antibodies (ABF) occurs. To reduce the risk of ABF, a new formulation of Botox (in the following “current Botox”; Allergan, Irvine, California, USA) with increased specific biological potency was introduced. Here we report the case of a 50-year-old woman who developed ABF despite receiving current Botox.

  5. Recurrent oropharyngeal cancer after organ preserving treatment: pattern of failure and survival.

    Science.gov (United States)

    de Ridder, M; Gouw, Z A R; Sonke, J J; Navran, A; Jasperse, B; Heukelom, J; Tesselaar, M E T; Klop, W M C; van den Brekel, M W M; Al-Mamgani, Abrahim

    2017-03-01

    The objectives is to thoroughly analyze the pattern of failure and oncologic outcome in recurrent oropharyngeal cancer (OPC) after (chemo)radiotherapy and correlate the site of failure to the planned radiation dose. Between January 2010 and April 2014, 57 patients with recurrent OPC after (chemo)radiotherapy were analyzed. Endpoints were pattern of failure and overall survival (OS). Local (LF) and regional failure (RF) were classified as in-field [>50% within gross tumor volume (GTV)], marginal [50% within clinical target volume (CTV)], or out-of-field (>50% outside CTV) recurrences. In the whole group, 70 recurrences were reported. Of the 31 LF, 29 (93.5%) were in-field and 2 (6.5%) were marginal. No out-field LF was reported. Of the 21 RF, 13 RF (62%) were in-field, 6 (28.5%) marginal, and 2 (9.5%) out-of-field recurrences. Forty-three percent of RF was developed in an electively treated neck level, and 2 of them were contralateral. OS at 2 years in recurrent HPV positive, compared to HPV-negative OPC, were 66 and 18%, respectively (p = 0.011). OS was also significantly better in patients that were salvage treatment which was possible (70 vs. 6%, p < 0.001). Median survival after distant failure was 3.6 months. The great majority of LFs were located within the GTV and 43% of RFs developed in an electively treated neck level. The currently used margins and dose recipe and the indication for bilateral nodal irradiation need to be reevaluated. OS was significantly better in recurrent HPV-positive OPC and in patients, where salvage treatment was possible.

  6. Premature ovarian failure/dysfunction following surgical treatment of polycystic ovarian syndrome: A case series

    Directory of Open Access Journals (Sweden)

    T.K. Al-Hussaini

    2017-09-01

    Full Text Available Polycystic ovarian syndrome (PCOS is one of the most common causes of infertility in women. Surgical treatment of PCOS, either by the antiquated wedge resection or ovarian drilling, is one of the commonly used lines in developing countries due to its low-cost. Premature ovarian failure and diminished ovarian reserve are serious complications of the surgical treatment but no published reports sufficiently highlighted these hazards. In this case series, we report on twenty one women aged between 19–39 years, presented to Infertility Clinic, Assiut Women Health Hospital with ovarian dysfunction, diagnosed within 6–36 months after surgical management of PCOS. Nineteen of them had laparoscopic bilateral ovarian drilling using electrocauterization, and the last two had bilateral wedge resection of the ovaries through minilaparotomy. Accurate and documented diagnosis of PCOS, appropriate surgical training, adjusted thermal injury and adjusted number of punctures are essential for the avoidance of excessive damage to the ovaries. Under treatment (failure of drilling is much better than premature ovarian failure or diminishing ovarian reserve.

  7. The Microcirculation Is Unchanged in Neonates with Severe Respiratory Failure after the Initiation of ECMO Treatment

    Directory of Open Access Journals (Sweden)

    Anke P. C. Top

    2012-01-01

    Full Text Available Purpose. Venoarterial extracorporeal membrane oxygenation (VA-ECMO is known to improve cardiorespiratory function and outcome in neonates with severe respiratory failure. We tested the hypothesis that VA-ECMO therapy improves the microcirculation in neonates with severe respiratory failure. Methods. This single-center prospective observational pilot study took place in an intensive care unit of a level III university children’s hospital. Twenty-one-term neonates, who received VA-ECMO treatment, were included. The microcirculation was assessed in the buccal mucosa, using Orthogonal Polarization Spectral imaging, within 24 hours before (T1 and within the first 24 hours after initiation of ECMO treatment (T2. Data were compared to data of a ventilated control group (=7. Results. At baseline (T1, median functional capillary density (FCD, microvascular flow index (MFI, and heterogeneity index (HI did not differ between the ECMO group and the control group. At T2 the median FCD was lower in the control group (median [range]: 2.4 [1.4–4.2] versus 4.3 [2.8–7.4] cm/cm2; P value <0.001. For MFI and HI there were no differences at T2 between the two groups. Conclusion. The perfusion of the microcirculation does not change after initiation of VA-ECMO treatment in neonates with severe respiratory failure.

  8. Intra-myocardial biomaterial injection therapy in the treatment of heart failure: Materials, outcomes and challenges.

    Science.gov (United States)

    Nelson, Devin M; Ma, Zuwei; Fujimoto, Kazuro L; Hashizume, Ryotaro; Wagner, William R

    2011-01-01

    Heart failure initiated by coronary artery disease and myocardial infarction (MI) is a widespread, debilitating condition for which there are a limited number of options to prevent disease progression. Intra-myocardial biomaterial injection following MI theoretically provides a means to reduce the stresses experienced by the infarcted ventricular wall, which may alter the pathological remodeling process in a positive manner. Furthermore, biomaterial injection provides an opportunity to concurrently introduce cellular components and depots of bioactive agents. Biologically derived, synthetic and hybrid materials have been applied, as well as materials designed expressly for this purpose, although optimal design parameters, including degradation rate and profile, injectability, elastic modulus and various possible bioactivities, largely remain to be elucidated. This review seeks to summarize the current body of growing literature where biomaterial injection, with and without concurrent pharmaceutical or cellular delivery, has been pursued to improve functional outcomes following MI. The literature to date generally demonstrates acute functional benefits associated with biomaterial injection therapy across a broad variety of animal models and material compositions. Further functional improvements have been reported when cellular or pharmaceutical agents have been incorporated into the delivery system. Despite these encouraging early results, the specific mechanisms behind the observed functional improvements remain to be fully explored and future studies employing hypothesis-driven material design and selection may increase the potential of this approach to alleviate the morbidity and mortality of heart failure. Copyright © 2010 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

  9. Factors associated with syphilis treatment failure and reinfection: a longitudinal cohort study in Shenzhen, China.

    Science.gov (United States)

    Luo, Zhenzhou; Zhu, Lin; Ding, Yi; Yuan, Jun; Li, Wu; Wu, Qiuhong; Tian, Lishan; Zhang, Li; Zhou, Guomao; Zhang, Tao; Ma, Jianping; Chen, Zhongwei; Yang, Tubao; Feng, Tiejian; Zhang, Min

    2017-09-13

    The treatment failure and reinfection rates among syphilis patients are high, and relevant studies in China are limited. The aim of this study was to detect the rates of treatment failure and reinfection after syphilis treatment and to explore the potential associated factors. We conducted a longitudinal cohort study in a sexually transmitted disease clinic, the Department of Dermatology and Venereology in Nanshan Center for Chronic Disease Control. Serological testing was performed at baseline and throughout the 2-year follow-up for syphilis patients. To identify potential predictors of treatment outcomes, multivariate logistics analyses were utilized to compare the demographic and clinical characteristics of patients with serological failure/reinfection to those with serological cure/serofast. From June 2011 to June 2016, a total of 1133 patients were screened for syphilis. Among the 770 patients who completed the 2-year follow-up, 510 first-diagnosed patients were included in the final analysis. Multivariate logistics analysis revealed the stage of syphilis (secondary syphilis VS. primary syphilis: adjusted odds ratio, 3.50; 95% confidence interval, 1.11-15.47; p = 0.04), HIV status (positive VS. negative: adjusted odds ratio, 3.06; 95% confidence interval, 1.15-8.04; p = 0.02) and frequency of condom use (always use VS. never use: adjusted odds ratio, 0.28; 95% confidence interval 0.08-0.75; p = 0.02) were significantly associated with the serological outcome. The clinical implications of our findings suggest that it is very important to perform regular clinical and serologic evaluations after treatment. Health counseling and safety education on sex activity should be intensified among HIV-infected patients and secondary syphilis patients after treatment.

  10. Influence of Endodontic Treatment and Retreatment on the Fatigue Failure Load, Numbers of Cycles for Failure, and Survival Rates of Human Canine Teeth.

    Science.gov (United States)

    Missau, Taiane; De Carlo Bello, Mariana; Michelon, Carina; Mastella Lang, Pauline; Kalil Pereira, Gabriel; Baldissara, Paolo; Valandro, Luiz Felipe; Souza Bier, Carlos Alexandre; Pivetta Rippe, Marília

    2017-12-01

    This study evaluated the effects of endodontic treatment and retreatment on the fatigue failure load, numbers of cycles for failure, and survival rates of canine teeth. Sixty extracted canine teeth, each with a single root canal, were selected and randomly divided into 4 groups (n = 15): untreated, teeth without endodontic intervention; prepared, teeth subjected only to rotary instrumentation; filled, teeth receiving complete endodontic treatment; and retreated, teeth retreated endodontically. After the different endodontic interventions, the specimens were subjected to fatigue testing by the stepwise method: 200 N (× 5000 load pulses), 300 N, 400 N, 500 N, 600 N, 800 N, and 900 N at a maximum of 30,000 load pulses each or the occurrence of fracture. Data from load to failure and numbers of cycles for fracture were recorded and subjected to Kaplan-Meier and Log Rank tests (P endodontic treatment and retreatment behaved similarly in terms of fatigue failure load and number of cycles to failure when compared with untreated teeth. Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  11. Reinfusion of ascites during hemodialysis as a treatment of massive refractory ascites and acute renal failure

    Directory of Open Access Journals (Sweden)

    Ta-Wei Hsu

    2011-02-01

    Full Text Available Ta-Wei Hsu1, Yi-Chuan Chen2, Meei-Ju Wu2, Anna Fen-Yau Li3, Wu-Chang Yang2, Yee-Yung Ng21Department of Medicine, I-Lan Hospital, 2Division of Nephrology, Department of Medicine, 3Department of Pathology, Taipei Veterans General Hospital, School of Medicine, National Yang-Ming University, Taipei, TaiwanAbstract: Refractory ascites can occur in patients with various conditions. Although several procedures based on the reinfusion of ascitic fluid have been reported after the failure of bed rest, salt and water restriction, diuretics, intravenous administration of albumin, and repeated paracentesis, these procedures are performed for ascitic fluid removal without dialytic effect. In this study, a flow control reinfusion of ascites during hemodialysis (HD was performed to demonstrate the efficacy of this method in a lupus patient with massive refractory ascites and respiratory and acute renal failure (ARF. The alleviation of ascites and ARF attests to the success of the flow control reinfusion of ascites during HD. This procedure can control the rate of ascites and body fluid removal simultaneously during HD using the roller pump. In conclusion, with a normal coagulation profile, the procedure of flow control reinfusion of ascites during HD is an effective alternative treatment for the alleviation of refractory ascites with renal failure.Keywords: ascites, lupus, renal failure, reinfusion

  12. The fascial system and exercise intolerance in patients with chronic heart failure: hypothesis of osteopathic treatment

    Directory of Open Access Journals (Sweden)

    Bordoni B

    2015-10-01

    Full Text Available Bruno Bordoni,1–3 F Marelli2,3 1Don Carlo Gnocchi Foundation, Department of Cardiology, IRCCS Santa Maria Nascente, Milan, Italy; 2School CRESO, Osteopathic Centre for Research and Studies, Falconara Marittima, AN, Italy; 3School CRESO, Osteopathic Centre for Research and Studies, Castellanza, VA, Italy Abstract: Chronic heart failure is a progressive, debilitating disease, resulting in a decline in the quality of life of the patient and incurring very high social economic costs. Chronic heart failure is defined as the inability of the heart to meet the demands of oxygen from the peripheral area. It is a multi-aspect complex disease which impacts negatively on all of the body systems. Presently, there are no texts in the modern literature that associate the symptoms of exercise intolerance of the patient with a dysfunction of the fascial system. In the first part of this article, we will discuss the significance of the disease, its causes, and epidemiology. The second part will explain the pathological adaptations of the myofascial system. The last section will outline a possible osteopathic treatment for patients with heart failure in order to encourage research and improve the general curative approach for the patient. Keywords: manual therapy, fatigue, chronic heart failure, osteopathic

  13. [Digoxin and angiotensin-converting enzyme inhibitors in the treatment of chronic congestive heart failure].

    Science.gov (United States)

    Thery, C

    1994-01-01

    Several controlled studies with the best methodology had showed that digoxin improves the symptoms of patients with chronic heart failure and sinus rhythm, whose ventricular systolic function is impaired. The Proved and Radiance studies show that in patients receiving diuretics and digoxin, or angiotensin-converting enzyme (ACE) inhibitors, diuretics and digoxin, the withdrawal of digoxin results in clinical deterioration and worsening of exercise tolerance. In addition to an inotropic action, digitalis exerts effects in the neurocardiovascular axis, produces reduction in plasma norepinephrine, renin, aldosterone, vasopressin activity and restores a more normal sympathetic-parasympathetic autonomic balance and baroreceptor function. ACE inhibitors reduce mortality, improve symptoms and exercise tolerance in patients with chronic heart failure in class IV (Consensus I trial), in class II and III (SOLVD, treatment trial) and prevent the development of heart failure in asymptomatic patients with ejection fraction myocardial infarction they reduce mortality, severe heart failure, re-hospitalization, and induce an unexpected reduction of recurrent myocardial infarction (SAVE trial). However, the early administration, within 2 hours after the onset of chest pain, of ACE inhibitors by intravenous infusion, does not improve survival; the hypotension may be responsible of increased mortality (Consensus II trial).

  14. [Improvement in functional capacity after levothyroxine treatment in patients with chronic heart failure and subclinical hypothyroidism].

    Science.gov (United States)

    Curotto Grasiosi, Jorge; Peressotti, Bruno; Machado, Rogelio A; Filipini, Eduardo C; Angel, Adriana; Delgado, Jorge; Cortez Quiroga, Gustavo A; Rus Mansilla, Carmen; Martínez Quesada, María del Mar; Degregorio, Alejandro; Cordero, Diego J; Dak, Marcelo; Izurieta, Carlos; Esper, Ricardo J

    2013-10-01

    To assess whether levothyroxine treatment improves functional capacity in patients with chronic heart failure (New York Heart Association class i-iii) and subclinical hypothyroidism. One hundred and sixty-three outpatients with stable chronic heart failure followed up for at least 6 months were enrolled. A physical examination was performed, and laboratory tests including thyroid hormone levels, Doppler echocardiogram, radionuclide ventriculography, and Holter monitoring were requested. Functional capacity was assessed by of the 6-min walk test. Patients with subclinical hypothyroidism were detected and, after undergoing the s6-min walk test, were given replacement therapy. When they reached normal thyrotropin (TSH) levels, the 6-min walk test was performed again. The distance walked in both tests was recorded, and the difference in meters covered by each patient was analyzed. Prevalence of subclinical hypothyroidism in patients with heart failure was 13%. These patients walked 292±63m while they were hypothyroid and 350±76m when TSH levels returned to normal, a difference of 58±11m (P<.011). Patients with normal baseline TSH levels showed no significant difference between the 2 6-min walk tests. Patients with chronic heart failure and subclinical hypothyroidism significantly improved their physical performance when normal TSH levels were reached. Copyright © 2012 SEEN. Published by Elsevier Espana. All rights reserved.

  15. Use of Diuretics in the Treatment of Heart Failure in Older Adults.

    Science.gov (United States)

    Sica, Domenic A; Gehr, Todd W B; Frishman, William H

    2017-07-01

    Diuretics are the most commonly prescribed class of drugs in patients with heart failure, and in the short term they remain the most effective treatment for relief from fluid congestion. This article reviews the mode of action of the various diuretic classes and the physiologic adaptations that follow and sets up the basis for their use in the treatment of volume-retaining states, particularly as applies to the elderly. In addition, the article reviews the common side effects related to diuretics. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Volume control in treatment-resistant congestive heart failure: role for peritoneal dialysis.

    Science.gov (United States)

    Broekman, K E; Sinkeler, S J; Waanders, F; Bartels, G L; Navis, G; Janssen, W M T

    2014-11-01

    Chronic congestive heart failure (HF) has a rising prevalence and increasing impact on health care systems. Current treatment consists of diuretics, renin-angiotensin-aldosterone system blockers, and restriction of salt and fluids. This strategy is often hampered by a drop in effective circulating volume and hence renal perfusion and function, triggering harmful counter regulatory mechanisms. Slow ultrafiltration by peritoneal dialysis (PD) might be an effective treatment strategy to relieve fluid overload without compromising cardiac output and thereby renal function. In this review, we discuss the (patho)physiological mechanisms of the cardiorenal interaction and the current literature on PD strategies in congestive HF.

  17. Continuous veno-venous hemofiltration for the treatment of contrast-induced acute renal failure after percutaneous coronary interventions.

    Science.gov (United States)

    Marenzi, GianCarlo; Bartorelli, Antonio L; Lauri, Gianfranco; Assanelli, Emilio; Grazi, Marco; Campodonico, Jeness; Marana, Ivana

    2003-01-01

    Acute renal failure (ARF) requiring hemodialysis after percutaneous coronary interventions (PCI) is a serious complication with poor prognosis. Hemodialysis-induced hypotension may have deleterious cardiovascular effects, especially in high-risk patients. Ultrafiltrate removal and simultaneous fluid replacement with a solution similar to plasma for high-volume controlled hydration can be obtained with hemodynamic stability by continuous veno-venous hemofiltration (CVVH). We prospectively assessed the safety and effectiveness of percutaneous CVVH (Y-shaped double-lumen catheter, circuit originating from and terminating in the femoral vein) in 33 consecutive patients (23 men and 10 women; mean age, 69 +/- 9 years) who, after PCI, developed oligo-anuric ARF, associated in 20 of them with congestive heart failure. All patients received a concomitant infusion of furosemide (500-1000 mg/day) and dopamine (2 microg/kg/min). During CVVH, the average fluid volume replacement and body fluid net reduction were 1000 +/- 247 and 75 +/- 48 ml/hr, respectively. Treatment with CVVH continued for 4.7 +/- 2.7 days and corrected fluid overload in all cases. No patient experienced systemic hypotension or hypovolemia. Diuresis recovered in 32 (97%) patients, who showed a parallel improvement of renal function parameters. One patient required chronic dialysis. In-hospital and 1-year mortality was 9.1% and 27.3%, respectively. In conclusion, our data indicate that CVVH is a safe and effective therapy of radiocontrast-induced ARF following PCI. It temporarily replaces renal function without deleterious cardiovascular effects, allowing the kidney to recover from the nephrotoxic injury. However, despite promising early results, large randomized trials are required to define the role of CVVH in ARF after PCI. Copyright 2003 Wiley-Liss, Inc.

  18. Risk assessment of Giardia from a full scale MBR sewage treatment plant caused by membrane integrity failure.

    Science.gov (United States)

    Zhang, Yu; Chen, Zhimin; An, Wei; Xiao, Shumin; Yuan, Hongying; Zhang, Dongqing; Yang, Min

    2015-04-01

    Membrane bioreactors (MBR) are highly efficient at intercepting particles and microbes and have become an important technology for wastewater reclamation. However, many pathogens can accumulate in activated sludge due to the long residence time usually adopted in MBR, and thus may pose health risks when membrane integrity problems occur. This study presents data from a survey on the occurrence of water-borne Giardia pathogens in reclaimed water from a full-scale wastewater treatment plant with MBR experiencing membrane integrity failure, and assessed the associated risk for green space irrigation. Due to membrane integrity failure, the MBR effluent turbidity varied between 0.23 and 1.90 NTU over a period of eight months. Though this turbidity level still met reclaimed water quality standards (≤5 NTU), Giardia were detected at concentrations of 0.3 to 95 cysts/10 L, with a close correlation between effluent turbidity and Giardia concentration. All β-giardin gene sequences of Giardia in the WWTP influents were genotyped as Assemblages A and B, both of which are known to infect humans. An exponential dose-response model was applied to assess the risk of infection by Giardia. The risk in the MBR effluent with chlorination was 9.83×10(-3), higher than the acceptable annual risk of 1.0×10(-4). This study suggested that membrane integrity is very important for keeping a low pathogen level, and multiple barriers are needed to ensure the biological safety of MBR effluent. Copyright © 2015. Published by Elsevier B.V.

  19. Early treatment with N-acetylcysteine in children with acute liver failure secondary to hepatitis A.

    Science.gov (United States)

    Sotelo, Norberto; de los Angeles Durazo, María; Gonzalez, Alejandro; Dhanakotti, Nagasharmila

    2009-01-01

    Hepatitis A virus can evolve to acute liver failure with a fatal outcome if it is not reversed. We describe the clinical course of 12 children who presented with hepatitis A acute liver failure and received treatment with oral N-acetylcysteine (NAC). Of the seventy-two patients with viral hepatitis A, 12 patients who had acute hepatic failure were included. The variables evaluated were age, sex, duration of clinical features prior to hospitalization, signs and symptoms, laboratory parameters [alanine aminotransferase (ALT), aspartate aminotransferase (AST), prothrombin time (PT), partial thromboplastin time (PTT), internal normalization ratio and ammonia], treatment (oral NAC 100 mg/kg/day, lactulose, neomycin and general measures) and clinical course during hospitalization. Six males and six females were included. School-aged and adolescent children predominated. All presented with jaundice, nausea, vomiting and hepatomegaly. Two had stage 2 neurological signs as per the West-Haven scale. All had altered laboratory parameters. All received NAC, six patients for a week and the remaining six for 9-36 days. Treatment was not ceased until patients showed clinical and laboratory improvement. All data were analyzed using both student's t test and Wilcoxon signed rank with alpha = 0.05, the ALT with P = 0.0003 and 0.005, AST with P = 0.0001 and 0.0005, PT with P = 0.0237 and 0.0005, PTT with P = 0.0515 and 0.0039, ammonia with P = 0.0197 and 0.0015 and direct bilirubin with P = 0.0190 and 0.068. There was good tolerance to medications and a satisfactory clinical course. The use of oral NAC appears to be an effective therapeutic alternative for hepatitis A-induced liver failure if it is offered appropriately. It can modify the clinical course to a favorable one and prevent the fatal outcome of hepatic encephalopathy.

  20. Curing the historically incurable: treatment success with ledipasvir/sofosbuvir for chronic hepatitis C virus in a heavily treatment-experienced individual.

    Science.gov (United States)

    Johnson, S W; Davis, M M; Stever, L M; Priest, D H

    2016-12-01

    Significant progression in the treatment of chronic hepatitis C virus has been made with the introduction of direct-acting antivirals (DAAs). However, limited data are available for the retreatment of individuals who have failed multiple prior DAAs. We report a single case of an individual who was unsuccessfully treated with five prior hepatitis C virus treatment regimens including simeprevir plus sofosbuvir who was successfully cured after treatment with ledipasvir/sofosbuvir. Ledipasvir/sofosbuvir may be an option for treating patients who have failed multiple prior DAA regimens; however, further research is warranted. © 2016 John Wiley & Sons Ltd.

  1. Mycoplasma genitalium infection: current treatment options, therapeutic failure, and resistance-associated mutations

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    Couldwell DL

    2015-05-01

    Full Text Available Deborah L Couldwell,1,2 David A Lewis1,21Western Sydney Sexual Health Centre, Parramatta, 2Centre for Infectious Diseases and Microbiology and Marie Bashir Institute for Infectious Diseases and Biosecurity, Westmead Clinical School, University of Sydney, Sydney, NSW, Australia Abstract: Mycoplasma genitalium is an important cause of non-gonococcal urethritis, cervicitis, and related upper genital tract infections. The efficacy of doxycycline, used extensively to treat non-gonococcal urethritis in the past, is relatively poor for M. genitalium infection; azithromycin has been the preferred treatment for several years. Research on the efficacy of azithromycin has primarily focused on the 1 g single-dose regimen, but some studies have also evaluated higher doses and longer courses, particularly the extended 1.5 g regimen. This extended regimen is thought to be more efficacious than the 1 g single-dose regimen, although the regimens have not been directly compared in clinical trials. Azithromycin treatment failure was first reported in Australia and has subsequently been documented in several continents. Recent reports indicate an upward trend in the prevalence of macrolide-resistant M. genitalium infections (transmitted resistance, and cases of induced resistance following azithromycin therapy have also been documented. Emergence of antimicrobial-resistant M. genitalium, driven by suboptimal macrolide dosage, now threatens the continued provision of effective and convenient treatments. Advances in techniques to detect resistance mutations in DNA extracts have facilitated correlation of clinical outcomes with genotypic resistance. A strong and consistent association exists between presence of 23S rRNA gene mutations and azithromycin treatment failure. Fluoroquinolones such as moxifloxacin, gatifloxacin, and sitafloxacin remain highly active against most macrolide-resistant M. genitalium. However, the first clinical cases of moxifloxacin treatment

  2. Evaluation of clinical and immunological markers for predicting virological failure in a HIV/AIDS treatment cohort in Busia, Kenya.

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    Cecilia Ferreyra

    Full Text Available BACKGROUND: In resource-limited settings where viral load (VL monitoring is scarce or unavailable, clinicians must use immunological and clinical criteria to define HIV virological treatment failure. This study examined the performance of World Health Organization (WHO clinical and immunological failure criteria in predicting virological failure in HIV patients receiving antiretroviral therapy (ART. METHODS: In a HIV/AIDS program in Busia District Hospital, Kenya, a retrospective, cross-sectional cohort analysis was performed in April 2008 for all adult patients (>18 years old on ART for ≥12 months, treatment-naive at ART start, attending the clinic at least once in last 6 months, and who had given informed consent. Treatment failure was assessed per WHO clinical (disease stage 3 or 4 and immunological (CD4 cell count criteria, and compared with virological failure (VL >5,000 copies/mL. RESULTS: Of 926 patients, 123 (13.3% had clinically defined treatment failure, 53 (5.7% immunologically defined failure, and 55 (6.0% virological failure. Sensitivity, specificity, positive predictive value, and negative predictive value of both clinical and immunological criteria (combined in predicting virological failure were 36.4%, 83.5%, 12.3%, and 95.4%, respectively. CONCLUSIONS: In this analysis, clinical and immunological criteria were found to perform relatively poorly in predicting virological failure of ART. VL monitoring and new algorithms for assessing clinical or immunological treatment failure, as well as improved adherence strategies, are required in ART programs in resource-limited settings.

  3. Hyponatraemia and congestive heart failure refractory to diuretic treatment. Utility of tolvaptan.

    Science.gov (United States)

    Pose, A; Almenar, L; Manzano, L; Gavira, J J; López Granados, A; Delgado, J; Aramburu, O; Arévalo, J C; Méndez, M; Comín, J; Manito, N

    2017-10-01

    Heart failure (HF) is currently one of the most significant healthcare problems in Spain and has a continuously increasing prevalence. Advances in our understanding of the various biological responses that promote cardiac remodelling and pulmonary venous congestion constitute the basis of current treatment. This article, prepared by members of the HF groups of the Spanish Society of Cardiology and the Spanish Society of Internal Medicine, discusses the current therapeutic strategies for patients with congestion refractory to diuretic treatment. The article includes our clinical experience with the use of tolvaptan as an additional treatment for congestion associated with hyponatraemia. To this end, we propose an algorithm for the use of tolvaptan in patients with congestive HF, natraemia <130mEq/l and poor response to conventional diuretic treatment. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  4. Treatment with beta-blockers in nurse-led heart failure clinics

    DEFF Research Database (Denmark)

    Gustafsson, Finn; Schou, Morten; Videbaek, Lars

    2007-01-01

    BACKGROUND: Beta-blockers (BBs) are a cornerstone in the treatment of chronic heart failure (HF), but several surveys have documented that many patients are not offered treatment or are not titrated to target doses. In part to address this problem, specialized, nurse-led HF clinics have been...... initiated in many countries. However, little information is available to describe if such programs are successful in initiating and up-titrating BBs in daily clinical practice. AIMS: To assess the proportion of patients with HF due to left ventricular systolic dysfunction on BB treatment three months after...... months (Ptitration continues to be a challenge even in specialized clinics dedicated to this task. Elderly patients appear to be less likely to receive treatment....

  5. Magnitude and Predictors of Anti-Retroviral Treatment (ART) Failure in Private Health Facilities in Addis Ababa, Ethiopia.

    Science.gov (United States)

    Teshome Yimer, Yesunesh; Yalew, Alemayehu Worku

    2015-01-01

    The public health approach to antiretroviral treatment management encourages the public private partnership in resource limited countries like Ethiopia. As a result, some private health facilities are accredited to provide antiretroviral treatment free services. Evidence on magnitude and predictors of treatment failure are crucial for timely actions. However, there are few studies in this regard. To assess the magnitude and predictors of ART failure in private health facilities in Addis Ababa, Ethiopia. The study followed retrospective cohort design, with 525 adult antiretroviral treatment clients who started the treatment since October 2009 and have at least six months follow up until December 31, 2013. Kaplan Meier survival analysis and Cox proportional hazard model were used for analysis. Treatment failure, using the three WHO antiretroviral treatment failure criteria, was 19.8%. The immunologic, clinical, and virologic failures were 15%, 6.3% and 1.3% respectively. The mean and median survival times in months were 41.17 with 95% Confidence Interval (CI) [39.69, 42.64] and 49.00, 95% CI [47.71, 50.29] respectively. The multivariate cox regression analysis showed years since HIV diagnosis (Adjusted Hazard Ratio (AHR)=13.87 with 95% CI [6.65, 28.92]), disclosure (AHR=0.59, 95% CI [0.36, 0.96]), WHO stage at start (AHR=1.84, 95% CI [1.16, 2.93]), weight at baseline (AHR=0.58, 95% CI [0.38, 0.89]), and functionality status at last visit (AHR=2.57, 95% CI [1.59, 4.15]) were independent predictors of treatment failure. The study showed that the treatment failure is high among the study subjects. The predictors for antiretroviral treatment failure were years since HIV diagnosis, weight at start, WHO stage at start, status at last visit and disclosure. Facilities need to monitor antiretroviral treatment clients to avoid disease progression and drug resistance.

  6. B-type natriuretic peptide-guided treatment for heart failure

    Science.gov (United States)

    McLellan, Julie; Heneghan, Carl J; Perera, Rafael; Clements, Alison M; Glasziou, Paul P; Kearley, Karen E; Pidduck, Nicola; Roberts, Nia W; Tyndel, Sally; Wright, F Lucy; Bankhead, Clare

    2016-01-01

    Background Heart failure is a condition in which the heart does not pump enough blood to meet all the needs of the body. Symptoms of heart failure include breathlessness, fatigue and fluid retention. Outcomes for patients with heart failure are highly variable; however on average, these patients have a poor prognosis. Prognosis can be improved with early diagnosis and appropriate use of medical treatment, use of devices and transplantation. Patients with heart failure are high users of healthcare resources, not only due to drug and device treatments, but due to high costs of hospitalisation care. B-type natriuretic peptide levels are already used as biomarkers for diagnosis and prognosis of heart failure, but could offer to clinicians a possible tool to guide drug treatment. This could optimise drug management in heart failure patients whilst allaying concerns over potential side effects due to drug intolerance. Objectives To assess whether treatment guided by serial BNP or NT-proBNP (collectively referred to as NP) monitoring improves outcomes compared with treatment guided by clinical assessment alone. Search methods Searches were conducted up to 15 March 2016 in the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library; MEDLINE (OVID), Embase (OVID), the Database of Abstracts of Reviews of Effects (DARE) and the NHS Economic Evaluation Database in the Cochrane Library. Searches were also conducted in the Science Citation Index Expanded, the Conference Proceedings Citation Index on Web of Science (Thomson Reuters), World Health Organization International Clinical Trials Registry and ClinicalTrials.gov. We applied no date or language restrictions. Selection criteria We included randomised controlled trials of NP-guided treatment of heart failure versus treatment guided by clinical assessment alone with no restriction on follow-up. Adults treated for heart failure, in both in-hospital and out-of-hospital settings, and trials reporting a

  7. The Use of a Novel Heart Failure Agent in the Treatment of Pregnancy-Associated Cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Vamsi C. Gaddipati

    2017-01-01

    Full Text Available Peripartum cardiomyopathy is an uncommon, pregnancy-related form of dilated cardiomyopathy that is associated with development of new-onset left ventricular dysfunction. Its etiology is presently unknown, but current standard of care involves the use of typical drug therapy for the treatment of heart failure. Pregnancy-associated cardiomyopathy (PACM is a similar condition that refers to patients who develop such symptoms prior to the last month of pregnancy. We report the case of a nulliparous Caucasian female who develops early, severe PACM during her first pregnancy with postpartum persistence of New York Heart Association class II-III symptoms despite medical therapy. The use of the novel heart failure agent, sacubitril/valsartan (Entresto, is initiated with near-complete resolution of her symptoms.

  8. Hyponatremia in acute decompensated heart failure: mechanisms, prognosis, and treatment options.

    Science.gov (United States)

    Jao, Geoffrey T; Chiong, Jun R

    2010-11-01

    Hyponatremia is common and is increasingly recognized as an independent prognostic marker that adversely affects morbidity and mortality in various disease states, including heart failure. In acute decompensated heart failure (ADHF), the degree of hyponatremia often parallels the severity of cardiac dysfunction and is further exacerbated by any reduction in glomerular filtration rate and arginine vasopressin dysregulation. A recent study showed that even modest improvement of hyponatremia may have survival benefits. Although management of hyponatremia in ADHF has traditionally focused on improving cardiac function and fluid restriction, the magnitude of improvement of serum sodium is fairly slow and unpredictable. In this article, we discuss the mechanisms of hyponatremia in ADHF, review its evolving prognostic significance, and evaluate the efficacy of various treatments for hyponatremia, including the recently approved vasopressin receptor antagonists for managing hyponatremia among patients hospitalized for ADHF. Copyright © 2008 Wiley Periodicals, Inc.

  9. Risk analysis of failure of root canal treatment for teeth with inaccessible apical constriction.

    Science.gov (United States)

    Negishi, Jun; Kawanami, Masamitsu; Ogami, Eriko

    2005-05-01

    The risk of failure of root canal therapy was assessed in teeth with inaccessible apical constriction and factors influencing treatment outcome in these teeth were analyzed. From the same 57 patients, one tooth with inaccessible apical constriction (n=57) and one tooth with adequate accessibility (n=57) were included in this retrospective investigation. Cox regression analysis was used to analyze factors that may have influenced the outcome one or more years after obturation. These factors included inaccessibility, systemic disease, canal curvature, preoperative periradicular lesion, widening of periodontal ligament space, patient gender and age, size of master apical file, preoperative pulp vitality, years of operator experience and obturation length. Inaccessible apical constriction was a significant factor related to outcome (odds ratio, 5.301). Preoperative presence of periradicular lesion significantly influenced the outcome in cases with inaccessibility (odds ratio, 4.448). Inaccessibility increases the risk of root canal therapy failure particularly in teeth with preoperative periradicular lesion.

  10. Successful treatment of thyroid crisis accompanied by hypoglycemia, lactic acidosis, and multiple organ failure.

    Science.gov (United States)

    Deng, Yongmei; Zheng, Weiwei; Zhu, Jihong

    2012-11-01

    We describe a case of thyroid crisis with hypoglycemia, lactic acidosis, multiple organ failure, and disseminated intravascular coagulation--rare but severe complications of thyroid crisis. The patient was a 59-year-old Chinese woman who presented with evidence of heart failure and atrial fibrillation. Analysis of a blood sample yielded astonishing results: her blood glucose was 1.7 mmol/L, and lactate greater than 15 mmol/L with the arterial pH as 6.94. Liver enzymes (alanine aminotransferase, 1846 U/L; aspartate aminotransferase, 6242 U/L) and bilirubin elevated rapidly and dramatically. Prompt treatments such as mechanical ventilation, plasma exchange, and continuous venovenous hemofiltration were preformed, along with antithyroid medication. The patient finally survived after 3 weeks of intensive care. We herein discuss the possible mechanisms of these metabolic disorders in thyroid crisis and possible therapeutic measures that could be used to reduce mortality.

  11. HEART-RATE-VARIABILITY IN LEFT-VENTRICULAR DYSFUNCTION AND HEART-FAILURE - EFFECTS AND IMPLICATIONS OF DRUG-TREATMENT

    NARCIS (Netherlands)

    TUININGA, YS; VANVELDHUISEN, DJ; BROUWER, J; HAAKSMA, J; CRIJNS, HJGM; MANINTVELD, AJ; LIE, KI

    1994-01-01

    Objective-To review the importance of heart rate variability analysis in left ventricular dysfunction and heart failure and to assess the effects of drug treatment. In patients with left: ventricular dysfunction or heart failure, a low heart rate variability is a strong predictor of a low

  12. Predicting the likelihood of QA failure using treatment plan accuracy metrics

    Science.gov (United States)

    Kairn, T.; Crowe, S. B.; Kenny, J.; Knight, R. T.; Trapp, J. V.

    2014-03-01

    This study used automated data processing techniques to calculate a set of novel treatment plan accuracy metrics, and investigate their usefulness as predictors of quality assurance (QA) success and failure. A small sample of 151 beams from 23 prostate and cranial IMRT treatment plans were used in this study. These plans had been evaluated before treatment using measurements with a diode array system. The TADA software suite was adapted to allow automatic batch calculation of several proposed plan accuracy metrics, including mean field area, small-aperture, off-axis and closed-leaf factors. All of these results were compared to the gamma pass rates from the QA measurements and correlations were investigated. The mean field area factor provided a threshold field size (5 cm2, equivalent to a 2.2 × 2.2 cm2 square field), below which all beams failed the QA tests. The small aperture score provided a useful predictor of plan failure, when averaged over all beams, despite being weakly correlated with gamma pass rates for individual beams. By contrast, the closed leaf and off-axis factors provided information about the geometric arrangement of the beam segments but were not useful for distinguishing between plans that passed and failed QA. This study has provided some simple tests for plan accuracy, which may help minimise time spent on QA assessments of treatments that are unlikely to pass.

  13. [Cost of therapeutic failure of ampicillin plus amikacin in the treatment of early neonatal sepsis].

    Science.gov (United States)

    Reyna-Figueroa, J; Ortiz-Ibarra, F J; Estéves Jaramillo, A; Reyna-Figueroa, J

    2009-07-01

    To evaluate the marginal cost of therapeutic failure with Ampicillin/amikacin as the first-line antibiotic treatment of early-onset neonatal sepsis (ENS). Out of a total of 121 newborns, 86 failed to respond to Ampicillin/amikacin when it was used as first-line treatment within their first 72h of life. All of them were admitted to the NICU between 2001 and 2005 with suspicion of sepsis. After this failure to respond, vancomycin and/or cefotaxime were used as the second treatment option for these newborns. Using a full cost method we performed a cost analysis with an activity-based-costing (ABC) perspective, identifying the costs generated by these 86 patients. The costs comprising medication, hospitalization, supplies and clinical staff salaries were higher when vancomycin and/or cefotaxime were used (350,924 dollars or 275,116 euros) compared to those generated with an Ampicillin/amikacin regimen (159,251 dollars or 124,878 euros). When compared as protective factors, the relative risk was 1.09 (95% CI; 0.39-2.1 P=0.8) for Ampicillin/amikacin vs. 0.02 (95% CI; 0.04-0.32 Pcostly, there is a cost saving derived from the use of this antibiotic treatment as the first-line therapeutic option instead of as a rescue therapy when a lower-efficacy regimen (Ampicillin/amikacin) has failed.

  14. HIV reservoirs and immune surveillance evasion cause the failure of structured treatment interruptions: a computational study.

    Directory of Open Access Journals (Sweden)

    Emiliano Mancini

    Full Text Available Continuous antiretroviral therapy is currently the most effective way to treat HIV infection. Unstructured interruptions are quite common due to side effects and toxicity, among others, and cannot be prevented. Several attempts to structure these interruptions failed due to an increased morbidity compared to continuous treatment. The cause of this failure is poorly understood and often attributed to drug resistance. Here we show that structured treatment interruptions would fail regardless of the emergence of drug resistance. Our computational model of the HIV infection dynamics in lymphoid tissue inside lymph nodes, demonstrates that HIV reservoirs and evasion from immune surveillance themselves are sufficient to cause the failure of structured interruptions. We validate our model with data from a clinical trial and show that it is possible to optimize the schedule of interruptions to perform as well as the continuous treatment in the absence of drug resistance. Our methodology enables studying the problem of treatment optimization without having impact on human beings. We anticipate that it is feasible to steer new clinical trials using computational models.

  15. Successful treatment of 54 patients with acute renal failure after cardiac surgery

    Directory of Open Access Journals (Sweden)

    Lei CHEN

    2015-06-01

    Full Text Available Objectives To evaluate the result of treatment of acute renal failure (ARF in patients after cardiac surgery. Methods The clinical data of 54 cases admitted to the hospital from Jan. 2004 to Jan. 2014 and suffered from ARF after cardiac surgery were retrospectively analyzed. Among 54 cases, there were 35 males and 19 females, aged from one month to 79 years with a median of 52 years. The surgical procedures included coronary artery bypass grafting (CABG, 10 cases, valve surgery (22 cases, combined CABG and valve surgery (4 cases, operation on aorta (14 case, and radical correction of Fallot tetralogy (4 cases. After the operations mentioned above, 50 patients received continuous renal replacement therapy (CRRT, and 4 patients received peritoneal dialysis. Results Nine patients died, the mortality rate was 16.7%. Exploratory hemostasis by thoracotomy was performed in 8 patients, and extubation failure occurred in 4 cases. Of the 9 non-survivors, 6 died from multiple organ failure (MOF, 2 died from cerebral hemorrhage, and one died from acute respiratory failure. Serum creatinine (SCr and blood urea nitrogen (BUN levels declined obviously after CRRT and peritoneal dialysis (P<0.05, and all the patients were shown to have stable hemodynamics in the course of treatment, and no hemorrhage or embolism occurred. Conclusions ARF after cardiac surgery should be detected early and treated in time. CRRT and peritoneal dialysis are safe, convenient and effective procedures, and may decrease the mortality rate in patients with ARF after cardiac surgery. DOI: 10.11855/j.issn.0557-7402.2015.04.13

  16. Effective Factors of INSURE Method Failure in Treatment of Respiratory Distress Syndrome in Preterm Infants

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    Navid Danaie

    2017-11-01

    Full Text Available Background INtubate-SURfactant-Extubate (INSURE method is one of the effective methods in treatment of infants with respiratory distress syndrome (RDS. This study was performed to predict risk factors for the failure of  INSURE method in treatment of RDS in preterm infants. Materials and Methods: In this cross-sectional study, 192 infants who born between July 2011 and April 2016 at women and children's hospital of Amiralmoemenin in Semnan, Iran, were included to the study. Inclusion criteria were infants with moderate to severe RDS, 26 to 38 gestational weeks and weighted 500 to 3,500 grams. All patients were treated with INSURE method, then were divided to success and failure INSURE. Severity of RDS was determined by RDS scoring system. The collected data including gender status, gestational age (GA, birth weight (BW, maternal diabetes mellitus, delivery type and neonatal morbidity (including intraventricular haemorrhage (IVH, Necrotizing enterocolitis (NEC stage 1, sepsis, chronic lung disease (CLD, pneumothorax, and pulmonary bleeding. Statistical analysis was done using SPSS software, version 22.0. Results: Of the 192 patients, 82 (42.7% infants were females. The mean GA and BW were 30.25 ± 1.85 weeks and 1950 ± 270 grams, respectively. Of all the patients, 156 infants (81.25% were born via cesarean section. INSURE failure was observed in 79 infants (41.1 % and INSURE success was observed in 113 (58.9%. Among the factors, INSURE method failure had a significant relationship with GA, BW, RDS severity and increased probability of IVH, CLD, pneumothorax and pulmonary bleeding (p

  17. Failures and Lessons in the Endovascular Treatment of Symptomatic Isolated Dissection of the Superior Mesenteric Artery.

    Science.gov (United States)

    Dong, Zhihui; Ning, Junjie; Fu, Weiguo; Guo, Daqiao; Xu, Xin; Chen, Bin; Jiang, Junhao; Wang, Yuqi

    2016-02-01

    To discuss failures and lessons in the endovascular treatment of symptomatic isolated dissection of the superior mesenteric artery (SIDSMA). Data from 33 patients with SIDSMA treated between July 2007 and September 2013 were retrospectively collected. The technical failures in and lessons from endovascular management were analyzed in terms of causes and prophylaxis. Eighteen patients were successfully treated medically, 13 underwent stent placement, 1 underwent a hybrid procedure, and 1 had open fenestration. Full follow-ups (37 ± 21 months) were achieved in 28 patients. Failures to cannulate the true lumen occurred in 8 patients. Among these patients, femoral and brachial approaches were taken in 6 and 2 patients, respectively, and a 2-sided Fisher's exact test revealed no significant differences (P = 0.204). Among the 6 femoral failures, the true lumina were cannulated after conversion to the brachial approach in 3 cases. The perfusion of the distal SMA was not improved until the second stent was distally placed to cover the entire expanded false lumen in 1 case. Numerous branches originating from the false lumen were overlooked in 1 patient and were apparently compromised after stenting. Consequently, the patient died of intestinal necrosis. In a patient with a huge dissecting aneurysm, a stent was misplaced across the false lumen. Fortunately, a remarkable aneurysmal thrombosis formed at 3 months. In a patient who received a hybrid procedure, the stent was occluded at 2 weeks, most likely because the thrombus protruded into the stent. Difficulty in cannulating the true lumen is not uncommon in the endovascular treatment of SIDSMA, and the selection of the arterial approach would benefit from being based on the morphology of the SMA arch. The lengths and branches of the involvement of the false lumen should be evaluated beforehand. Covered stents would be a reasonable option for lumina that contain thrombi. Copyright © 2016 Elsevier Inc. All rights

  18. High levels of pre-treatment HIV drug resistance and treatment failure in Nigerian children

    NARCIS (Netherlands)

    Boerma, Ragna S.; Boender, T. Sonia; Sigaloff, Kim C. E.; Rinke de Wit, Tobias F.; van Hensbroek, Michael Boele; Ndembi, Nicaise; Adeyemo, Titilope; Temiye, Edamisan O.; Osibogun, Akin; Ondoa, Pascale; Calis, Job C.; Akanmu, Alani Sulaimon

    2016-01-01

    Pre-treatment HIV drug resistance (PDR) is an increasing problem in sub-Saharan Africa. Children are an especially vulnerable population to develop PDR given that paediatric second-line treatment options are limited. Although monitoring of PDR is important, data on the paediatric prevalence in

  19. [Ganciclovir treatment failure in adult allogeneic hematopoietic stem cell transplant recipients with cytomegalovirus infection--a single centre experience].

    Science.gov (United States)

    Vejražková, E; Hubáček, P; Kutová, R; Plíšková, L; Košťál, M; Štěpánová, V; Zavřelová, A; Radocha, J; Malá, E; Žák, P

    2015-09-01

    To determine the incidence of infection with ganciclovir-resistant cytomegalovirus (CMV) in adult allogeneic hematopoietic stem cell transplant (HSCT) recipients. Clinical resistance or treatment failure was defined as persistent DNAemia or increasing viral load in peripheral blood after 2 weeks of virostatic treatment. The association between the treatment failure and viral resistance was analysed. The presence of ganciclovir-resistant CMV strains was confirmed by genotypic testing able to detect mutations conferring resistance. In 2012 and 2014, 40 patients who underwent allogeneic HSCT for hematologic malignancies and were treated for human CMV reactivation/disease were followed up prospectively. In patients with treatment failure, CMV DNA was isolated and analysed by nucleotide sequence analysis of the UL 97 and UL 54 genes conferring resistance to the virostatic agent. The treatment failure occurred in seven patients, but ganciclovir resistance conferring mutations were only detected in two of them (mutations L595F and M460I in the UL 97 gene). Another mutation in the UL 97 gene (N510S) was found in a patient with recurrent CMV replication who needed to be retreated but did not meet the criteria for treatment failure. The low incidence of genetically confirmed ganciclovir-resistant CMV isolates in HSCT recipients with relatively common clinical treatment failure suggests that the mechanism underlying slower viral clearance is often other than mutations conferring ganciclovir resistance to the virus.

  20. Ovarian failure and cancer treatment: Incidence and interventions for premenopausal women

    Energy Technology Data Exchange (ETDEWEB)

    Feldman, J.E.

    1989-09-01

    Ovarian failure may be a long-term consequence of cancer treatment for premenopausal women. Caused by several treatments, including radiation therapy and the alkylating agents, it produces signs and symptoms associated with menopause: hot flashes, amenorrhea, dyspareunia, loss of libido, and irritability. Critical factors that determine ovarian functioning after treatment for cancer are the patient's age at the time of therapy, the amount of radiation that the ovaries received, and the dose of the antineoplastic agent(s). Medical interventions, such as hormonal therapy and surgical repositioning of the ovaries, may maintain ovarian function for some women. Nursing intervention includes assessment, education, and counseling. Counseling focuses on how the prematurely menopausal patient feels about herself as indicated by self-esteem, body image, and sexuality.

  1. Malarone treatment failure not associated with previously described mutations in the cytochrome b gene

    Directory of Open Access Journals (Sweden)

    Mockenhaupt Frank P

    2004-06-01

    Full Text Available Abstract Malarone® (atovaquone-proguanil is an effective drug for the treatment and prophylaxis of multidrug-resistant falciparum malaria. However, first cases of resistance have been reported, which are associated with mutations at codon 268 of the parasite's cytochrome b gene. We report the first case of Malarone® treatment failure from Central Africa. Drug concentration was well within curative range. Pre- and post-treatment Plasmodium falciparum isolates revealed codon 268 wild-type alleles, and no other mutations of the putative atovaquone-binding domain. These findings illustrate the spread of atovaquone-proguanil-resistance in Africa and question the usefulness of codon 268 as the only target for the surveillance of its emergence.

  2. The use of metoprolol CR/XL in the treatment of patients with diabetes and chronic heart failure

    Directory of Open Access Journals (Sweden)

    Ovidio De Freitas

    2006-06-01

    Full Text Available Ovidio De Freitas, Oliver Lenz, Alessia Fornoni, Barry J MatersonDivision of Nephrology and Hypertension, Department of Medicine, Miller School of Medicine, University of Miami, Miami, Florida, USAAbstract: About 5 million Americans suffer from heart failure. Given the correlation of heart failure with age and the rising life expectancy, the prevalence of heart failure continues to increase in the general population. Sympathetic stimulation intensifies with progressive heart failure. The rationale to use β-blockers in individuals with impaired myocardial function is based on experimental evidence supporting the notion that prolonged α- and β-adrenergic stimulation leads to worsening heart failure. Until recently, safety concerns have precluded the use of β-blockers in patients with diabetes and heart failure. However, several large, randomized, placebo-controlled clinical trials such as Metoprolol Randomized Intervention Trial in Congestive Heart Failure (MERIT-HF have shown that β-blockers can be safely used in patients with diabetes and heart failure. Moreover, β-blockers significantly improved morbidity and mortality in this population. Based on this evidence, it is now recommended to add β-blockers such as metoprolol CR/XL with an escalating dosage regimen to the treatment of patients with symptomatic heart failure who already are receiving a stable medical regimen including angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, diuretics, vasodilators, or digitalis.Keywords: metoprolol, heart failure, diabetes mellitus, β-adrenergic blocking agents, MERITHF

  3. Surgical Treatment, Oral Rehabilitation, and Orthognathic Surgery After Failure of Pharmacologic Treatment of Central Giant Cell Lesion: A Case Report.

    Science.gov (United States)

    Maia Nogueira, Renato Luiz; Osterne, Rafael Lima Verde; Cavalcante, Roberta Barroso; Abreu, Ricardo Teixeira

    2016-12-01

    Although pharmacologic treatments for central giant cell lesions have gained much emphasis, these treatment modalities do not always have successful outcomes, and surgical treatment may be necessary. The purpose of the present study was to report a case of aggressive central giant cell lesion initially treated by nonsurgical methods without satisfactory results, necessitating segmental mandibular resection for definitive treatment and oral rehabilitation. A 20-year-old woman was diagnosed with an aggressive central giant cell lesion in the mandible. The patient was first treated with intralesional corticosteroid injections. Subsequently, the lesion increased in size. Therefore, a second pharmacologic treatment was proposed with salmon calcitonin nasal spray, but no signs of a treatment response were noted. Because of the lack of response, surgical excision was performed, and a mandibular reconstruction plate was installed. At 12 months after surgical resection, the patient underwent mandibular reconstruction with bone grafts. After 6 months, 7 dental implants were installed, and fixed prostheses were made. After installation of the prostheses, the patient experienced persistent mandibular laterognathism, and a mandibular orthognathic surgery was performed to correct the laterognathia. The follow-up examination 4 years after orthognathic surgery showed no signs of recurrence and good facial symmetry. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  4. Prediction factors for failure to seek treatment following traumatic dental injuries to primary teeth

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    Ramon Targino Firmino

    2014-06-01

    Full Text Available The objective of this study was to evaluate prediction factors for failure to seek treatment following a traumatic dental injury (TDI to primary teeth among preschool children in the city of Campina Grande, Brazil. A cross-sectional study was carried out involving 277 children 3 to 5 years of age, with TDI, enrolled in public and private preschools. Parents filled out a form addressing demographic data and whether or not they had sought treatment. Clinical examinations were performed by three dentists who had undergone a calibration exercise (Kappa: 0.85 to 0.90 for the evaluation of TDI. Bivariate and multivariate Poisson regression models were constructed (α = 5%. Enamel fracture was the most prevalent type of TDI (48.7% and the upper central incisors were the most affected teeth (88.4%. The frequency of seeking dental treatment was low (9.7%. The following variables were associated with failure to seek treatment following TDI: a household income greater than one minimum wage (PR = 1.170; 95%CI 1.018-1.341, parents/caregivers’ perception of a child’s oral health as poor (PR = 1.100; 95%CI 1.026-1.176, and the non-perception of TDI by parents/caregivers (PR = 1.250; 95%CI 1.142-1.360. In the present study, the frequency of seeking treatment following TDI was low, and parents/caregivers with a higher income, a poor perception of their child’s oral health and a lack of awareness regarding the trauma were more likely to fail to seek treatment following TDI to primary teeth.

  5. Macrolide treatment failure in streptococcal pharyngitis resulting in acute rheumatic fever.

    Science.gov (United States)

    Logan, Latania K; McAuley, James B; Shulman, Stanford T

    2012-03-01

    Macrolide resistance (MR) in group A Streptococcus (GAS) has been well documented in several countries and has become clinically significant since the large increases in macrolide usage during the 1970s. Macrolides are recommended as an alternative therapy for GAS pharyngitis, the most common cause of bacterial pharyngitis. Macrolide resistance has been associated with certain emm types, a sequence-based typing system of the hypervariable region of the GAS M-protein gene. Clinical failure of macrolide treatment of GAS infections can be associated with complications including acute rheumatic fever and rheumatic heart disease, the leading cause of acquired heart disease in children worldwide. Here we report 2 pediatric cases of MR and/or treatment failure in the treatment of GAS pharyngitis with the subsequent development of acute rheumatic fever. We also review the literature on worldwide MR rates, molecular classifications, and emm types, primarily associated with GAS pharyngeal isolates between the years of 2000 and 2010. The use of macrolides in the management of GAS pharyngitis should be limited to patients with significant penicillin allergy.

  6. Virological efficacy with first-line antiretroviral treatment in India: predictors of viral failure and evidence of viral resuppression.

    Science.gov (United States)

    Shet, Anita; Neogi, Ujjwal; Kumarasamy, N; DeCosta, Ayesha; Shastri, Suresh; Rewari, Bharat Bhushan

    2015-11-01

    Combination antiretroviral therapy (ART) has improved in efficacy, durability and tolerability. Virological efficacy studies in India are limited. We determined incidence and predictors of virological failure among patients initiating first-line ART and described virological resuppression after confirmed failure, with the goal of informing national policy. Therapy-naïve patients initiated on first-line ART as per national guidelines were monitored every 3 months for adherence and virological response over 2 years. Genotyping on baseline samples was performed to assess primary drug resistance. Multivariate Cox regression analysis was used to assess predictors of virological failure. Virological failure rate among 599 eligible patients was 10.7 failures per 100 person-years. Cumulative failure incidence was 13.2% in the first year and 16.5% over 2 years. Patients initiated on tenofovir had a significantly lower rate of virological failure than those on stavudine or zidovudine (6.7 vs. 11.9 failures per 100 person-years, P = 0.013). Virological failure was independently associated with age <40 years, mean adherence <95%, non-tenofovir-containing regimens and presence of primary drug resistance. In a subset of 311 patients who were reassessed after treatment failure, 19% (11/58) patients resuppressed their viral load to <400 copies/ml after confirmed virological failure. Our results support the inclusion of tenofovir as first-line ART in resource-limited settings and a role for regular adherence counselling and virological monitoring for enhanced treatment success. Detection of early virological failure should provide an opportunity to augment adherence counselling and repeat viral load testing before therapy switch is considered. © 2015 John Wiley & Sons Ltd.

  7. [Octreotide in the treatment of angiodysplasia in patients with advanced chronic renal failure].

    Science.gov (United States)

    Rivera, M; Lucero, J; Guerrero, A; Márquez, J L; Montes, R; Suñer, M; Ruiz, A; Valdivia, M A; Mateos, J

    2005-01-01

    Angiodysplasia is an important cause of gastrointestinal bleeding in patients with chronic renal failure. Octreotide, a long-acting synthetic somatostatin analogue that reduces splachnic blood flow have been used to treat esophageal varicose hemorrhage, but its efficacy for bleeding vascular ecstasies is awaiting support. We present three patients with chronic renal failure (two with diabetic nephropaty and the third with mesangiocapilar glomerulonephritis and hepatic cirrosis), seric creatinine 3-4,5 mg/dl, and recurrent gastrointestinal bleeding due to diffuse angiodysplasia and vascular ecstasies, diagnosed by oral endoscopy, colonoscopy and video capsule. They all were treated with octreotide, administered subcutanesly 0.1 mg twice a day for six months, with significantly decreased blood requirements in all of them, as well as the occurrence of bleeding episodes. It was well tolerated and none side-effects occurred in any subject. In our experience, octreotide is an effective and safe drug in bleeding angiodysplasia and ecstasies vascular of the gastrointestinal tract in patients with chronic renal failure, and it may be a good option especially in patients who are not candidates for surgery or endoscopic treatment due to inaccessible sites, spread of the lesion, old age and/or concomitant disorders.

  8. [Factors associated with the failure of Intermittent Preventive Treatment for malaria among pregnant women in Yaounde].

    Science.gov (United States)

    Essiben, Félix; Foumane, Pascal; de Nguefack, Marcelle Aurelie Tsafack; Eko, Filbert Eko; Njotang, Philip Nana; Enow, Robinson Mbu; Mboudou, Emile Telesphore

    2016-01-01

    Intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) is recommended for malaria prevention during pregnancy. We investigated factors associated with the failure of this strategy. We conducted a case-control study in two health care facilities in Yaounde, from 1 May 2014 to 30 April 2015. Pregnant women treated with IPTp-SP, hospitalized for malaria and having a positive Rapid Diagnostic Test (RDT) result (case-subjects) were compared to pregnant women treated with IPTp-SP having a negative RDT result (control-subjects). Epi Info 7 software and SPSS 18.0 software were used with Phistory of hospitalization for malaria (P=0.007; OR= 2.19; IC= 1.23 - 3.89), IPTp-SP administration after 28 gestational weeks (P=0.001, OR= 3.55; IC= 1.7 - 7.61). After logistic regression, prematurity (P=0.024; OR=2.01; IC=1.1-3.7) and a history of hospitalization for malaria (P=0.001; OR=2.83; IC=1.50-5.4) remained associated with IPTp-SP failure. A history of hospitalization for malaria and prematurity are independent predictor of IPTp-SP failure.

  9. Systemic treatment of hepatocellular carcinoma: why so many failures in the development of new drugs?

    Science.gov (United States)

    Brizzi, Maria Pia; Pignataro, Daniele; Tampellini, Marco; Scagliotti, Giorgio Vittorio; Di Maio, Massimo

    2016-10-01

    The increasing knowledge of the genomic landscape of hepatocellular carcinoma (HCC) and the development of molecular targeted therapies are a promising background for increasing the number of effective drugs for HCC patients. In recent years, many new drugs have been tested as an alternative to sorafenib or after sorafenib failure. In this review, our aim is to describe the randomized trials recently conducted in HCC patients, in order to understand the main reasons potentially related to the failures of many drugs. In addition, we briefly describe the main ongoing trials, that could potentially change the scenario of HCC treatment in the next years. Expert commentary: Heterogeneity of study populations, lack of understanding of critical drivers of tumor progression, risk of liver toxicity associated with experimental agents, flaws in trial design and marginal antitumoral potency can be considered the main reasons for failure of phase III clinical trials in HCC. Most ongoing trials are conducted without any molecular selection criteria, although many drugs could be probably better tested in a molecularly selected population. The knowledge of potential predictive factors for drug efficacy in patients with advanced HCC could improve the chance of obtaining positive results in clinical trials.

  10. Gut hormones in the treatment of short-bowel syndrome and intestinal failure

    DEFF Research Database (Denmark)

    Jeppesen, Palle B

    2015-01-01

    PURPOSE OF REVIEW: The approval of teduglutide, a recombinant analog of human glucagon-like peptide (GLP) 2, by the US Food and Drug Administration (Gattex) and the European Medicines Agency (Revestive) has illustrated the potential of selected gut hormones as treatments in patients with short......-bowel syndrome and intestinal failure. Gut hormones may improve the structural and functional intestinal adaptation following intestinal resection by decreasing a rapid gastric emptying and hypersecretion, by increasing the intestinal blood flow, and by promoting intestinal growth. This review summarizes...

  11. EFFECTIVE TREATMENT OF PATIENTS WITH CHRONIC HEART FAILURE AND DEPRESSIVE DISORDERS WITH NOOTROPICS DRUG PANTOGAM ACTIV

    Directory of Open Access Journals (Sweden)

    A. P. Baranov

    2016-01-01

    Full Text Available We investigate the efficiency of the inclusion nootropic drug Pantogam Activ in the complex therapy of 82 patients with heart failure, ischemic heart diseases, anxiety and depressive disorders. It was shown that an 8-week treatment with Pantogam Activ in most patients is accompanied by a significant reduction of anxiety and depressive disorders, increase exercise tolerance, improved autonomic regulation of heart function and decrease the frequency of supraventricular and ventricular arrhythmias, which is accompanied by a marked improvement in the quality of life. 

  12. Influence of bone density and surgical treatment choice on failure of femoral neck fracture

    DEFF Research Database (Denmark)

    Viberg, Bjarke

    Femoral neck fractures are usually operated with either IF or HA, but a clarification is needed on the consequences of surgical choice, especially for the dislocated fracture. Compared to HA, IF is surgical faster and involves less initial surgical trauma, but treatment with IF has a high...... reoperation rate of approximately 35 %. HA has a reoperation rate of approximately 7 %, primarily due to deep wound infection and prosthesis complications such as loosening, dislocation and periprosthetic femoral fracture. Failure is in this thesis defined as major reoperations. Predictors for increased risk...

  13. Potential Impact of a Free Online HIV Treatment Response Prediction System for Reducing Virological Failures and Drug Costs after Antiretroviral Therapy Failure in a Resource-Limited Setting

    Directory of Open Access Journals (Sweden)

    Andrew D. Revell

    2013-01-01

    Full Text Available Objective. Antiretroviral drug selection in resource-limited settings is often dictated by strict protocols as part of a public health strategy. The objective of this retrospective study was to examine if the HIV-TRePS online treatment prediction tool could help reduce treatment failure and drug costs in such settings. Methods. The HIV-TRePS computational models were used to predict the probability of response to therapy for 206 cases of treatment change following failure in India. The models were used to identify alternative locally available 3-drug regimens, which were predicted to be effective. The costs of these regimens were compared to those actually used in the clinic. Results. The models predicted the responses to treatment of the cases with an accuracy of 0.64. The models identified alternative drug regimens that were predicted to result in improved virological response and lower costs than those used in the clinic in 85% of the cases. The average annual cost saving was $364 USD per year (41%. Conclusions. Computational models that do not require a genotype can predict and potentially avoid treatment failure and may reduce therapy costs. The use of such a system to guide therapeutic decision-making could confer health economic benefits in resource-limited settings.

  14. Failure of treatment with first-line lopinavir boosted with ritonavir can be explained by novel resistance pathways with protease mutation 76V

    NARCIS (Netherlands)

    Nijhuis, Monique; Wensing, Annemarie M J; Bierman, Wouter F W; de Jong, Dorien; Kagan, Ron; Fun, Axel; Jaspers, Christian A J J; Schurink, Karin A M; van Agtmael, Michael A; Boucher, Charles A B

    2009-01-01

    BACKGROUND: Virological failure of first-line antiretroviral therapy based on lopinavir boosted with ritonavir (lopinavir/r) has rarely been associated with resistance in protease. We identified a new genotypic resistance pathway in 3 patients who experienced failure of first-line lopinavir/r

  15. Pulmonary arterial hypertension treatment with carvedilol for heart failure: a randomized controlled trial

    Science.gov (United States)

    Saygin, Didem; Park, Margaret M.; Cheong, Hoi I.; Asosingh, Kewal; Comhair, Suzy A.A.; Stephens, Olivia R.; Roach, Emir C.; Sharp, Jacqueline; Highland, Kristin B.; DiFilippo, Frank P.; Neumann, Donald R.; Tang, W.H. Wilson; Erzurum, Serpil C.

    2017-01-01

    BACKGROUND. Right-sided heart failure is the leading cause of death in pulmonary arterial hypertension (PAH). Similar to left heart failure, sympathetic overactivation and β-adrenoreceptor (βAR) abnormalities are found in PAH. Based on successful therapy of left heart failure with β-blockade, the safety and benefits of the nonselective β-blocker/vasodilator carvedilol were evaluated in PAH. METHODS. PAH Treatment with Carvedilol for Heart Failure (PAHTCH) is a single-center, double-blind, randomized, controlled trial. Following 1-week run-in, 30 participants were randomized to 1 of 3 arms for 24 weeks: placebo, low-fixed-dose, or dose-escalating carvedilol. Outcomes included clinical measures and mechanistic biomarkers. RESULTS. Decreases in heart rate and blood pressure with carvedilol were well tolerated; heart rate correlated with carvedilol dose. Carvedilol-treated groups had no decrease in exercise capacity measured by 6-minute walk, but had lower heart rates at peak and after exercise, and faster heart rate recovery. Dose-escalating carvedilol was associated with reduction in right ventricular (RV) glycolytic rate and increase in βAR levels. There was no evidence of RV functional deterioration; rather, cardiac output was maintained. CONCLUSIONS. Carvedilol is likely safe in PAH over 6 months of therapy and has clinical and mechanistic benefits associated with improved outcomes. The data provide support for longer and larger studies to establish guidelines for use of β-blockers in PAH. TRIAL REGISTRATION. ClinicalTrials.gov NCT01586156 FUNDING. This project was supported by NIH R01HL115008 and R01HL60917 and in part by the National Center for Advancing Translational Sciences, UL1TR000439. PMID:28814664

  16. Levosimendan treatment of severe acute congestive heart failure refractory to dobutamine/milrinone in children

    Directory of Open Access Journals (Sweden)

    Prijić Sergej

    2011-01-01

    Full Text Available Introduction. Levosimendan is a novel positive inotropic agent which, improves myocardial contractility through its calcium-sensitizing action, without causing an increase in myocardial oxygen demand. Also, by opening ATP-sensitive potassium channels, it causes vasodilatation with the reduction in both afterload and preload. Because of the long halflife, its effects last for up 7 to 9 days after 24-hour infusion. Case report. We presented three patients 2, 15 and 17 years old. All the patients had severe acute deterioration of the previously diagnosed chronic heart failure (dilatative cardiomyopathy; univentricular heart with bidirectional Glenn anastomosis and restrictive bulboventricular foramen; bacterial endocarditis on artificial aortic valve with severe stenosis and regurgitation. Signs and symptoms of severe heart failure, cardiomegaly (cardio-thoracic index 0.65 and left ventricular dilatation (end-diastolic diameter z-score 2.6; 4.1 and 4.0 were confirmed on admission. Also, myocardial contractility was poor with ejection fraction (EF - 27%, 25%, 35%, fractional shortening (FS - 13%, 11%, 15% and stroke volume (SV - 40, 60, 72 mL/m2. The treatment with standard intravenous inotropic agents resulted in no improvement but in clinical deterioration. Thus, standard intravenous inotropic support was stopped and levosimendan treatment was introduced. All the patients received a continuous 24-h infusion 0.1 μg/kg/min of levosimendan. In a single patient an initial loading dose of 11 μg/kg over 10 min was administrated, too. Levosimendan treatment resulted in both clinical and echocardiography improvement with the improved EF (42%, 34%, 44%, FS (21%, 16%, 22% and SV (59, 82, 93 mL/m2. Hemodynamic improvement was registered too, with the reduction in heart rate in all the treated patients from 134-138 bpm before, to less than 120 bpm after the treatment. These parameters were followed by the normalization of lactate levels. Nevertheless, left

  17. Management of chronic hepatitis C treatment failures: role of consensus interferon

    Directory of Open Access Journals (Sweden)

    Stevan A Gonzalez

    2009-03-01

    Full Text Available Stevan A Gonzalez1, Emmet B Keeffe21Division of Hepatology, Baylor Regional Transplant Institute, Baylor All Saints Medical Center, Fort Worth and Baylor University Medical Center, Dallas, TX, USA; 2Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Stanford, CA, USAAbstract: A significant proportion of patients with chronic hepatitis C virus (HCV infection who undergo antiviral therapy have persistent or recurrent viremia and fail to achieve a sustained virologic response (SVR. Factors associated with treatment failure include HCV genotype 1 infection, high serum HCV RNA levels, and advanced fibrosis. Consensus interferon (CIFN is a synthetic type I interferon derived from a consensus sequence of the most common amino acids found in naturally occurring alpha interferon subtypes. Several prospective clinical studies have demonstrated that CIFN may be a treatment option in patients who have failed prior interferonbased therapy, including those who have failed combination therapy with standard interferon or peginterferon plus ribavirin. Daily CIFN in combination with ribavirin may be an effective regimen in this setting; however, optimal dose and treatment duration of CIFN therapy have not been well established. Patients who achieve viral suppression during prior interferon-based therapy and those who do not have advanced fibrosis have a greater likelihood of achieving a SVR with CIFN retreatment. Individualized therapy targeting specific patient groups will be an important consideration in the successful management of prior treatment failures. Additional prospective studies are required in order to identify optimal treatment strategies for the use of CIFN in these patients.Keywords: consensus interferon, hepatitis C, interferon, nonresponder, relapser

  18. Review of novel therapeutic targets for improving heart failure treatment based on experimental and clinical studies

    Directory of Open Access Journals (Sweden)

    Bonsu KO

    2016-06-01

    Full Text Available Kwadwo Osei Bonsu,1,2 Isaac Kofi Owusu,3 Kwame Ohene Buabeng,4 Daniel Diamond Reidpath,1 Amudha Kadirvelu1 1School of Medicine and Health Sciences, Monash University Sunway Campus, Jalan Lagoon Selatan, Bandar Sunway, Subang Jaya, Selangor, Malaysia; 2Accident and Emergency Directorate, Komfo Anokye Teaching Hospital, 3Department of Medicine, 4Department of Clinical and Social Pharmacy, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana Abstract: Heart failure (HF is a major public health priority due to its epidemiological transition and the world’s aging population. HF is typified by continuous loss of contractile function with reduced, normal, or preserved ejection fraction, elevated vascular resistance, fluid and autonomic imbalance, and ventricular dilatation. Despite considerable advances in the treatment of HF over the past few decades, mortality remains substantial. Pharmacological treatments including β-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and aldosterone antagonists have been proven to prolong the survival of patients with HF. However, there are still instances where patients remain symptomatic, despite optimal use of existing therapeutic agents. This understanding that patients with chronic HF progress into advanced stages despite receiving optimal treatment has increased the quest for alternatives, exploring the roles of additional pathways that contribute to the development and progression of HF. Several pharmacological targets associated with pathogenesis of HF have been identified and novel therapies have emerged. In this work, we review recent evidence from proposed mechanisms to the outcomes of experimental and clinical studies of the novel pharmacological agents that have emerged for the treatment of HF. Keywords: novel treatment, experimental and clinical studies, therapeutic targets, heart failure

  19. The Correlation of Initial Sputum Smear Positivity on Treatment Failure of Category 1 Therapy for Pulmonary Tuberculosis

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    Puput Dyah Ayu

    2016-11-01

    Full Text Available Tuberculosis is an infectious disease and is an important public health problem. Based on data from East Java Province Health Department reported that number of tuberculosis patient in Surabaya is the highest in East Java on year 2014. Early identification and good treatment based on the result of sputum identification are the strategy use to control tuberculosis widespread. So that why, microscopic observation to identify acid fast bacilli (AFB is the fundamental stage to determine recovery treatment. Initial sputum smear positivity is necessary to determine infectious graded. The objectives of the study were to identify of initial sputum smear positivity on treatment failure of category 1 therapy for pulmonary tuberculosis in RS Paru Surabaya year 2011-2014. This study used case control method with quantitative approach. Forty two samples were taken from secondary data. Case group is 21 samples who have treatment failure and control group is 21 successful treatment. Samples were selected by simple random sampling. The chi square correlation showed that highly positive initial smear (p = 0,045; OR = 5,4 have correlated and risk factor to treatment failure on category 1 therapy for pulmonary tuberculosis. The conclusion is patient’s high positive sputum smear initially correlated to treatment failure on category 1 therapy for pulmonary tuberculosis in RS Paru Surabaya year 2011–2014. Keywords: initial sputum smear positivity, treatment failure,, category 1 therapy for pulmonary tuberculosis

  20. Impact of previous virological treatment failures and adherence on the outcome of antiretroviral therapy in 2007.

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    Marie Ballif

    Full Text Available BACKGROUND: Combination antiretroviral treatment (cART has been very successful, especially among selected patients in clinical trials. The aim of this study was to describe outcomes of cART on the population level in a large national cohort. METHODS: Characteristics of participants of the Swiss HIV Cohort Study on stable cART at two semiannual visits in 2007 were analyzed with respect to era of treatment initiation, number of previous virologically failed regimens and self reported adherence. Starting ART in the mono/dual era before HIV-1 RNA assays became available was counted as one failed regimen. Logistic regression was used to identify risk factors for virological failure between the two consecutive visits. RESULTS: Of 4541 patients 31.2% and 68.8% had initiated therapy in the mono/dual and cART era, respectively, and been on treatment for a median of 11.7 vs. 5.7 years. At visit 1 in 2007, the mean number of previous failed regimens was 3.2 vs. 0.5 and the viral load was undetectable (4 previous failures compared to 1 were 0.9 (95% CI 0.4-1.7, 0.8 (0.4-1.6, 1.6 (0.8-3.2, 3.3 (1.7-6.6 respectively, and 2.3 (1.1-4.8 for >2 missed cART doses during the last month, compared to perfect adherence. From the cART era, odds ratios with a history of 1, 2 and >2 previous failures compared to none were 1.8 (95% CI 1.3-2.5, 2.8 (1.7-4.5 and 7.8 (4.5-13.5, respectively, and 2.8 (1.6-4.8 for >2 missed cART doses during the last month, compared to perfect adherence. CONCLUSIONS: A higher number of previous virologically failed regimens, and imperfect adherence to therapy were independent predictors of imminent virological failure.

  1. [Clinical application of mesenchymal stem cells in treatment of acute-on-chronic liver failure and related research advances].

    Science.gov (United States)

    Feng, L Y; Zhang, D Z

    2017-09-20

    Acute-on-chronic liver failure is a syndrome characterized by acute exacerbation of chronic hepatitis, organ failure, and high mortality. Clinical treatment of acute-on-chronic liver failure included comprehensive medical treatment, artificial liver support system, and liver transplantation, but such methods have their own shortcomings and patients tend to have a poor prognosis. Mesenchymal stem cells (MSCs), as a new type of cell therapy, have wide sources and are easy to extract and culture. Many studies have shown that MSC treatment not only helps to achieve a high survival rate, but also has good tolerability and safety; therefore, the clinical value of MSCs has become a hot research topic. This article reviews the clinical studies on acute-on-chronic liver failure, related mechanisms, and research advances, in order to provide a reference for future clinical trials and application.

  2. Persistent genital tract HIV-1 RNA shedding after change in treatment regimens in antiretroviral-experienced women with detectable plasma viral load.

    Science.gov (United States)

    Venkatesh, Kartik K; DeLong, Allison K; Kantor, Rami; Chapman, Stacey; Ingersoll, Jessica; Kurpewski, Jaclynn; De Pasquale, Maria Pia; D'Aquila, Richard; Caliendo, Angela M; Cu-Uvin, Susan

    2013-04-01

    To longitudinally assess the association between plasma viral load (PVL) and genital tract human immunodeficiency virus (GT HIV) RNA among HIV-1 infected women changing highly active antiretroviral therapy (HAART) because of detectable PVL on current treatment. Women were eligible for the study if they had detectable PVL (defined as two consecutive samples with PVL>1000 copies/mL) and intended to change their current HAART regimen at the time of enrollment. Paired plasma and GT HIV-1 RNA were measured prospectively over 3 years. Longitudinal analyses examined rates of GT HIV-1 RNA shedding and the association with PVL. Sixteen women were followed for a median of 11 visits contributing a total of 205 study visits. At study enrollment, all had detectable PVL and 69% had detectable GT HIV-1 RNA. Half of the women changed to a new HAART regimen with ≥3 active antiretroviral drugs. The probability of having detectable PVL ≥30 days after changing HAART was 0.56 (95% CI: 0.37 to 0.74). Fourteen women (88%) had detectable PVL on a follow-up visit ≥30 or 60 days after changing HAART; and 12 women (75%) had detectable GT HIV-1 RNA on a follow-up visit ≥30 or 60 days after changing HAART. When PVL was undetectable, GT shedding occurred at 11% of visits, and when PVL was detectable, GT shedding occurred at 47% of visits. Some treatment-experienced HIV-infected women continue to have detectable virus in both the plasma and GT following a change in HAART, highlighting the difficulty of viral suppression in this patient population.

  3. Antiretroviral Drug Resistance Mutations among HIV Treatment Failure Patients in Tehran, Iran.

    Science.gov (United States)

    Farrokhi, Molood; Moallemi, Samaneh; Shirkoohi, Reza; Golmohammadi, Reza; Ahsani-Nasab, Sara; Sardashti, Sara; Abbasian, Ladan; Baesi, Kazem; Mohraz, Minoo

    2017-09-01

    This study aimed to determine drug resistance mutations in patients with virological failure and find correlation between HIV drug resistance test and viral load. Blood sample was collected from 51 patients who suspicious treatment failure in the center of Imam Khomeini Hospital, Tehran, Iran in 2015. Viral voluntary counseling and testing load test was done and the patients with viral load above 1000 copies choose for detection of drug resistance mutations by genotyping method (29 patients). The majority of patients (82.75) harbored the HIV subtype CRF 35 A-D. The 86.2% patients compromised at least one resistance mutation. The analysis of reverse transcriptase showed M184V (68.9%), T215YISF (44.8%), K103N (27.6%) and the analysis results of protease revealed G73SC (13.8%) and I47VA (6.9%). Eventually, the significant correlation between viral load and drug resistance was found. The result of our research stress the significance of recognizing drug resistant on time that prohibits the accumulation of drug resistance mutation and circulates the resistance strain of HIV-1 virus and the importance of national study according to the reliable findings for treatment guidelines.

  4. Merit of Ginseng in the Treatment of Heart Failure in Type 1-Like Diabetic Rats

    Directory of Open Access Journals (Sweden)

    Cheng-Chia Tsai

    2014-01-01

    Full Text Available The present study investigated the merit of ginseng in the improvement of heart failure in diabetic rats and the role of peroxisome proliferator-activated receptors δ (PPARδ. We used streptozotocin-induced diabetic rat (STZ-rat to screen the effects of ginseng on cardiac performance and PPARδ expression. Changes of body weight, water intake, and food intake were compared in three groups of age-matched rats; the normal control (Wistar rats received vehicle, STZ-rats received vehicle and ginseng-treated STZ-rats. We also determined cardiac performances in addition to blood glucose level in these animals. The protein levels of PPARδ in hearts were identified using Western blotting analysis. In STZ-rats, cardiac performances were decreased but the food intake, water intake, and blood glucose were higher than the vehicle-treated control. After a 7-day treatment of ginseng in STZ-rats, cardiac output was markedly enhanced without changes in diabetic parameters. This treatment with ginseng also increased the PPARδ expression in hearts of STZ-rats. The related signal of cardiac contractility, troponin I phosphorylation, was also raised. Ginseng-induced increasing of cardiac output was reversed by the cotreatment with PPARδ antagonist GSK0660. Thus, we suggest that ginseng could improve heart failure through the increased PPARδ expression in STZ-rats.

  5. Risk-Cost Estimation of On-Site Wastewater Treatment System Failures Using Extreme Value Analysis.

    Science.gov (United States)

    Kohler, Laura E; Silverstein, JoAnn; Rajagopalan, Balaji

    2017-05-01

      Owner resistance to increasing regulation of on-site wastewater treatment systems (OWTS), including obligatory inspections and upgrades, moratoriums and cease-and-desist orders in communities around the U.S. demonstrate the challenges associated with managing risks of inadequate performance of owner-operated wastewater treatment systems. As a result, determining appropriate and enforceable performance measures in an industry with little history of these requirements is challenging. To better support such measures, we develop a statistical method to predict lifetime failure risks, expressed as costs, in order to identify operational factors associated with costly repairs and replacement. A binomial logistic regression is used to fit data from public records of reported OWTS failures, in Boulder County, Colorado, which has 14 300 OWTS to determine the probability that an OWTS will be in a low- or high-risk category for lifetime repair and replacement costs. High-performing or low risk OWTS with repairs and replacements below the threshold of $9000 over a 40-year life are associated with more frequent inspections and upgrades following home additions. OWTS with a high risk of exceeding the repair cost threshold of $18 000 are further analyzed in a variation of extreme value analysis (EVA), Points Over Threshold (POT) where the distribution of risk-cost exceedance values are represented by a generalized Pareto distribution. The resulting threshold cost exceedance estimates for OWTS in the high-risk category over a 40-year expected life ranged from $18 000 to $44 000.

  6. A systems BIOlogy Study to TAilored Treatment in Chronic Heart Failure: rationale, design, and baseline characteristics of BIOSTAT-CHF.

    Science.gov (United States)

    Voors, Adriaan A; Anker, Stefan D; Cleland, John G; Dickstein, Kenneth; Filippatos, Gerasimos; van der Harst, Pim; Hillege, Hans L; Lang, Chim C; Ter Maaten, Jozine M; Ng, Leong; Ponikowski, Piotr; Samani, Nilesh J; van Veldhuisen, Dirk J; Zannad, Faiz; Zwinderman, Aeilko H; Metra, Marco

    2016-06-01

    Despite major improvements in pharmacological and device treatments, heart failure remains a syndrome with high morbidity and mortality, poor quality of life, and high health-care costs. Given the extensive heterogeneity among patients with heart failure, substantial differences in the response to therapy can be expected. We hypothesize that individualized therapy is an essential next step to improve outcomes in patients with heart failure. The BIOlogy Study to TAilored Treatment in Chronic Heart Failure (BIOSTAT-CHF) included 2516 patients with worsening signs and/or symptoms of heart failure from 11 European countries, who were considered to be on suboptimal medical treatment. Another 1738 patients from Scotland were included in a validation cohort. Overall, both patient cohorts were well matched. The majority of patients were hospitalized for acute heart failure, and the remainder presented with worsening signs and/or symptoms of heart failure at outpatient clinics. Approximately half of the patients were in New York Heart Association class III, and 7% vs 34% of patients of the index vs validation cohort had heart failure with preserved ejection fraction. According to study design, all patients used diuretics, but owing to the inclusion criteria of both cohorts, patients were not on optimal, evidence-based medical therapy. In the follow-up phase, uptitration to guideline-recommended doses was encouraged. By using a novel systems biology approach, incorporating demographics, biomarkers, genome-wide analysis, and proteomics, a model that predicts response to therapy will be developed, which should be instrumental in developing alternative therapies for patients with suboptimal response to currently recommended therapies and thus further improve care for patients with heart failure. © 2016 The Authors European Journal of Heart Failure © 2016 European Society of Cardiology.

  7. Long-term L-Triiodothyronine (T3) treatment in stable systolic heart failure patients

    DEFF Research Database (Denmark)

    Holmager, Pernille; Schmidt, Ulla; Mark, Peter

    2015-01-01

    BACKGROUND: Chronic heart failure (HF) is characterized by reduced serum T3 levels and increased activity of the T3 degrading enzyme deiodinase D3. This may result in an intracellular composition of the cardiomyocyte mimicking that of hypothyroidism. Short-term T3-administration to systolic HF...... during T3-treatment and neither did the neurohormonal profile. There were no side-effects in terms of cardiac arrhythmias and no change in resting heart rate. CONCLUSIONS: This study does not support the hypothesis that oral T3 treatment might be beneficial to patients with chronic, stable systolic HF...... with a modest degree of reduced LVEF and low-normal serum T3 concentrations. The study included both functional studies of heart contractility as well as measures of the neurohormonal activation....

  8. Varying effects of recommended treatments for heart failure with reduced ejection fraction

    DEFF Research Database (Denmark)

    Thomsen, Marius Mark; Lewinter, Christian; Køber, Lars

    2016-01-01

    The aim of this paper is to evaluate the treatment effects of recommended drugs and devices on key clinical outcomes for patients with heart failure with reduced ejection fraction (HFREF). Randomized controlled trials (RCTs) listed in the 2012 HF guideline from the European Society of Cardiology...... as well as the 2013 HF guideline from the American College of Cardiology Foundation and American Heart Association were evaluated for use in the meta-analysis. RCTs written in English evaluating recommended drugs and devices for the treatment of patients with HFREF were included. Meta-analyses, based...... on the outcomes of all-cause mortality and hospitalization because of HF, were performed with relative risk ratio as the effect size. In the identified 47 RCTs, patients were on average 63 years old and 22% were female. Drugs targeting the renin-angiotensin-aldosterone system, beta-blockers, cardiac...

  9. Clinical aspects of people with chronic renal failure in conservative treatment

    Directory of Open Access Journals (Sweden)

    Camila Castro Roso

    2014-01-01

    Full Text Available This study aimed to describe the social and clinical needs of people with chronic renal failure on conservative treatment in an outpatient uremia in southern Brazil. It is a research descriptive, developed with 15 people. Data were collected from march to may 2011, through the documentary analysis and experiences of narrative interview. The age ranged from 19 to 85 years and it was evident that most participants have underlying disease as hypertension and diabetes mellitus. In conclusion that laboratory abnormalities are related to worsening of renal function, worsening of cardiovascular disease and increased morbidity and mortality. The conservative treatment reduction in the rate of disease progression, maintaining renal function and improving the clinical, psychological and social people. The nurse can develop health education activities effective in promoting the health of these people.

  10. Antithrombotic treatment in patients with heart failure and associated atrial fibrillation and vascular disease

    DEFF Research Database (Denmark)

    Lamberts, Morten; Lip, Gregory Y. H.; Ruwald, Martin H.

    2014-01-01

    OBJECTIVES: The aim of this study was to investigate the impact of atrial fibrillation (AF) and antithrombotic treatment on the prognosis in patients with heart failure (HF) as well as vascular disease. BACKGROUND: HF, vascular disease, and AF are pathophysiologically related, and understanding...... antithrombotic treatment for these conditions is crucial. METHODS: In hospitalized patients with HF and coexisting vascular disease (coronary artery disease or peripheral arterial disease) followed from 1997 to 2009, AF status was categorized as prevalent AF, incident AF, or no AF. Risk of thromboembolism (TE...... differences were seen between antithrombotic therapies in TE or MI risk, whereas bleeding risk was significantly increased for VKA with and without single-antiplatelet therapy. CONCLUSIONS: In AF patients with coexisting HF and vascular disease, adding single-antiplatelet therapy to VKA therapy...

  11. An evaluation of culture results during treatment for tuberculosis as surrogate endpoints for treatment failure and relapse.

    Directory of Open Access Journals (Sweden)

    Patrick P J Phillips

    Full Text Available It is widely acknowledged that new regimens are urgently needed for the treatment of tuberculosis. The primary endpoint in the Phase III trials is a composite outcome of failure at the end of treatment or relapse after stopping treatment. Such trials are usually both long and expensive. Valid surrogate endpoints measured during or at the end of treatment could dramatically reduce both the time and cost of assessing the effectiveness of new regimens. The objective of this study was to evaluate sputum culture results on solid media during treatment as surrogate endpoints for poor outcome. Data were obtained from twelve randomised controlled trials conducted by the British Medical Research Council in the 1970s and 80s in East Africa and East Asia, consisting of 6974 participants and 49 different treatment regimens. The month two culture result was shown to be a poor surrogate in East Africa but a good surrogate in Hong Kong. In contrast, the month three culture was a good surrogate in trials conducted in East Africa but not in Hong Kong. As well as differences in location, ethnicity and probable strain of Mycobacteria tuberculosis, Hong Kong trials more often evaluated regimens with rifampicin throughout and intermittent regimens, and patients in East African trials more often presented with extensive cavitation and were slower to convert to culture negative during treatment. An endpoint that is a summary measure of the longitudinal profile of culture results over time or that is able to detect the presence of M. tuberculosis later in treatment is more likely to be a better endpoint for a phase II trial than a culture result at a single time point and may prove to be an acceptable surrogate. More data are needed before any endpoint can be used as a surrogate in a confirmatory phase III trial.

  12. SU-F-P-07: Applying Failure Modes and Effects Analysis to Treatment Planning System QA

    Energy Technology Data Exchange (ETDEWEB)

    Mathew, D; Alaei, P [University Minnesota, Minneapolis, MN (United States)

    2016-06-15

    Purpose: A small-scale implementation of Failure Modes and Effects Analysis (FMEA) for treatment planning system QA by utilizing methodology of AAPM TG-100 report. Methods: FMEA requires numerical values for severity (S), occurrence (O) and detectability (D) of each mode of failure. The product of these three values gives a risk priority number (RPN). We have implemented FMEA for the treatment planning system (TPS) QA for two clinics which use Pinnacle and Eclipse TPS. Quantitative monthly QA data dating back to 4 years for Pinnacle and 1 year for Eclipse have been used to determine values for severity (deviations from predetermined doses at points or volumes), and occurrence of such deviations. The TPS QA protocol includes a phantom containing solid water and lung- and bone-equivalent heterogeneities. Photon and electron plans have been evaluated in both systems. The dose values at multiple distinct points of interest (POI) within the solid water, lung, and bone-equivalent slabs, as well as mean doses to several volumes of interest (VOI), have been re-calculated monthly using the available algorithms. Results: The computed doses vary slightly month-over-month. There have been more significant deviations following software upgrades, especially if the upgrade involved re-modeling of the beams. TG-100 guidance and the data presented here suggest an occurrence (O) of 2 depending on the frequency of re-commissioning the beams, severity (S) of 3, and detectability (D) of 2, giving an RPN of 12. Conclusion: Computerized treatment planning systems could pose a risk due to dosimetric errors and suboptimal treatment plans. The FMEA analysis presented here suggests that TPS QA should immediately follow software upgrades, but does not need to be performed every month.

  13. Robust Algorithm for Systematic Classification of Malaria Late Treatment Failures as Recrudescence or Reinfection Using Microsatellite Genotyping.

    Science.gov (United States)

    Plucinski, Mateusz M; Morton, Lindsay; Bushman, Mary; Dimbu, Pedro Rafael; Udhayakumar, Venkatachalam

    2015-10-01

    Routine therapeutic efficacy monitoring to measure the response to antimalarial treatment is a cornerstone of malaria control. To correctly measure drug efficacy, therapeutic efficacy studies require genotyping parasites from late treatment failures to differentiate between recrudescent infections and reinfections. However, there is a lack of statistical methods to systematically classify late treatment failures from genotyping data. A Bayesian algorithm was developed to estimate the posterior probability of late treatment failure being the result of a recrudescent infection from microsatellite genotyping data. The algorithm was implemented using a Monte Carlo Markov chain approach and was used to classify late treatment failures using published microsatellite data from therapeutic efficacy studies in Ethiopia and Angola. The algorithm classified 85% of the Ethiopian and 95% of the Angolan late treatment failures as either likely reinfection or likely recrudescence, defined as a posterior probability of recrudescence of 0.9, respectively. The adjusted efficacies calculated using the new algorithm differed from efficacies estimated using commonly used methods for differentiating recrudescence from reinfection. In a high-transmission setting such as Angola, as few as 15 samples needed to be genotyped in order to have enough power to correctly classify treatment failures. Analysis of microsatellite genotyping data for differentiating between recrudescence and reinfection benefits from an approach that both systematically classifies late treatment failures and estimates the uncertainty of these classifications. Researchers analyzing genotyping data from antimalarial therapeutic efficacy monitoring are urged to publish their raw genetic data and to estimate the uncertainty around their classification. Copyright © 2015, American Society for Microbiology. All Rights Reserved.

  14. Trunnion Failure of the Recalled Low Friction Ion Treatment Cobalt Chromium Alloy Femoral Head.

    Science.gov (United States)

    Urish, Kenneth L; Hamlin, Brian R; Plakseychuk, Anton Y; Levison, Timothy J; Higgs, Genymphas B; Kurtz, Steven M; DiGioia, Anthony M

    2017-09-01

    Gross trunnion failure (GTF) is a rare complication in total hip arthroplasty (THA) reported across a range of manufacturers. Specific lots of the Stryker low friction ion treatment (LFIT) anatomic cobalt chromium alloy (CoCr) V40 femoral head were recalled in August 2016. In part, the recall was based out of concerns for disassociation of the femoral head from the stem and GTF. We report on 28 patients (30 implants) with either GTF (n = 18) or head-neck taper corrosion (n = 12) of the LFIT CoCr femoral head and the Accolade titanium-molybdenum-zirconium-iron alloy femoral stems. All these cases were associated with adverse local tissue reactions requiring revision of the THA. In our series, a conservative estimate of the incidence of failure was 4.7% (n = 636 total implanted) at 8.0 ± 1.4 years from the index procedure. Failures were associated with a high-offset 127° femoral stem neck angle and increased neck lengths; 43.3% (13 of 30) of the observed failures included implant sizes outside the voluntary recall (27.8% [5 of 18] of the GTF and 75.0% [8 of 12] of the taper corrosion cases). Serum cobalt and chromium levels were elevated (cobalt: 8.4 ± 7.0 μg/mL; chromium: 3.4 ± 3.3 μ/L; cobalt/chromium ratio: 3.7). The metal artifact reduction sequence magnetic resonance imaging demonstrated large cystic fluid collections typical with adverse local tissue reactions. During revision, a pseudotumor was observed in all cases. Pathology suggested a chronic inflammatory response. Impending GTF could be diagnosed based on aspiration of black synovial fluid and an oblique femoral head as compared with the neck taper on radiographs. In our series of the recalled LFIT CoCr femoral head, the risk of impending GTF or head-neck taper corrosion should be considered as a potential diagnosis in a painful LFIT femoral head and Accolade titanium-molybdenum-zirconium-iron alloy THA with unknown etiology. Almost half of the failures we observed included sizes outside of the

  15. Second date appendectomy: Operating for failure of nonoperative treatment in perforated appendicitis.

    Science.gov (United States)

    Lotti, Marco

    2017-06-01

    Nonoperative treatment of acute appendicitis is embraced by many surgical teams, driven by low to moderate quality randomized studies that support noninferiority of antibiotics versus appendectomy for treatment of acute uncomplicated appendicitis. Several flaws of these studies have emerged, especially in the recruitment strategy and in the diagnostic criteria that were used. The growing confidence given to antibiotics, together with the lack of reliable criteria to distinguish between uncomplicated and perforated appendicitis, exposes patients with perforated appendicitis to the likelihood to be treated with antibiotics instead of surgery. Among them, those patients who experience a temporary relief of symptoms due to antibiotics, followed by early recurrence of disease when antibiotics are discontinued, are likely to undergo appendectomy at their second date. Second date appendectomy, i.e. the removal of the appendix when acute inflammation relapses within the scar of a previously unhealed perforated appendicitis, is the unwanted child of the nonoperative treatment and a new challenge for both the surgeon and the patient. Between June and July 2016, two patients were readmitted and operated for failure of nonoperative treatment with antibiotics. A video is presented, which focuses on the different anatomic presentation and technical challenges between prompt and second date laparoscopic appendectomy. When proposing nonoperative treatment for acute appendicitis, surgeons should be aware and inform their patients that if the appendix is perforated and an incomplete healing and early recurrence occur, a second date appendectomy could be a more challenging operation compared to a prompt appendectomy. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Association between uterine position and transvaginal misoprostol treatment for early pregnancy failure.

    Science.gov (United States)

    Chill, Henry H; Malyanker, Nirit; Karavani, Gilad; Haj-Yahya, Rani; Herzberg, Shmuel; Bahar, Raz; Shveiky, David; Dior, Uri P

    2017-11-02

    We aimed to determine the importance of uterine position as a predicting factor of success rate in medically treated early pregnancy failure (EPF). We carried out a retrospective cohort study at the Obstetrics and Gynecology Department of a tertiary medical center between January 2011 and June 2012. We included women diagnosed with EPF, which we defined as women diagnosed with missed abortion up to 13 gestational weeks. Patients were treated with one or two doses of 800 μg of misoprostol vaginally in accordance with the department's protocol. Demographic, clinical, and treatment success data were collected from patient electronic records. A total of 255 women were included in our study. The success rate after treatment with misoprostol for the anterior uterine group was 78.7% as compared to the non-anterior uterine group, which achieved a success rate of 88.1%. This difference was not statistically significant (P = 0.180). In a multivariate analysis comparing patients for whom treatment with misoprostol was successful as opposed to patients for whom treatment failed, only embryonic sac size showed a statistically significant difference, measuring shorter in the success group. Uterine position has no effect on success rate of misoprostol treatment for EPF. © 2017 Japan Society of Obstetrics and Gynecology.

  17. Predominant Api m 10 sensitization as risk factor for treatment failure in honey bee venom immunotherapy.

    Science.gov (United States)

    Frick, Marcel; Fischer, Jörg; Helbling, Arthur; Ruëff, Franziska; Wieczorek, Dorothea; Ollert, Markus; Pfützner, Wolfgang; Müller, Sabine; Huss-Marp, Johannes; Dorn, Britta; Biedermann, Tilo; Lidholm, Jonas; Ruecker, Gerta; Bantleon, Frank; Miehe, Michaela; Spillner, Edzard; Jakob, Thilo

    2016-12-01

    Component resolution recently identified distinct sensitization profiles in honey bee venom (HBV) allergy, some of which were dominated by specific IgE to Api m 3 and/or Api m 10, which have been reported to be underrepresented in therapeutic HBV preparations. We performed a retrospective analysis of component-resolved sensitization profiles in HBV-allergic patients and association with treatment outcome. HBV-allergic patients who had undergone controlled honey bee sting challenge after at least 6 months of HBV immunotherapy (n = 115) were included and classified as responder (n = 79) or treatment failure (n = 36) on the basis of absence or presence of systemic allergic reactions upon sting challenge. IgE reactivity to a panel of HBV allergens was analyzed in sera obtained before immunotherapy and before sting challenge. No differences were observed between responders and nonresponders regarding levels of IgE sensitization to Api m 1, Api m 2, Api m 3, and Api m 5. In contrast, Api m 10 specific IgE was moderately but significantly increased in nonresponders. Predominant Api m 10 sensitization (>50% of specific IgE to HBV) was the best discriminator (specificity, 95%; sensitivity, 25%) with an odds ratio of 8.444 (2.127-33.53; P = .0013) for treatment failure. Some but not all therapeutic HBV preparations displayed a lack of Api m 10, whereas Api m 1 and Api m 3 immunoreactivity was comparable to that of crude HBV. In line with this, significant Api m 10 sIgG 4 induction was observed only in those patients who were treated with HBV in which Api m 10 was detectable. Component-resolved sensitization profiles in HBV allergy suggest predominant IgE sensitization to Api m 10 as a risk factor for treatment failure in HBV immunotherapy. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  18. Efficacy of Continuous Positive Airway Pressure in the Treatment of Chronic Obstructive Pulmonary Disease Combined With Respiratory Failure.

    Science.gov (United States)

    Sun, Yu-Qiang; Wei, Qian; Liu, Zhi

    2016-01-01

    Our aim is to investigate the efficacy of continuous positive airway pressure (CPAP) in chronic obstructive pulmonary disease (COPD) combined with respiratory failure. Electronic and manual searches were applied to retrieve published studies relevant to CPAP, COPD, and respiratory failure. The retrieved studies were screened based on stringent inclusion and exclusion criteria to identify high-quality clinical studies for meta-analysis. Comprehensive meta-analysis 2.0 was conducted to statistical analysis. Initially, we retrieved 958 studies based on stringent inclusion and exclusion criteria, 10 studies, containing a total of 372 patients with COPD combined with respiratory failure, were selected for meta-analysis. The result of our meta-analysis revealed that partial pressure of carbon dioxide (PaCO2) in patients with COPD combined with respiratory failure was significantly lower 24 hours after CPAP treatment, and partial pressure of oxygen (PaO2) and pH were markedly higher 24 hours after CPAP treatment in the same patient group, indicating statistically significant differences as a result of CPAP treatment. Subgroup analysis based on ethnicity demonstrated that PaCO2 in patients with COPD combined with respiratory failure is evidently lower 24 hours after CPAP treatment among whites, but no such statistical correlation was observed among Asians. The results of this meta-analysis indicate that CPAP can effectively improve the respiratory function of patients with COPD combined with respiratory failure, and CPAP can be an effective way of treating COPD.

  19. Choices: a study of preferences for end-of-life treatments in patients with advanced heart failure.

    Science.gov (United States)

    MacIver, Jane; Rao, Vivek; Delgado, Diego H; Desai, Nimesh; Ivanov, Joan; Abbey, Susan; Ross, Heather J

    2008-09-01

    The purpose of this study is to describe the treatment preferences of patients with heart failure among three distinct treatment options--optimal medical management, oral inotropes or left ventricular device (LVAD) support--to determine if there were differences in preferences between patients with mild heart failure (New York Heart Association [NYHA] Class II) and severe heart failure (NYHA Class IV), and also to determine whether quality of life, perceived severity of symptoms and overall health influenced treatment preferences. We enrolled 91 patients who completed the Minnesota Living with Heart Failure Questionnaire (MLHFQ); visual analog scales for depicting their perceived severity of overall health, dyspnea and fatigue; and a treatment trade-off tool. The most preferred treatment options were oral inotropes, LVAD and standard medical management. There were no differences in treatment preferences between NYHA II and NYHA IV patients. Patient preferences correlated poorly with MLHFQ, symptom and overall health scores. Although not statistically significant, there was a trend toward patients with worse quality of life and symptom scores preferring more aggressive treatment. The results of our study identified two distinct groups of patients: one group preferring treatments that prolonged survival time and another group that favored strategies that improved quality of life but reduced survival time. Treatment preferences were independent of functional or symptom status, suggesting that preferences may be decided early in the course of illness.

  20. Parent Expectancies and Preferences for Mental Health Treatment: The Roles of Emotion Mind-Sets and Views of Failure.

    Science.gov (United States)

    Schleider, Jessica L; Weisz, John R

    2018-01-24

    Because parents are primary gatekeepers to mental health care for their children, parental expectations that mental health treatment is ineffective may undermine treatment seeking, retention, and response. Thus, a need exists to understand parents' expectations about treatment and to develop scalable interventions that can instill more favorable views. We examined parents' treatment expectancies and preferences for their offspring and themselves in relation to two global beliefs: mind-sets (malleability beliefs) of emotions and anxiety, and views of failure as enhancing versus debilitating. Study 1 (N = 200; 49.5% fathers; 70.4% Caucasian) examined associations among parents' emotion mind-sets, anxiety mind-sets, failure beliefs, and treatment expectancies and preferences. Study 2 (N = 430; 44.70% fathers; 75.80% Caucasian) tested whether online inductions teaching "growth emotion mind-sets" (viewing emotions as malleable), adaptive failure beliefs, or both improved parents' treatment expectancies and hypothetical preferences for treatment (vs. no-treatment). Participants received one of three 8- to 15-min inductions or a psychoeducation control, rating treatment expectancies. and preferences pre- and postinduction. In Study 1, fixed emotion mind-sets and failure-is-debilitating beliefs were associated with lower parent psychotherapy expectancies for offspring and themselves and stronger "no-treatment" preferences for offspring. In Study 2, inductions teaching (a) growth emotion mind-sets only and (b) growth emotion mind-sets and failure-is-enhancing beliefs improved parents' psychotherapy expectancies for themselves (ds = .38, .51) and offspring (ds = .30, .43). No induction increased parents' hypothetical preferences for treatment (vs. no-treatment). Findings suggest scalable strategies for strengthening parents' psychotherapy effectiveness beliefs for themselves and their children.

  1. Healthy lifestyle status, antihypertensive treatment and the risk of heart failure among Finnish men and women.

    Science.gov (United States)

    Wang, Yujie; Tuomilehto, Jaakko; Jousilahti, Pekka; Antikainen, Riitta; Mähönen, Markku; Katzmarzyk, Peter T; Hu, Gang

    2013-11-01

    To compare the association between antihypertensive drug treatment and heart failure (HF) risk with the association between engaging in a healthy lifestyle and HF risk. We prospectively investigated the single and joint associations of lifestyle factors and awareness, treatment, blood pressure control status with HF risk among 38 075 Finns, who were 25-74 years old and free of HF at baseline. During a median follow-up of 14.1 years, 638 men and 445 women developed HF. Engaging in a healthy lifestyle was associated with an decreased risk of HF. Compared with normotensive people, hypertensive patients with and without antihypertensive treatment had a higher risk of HF. Hypertensive patients who used antihypertensive drugs but did not engage in a healthy lifestyle had a significantly higher risk of HF [HR 1.75; 95% confidence interval (CI) 1.39-2.21] than hypertensive patients who did not use antihypertensive drugs but engaged in a healthy lifestyle. In addition, compared with hypertensive patients who used antihypertensive drugs and engaged in a healthy lifestyle, hypertensive patients who did not use antihypertensive drug or engage in a healthy lifestyle had a significantly higher risk of HF (HR 1.55; 95% CI 1.24-1.95). The present study demonstrates that HF risk was lower in hypertensive patients who engaged in a healthy lifestyle but higher in hypertensive people using antihypertensive drug treatment.

  2. Development of an electronic medical record based alert for risk of HIV treatment failure in a low-resource setting.

    Directory of Open Access Journals (Sweden)

    Nancy Puttkammer

    Full Text Available The adoption of electronic medical record systems in resource-limited settings can help clinicians monitor patients' adherence to HIV antiretroviral therapy (ART and identify patients at risk of future ART failure, allowing resources to be targeted to those most at risk.Among adult patients enrolled on ART from 2005-2013 at two large, public-sector hospitals in Haiti, ART failure was assessed after 6-12 months on treatment, based on the World Health Organization's immunologic and clinical criteria. We identified models for predicting ART failure based on ART adherence measures and other patient characteristics. We assessed performance of candidate models using area under the receiver operating curve, and validated results using a randomly-split data sample. The selected prediction model was used to generate a risk score, and its ability to differentiate ART failure risk over a 42-month follow-up period was tested using stratified Kaplan Meier survival curves.Among 923 patients with CD4 results available during the period 6-12 months after ART initiation, 196 (21.2% met ART failure criteria. The pharmacy-based proportion of days covered (PDC measure performed best among five possible ART adherence measures at predicting ART failure. Average PDC during the first 6 months on ART was 79.0% among cases of ART failure and 88.6% among cases of non-failure (p<0.01. When additional information including sex, baseline CD4, and duration of enrollment in HIV care prior to ART initiation were added to PDC, the risk score differentiated between those who did and did not meet failure criteria over 42 months following ART initiation.Pharmacy data are most useful for new ART adherence alerts within iSanté. Such alerts offer potential to help clinicians identify patients at high risk of ART failure so that they can be targeted with adherence support interventions, before ART failure occurs.

  3. [The place of cardiac glycosides in the treatment of chronic heart failure. Part II. Results of small studies].

    Science.gov (United States)

    Sidorenko, B A; Preobrazhenskiĭ, D V; Sharoshina, I A; Bataraliev, T A; Pershukov, I V; Makhmutkhodzhaev, S A

    2005-01-01

    In a series of papers the authors analyze literature data on the use of cardiac glycosides for long term treatment of chronic heart failure. Part II is devoted to analysis of results of small controlled studies of pharmacological effects of low dose digoxin in patients with sinus rhythm. Low dose digoxin improves exercise tolerance and lowers risk of decompensation of heart failure but produces no substantial effect on contractility of left ventricular myocardium. Therefore its favorable action on clinical course and outcomes of chronic heart failure is most probably related to modulation of neuro-humoral systems. Retrospective analysis of some trials shows that digoxin is able to increase mortality of survivors of acute myocardial infarction. Hence great care is required when digoxin is used for long term treatment of chronic heart failure due to systolic left ventricular dysfunction after myocardial infarction.

  4. Fibrin clot structure and platelet aggregation in patients with aspirin treatment failure.

    Science.gov (United States)

    Neergaard-Petersen, Søs; Ajjan, Ramzi; Hvas, Anne-Mette; Hess, Katharina; Larsen, Sanne Bøjet; Kristensen, Steen Dalby; Grove, Erik Lerkevang

    2013-01-01

    Aspirin is a cornerstone in prevention of cardiovascular events and modulates both platelet aggregation and fibrin clot formation. Some patients experience cardiovascular events whilst on aspirin, often termed aspirin treatment failure (ATF). This study evaluated both platelet aggregation and fibrin clot structure in patients with ATF. We included 177 stable coronary artery disease patients on aspirin monotherapy. Among these, 116 (66%) had ATF defined as myocardial infarction (MI) whilst on aspirin. Platelet aggregation was assessed by Multiplate® aggregometry and VerifyNow®, whereas turbidimetric assays and scanning electron microscopy were employed to study fibrin clot characteristics. Enhanced platelet aggregation was observed in patients with ATF compared with non-MI patients following stimulation with arachidonic acid 1.0 mM (median 161 (IQR 95; 222) vs. 97 (60; 1776) AU*min, p = 0.005) and collagen 1.0 µg/mL (293 (198; 427) vs. 220 (165; 370) AU*min, p = 0.03). Similarly, clot maximum absorbance, a measure of fibrin network density, was increased in patients with ATF (0.48 (0.41; 0.52) vs. 0.42 (0.38; 0.50), p = 0.02), and this was associated with thinner fibres (mean ± SD: 119.7±27.5 vs. 127.8±31.1 nm, p = 0.003) and prolonged lysis time (552 (498; 756) vs. 519 (468; 633) seconds; p = 0.02). Patients with ATF also had increased levels of C-reactive protein (CRP) (1.34 (0.48; 2.94) and 0.88 (0.32; 1.77) mg/L, p = 0.01) compared with the non-MI group. Clot maximum absorbance correlated with platelet aggregation (r = 0.31-0.35, p-valuesaspirin treatment failure showed increased platelet aggregation and altered clot structure with impaired fibrinolysis compared with stable CAD patients without previous MI. These findings suggest that an increased risk of aspirin treatment failure may be identified by measuring both platelet function and fibrin clot structure.

  5. Fibrin clot structure and platelet aggregation in patients with aspirin treatment failure.

    Directory of Open Access Journals (Sweden)

    Søs Neergaard-Petersen

    Full Text Available Aspirin is a cornerstone in prevention of cardiovascular events and modulates both platelet aggregation and fibrin clot formation. Some patients experience cardiovascular events whilst on aspirin, often termed aspirin treatment failure (ATF. This study evaluated both platelet aggregation and fibrin clot structure in patients with ATF.We included 177 stable coronary artery disease patients on aspirin monotherapy. Among these, 116 (66% had ATF defined as myocardial infarction (MI whilst on aspirin. Platelet aggregation was assessed by Multiplate® aggregometry and VerifyNow®, whereas turbidimetric assays and scanning electron microscopy were employed to study fibrin clot characteristics.Enhanced platelet aggregation was observed in patients with ATF compared with non-MI patients following stimulation with arachidonic acid 1.0 mM (median 161 (IQR 95; 222 vs. 97 (60; 1776 AU*min, p = 0.005 and collagen 1.0 µg/mL (293 (198; 427 vs. 220 (165; 370 AU*min, p = 0.03. Similarly, clot maximum absorbance, a measure of fibrin network density, was increased in patients with ATF (0.48 (0.41; 0.52 vs. 0.42 (0.38; 0.50, p = 0.02, and this was associated with thinner fibres (mean ± SD: 119.7±27.5 vs. 127.8±31.1 nm, p = 0.003 and prolonged lysis time (552 (498; 756 vs. 519 (468; 633 seconds; p = 0.02. Patients with ATF also had increased levels of C-reactive protein (CRP (1.34 (0.48; 2.94 and 0.88 (0.32; 1.77 mg/L, p = 0.01 compared with the non-MI group. Clot maximum absorbance correlated with platelet aggregation (r = 0.31-0.35, p-values<0.001 and CRP levels (r = 0.60, p<0.001.Patients with aspirin treatment failure showed increased platelet aggregation and altered clot structure with impaired fibrinolysis compared with stable CAD patients without previous MI. These findings suggest that an increased risk of aspirin treatment failure may be identified by measuring both platelet function and fibrin clot structure.

  6. The lung impedance monitoring in treatment of chronic heart failure (the LIMIT-CHF study).

    Science.gov (United States)

    Domenichini, Giulia; Rahneva, Tsveta; Diab, Ihab G; Dhillon, Onkar S; Campbell, Niall G; Finlay, Malcolm C; Baker, Victoria; Hunter, Ross J; Earley, Mark J; Schilling, Richard J

    2016-03-01

    To assess the usefulness of intrathoracic impedance monitoring (IIM) alerts in guiding empirical treatment of chronic heart failure (CHF) patients to prevent heart failure (HF) hospitalizations and unplanned HF care. Chronic heart failure patients with OptiVol or CorVue capable implantable cardioverter-defibrillators were randomized to either the active group (IIM alarm turned on and diuretic dose increased by 50% for 1 week in the event of alarm sounding) or the control group (IIM alarm turned off). The primary endpoint was the number of HF hospitalizations per patient at 1 year. The NYHA class, 6MWT, B-type natriuretic peptide (BNP), and MLWHF questionnaire score were collected at baseline and follow-up. Eighty patients were included and 71 reached 1-year follow-up. There were 1.7 ± 1.5 alerts in the active group and 1.1 ± 1.0 in the control group, P = 0.07. In the active group, 61% of alerts led to a diuretic dose increase. There was a total of 11 HF hospitalizations in the active group vs. 6 in the control group without significant differences in the number of episodes per patient (0.3 ± 0.9 vs. 0.2 ± 0.4, P = 0.95). There were no unplanned HF visits in the active group vs. 0.1 ± 0.3 per patient in the control group, P = 0.08. The total MLWHF scores were significantly increased at the final follow-up in the control group, whereas a trend towards reduction was observed in the active group. In this study, an empirical HF treatment guided by IIM alerts did not reduce emergency treatment of HF. However, it seems to have a positive impact on quality of life. CLINICAL TRIAL REGISTRATIONURL: http://www.clinicaltrials.gov. Unique identifier: NCT01320007. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

  7. 20 CFR 416.1326 - Suspension for failure to comply with treatment for drug addiction or alcoholism.

    Science.gov (United States)

    2010-04-01

    ... treatment for drug addiction or alcoholism. 416.1326 Section 416.1326 Employees' Benefits SOCIAL SECURITY....1326 Suspension for failure to comply with treatment for drug addiction or alcoholism. (a) Basis for suspension. If you are disabled and drug addiction or alcoholism is a contributing factor material to the...

  8. Antibody-induced secondary treatment failure in a patient treated with botulinum toxin type A for glabellar frown lines

    Directory of Open Access Journals (Sweden)

    Stengel G

    2011-11-01

    Full Text Available Gabriele Stengel, Eva Kristina Bee Hautarztpraxis Stengel and Bee, Münster, Germany Abstract: Botulinum toxin type A (BTX-A preparations are widely used nonsurgical treatments for facial wrinkles. Higher doses of BTX-A are also used for therapeutic purposes in the treatment of conditions involving increased muscle tone, such as cervical dystonia. The phenomenon of antibody-induced treatment failure is well known in the therapeutic setting, but reports are also emerging following cosmetic use of BTX-A. We describe the case of a 41-year-old female nurse who developed secondary treatment failure during 6 years of BTX-A treatment for glabellar lines. After a good response to the first BTX-A injection, the intensity and duration of effect decreased after subsequent treatments. Antibody tests revealed a high titer of neutralizing anti-BTX-A antibodies. This case shows secondary treatment failure due to the production of neutralizing antibodies following administration of BTX-A formulations for cosmetic purposes and demonstrates that immunogenicity of BTX-A preparations is an important consideration, even in the cosmetic setting. Keywords: botulinum toxin type A, neutralizing antibodies, antibody-induced treatment failure

  9. 20 CFR 416.1725 - Effect of your failure to comply with treatment requirements for your drug addiction or alcoholism.

    Science.gov (United States)

    2010-04-01

    ... treatment requirements for your drug addiction or alcoholism. 416.1725 Section 416.1725 Employees' Benefits... Or Drug Addiction § 416.1725 Effect of your failure to comply with treatment requirements for your drug addiction or alcoholism. (a) Suspension of benefits. Your eligibility for benefits will be...

  10. FDG PET/CT patterns of treatment failure of malignant pleural mesothelioma: relationship to histologic type, treatment algorithm, and survival

    Energy Technology Data Exchange (ETDEWEB)

    Gerbaudo, Victor H.; Mamede, Marcelo [Brigham and Women' s Hospital, Harvard Medical School, Division of Nuclear Medicine and Molecular Imaging, Boston, MA (United States); Trotman-Dickenson, Beatrice; Hatabu, Hiroto [Brigham and Women' s Hospital, Harvard Medical School, Division of Thoracic Radiology, Boston, MA (United States); Sugarbaker, David J. [Brigham and Women' s Hospital, Harvard Medical School, Division of Thoracic Surgery, Boston, MA (United States)

    2011-05-15

    This study investigated the diagnostic performance and prognostic value of fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT in suspected malignant pleural mesothelioma (MPM) recurrence, in the context of patterns and intensity of FDG uptake, histologic type, and treatment algorithm. Fifty patients with MPM underwent FDG PET/CT for restaging 11 {+-} 6 months after therapy. Tumor relapse was confirmed by histopathology, and by clinical evolution and subsequent imaging. Progression-free survival was defined as the time between treatment and the earliest clinical evidence of recurrence. Survival after FDG PET/CT was defined as the time between the scan and death or last follow-up. Overall survival was defined as the time between initial treatment and death or last follow-up date. Treatment failure was confirmed in 42 patients (30 epithelial and 12 non-epithelial MPM). Sensitivity, specificity, accuracy, negative predictive value, and positive predictive value for FDG PET/CT were 97.6, 75, 94, 86, and 95.3%, respectively. FDG PET/CT evidence of single site of recurrence was observed in the ipsilateral hemithorax in 18 patients (44%), contralaterally in 2 (5%), and in the abdomen in 1 patient (2%). Bilateral thoracic relapse was detected in three patients (7%). Simultaneous recurrence in the ipsilateral hemithorax and abdomen was observed in ten (24%) patients and in seven (17%) in all three cavities. Unsuspected distant metastases were detected in 11 patients (26%). Four patterns of uptake were observed in recurrent disease: focal, linear, mixed (focal/linear), and encasing, with a significant difference between the intensity of uptake in malignant lesions compared to benign post-therapeutic changes. Lesion uptake was lower in patients previously treated with more aggressive therapy and higher in intrathoracic lesions of patients with distant metastases. FDG PET/CT helped in the selection of 12 patients (29%) who benefited from additional previously

  11. Impact of treatment on myocardial lysyl oxidase expression and collagen cross-linking in patients with heart failure

    OpenAIRE

    Lopez, B. (Begoña); Querejeta, R. (Ramón); Gonzalez, A. (Arantxa); Beaumont, J. (Javier); Larman, M. (Mariano); Diez, J. (Javier)

    2009-01-01

    The aim of this study was to investigate whether torasemide modifies collagen cross-linking in the failing human heart. We analyzed the degree of cross-linking and the expression of the enzyme lysyl oxidase, which regulates cross-linking, in the myocardium of patients with chronic heart failure at baseline and after 8 months of treatment with either torasemide or furosemide in addition to their standard heart failure therapy. Whereas lysyl oxidase protein expression was very scarce in normal ...

  12. Implications of Infliximab Treatment Failure and Influence of Personalized Treatment on Patient-reported Health-related Quality of Life and Productivity Outcomes in Crohn's Disease

    DEFF Research Database (Denmark)

    Steenholdt, Casper; Brynskov, Jørn; Thomsen, Ole Østergaard

    2015-01-01

    BACKGROUND: This study assessed the effects of infliximab (IFX) treatment failure on patient-reported outcomes and explored the influence of using personalized treatment in this situation. METHODS: Sixty-nine Crohn's disease patients with IFX treatment failure were randomized to an intensified IFX...... in these patients compared with patients routinely dose-intensified on IFX. CONCLUSION: Regaining low disease activity after IFX failure is necessary for minimizing patient impairment and indirect disease-related costs. A personalized treatment strategy does not have a negative influence on patient...... regimen (n = 36) or personalized treatment defined by IFX and anti-IFX antibodies (n = 33). Health-related quality of life evaluated with the Short Inflammatory Bowel Disease Questionnaire (IBDQ) and productivity evaluated with the Work Productivity and Activity Impairment Questionnaire (WPAI:CD) were...

  13. Effect of changing heart rate during treatment of hypertension on incidence of heart failure.

    Science.gov (United States)

    Okin, Peter M; Kjeldsen, Sverre E; Julius, Stevo; Hille, Darcy A; Dahlöf, Björn; Devereux, Richard B

    2012-03-01

    An elevated heart rate (HR) at rest at baseline is associated with an increased risk of incident heart failure (HF) and with greater cardiovascular event rates in patients with chronic HF. However, despite the high attributable risk of hypertension for HF, whether the in-treatment HR predicts incident HF in patients with treated hypertension has not been evaluated. The HR was evaluated on annual electrocardiograms from 9,024 patients with hypertension without HF who were treated with losartan- or atenolol-based regimens. During a mean follow-up of 4.7 ± 1.1 years, HF developed in 285 patients (3.2%). On multivariate Cox analyses adjusted for randomized treatment, the baseline risk factors for HF, baseline and in-treatment blood pressure, QRS duration, and electrocardiographic left ventricular hypertrophy, a greater in-treatment HR predicted a 45% greater adjusted risk of new HF for every 10-beats/min increase in the HR (95% confidence interval [CI] 34% to 57%) or a 159% greater risk of HF in patients with the persistence or development of a HR of ≥84 beats/min (95% CI 88% to 257%). In contrast, with adjustment for the same covariates, the baseline HR as a continuous variable was a significantly less powerful predictor of new HF (hazard ratio 1.15 per 10 beats/min, 95% CI 1.03 to 1.28) and a baseline HR of ≥84 beats/min did not predict new HF (hazard ratio 1.00, 95% CI 0.63 to 1.58). In conclusion, a greater in-treatment HR on the serial electrocardiograms predicts a greater risk of incident HF during antihypertensive treatment, independent of the covariates, in patients with hypertension with electrocardiographic left ventricular hypertrophy. These findings support serial HR assessment to improve the risk stratification of patients with hypertension. Copyright © 2012 Elsevier Inc. All rights reserved.

  14. Magnitude and Predictors of Anti-Retroviral Treatment (ART Failure in Private Health Facilities in Addis Ababa, Ethiopia.

    Directory of Open Access Journals (Sweden)

    Yesunesh Teshome Yimer

    Full Text Available The public health approach to antiretroviral treatment management encourages the public private partnership in resource limited countries like Ethiopia. As a result, some private health facilities are accredited to provide antiretroviral treatment free services. Evidence on magnitude and predictors of treatment failure are crucial for timely actions. However, there are few studies in this regard.To assess the magnitude and predictors of ART failure in private health facilities in Addis Ababa, Ethiopia.The study followed retrospective cohort design, with 525 adult antiretroviral treatment clients who started the treatment since October 2009 and have at least six months follow up until December 31, 2013. Kaplan Meier survival analysis and Cox proportional hazard model were used for analysis.Treatment failure, using the three WHO antiretroviral treatment failure criteria, was 19.8%. The immunologic, clinical, and virologic failures were 15%, 6.3% and 1.3% respectively. The mean and median survival times in months were 41.17 with 95% Confidence Interval (CI [39.69, 42.64] and 49.00, 95% CI [47.71, 50.29] respectively. The multivariate cox regression analysis showed years since HIV diagnosis (Adjusted Hazard Ratio (AHR=13.87 with 95% CI [6.65, 28.92], disclosure (AHR=0.59, 95% CI [0.36, 0.96], WHO stage at start (AHR=1.84, 95% CI [1.16, 2.93], weight at baseline (AHR=0.58, 95% CI [0.38, 0.89], and functionality status at last visit (AHR=2.57, 95% CI [1.59, 4.15] were independent predictors of treatment failure.The study showed that the treatment failure is high among the study subjects. The predictors for antiretroviral treatment failure were years since HIV diagnosis, weight at start, WHO stage at start, status at last visit and disclosure.Facilities need to monitor antiretroviral treatment clients to avoid disease progression and drug resistance.

  15. Carotid Sinus/Nerve Stimulation for Treatment of Resistant Hypertension and Heart Failure.

    Science.gov (United States)

    Yin, Dali; Slavin, Konstantin V

    2015-01-01

    Hypertension and cardiovascular disease are leading causes of morbidity and mortality worldwide. The prevalence of resistant hypertension remains high and is expected to increase. Moreover, there are limitations to therapeutic interventions aimed at treating resistant hypertension and heart failure despite the wide availability of therapeutic agents and dietary and lifestyle modification. Device-based therapy by baroreflex activation via carotid sinus/nerve stimulation is currently undergoing investigation, and promising findings from clinical trials have been published. Baroreflex activation therapy may represent a new approach for treatment of these conditions by reducing sympathetic drive and increasing parasympathetic activity. Here we describe a new technology which is designed to deliver carotid sinus stimulation to electrically activate the carotid baroreceptors and baroreflex, thereby reducing blood pressure and improving cardiac function. The theory, surgical techniques, and clinical trials of carotid sinus stimulation are highlighted. © 2016 S. Karger AG, Basel.

  16. HEART FAILURE AND DIABETES MELLITUS: SELECTED ISSUES OF ETIOLOGY AND PATHOGENESIS, PROGNOSIS AND TREATMENT

    Directory of Open Access Journals (Sweden)

    B. U. Mardanov

    2016-01-01

    Full Text Available This review is devoted to the study of issues relating to the features of associated course of chronic heart failure (CHF and diabetes mellitus (DM. The modern views on the epidemiology, pathogenesis of DM and CHF are systematized. The pathogenesis of diabetic cardiomyopathy is described in details. The results of the well-known studies that show the negative impact of DM on CHF prognosis are presented. The principles of CHF pathogenetic therapy in patients with DM including the role of neurohormonal modulators are analyzed. The results of multicenter studies in patients with CHF and concomitant DM type 2 show that almost all first-line drugs recommended for CHF treatment are effective in patients with DM.

  17. Is transoral robotic surgery a safe and effective multilevel treatment for obstructive sleep apnoea in obese patients following failure of conventional treatment(s)?

    Science.gov (United States)

    Garas, George; Kythreotou, Anthousa; Georgalas, Christos; Arora, Asit; Kotecha, Bhik; Holsinger, Floyd C; Grant, David G; Tolley, Neil

    2017-07-01

    A best evidence topic was written according to a structured protocol. The question addressed was whether TransOral Robotic Surgery (TORS) is a safe and effective multilevel treatment for Obstructive Sleep Apnoea (OSA) in obese patients following failure of conventional treatment(s). A total of 39 papers were identified using the reported searches of which 5 represented the best evidence to answer the clinical question. The authors, date, journal, study type, population, main outcome measures and results are tabulated. Existing treatments for OSA - primarily CPAP - though highly effective are poorly tolerated resulting in an adherence often lower than 50%. As such, surgery is regaining momentum, especially in those patients failing non-surgical treatment (CPAP or oral appliances). TORS represents the latest addition to the armamentarium of Otorhinolaryngologists - Head and Neck Surgeons for the management of OSA. The superior visualisation and ergonomics render TORS ideal for the multilevel treatment of OSA. However, not all patients are suitable candidates for TORS and its suitability is questionable in obese patients. In view of the global obesity pandemic, this is an important question that requires addressing promptly. Despite the drop in success rates with increasing BMI, the success rate of TORS in non-morbidly obese patients (BMI = 30-35kgm-2) exceeds 50%. A 50% success rate may at first seem low, but it is important to realize that this is a patient cohort suffering from a life-threatening disease and no option left other than a tracheostomy. As such, TORS represents an important treatment in non-morbidly obese OSA patients following failure of conventional treatment(s).

  18. Is transoral robotic surgery a safe and effective multilevel treatment for obstructive sleep apnoea in obese patients following failure of conventional treatment(s?

    Directory of Open Access Journals (Sweden)

    George Garas

    2017-07-01

    Full Text Available A best evidence topic was written according to a structured protocol. The question addressed was whether TransOral Robotic Surgery (TORS is a safe and effective multilevel treatment for Obstructive Sleep Apnoea (OSA in obese patients following failure of conventional treatment(s. A total of 39 papers were identified using the reported searches of which 5 represented the best evidence to answer the clinical question. The authors, date, journal, study type, population, main outcome measures and results are tabulated. Existing treatments for OSA - primarily CPAP - though highly effective are poorly tolerated resulting in an adherence often lower than 50%. As such, surgery is regaining momentum, especially in those patients failing non-surgical treatment (CPAP or oral appliances. TORS represents the latest addition to the armamentarium of Otorhinolaryngologists - Head and Neck Surgeons for the management of OSA. The superior visualisation and ergonomics render TORS ideal for the multilevel treatment of OSA. However, not all patients are suitable candidates for TORS and its suitability is questionable in obese patients. In view of the global obesity pandemic, this is an important question that requires addressing promptly. Despite the drop in success rates with increasing BMI, the success rate of TORS in non-morbidly obese patients (BMI = 30-35kgm-2 exceeds 50%. A 50% success rate may at first seem low, but it is important to realize that this is a patient cohort suffering from a life-threatening disease and no option left other than a tracheostomy. As such, TORS represents an important treatment in non-morbidly obese OSA patients following failure of conventional treatment(s.

  19. REFRACTORY HYPERTENSION: EVIDENCE OF HEIGHTENED SYMPATHETIC ACTIVITY AS A CAUSE OF ANTIHYPERTENSIVE TREATMENT FAILURE

    Science.gov (United States)

    Dudenbostel, Tanja; Acelajado, Maria C.; Pisoni, Roberto; Li, Peng; Oparil, Suzanne; Calhoun, David A.

    2015-01-01

    Refractory hypertension is an extreme phenotype of treatment failure defined as uncontrolled blood pressure (BP) in spite of ≥5 classes of antihypertensive agents, including chlorthalidone and a mineralocorticoid receptor antagonist. A prospective evaluation of possible mechanisms of refractory hypertension has not been done. The goal of this study was to test for evidence of heightened sympathetic tone as indicated by 24-hr urinary (U-) normetanephrine levels, clinic and ambulatory heart rate (HR), HR variability (HRV), arterial stiffness as indexed by pulse wave velocity (PWV), and systemic vascular resistance (SVR) compared to patients with controlled resistant hypertension. Forty-four consecutive patients, 15 with refractory and 29 with controlled resistant hypertension, were evaluated prospectively. Refractory hypertensive patients were younger (48±13.3 vs. 56.5±14.1 years, p=0.038) and more likely female (80.0 vs 51.9 %, p=0.047) compared to patients with controlled resistant hypertension. They also had higher U-normetanephrine levels (464.4±250.2 vs. 309.8±147.6 μg/24h, p=0.03), higher clinic HR (77.8±7.7 vs. 68.8±7.6 bpm, p=0.001) and 24-hr ambulatory HR (77.8±7.7 vs 68.8±7.6, p=0.0018), higher PWV (11.8±2.2 vs. 9.4±1.5 m/s, p=0.009), reduced HRV (4.48 vs. 6.11, p=0.03), and higher SVR (3795±1753 vs. 2382±349 dyne·sec·cm5·m2, p=0.008). These findings are consistent with heightened sympathetic tone being a major contributor to antihypertensive treatment failure and highlight the need for effective sympatholytic therapies in patients with refractory hypertension. PMID:25987662

  20. Operative shortening of the sling as a second-line treatment after TVT failure

    Science.gov (United States)

    Matuszewski, Marcin; Michajłowski, Jerzy; Krajka, Kazimierz

    2011-01-01

    Introduction Stress urinary incontinence (SUI) is defined as an involuntary loss of urine during physical exertion, sneezing, coughing, laughing, or other activities that put pressure on the bladder. In some cases, recurrent or persistent SUI after sling operations may be caused by too loose placement of the sling. In the current study, we describe our method of shortening of the sling as a second-line treatment of tension-free vaginal tape (TVT) failure. Materials and methods Four women, aged 46-61, after initial TVT operation were treated for persistent SUI. The severity of SUI was estimated by: physical examinations, cough tests, 24-h pad tests, and King's Health Questionnaire. The shortening procedure, based on excising the fragment of tape and suturing it back, was performed in all patients. Results All cases achieved a good result, which was defined as restoration of full continence. No complications occurred. The 12-month follow-up showed no side-effects. The postoperative control tests: the cough and 24-h pad tests were negative in all women. The general health perceptions increased after the shortening procedure by a mean value 44.25%. The incontinence impact decreased by a mean value 44.6%. In all patients, role and physical limitations significantly decreased (by 88.5% and 80.5%, respectively). The negative emotions connected with SUI significantly decreased after the second procedure. Conclusions The operative shortening of the implanted sling is a simple, cheap, and effective method of second-line treatment in cases of TVT failure and may be offered to the majority of patients with insufficient urethral support after the first procedure. PMID:24578885

  1. Refractory Hypertension: Evidence of Heightened Sympathetic Activity as a Cause of Antihypertensive Treatment Failure.

    Science.gov (United States)

    Dudenbostel, Tanja; Acelajado, Maria C; Pisoni, Roberto; Li, Peng; Oparil, Suzanne; Calhoun, David A

    2015-07-01

    Refractory hypertension is an extreme phenotype of treatment failure defined as uncontrolled blood pressure in spite of ≥5 classes of antihypertensive agents, including chlorthalidone and a mineralocorticoid receptor antagonist. A prospective evaluation of possible mechanisms of refractory hypertension has not been done. The goal of this study was to test for evidence of heightened sympathetic tone as indicated by 24-hour urinary normetanephrine levels, clinic and ambulatory heart rate (HR), HR variability, arterial stiffness as indexed by pulse wave velocity, and systemic vascular resistance compared with patients with controlled resistant hypertension. Forty-four consecutive patients, 15 with refractory and 29 with controlled resistant hypertension, were evaluated prospectively. Refractory hypertensive patients were younger (48±13.3 versus 56.5±14.1 years; P=0.038) and more likely women (80.0 versus 51.9%; P=0.047) compared with patients with controlled resistant hypertension. They also had higher urinary normetanephrine levels (464.4±250.2 versus 309.8±147.6 µg per 24 hours; P=0.03), higher clinic HR (77.8±7.7 versus 68.8±7.6 bpm; P=0.001) and 24-hour ambulatory HR (77.8±7.7 versus 68.8±7.6; P=0.0018), higher pulse wave velocity (11.8±2.2 versus 9.4±1.5 m/s; P=0.009), reduced HR variability (4.48 versus 6.11; P=0.03), and higher systemic vascular resistance (3795±1753 versus 2382±349 dyne·s·cm(5)·m(2); P=0.008). These findings are consistent with heightened sympathetic tone being a major contributor to antihypertensive treatment failure and highlight the need for effective sympatholytic therapies in patients with refractory hypertension. © 2015 American Heart Association, Inc.

  2. Relationship of teicoplanin MICs to treatment failure in teicoplanin-treated patients with methicillin-resistant Staphylococcus aureus pneumonia.

    Science.gov (United States)

    Chen, Ke-Yuan; Chang, Hong-Jyun; Hsu, Po-Chang; Yang, Chien-Chang; Chia, Ju-Hsin; Wu, Tsu-Lan; Huang, Ching-Tai; Lee, Ming-Hsun

    2013-06-01

    The objective of this study was to determine the predictive value of teicoplanin minimal inhibitory concentrations (MICs) for treatment failure among patients with methicillin-resistant Staphylococcus aureus (MRSA) pneumonia. In this study, all patients with ≥1 tracheal aspirates or sputum cultures positive for MRSA admitted to the hospital between April 2011 and September 2011 were reviewed. We enrolled patients who are ≥18 years of age, with a diagnosis of pneumonia, and with a receipt of teicoplanin therapy throughout the course. The relationship between teicoplanin Etest MICs and treatment outcomes of MRSA pneumonia was analyzed to identify the breakpoint of teicoplanin MICs influencing treatment outcomes. Of the 80 patients enrolled, 31 had a lower teicoplanin MIC level (teicoplanin treatment [4 (12.9%) vs. 18 (36.7%), p = 0.020]. A comparison between the treatment success and failure groups showed that the former had a longer duration of teicoplanin use (18.76 ± 10.34vs.12.41 ± 5.65 days; p = 0.014). Results of a multivariate analysis showed that teicoplanin MICs ≥ 2.0 mg/Land shorter duration of teicoplanin therapy were independent risk factors for treatment failure. A higher teicoplanin MIC value (≥2.0 mg/L) may predict the treatment failure among patients with teicoplanin-treated MRSA pneumonia. Copyright © 2012. Published by Elsevier B.V.

  3. Clinical and economic aspects of the use of nebivolol in the treatment of elderly patients with heart failure

    Directory of Open Access Journals (Sweden)

    Donatella Del Sindaco

    2010-12-01

    Full Text Available Donatella Del Sindaco1, Maria Denitza Tinti2, Luca Monzo2, Giovanni Pulignano2,1Heart Failure Unit, Division of Cardiology, INRCA Institute of Care and Research for Elderly, Rome, Italy; 2Heart Failure Clinic, Division of Cardiology/CCU, San Camillo Hospital, Rome, ItalyAbstract: Heart failure is a common and disabling condition with morbidity and mortality that increase dramatically with advancing age. Large observational studies, retrospective subgroup analyses and meta-analyses of clinical trials in systolic heart failure, and recently published randomized studies have provided data supporting the use of beta-blockers as a baseline therapy in heart failure in the elderly. Despite the available evidence about beta-blockers, this therapy is still less frequently used in elderly compared to younger patients. Nebivolol is a third-generation cardioselective beta-blocker with L-arginine/nitric oxide-induced vasodilatory properties, approved in Europe and several other countries for the treatment of essential hypertension, and in Europe for the treatment of stable, mild, or moderate chronic heart failure, in addition to standard therapies in elderly patients aged 70 years old or older. The effects of nebivolol on left ventricular function in elderly patients with chronic heart failure (ENECA and the study of effects of nebivolol intervention on outcomes and rehospitalization in seniors with heart failure (SENIORS have been specifically aimed to assess the efficacy of beta-blockade in elderly heart failure patients. The results of these two trials demonstrate that nebivolol is well tolerated and effective in reducing mortality and morbidity in older patients, and that the beneficial clinical effect is present also in patients with mildly reduced ejection fraction. Moreover, nebivolol appears to be significantly cost-effective when prescribed in these patients. However, further targeted studies are needed to better define the efficacy as well as

  4. Is fibromyalgia a cause of failure in the treatment of a painful shoulder?

    Science.gov (United States)

    Blonna, D; Bellato, E; Marini, E; Barbasetti, N; Mattei, L; Fissore, F; Arrigoni, C; Castoldi, F

    2013-06-01

    This study aims to review the incidence of fibromyalgia in a cohort of patients who were treated for shoulder pain and address whether a concomitant fibromyalgia could have had detrimental effect on outcomes. The treatment of 286 consecutive patients for shoulder pain was reviewed. Eighteen patients (6.3 %) were diagnosed as having fibromyalgia, but in 13 of them (72 %), the diagnosis was initially missed. Five patients received a total of 11 surgeries for treatment of the shoulder. At an average follow-up of 15 months (range 12-27), the average new Oxford shoulder score (OS score) was 49 % (range 6-87 %). The average physical component of the Short-Form-12 Healthy Survey (SF-12) was 36 (range 21-55), and the mental component 30 (range 15-46). The Summary Outcome Determination score (SOD score) was 1.3 (range-3 to 6). Fibromyalgia occurs relatively frequently in patients who complain of shoulder pain and it can be a cause of failure in the treatment of concomitant painful shoulder conditions.

  5. The Microcirculation Is Unchanged in Neonates with Severe Respiratory Failure after the Initiation of ECMO Treatment

    NARCIS (Netherlands)

    Top, Anke P. C.; Buijs, Erik A. B.; Schouwenberg, Patrick H. M.; van Dijk, Monique; Tibboel, Dick; Ince, Can

    2012-01-01

    Purpose. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is known to improve cardiorespiratory function and outcome in neonates with severe respiratory failure. We tested the hypothesis that VA-ECMO therapy improves the microcirculation in neonates with severe respiratory failure.

  6. Successful adalimumab treatment of a psoriasis vulgaris patient with hemodialysis for renal failure: A case report and a review of the previous reports on biologic treatments for psoriasis patients with hemodialysis for renal failure.

    Science.gov (United States)

    Kusakari, Yoshiyuki; Yamasaki, Kenshi; Takahashi, Toshiya; Tsuchiyama, Kenichiro; Shimada-Omori, Ryoko; Nasu-Tamabuchi, Mei; Aiba, Setsuya

    2015-07-01

    The efficacy and safety of biologic treatments have been established in patients with moderate to severe psoriasis, but there are few reports on biologic therapy for patients with psoriasis complicated by end-stage renal failure on hemodialysis (HD). In this report, we demonstrated the efficacy and safety of adalimumab for patients with severe psoriasis on HD. A 46-year-old Japanese man with a 14-year history of psoriasis was referred to our clinic in September 2009. He had developed hypertension and renal failure during a 7-year history of cyclosporin treatment. With the infliximab treatment, he achieved 75% improvement of the Psoriasis Area and Severity Index (PASI) score within 3 months from the PASI of 42.3 before the treatment. However, his renal failure gradually deteriorated, and HD was initiated at 1 year after the introduction of infliximab. Because of hydration during the i.v. injection of infliximab, he developed pulmonary edema with every infliximab treatment after starting HD. We switched to ustekinumab treatment, but his psoriasis was not improved. Then, we switched to adalimumab and achieved a PASI-100 response within 2 months. The patient received adalimumab treatment for more than a year without any adverse effects. In addition to our case, five articles reported cases of psoriasis patients with renal failure on HD who were treated with biologics. The psoriatic lesions were improved by biologics in these cases, and no severe adverse effects on the renal function were reported. Thus, biologics are a reasonable treatment option for patients with severe psoriasis with renal failure on HD. © 2015 Japanese Dermatological Association.

  7. Childhood Obesity Increases the Risk of Failure in the Treatment of Distal Forearm Fractures.

    Science.gov (United States)

    Auer, Ronald T; Mazzone, Paul; Robinson, Luke; Nyland, John; Chan, Gilbert

    2016-12-01

    Childhood obesity is a national problem that has gained significant attention in both the medical literature and the national media. Obesity in the adult population has been associated with increased failure of conservative treatments. Our hypothesis is that childhood obesity is associated with a loss of reduction after closed treatment of distal radius fractures. A total of 157 patients with consecutive distal radius fractures who underwent closed reduction in the emergency department or the operating room were included from the office records of the sole pediatric orthopaedic subspecialist group in a metropolitan area from January 2011 to June 2012. All cases were initially treated with fiberglass casting with or without closed reduction. All patients completed the casting treatment and demonstrated radiographic union. Patients' age, weight, height, number of office visits, subsequent surgeries, and fracture angulation were recorded and analyzed. Sixty-six (42%) children were overweight (BMI>85th percentile) and 46 (29%) children met the criteria for obesity (BMI>95th percentile). Fourteen normal-sized children (12%) and 13 obese children (28%) required a reduction in the operating room after initial treatment, which was significant (P=0.02). Obese children needed significantly more visits requiring radiographs (P=0.004). Obese children were significantly less likely to have an initial perfect reduction in the emergency room (P=0.005). The results of closed reduction and casting for displaced distal radius fractures are typically excellent with few complications or risks. The present study supports the hypothesis that obesity results in a higher rate of malreduction and subsequent manipulations with closed reduction and casting. Close follow-up and early consideration for additional treatment in this patient population may help reduce the need for further manipulations. Level III.

  8. Lymph Node Failure Pattern and Treatment Results of Esophageal Cancer Patients Treated with Definitive Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Sun Young; Kwon, Hyoung Cheol; Kim, Jung Soo [Chonbuk National University Hospital, Jeonju (Korea, Republic of); Lee, Heui Kwan [The Catholic University of Korea, Seoul (Korea, Republic of); Kim, Soo Geon [Jesushospital, Jeonju (Korea, Republic of)

    2008-06-15

    We evaluated the failure pattern of the celiac axis, gastric lymph node, and treatment outcome in the upper and mid-esophageal region of cancer patients treated by definitive radiotherapy, except when treating the celiac axis and gastric lymph node for treatment volume, retrospectively. Materials and Methods: The study constituted the evaluation 108 patients with locally advanced esophageal cancer receiving radiotherapy or a combination of radiotherapy and chemotherapy at Chonbuk National University Hospital from January 1986 to December 2006. In total, 82 patients treated by planned radiotherapy, except when treating the celiac axis and gastric lymph node for treatment volume, were analysed retrospectively. The study population consisted of 78 men and 2 women (mean age of 63.2 years). In addition, 51 patients received radiotherapy alone, whereas 31 patients received a combination of radiation therapy and chemotherapy. The primary cancer sites were located in the upper portion (17 patients), and mid portion (65 patients), respectively. Further, the patients were in various clinical stages including T1N0-1M0 (7 patients), T2N0-1M0 (18 patients), T3N0-1M0 (44 patients) and T4N0-1M0 (13 patients). The mean follow up period was 15 months. Results: The various treatment outcomes included complete response (48 patients), partial response (31 patients) and no response (3 patients). The failure patterns of the lymph node were comprised of the regional lymph node (23 patients) and the distance lymph node which included celiac axis and gastric lymph node (13 patients). However, metastasis was not observed in the regional and distant lymph node in 10 patients, whereas 36 patients were not evaluated. Furthermore, of the 13 patients who developed celiac axis and gastric lymph node metastases, 3 were in stage T1N0-1M0 and 10 were in stage T2-4N0-1M0. A complete response appeared in 12 patients, whereas a partial response appeared in 1 patient. The mean survival time of the

  9. Effect of Somatic Experiencing Resiliency-Based Trauma Treatment Training on Quality of Life and Psychological Health as Potential Markers of Resilience in Treating Professionals

    Directory of Open Access Journals (Sweden)

    Neal E. Winblad

    2018-02-01

    Full Text Available Background: Individuals who treat trauma are at significant risk of vicarious traumatization and burnout. Somatic Experiencing® (SE® is a resiliency-focused trauma treatment modality designed to address autonomic nervous system (ANS dysregulation and its impacted physical health and mental health symptoms e.g., anxiety, depression, post-traumatic stress disorder, migraines, fibromyalgia, and chronic fatigue, etc. The SE® training supports the development of clinical skills to reduce physical health/mental health symptoms as well as increase clinician resilience. Individuals who display resilience often have increased experiences of well-being (quality of life and decreased levels of self-reported psychological symptoms. Greater resilience could mitigate the risks to providers and the clients they treat.Materials and Methods: This within-groups, longitudinal study assessed students (N = 18 over the course of a 3-year SE® practitioner training. This training focuses on increased ANS, physical, and emotional regulation skills. The convenience of a web-based survey allowed for: measures of a general quality of life (WHOQOL-BREF, psychological symptoms, somatic, anxiety, and depressive symptoms (PHQ-SADS, as well as a measure of early life exposure to adversity (CDC/Kaiser Permanente ACE Score Calculator Questionnaire. The clinician survey was conducted yearly for 3 years. Future studies would do well to also include laboratory-based objective measures of ANS functioning.Results: ANOVA with repeated measures showed that there were significant reductions in anxiety symptoms (GAD7, p < 0.001 and somatization symptoms (PHQ15, p < 0.001. Health-related quality of life (a measure of physical well-being and social quality of life (a measure of interpersonal well-being both increased significantly (Health QoL p = 0.028; Social QoL p = 0.046.Conclusions: Results suggest that professionals attending the 3-year SE® training course experience a significant

  10. Treatment of Advanced Hepatocellular Carcinoma after Failure of Sorafenib Treatment: Subsequent or Additional Treatment Interventions Contribute to Prolonged Survival Postprogression.

    Science.gov (United States)

    Kondo, Masaaki; Numata, Kazushi; Hara, Koji; Nozaki, Akito; Fukuda, Hiroyuki; Chuma, Makoto; Maeda, Shin; Tanaka, Katsuaki

    2017-01-01

    Sorafenib is a first-line treatment option for advanced hepatocellular carcinoma (HCC) patients; however, survival predictors upon progression have not been well characterized. In the present study, we aimed to show the efficacy of multidisciplinary therapy for patients who had failed to respond to sorafenib treatment. Among 146 BCLC stage B or C HCC patients treated with sorafenib monotherapy between July 2009 and August 2014, the first radiological progression according to the modified RECIST was identified in 71 patients; factors predicting overall survival (OS) and survival postprogression (SPP) were analyzed in these patients. The median OS and SPP for patients who failed to respond to sorafenib treatment were 10.5 and 6.2 months, respectively, and the SPP was strongly correlated with the OS (r = 0.982, P < 0.01, and R2 = 0.965). The independent predictors of OS and SPP were identical. The predictors of SPP were des-gamma-carboxy prothrombin, progression of portal vein thrombosis, and subsequent second-line or additional treatment. SPP is closely associated with OS and might be notable in patients who have failed to respond to initial sorafenib treatment. Furthermore, interventions consisting of other treatment options upon the appearance of progression might prolong OS.

  11. Prognostic factors in patients with advanced transitional cell carcinoma of the urothelial tract experiencing treatment failure with platinum-containing regimens

    DEFF Research Database (Denmark)

    Bellmunt, Joaquim; Choueiri, Toni K; Fougeray, Ronan

    2010-01-01

    analysis was used to identify independent prognostic factors, and bootstrap analysis was performed for internal validation, forming a prognostic model. External validation was performed on the phase II vinflunine study CA183001. RESULTS Multivariate analysis and the internal validation identified Eastern......, or three prognostic factors; the median OS times for these groups were 14.2, 7.3, 3.8, and 1.7 months (P internally and externally validated three adverse risk factors (PS, hemoglobin level, and liver metastasis) that predict for OS and developed...... Cooperative Oncology Group performance status (PS) more than 0, hemoglobin level less than 10 g/dL, and the presence of liver metastasis as the main adverse prognostic factors for OS. External validation confirmed these prognostic factors. Four subgroups were formed based on the presence of zero, one, two...

  12. Sorafenib-Associated Heart Failure Complicated by Cardiogenic Shock after Treatment of Advanced Stage Hepatocellular Carcinoma: A Clinical Case Discussion

    Directory of Open Access Journals (Sweden)

    Candace Wu

    2017-01-01

    Full Text Available Background. Sorafenib, an oral tyrosine kinase inhibitor (TKI, targets multiple tyrosine kinase receptors (TKRs involved in angiogenesis and tumor growth. Studies suggest that inhibition of TKR impacts cardiomyocyte survival. Inhibition of VEGF signaling interrupts angiogenesis and is associated with the development of hypertension and compensatory hypertrophy. Compensated hypertrophy ultimately leads to heart failure. Case Description. A 76-year-old man with a past medical history of systolic heart failure due to ischemic cardiomyopathy and stage IIIC hepatocellular carcinoma (HCC presented with symptoms of decompensated heart failure. Four months prior to admission, he was started on sorafenib. Results. Our patient was treated with intravenous furosemide and guideline directed therapy. Clinical status was complicated by the development of low cardiac output and shock requiring inotropic support. Careful titration of heart failure medication led to hemodynamic improvement and discontinuation of dobutamine. Conclusion. Greater awareness of sorafenib cardiotoxicity is essential. As TKI usage grows for treatment of cancers, heart failure-related complications will increase. In our patient, routine heart failure management and cessation of sorafenib led to clinical improvement. Future studies on the treatment of sorafenib cardiotoxicity should be explored further in this unique patient population.

  13. Sorafenib-Associated Heart Failure Complicated by Cardiogenic Shock after Treatment of Advanced Stage Hepatocellular Carcinoma: A Clinical Case Discussion.

    Science.gov (United States)

    Wu, Candace; Shemisa, Kamal

    2017-01-01

    Background. Sorafenib, an oral tyrosine kinase inhibitor (TKI), targets multiple tyrosine kinase receptors (TKRs) involved in angiogenesis and tumor growth. Studies suggest that inhibition of TKR impacts cardiomyocyte survival. Inhibition of VEGF signaling interrupts angiogenesis and is associated with the development of hypertension and compensatory hypertrophy. Compensated hypertrophy ultimately leads to heart failure. Case Description. A 76-year-old man with a past medical history of systolic heart failure due to ischemic cardiomyopathy and stage IIIC hepatocellular carcinoma (HCC) presented with symptoms of decompensated heart failure. Four months prior to admission, he was started on sorafenib. Results. Our patient was treated with intravenous furosemide and guideline directed therapy. Clinical status was complicated by the development of low cardiac output and shock requiring inotropic support. Careful titration of heart failure medication led to hemodynamic improvement and discontinuation of dobutamine. Conclusion. Greater awareness of sorafenib cardiotoxicity is essential. As TKI usage grows for treatment of cancers, heart failure-related complications will increase. In our patient, routine heart failure management and cessation of sorafenib led to clinical improvement. Future studies on the treatment of sorafenib cardiotoxicity should be explored further in this unique patient population.

  14. Comparison between acarbose, metformin, and insulin treatment in type 2 diabetic patients with secondary failure to sulfonylurea treatment.

    Science.gov (United States)

    Calle-Pascual, A L; Garcia-Honduvilla, J; Martin-Alvarez, P J; Vara, E; Calle, J R; Munguira, M E; Marañes, J P

    1995-10-01

    The purpose of this study was to determine the most suitable treatment for Type 2 (non-insulin-dependent) diabetic patients with secondary failure to sulfonylureas (SFS). In a four-month comparative study, 36 Type 2 diabetic patients given SFS were allocated to three treatment groups: A (n = 12, M/F 6/6, HbAlc 9.1 +/- 1.6%) received 0.3 IU/Kg body weight (BW) of insulin-Zn between 10 and 11 p.m.; B (n = 12, M/F 6/6, HbAlc 9.2 +/- 1.6%) SFS plus 850 mg/day of metformin; and C (n = 12, M/F 6/6, HbAlc 9.5 +/- 2.4%) SFS plus acarbose 3 x 100 mg daily. Modifications in HbAlc, BW, blood pressure (BP), lipoprotein profile and insulin sensitivity were evaluated. HbAlc decreased in the three groups (A: 17.9 +/- 13.5%; B: 18.2 +/- 4.5%; C: 7.6 +/- 16.8%; all p diabetic patients given SFS, both insulin and metformin plus SFS provided better glycaemic control than acarbose plus SFS. Metformin combined with SFS offered further advantages for the control of BW and BP.

  15. A failure-type specific risk prediction tool for selection of head-and-neck cancer patients for experimental treatments

    DEFF Research Database (Denmark)

    Håkansson, Katrin; Rasmussen, Jacob H.; Rasmussen, Gregers B.

    2017-01-01

    variables (tumor subsite, T stage, N stage, smoking status, age and performance status) and one additional variable (tumor volume). The treatment failure discrimination ability of the developed model was superior of that of UICC staging, 8(th) edition (AUCLRF=72.7% vs 64.2%, p...OBJECTIVES: The objective of this work was to develop a tool for decision support, providing simultaneous predictions of the risk of loco-regional failure (LRF) and distant metastasis (DM) after definitive treatment for head-and-neck squamous cell carcinoma (HNSCC). MATERIALS AND METHODS...

  16. Efficacy of peritoneal ultrafiltration in the treatment of refractory congestive heart failure.

    Science.gov (United States)

    Sánchez, Jose E; Ortega, Teresa; Rodríguez, Carmen; Díaz-Molina, Beatriz; Martín, Maria; Garcia-Cueto, Carmen; Vidau, Pedro; Gago, Emilio; Ortega, Francisco

    2010-02-01

    Heart failure (HF) is a major health problem in developed countries. HF is a progressive, lethal disorder, even with adequate treatment. There exists a vicious circle in the pathophysiology of HF that perpetuates and magnifies the problem. Concomitant fluid accumulation may worsen the congestive HF, it is responsible for numerous hospitalizations and it is an important cause of mortality. In this situation, any means of fluid removal may aid in the management of these patients. The objective of this study was to evaluate the efficacy of peritoneal dialysis (PD) in the treatment of refractory HF in terms of functional status, hospitalization and mortality. We also determined the improvement in health-related quality of life with the use of PD, and examined the economic consequences of its use. We conducted a single centre, prospective, non-randomized study involving patients showing symptoms and signs of congestive HF refractory to maximum tolerable drug treatment. All of them were treated with PD. We analysed physical and biochemical determinations, functional status (according to the NYHA classification) and echocardiogram parameters. Also, to determine the efficacy of the technique we compared the perceived state of health (measured by the EQ5D) to PD patients respect to those reported with conservative therapies. Finally, we carried out a cost-utility evaluation measured by the incremental cost-utility ratio between these two options. Seventeen patients (65% men, 64 +/- 9 years) were included in the study, and 12 were still undergoing PD treatment at the end of the follow-up period (15 +/- 9 months). All patients improved their NYHA functional status (65% two classes; the rest, one; P cost-effective compared with the conservative therapy. We demonstrate that congestive HF programmes should consider offering PD in hope of seeing better functional status, reduced morbidity and mortality, better quality of life as well as reduced health care costs.

  17. Role of the heart surgeon in the emergency treatment of diuretic resistant edema in grades III-IV heart failure.

    Science.gov (United States)

    de Vivo, F; DeSanto, L S; Maiello, C; Trunfio, R; Marra, C; De Feo, M; Damiani, G; Galdieri, N; Cotrufo, M

    1997-06-01

    Acute or chronic valvular diseases, acute myocardial infarction and its complications, dilated cardiomyopathies, all may became the cause of heart failure leading to different degrees of cardiogenic edema. Today cardiac failure is treated from its the early stage by medical and/or surgical therapy. Thereafter, in a small population of patients, heart failure may became unresponsive to any kind of standard medical treatment. Conventional surgical procedures are often inadequate and carry a high risk of perioperative mortality. This study analyzes the outcome of 139 patients with end-stage cardiomyopathy who underwent heart transplantation between January 1988 and October 1996. We found that patients transplanted while on severe decompensation are at a higher perioperative mortality due to irreversible multi-organ failure. The study also suggests that the implantation of a left ventricle assist device as a bridge to transplantation is a promising maneuver for the most severe patients.

  18. Circulating cytokines and cytokine receptors in infliximab treatment failure due to TNF-α independent Crohn disease

    DEFF Research Database (Denmark)

    Steenholdt, Casper; Coskun, Mehmet; Buhl, Sine

    2016-01-01

    -IFX antibodies. Circulating cytokines and cytokine receptors were assessed by enzyme-linked immunosorbent assay: granulocyte-macrophage colony-stimulating factor, interferon-γ, interleukin (IL)-1α, IL-1β, IL-1Ra, IL-6, IL-10, IL-12p70, soluble TNF receptor (sTNF-R) 1, sTNF-R2, IL-17A, and monocyte chemotactic...... to predominantly TNF-α-independent signaling pathways in their disease. Cytokine and cytokine receptor levels were comparable between patients with nonimmune PK failure and PD failure at time of manifestation of IFX failure, but with higher IL-6 and sTNF-R2 levels among IFX treatment failures as compared...

  19. Radiotherapy in desmoid tumors. Treatment response, local control, and analysis of local failures

    Energy Technology Data Exchange (ETDEWEB)

    Santti, Kirsi; Beule, Annette; Tuomikoski, Laura; Jaeaeskelaeinen, Anna-Stina; Saarilahti, Kauko; Tarkkanen, Maija; Blomqvist, Carl [Helsinki University Hospital and University of Helsinki, Comprehensive Cancer Center, Helsinki (Finland); Roenty, Mikko [HUSLAB and University of Helsinki, Department of Pathology, Helsinki (Finland); Ihalainen, Hanna [Helsinki University Hospital and University of Helsinki, Department of Plastic Surgery, Helsinki (Finland)

    2017-04-15

    Desmoid tumors (aggressive fibromatosis) are rare soft tissue tumors which frequently recur after surgery. Desmoid tumors arise from musculoaponeurotic tissue in the extremities, head and neck, abdominal wall, or intra-abdominally. Our aim was to examine the outcome of radiotherapy of desmoid tumors in a single institution series. We evaluated 41 patients with desmoid tumors treated with 49 radiotherapies between 1987 and 2012. Radiologic images for response evaluation were reassessed and responses to treatment registered according to RECIST criteria 1.1. For patients with local failures radiation dose distribution was determined in each local failure volume using image co-registration. Recurrences were classified as in-target, marginal, or out-of-target. Prognostic factors for radiotherapy treatment failure were evaluated. Radiotherapy doses varied from 20-63 Gy (median 50 Gy) with a median fraction size of 2 Gy. The objective response rate to definitive radiotherapy was 55% (12/22 patients). Median time to response was 14 months. A statistically significant dose-response relation for definitive and postoperative radiotherapy was observed both in univariate (p-value 0.002) and in multivariate analysis (p-value 0.02) adjusted for potential confounding factors. Surgery before radiotherapy or surgical margin had no significant effect on time to progression. Nine of 11 (82%) local failures were classified as marginal and two of 11 (18%) in-target. None of the recurrences occurred totally out-of-target. Radiotherapy is a valuable option for treating desmoid tumors. Radiotherapy dose appears to be significantly associated to local control. (orig.) [German] Desmoide (aggressive Fibromatosen) sind seltene Weichteiltumore der muskulaeren Membranen von Kopf, Hals, Extremitaeten und Bauchwand. Ziel war es, die Wirksamkeit der Strahlentherapie bei aggressiver Fibromatose an einer einzelnen Klinik zu untersuchen. Ausgewertet wurden 41 Patienten mit aggressiver Fibromatose, die

  20. Finding success in failure: using latent profile analysis to examine heterogeneity in psychosocial functioning among heavy drinkers following treatment.

    Science.gov (United States)

    Wilson, Adam D; Bravo, Adrian J; Pearson, Matthew R; Witkiewitz, Katie

    2016-12-01

    To estimate differences in post-treatment psychosocial functioning among treatment 'failures' (i.e. heavy drinkers, defined as 4+/5+ drinks for women/men) from two large multi-site clinical trials and to compare these levels of functioning to those of the purported treatment 'successes' (i.e. non-heavy drinkers). Separate latent profile analyses of data from two of the largest alcohol clinical trials conducted in the United States, COMBINE (Combined Pharmacotherapies and Behavioral Interventions) and Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity), comparing psychosocial outcomes across derived classes of heterogeneous treatment responders. Eleven US academic sites in COMBINE, 27 US treatment sites local to nine research sites in Project MATCH. A total of 962 individuals in COMBINE (69% male, 77% white, mean age: 44 years) treated January 2001 to January 2004 and 1528 individuals in Project MATCH (75% male, 80% white, mean age: 40 years) treated April 1991 to September 1994. In COMBINE, we analyzed health, quality of life, mental health symptoms and alcohol consequences 12 months post-baseline. In Project MATCH, we examined social functioning, mental health symptoms and alcohol consequences 15 months post-baseline. Latent profile analysis of measures of functioning in both samples supported a three-profile solution for the group of treatment 'failures', characterized by high-, average- and low-functioning individuals. The high-functioning treatment 'failures' generally performed better across measures of psychosocial functioning at follow-up than participants designated treatment 'successes' by virtue of being abstainers or light drinkers. Current United States Food and Drug Administration guidance to use heavy drinking as indicative of treatment 'failure' fails to take into account substantial psychosocial improvements made by individuals who continue occasionally to drink heavily post-treatment. © 2016 Society for the Study of Addiction.

  1. Third-generation beta-adrenoceptor antagonists in the treatment of hypertension and heart failure.

    Science.gov (United States)

    Fisker, Filip Y; Grimm, Daniela; Wehland, Markus

    2015-07-01

    Hypertensive treatment with beta-adrenoceptor antagonists (BAAs) has been successfully applied for four decades. These drugs have a beneficial effect on the health of the patients by both decreasing number of deaths and improving morbidity. Nevertheless, the BAAs differ in pharmacological properties. They have different lipophilicity, different adrenoceptor selectivity and/or varying additional abilities in cardiac tissue and periphery vasculature hereby exceeding their known receptor-blocking effects. Nebivolol shows nitric oxide-mediated vasodilating properties that improve arterial rigidity. Carvedilol has anti-oxidative and antiproliferative effects, which exert a beneficial effect on patients with chronic congestive heart failure (CHF). These findings suggest that the true potential of the third-generation BAAs and their value in the treatment of CHF, hypertension and following cardiovascular events has yet to be acknowledged. This MiniReview provides an overview of the third-generation BAAs and their effects on the vasculature of hypertensive patients and patients with CHF. Additionally, BAAs that potentially can be used in different patient groups are discussed. © 2015 Nordic Association for the Publication of BCPT (former Nordic Pharmacological Society).

  2. Nonpharmacologic care of heart failure: counseling, dietary restriction, rehabilitation, treatment of sleep apnea, and ultrafiltration.

    Science.gov (United States)

    Colonna, Paolo; Sorino, Margherita; D'Agostino, Carlo; Bovenzi, Francesco; De Luca, Leonardo; Arrigo, Francesco; de Luca, Italo

    2003-05-08

    The prognosis of patients with chronic congestive heart failure (CHF) depends not only on pharmacologic therapy but also on nonpharmacologic aspects. A complete and ongoing education program for treating CHF includes an understanding of the causes of CHF, symptoms, diet, salt and fluid restriction, drug regimen, compliance, physical and work activities, lifestyle changes, and measures of self-control. Moreover, the nonpharmacologic treatment (dietary modifications, lifestyle, physical exercise, and health care education) must be inserted in a multidisciplinary program organized by the physician in conjunction with the health system, the nurses, and, especially, the patients themselves, who must understand their disease and the many therapeutic options. Cardiologists should treat patients in a clear and comprehensible way, and other specialists (dietitians, physiotherapists, psychologists, nurses, and social workers), together with the patient's family, should strive for the best living conditions for the patient. In this way, the treatment of CHF can improve the quantity and quality of life and save a significant amount in health care costs.

  3. [Complementary treatment of acute heart failure in patients with diabetes, chronic obstructive pulmonary disease or anemia].

    Science.gov (United States)

    Carrasco Sánchez, Francisco Javier; Recio Iglesias, Jesús; Grau Amorós, Jordi

    2014-03-01

    Diabetes, chronic obstructive pulmonary disease (COPD) and anemia are comorbidities with a high prevalence and impact in heart failure (HF). The presence of these comorbidities considerably worsens the prognosis of HF. Diabetic patients have a higher likelihood of developing symptoms of HF and both the treatment of diabetes and that of acute HF are altered by the coexistence of both entities. The glycemic targets in patients with acute HF are not well-defined, but could show a U-shaped relationship. Stress hyperglycemia in non-diabetic patients with HF could also have a deleterious effect on the medium-term prognosis. The inter-relationship between COPD and HF hampers diagnosis due to the overlap between the symptoms and signs of both entities and complementary investigations. The treatment of acute HF is also altered by the presence of COPD. Anemia is highly prevalent and is often the direct cause of decompensated HF, the most common cause being iron deficiency anemia. Iron replacement therapy, specifically intravenous forms, has helped to improve the prognosis of acute HF. Copyright © 2014 Elsevier España, S.L. All rights reserved.

  4. Heart Failure with Preserved Ejection Fraction – Concept, Pathophysiology, Diagnosis and Challenges for Treatment

    Directory of Open Access Journals (Sweden)

    Lidija Veterovska Miljkovik

    2015-07-01

    Full Text Available Heart failure (HF with preserved left ventricular (LV ejection fraction (HFpEF occurs in 40 to 60% of the patients with HF, with a prognosis which is similar to HF with reduced ejection fraction (HFrEF. HFpEF pathophysiology is different from that of HFrEF, and has been characterized with diastolic dysfunction. Diastolic dysfunction has been defined with elevated left ventricular stiffness, prolonged iso-volumetric LV relaxation, slow LV filing and elevated LV end-diastolic pressure. Arterial hypertension occurs in majority cases with HFpEF worldwide. Patients are mostly older and obese. Diabetes mellitus and atrial fibrillation appear proportionally in a high frequency of patients with HFpEF. The HFpEF diagnosis is based on existence of symptoms and signs of heart failure, normal or approximately normal ejection and diagnosing of LV diastolic dysfunction by means of heart catheterization or Doppler echocardiography and/or elevated concentration of plasma natriuretic peptide. The present recommendations for HFpEF treatment include blood pressure control, heart chamber frequency control when atrial fibrillation exists, in some situations even coronary revascularization and an attempt for sinus rhythm reestablishment. Up to now, it is considered that no medication or a group of medications improve the survival of HFpEF patients. Due to these causes and the bad prognosis of the disorder, rigorous control is recommended of the previously mentioned precipitating factors for this disorder. This paper presents a universal review of the most important parameters which determine this disorder.

  5. Failure mode and effect analysis oriented to risk-reduction interventions in intraoperative electron radiation therapy: the specific impact of patient transportation, automation, and treatment planning availability.

    Science.gov (United States)

    López-Tarjuelo, Juan; Bouché-Babiloni, Ana; Santos-Serra, Agustín; Morillo-Macías, Virginia; Calvo, Felipe A; Kubyshin, Yuri; Ferrer-Albiach, Carlos

    2014-11-01

    Industrial companies use failure mode and effect analysis (FMEA) to improve quality. Our objective was to describe an FMEA and subsequent interventions for an automated intraoperative electron radiotherapy (IOERT) procedure with computed tomography simulation, pre-planning, and a fixed conventional linear accelerator. A process map, an FMEA, and a fault tree analysis are reported. The equipment considered was the radiance treatment planning system (TPS), the Elekta Precise linac, and TN-502RDM-H metal-oxide-semiconductor-field-effect transistor in vivo dosimeters. Computerized order-entry and treatment-automation were also analyzed. Fifty-seven potential modes and effects were identified and classified into 'treatment cancellation' and 'delivering an unintended dose'. They were graded from 'inconvenience' or 'suboptimal treatment' to 'total cancellation' or 'potentially wrong' or 'very wrong administered dose', although these latter effects were never experienced. Risk priority numbers (RPNs) ranged from 3 to 324 and totaled 4804. After interventions such as double checking, interlocking, automation, and structural changes the final total RPN was reduced to 1320. FMEA is crucial for prioritizing risk-reduction interventions. In a semi-surgical procedure like IOERT double checking has the potential to reduce risk and improve quality. Interlocks and automation should also be implemented to increase the safety of the procedure. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  6. Factors influencing syphilis treatment failure and/or re-infection in HIV co-infected patients: immunosuppression or behaviors.

    Science.gov (United States)

    Kim, Jong Hun; Psevdos, George; Suh, Jin; Sharp, Victoria

    2011-07-01

    Recent studies have reported overall increasing rates of syphilis with a high rate of human immunodeficiency virus (HIV) co-infection. However, there is little information about factors influencing syphilis treatment failure and/or re-infection in HIV co-infected patients. We conducted a study to evaluate factors associated with syphilis treatment failure/re-infection in HIV co-infected patients. We reviewed 3542 medical records of HIV-infected patients from January 2005 to December 2007 followed up at HIV Clinic in New York City. Patients were categorized by rapid plasma regain titer (RPR) into success/serofast (4-fold decrease in RPR by 12 months after treatment, RPR conversion to nonreactive, persistently stable reactive RPR with no 4-fold increase), and failure/re-infection (failure to decrease 4 folds in RPR by 12 months after treatment, 4-fold increase in RPR from baseline). Among a total of 156 patients who met the eligibility criteria, 122 (78.2%) were under success/serofast category, and 34 (21.8%) were under failure/re-infection category. HIV viral load, CD4 cell count, and use of highly active antiretroviral therapy (HAART) were not associated with syphilis treatment failure/re-infection. However, early syphilis stage (OR: 11.036, 95%CI: 2.499 - 48.740, P = 0.002) and high (> 1:64) RPR titers (OR: 715.921, 95%CI: 422.175 - 23 113.396, P sexual behaviors may be the most important leading factor, emphasizing needs for safe sex education.

  7. Treatment failure in cognitive-behavioural therapy: therapeutic alliance as a precondition for an adherent and competent implementation of techniques.

    Science.gov (United States)

    Weck, Florian; Grikscheit, Florian; Jakob, Marion; Höfling, Volkmar; Stangier, Ulrich

    2015-03-01

    Treatment failure is a common phenomenon, but little is known about the reasons. Therapeutic alliance, therapist adherence, and therapist competence are considered important aspects of treatment success and formed the focus of the current investigation. Three randomized controlled trials for the treatment of depression, social phobia, and hypochondriasis were the basis of the current study. The role of therapeutic alliance, as well as therapist adherence and competence, were investigated in 61 patients, which were classified either as treatment failure or as treatment success. Process variables were evaluated by independent raters on the basis of videotapes of the first three treatment sessions. Therapists' adherence and therapeutic alliance differed significantly between successful treatments and those classified as failures, whereas therapists' competence did not. In cross-sectional analysis, we found a moderating effect of adherence with alliance on treatment outcome, indicating that the better the therapeutic alliance, the stronger the effect of adherence on treatment outcome. Moreover, higher therapists' competence was found to affect treatment outcome positively, only mediated by therapeutic alliance. Higher therapists' adherence affected treatment outcome positively, only mediated by the competence-alliance relationship. In additional longitudinal analyses, we found evidence that the therapeutic alliance within one session influences therapists' adherence and competence in the subsequent session, but not the other way around. Therapeutic alliance proved to be an important variable for the prediction of treatment failure. Furthermore, in our longitudinal analyses, we found evidence that the therapeutic alliance is a precondition for the adherent and competent implementation of therapeutic techniques, which questions the results of our cross-sectional analysis and of previous research. Clinical implications Treatment failure is associated with a lower

  8. Arginine-Vasopressin Receptor Antagonists: A New Hope for Treatment of Hyponatremia in Patients with Heart Failure

    Directory of Open Access Journals (Sweden)

    Saepudin

    2015-06-01

    Full Text Available Hyponatremia is an important problem in patients with heart failure. It has also been known as a predictor both of short and long-term clinical outcome of heart failure patients. While evidences of clinical efficacy and safety of conventional options for treatment of hyponatremia resulted from clinical trials are very limited, several clinical trials have been conducted to evaluate the efficacy and safety of arginine vasopressin antagonists or also known as vaptan group. This paper reviews hyponatremia in patients with heart failure and the important roles of arginine vasopressin in its development, pharmacological aspects and clinical trials outcomes of some vaptans and several questions emerged from those clinical trials. Relevant research papers, reviews, and website information have been searched and included in this review using keyword of heart failure, hyponatremia, arginine-vasopressin, arginine-vasopressin receptor antagonist and vaptan. Generally, clinical trials have highlighted the efficacy and safety of vaptan groups in the management of hypervolemic hyponatremia in patients with heart failure. Those drugs can effectively increase serum sodium level with tolerable adverse reactions. Based on those clinical data two drugs of vaptan group, conivaptan and tolvaptan, have been approved by Food and Drug Administration in The United States to be used for the treatment of euvolemic and hypervolemic hyponatremia. However, many experts are still hesitant to recommend vaptans as treatment of choice for hyponatremia due to the lack of patients-focused outcomes measurements.

  9. Predictors of early treatment failure following initial therapy for systemic immunoglobulin light-chain amyloidosis.

    Science.gov (United States)

    Tandon, Nidhi; Sidana, Surbhi; Rajkumar, S Vincent; Dispenzieri, Angela; Gertz, Morie A; Lacy, Martha Q; Kyle, Robert A; Buadi, Francis K; Dingli, David; Hayman, Suzanne R; Fonder, Amie L; Hobbs, Miriam A; Gonsalves, Wilson I; Kapoor, Prashant; Hwa, Yi Lisa; Leung, Nelson; Go, Ronald S; Lust, John A; Russell, Stephen J; Zeldenrust, Steven R; Kumar, Shaji K

    2017-09-01

    We analysed factors predicting early treatment failure (ETF), after first-line therapy for light-chain amyloidosis (AL). AL amyloidosis patients seen at Mayo Clinic within 90 days of diagnosis, from 2006 to 2015, excluding those who died within 3 months of initial therapy, were analysed retrospectively. ETF was defined as progression requiring treatment change or death within 12 (ETF12) or 24 (ETF24) months of first-line treatment. Non-ETF included those with a follow-up of more than 12 or 24 months who had progression beyond 12 or 24 months. A total of 724 patients met the study criteria; 244 (33.7%) had ETF12 and 388 (53.6%) had ETF24. Patients with ETF12 were older (64.1 vs. 62.2 years) with higher prevalence of cardiac (81 vs. 64.1%) and multi-organ involvement (67.2 vs. 45.4%) and higher proportion of patients with t(11; 14) (58.5 vs. 44.3%) or in higher Mayo 2012 stage (58.5 vs. 41.1%).The median follow-up was 5.4 years from start of initial therapy. In multivariate analysis, presence of t(11; 14) and non-incorporation of autologous transplant in initial therapy are significant predictors of ETF12 (p = .01and p = .003) and ETF24 (p = .0001 and p = .005) while Mayo stage is predictive of ETF24 (p = .002), but not ETF12.

  10. Effect of treatment choice on survival in a case with meningococcemia and multiorgan failure

    Directory of Open Access Journals (Sweden)

    Kadriye Özdemir

    2016-03-01

    Full Text Available We report in this paper a case had continuous veno-venous hemodiafiltration (CVVHDF with the diagnosis of meningococcemia - multiple organ failure (MOF and without permanent damage development although it took more than 4 weeks of loss of kidney function. Three-year-old female patient was hospitalized for unconsciousness, no spontaneous respiration, blood pressure 50/30 mmHg, and widely echimotic- purpuric rash. In her laboratory. there were 19.600 / mm3 white blood cells, 5.7 g / dL he­moglobin, 76,000 / mm3 platelets, prothrombin time was 23.9 seconds, aPTT was higher than measurable values, creatinine was 7.2 mg / dL, ALT / AST were 378/714 / L, and she was anuric. She underwent CVVHDF treatment with the diagnosis of meningococcemia and MOF. On the 48 hours of treatment, her vital signs were improved, on 55 hours MOF was revealed except for renal functions and CVVHDF treatment was discontinued. Because of the damage to the kidneys continue, she had 3 hours/ day dose of hemodialysis. At the end of hospitalization for 1 week, her hemodialysis need was declined to 3 days/ week, on 5th week to 2 days / week and on the beginning of 6 weeks, there was entirely no need for dialysis and she had been seen in services in one more week with­out dialysis need. On the last visit, she had normal blood pressure, creatinine clearance, urine osmolarity and pro­tein excretion. She was followed up for 4.5 years with no abnormality.

  11. [Efficacy observation of Guan's quadruple therapy for kidney disease on the treatment of chronic renal failure].

    Science.gov (United States)

    Zuo, Zheng; Chen, Xiao-Mei; Jiang, Yun-Wu; Tang, Xiao-Yun; Guan, Zun-Xin

    2014-07-01

    To compare the differences in the clinical efficacy between Guan's quadruple therapy for kidney disease and the conventional western medication in the treatment of chronic renal failure (CRF). Eighty patients were randomized into an observation group and a control group, 40 cases in each one. In the observation group, besides the physician instruction of low protein and low phosphorus diet in the two groups, Guan's quadruple therapy for kidney disease was applied, including (1) the isolated herbal moxibustion at Shenshu (BL 23) and Pishu (BL 21), or Ganshu (BL 18), Zusanli (ST 36) and Guanyuan (CV 4) alternatively; (2) acupuncture at the auricular points such as shen (CO10), jiaogan (AHR6), Shenshangxian (TG2), fei (CO14) and pizhixia (AT4); (3) injection of mixture of astragalus injection and lidocaine injection at Feishu (BL 13), Pishu (BL 21), Shenshu (BL 23) and the others; (4) modified Shenshuai Yihao decoction according to syndrome differentiation. In the control group, the conventional western medication was used. After 6 months of treatment, the differences were observed between the two groups in the clinical efficacy, serum creatinine (Scr), blood urea nitrogen (BUN), endogenous creatinine (Ccr) and 24 h urine protein quantitation (UPQ). In the observation group, after treatment, the remarkably effective rate was 50.0% (20/40) and the total effective rate was 82.5% (33/40), which were superior to 25.0% (10/40) and 45.0% (18/40) in the control group (both P kidney disease achieves a better efficacy on CRF compared with the conventional western medication. This therapy improves renal functions, relieves clinical symptoms and physical signs and benefits the life quality of patients.

  12. Impact of medical treatment on lung diffusion capacity in elderly patients with heart failure. Baseline characteristics and 1-year follow up after medical treatment

    DEFF Research Database (Denmark)

    Petersen, Claus Leth; Kjaer, Andreas

    2005-01-01

    AIM: The aim of this investigation was (1) to study the effect of untreated chronic heart failure (CHF) on alveolar membrane diffusion capacity (transfer coefficient, K(CO)) in elderly patients and (2) to study the impact of the standard regime of medical treatment with diuretics and ACE-inhibito......AIM: The aim of this investigation was (1) to study the effect of untreated chronic heart failure (CHF) on alveolar membrane diffusion capacity (transfer coefficient, K(CO)) in elderly patients and (2) to study the impact of the standard regime of medical treatment with diuretics and ACE...... of multiple ECG-gated radionuclide ventriculography (MUGA). LVEF

  13. High reinfection rate and treatment failures in children treated with amodiaquine for falciparum malaria in Muheza villages, Northeastern Tanzania

    DEFF Research Database (Denmark)

    Lemnge, Martha; Alifrangis, Michael; Kafuye, Mwanaidi Y

    2006-01-01

    by polymerase chain reaction (PCR) genotyping of msp1 and msp2 genes. Additionally, Pfcrt codon 72-76 polymorphisms were studied by PCR and sequence-specific oligonucleotide probe (SSOP) ELISA. In 54 cases with complete follow-up, a significant difference in late treatment failure (LTF) rates was seen (60...

  14. Use of hepatocyte and stem cells for treatment of post-resectional liver failure: are we there yet?

    NARCIS (Netherlands)

    Ezzat, T. M.; Dhar, D. K.; Newsome, P. N.; Malago, M.; Olde Damink, S.

    2011-01-01

    Post-operative liver failure following extensive resections for liver tumours is a rare but significant complication. The only effective treatment is liver transplantation (LT); however, there is a debate about its use given the high mortality compared with the outcomes of LT for chronic liver

  15. The effect of treatment with bisoprolol-first versus enalapril-first on cardiac structure and function in heart failure

    NARCIS (Netherlands)

    Van de Ven, Louis L. M.; van Veldhuisen, Dirk J.; Goulder, Michael; Zilahi, Zsolt; Meyer, Wilfried R.; Willenheimer, Ronnie

    2010-01-01

    Background: In CIBIS III, initiating chronic heart failure (CHF) treatment with bisoprolol (target dose 10 mg q.d.) followed by combination therapy with enalapril (target dose 10 mg b.i.d.), compared to the opposite order, showed similar effects on survival and hospitalization. By echocardiography,

  16. Vitamin D status is associated with treatment failure and duration of illness in Nepalese children with severe pneumonia.

    Science.gov (United States)

    Haugen, Johanne; Basnet, Sudha; Hardang, Ingrid M; Sharma, Arun; Mathisen, Maria; Shrestha, Prakash; Valentiner-Branth, Palle; Strand, Tor A

    2017-07-05

    There is no consensus on optimal Vitamin D status. The objective of this study was to estimate the extent to which vitamin D status predicts illness duration and treatment failure in children with severe pneumonia by using different cut-offs for vitamin D concentration. We measured the plasma-concentration of 25(OH)D in 568 children hospitalized with WHO-defined severe pneumonia. The associations between vitamin D status, using the most frequently used cut-offs of vitamin D insufficiency (25(OH)D <50 and <75 nmol/l) and risk of treatment failure and time until recovery were analysed in multiple logistic regression and Cox proportional hazards models, respectively. Of the 568 children, 322 (56.7%) had plasma-25(OH)D ≥75 nmol/l, 179 (31.5%) 50-74.9 nmol/l and 67 (%) <50 nmol/l. Plasma-25(OH)D <50 nmol/l was associated with increased risk of treatment failure and longer time until recovery. Our findings indicate that low vitamin D status (25(OH)D <50 nmol/l) is an independent risk factor for treatment failure and delayed recovery of severe lower respiratory infections in children. NCT00252304.Pediatric Research accepted article preview online, 05 July 2017. doi:10.1038/pr.2017.71.

  17. Surfactant treatment of neonates with respiratory failure and group B streptococcal infection. Members of the Collaborative European Multicenter Study Group

    NARCIS (Netherlands)

    Herting, E.; Gefeller, O.; Land, M.; Van Sonderen, L.; Harms, K.; Robertson, B.

    2000-01-01

    Connatal pneumonia caused by group B streptococcal (GBS) infection may be associated with surfactant dysfunction. We investigated the effects of surfactant treatment in term and preterm neonates with GBS infection and respiratory failure, in comparison with corresponding data from a control

  18. PS1-09: Clinical Features, Treatment Practices, and Outcomes of Older Patients Hospitalized with Decompensated Heart Failure

    OpenAIRE

    Saczynski, Jane S; Darling, Chad E.; Spencer, Frederick A.; Lessard, Darleen; Gore, Joel M.; Goldberg, Robert J.

    2010-01-01

    Background: Heart failure (HF) disproportionately affects older adults and previous studies have suggested that the demographic as well as clinical profile of older patients with HF is different from that of younger patients. However, generalizable, population-based data on the clinical, treatment, and prognostic profile of older as compared to middle aged and younger patients with HF are lacking.

  19. Risk factors for unsuccessful tuberculosis treatment outcome (failure, default and death) in public health institutions, Eastern Ethiopia.

    Science.gov (United States)

    Amante, Tariku Dingeta; Ahemed, Tekabe Abdosh

    2015-01-01

    Unsuccessful TB treatment outcome is a serious public health concern. It is compelling to identify, and deal with factors determining unsuccessful treatment outcome. Therefore, study was aimed to determine pattern of unsuccessful TB treatment outcome and associated factors in eastern Ethiopia. A case control study was used. Cases were records of TB patients registered as defaulter, dead and/or treatment failure where as controls were those cured or treatment complete. Multivariate logistic regression models were used to derive adjusted odds ratios (OR) at 95% CI to examine the relationship between the unsuccessful TB treatment outcome and patients' characteristics. A total of 990 sample size (330 cases and 660 controls) were included. Among cases (n = 330), majority 212(64.2%) were because of death, 100(30.3%) defaulters and 18(5.5%) were treatment failure. Lack of contact person(OR = 1.37; 95% CI 1.14-2.9, P, .024), sputum smear negative treatment category at initiation of treatment (OR = 1.8; 95% CI 1.3-5.5,P, .028), smear positive sputum test result at 2(nd) month after initiation treatment (OR = 14; 95% CI 5.5-36, P,0.001) and HIV positive status (OR = 2.5; 95% CI 1.34-5.7, P, 0.01) were independently associated with increased risk of unsuccessful TB treatment outcome. Death was the major cause of unsuccessful TB treatment outcome. TB patients do not have contact person, sputum smear negative treatment category at initiation of treatment, smear positive on 2(nd) month after treatment initiation and HIV positive were factors significantly associated unsuccessful treatment outcome. TB patients with sputum smear negative treatment category, HIV positive and smear positive on 2(nd) nd month of treatment initiation need strict follow up throughout DOTs period.

  20. Identification of genetic markers for treatment success in heart failure patients: insight from cardiac resynchronization therapy.

    Science.gov (United States)

    Schmitz, Boris; De Maria, Renata; Gatsios, Dimitris; Chrysanthakopoulou, Theodora; Landolina, Maurizio; Gasparini, Maurizio; Campolo, Jonica; Parolini, Marina; Sanzo, Antonio; Galimberti, Paola; Bianchi, Michele; Lenders, Malte; Brand, Eva; Parodi, Oberdan; Lunati, Maurizio; Brand, Stefan-Martin

    2014-12-01

    Cardiac resynchronization therapy (CRT) can improve ventricular size, shape, and mass and reduce mitral regurgitation by reverse remodeling of the failing ventricle. About 30% of patients do not respond to this therapy for unknown reasons. In this study, we aimed at the identification and classification of CRT responder by the use of genetic variants and clinical parameters. Of 1421 CRT patients, 207 subjects were consecutively selected, and CRT responder and nonresponder were matched for their baseline parameters before CRT. Treatment success of CRT was defined as a decrease in left ventricular end-systolic volume >15% at follow-up echocardiography compared with left ventricular end-systolic volume at baseline. All other changes classified the patient as CRT nonresponder. A genetic association study was performed, which identified 4 genetic variants to be associated with the CRT responder phenotype at the allelic (Pheart failure patients in CRT responder and nonresponder status using clinical and genetic parameters. Our analysis included information on alleles and genotypes of 4 genetic loci, rs3766031 (ATPIB1), rs5443 (GNB3), rs5522 (NR3C2), and rs7325635 (TNFSF11), pathophysiologically associated with remodeling of the failing ventricle. © 2014 American Heart Association, Inc.

  1. Is MARS system enough for A. phalloides-induced liver failure treatment?

    Science.gov (United States)

    Sorodoc, Laurentiu; Lionte, Catalina; Sorodoc, Victorita; Petris, Ovidiu; Jaba, Irina

    2010-10-01

    Patients with Amanita phalloides-induced liver failure (LF) have a high mortality, despite significant advances in intensive care management. Our study evaluated the effect of Molecular Absorbents Recirculating System (MARS) comparative with optimal intensive care (OIC) in adults with this condition, in the absence of liver transplantation (LT). Six consecutive patients (women, range 16-61 years) affected by A. phalloides-induced LF were treated with OIC (3 patients) and MARS (3 patients). Laboratory parameters and hepeatic encephalopaty were evaluated 15 min before and 24 hours following each MARS treatment. Three 6-hour sessions per patient were performed in MARS group, with a statistically significant decrease in ammonia (p value 0.011), alaninaminotransferase (ALT) and prothrombin time (PT) (p value 0.004). Two patients had a significant rebound in bilirubin (+116%; p value 0. 04) 24 hours following MARS. Mortality in MARS group was 66.7%. Survival rate in OIC was 0%. Negative prognostic markers: lack of PT and hepatic encephalopaty improvement, rebound in bilirubin, and delay of MARS therapy initiation. No significant adverse reactions occurred during MARS. MARS is an effective depurative therapy in adults with A. phalloides-induced LF, but alone is not enough. Survival is predicted by the results of the initial MARS, amount of mushroom consumed, and time from toxin exposure.

  2. Comparative pharmacology and clinical efficacy of newer agents in treatment of heart failure.

    Science.gov (United States)

    Taylor, C R; Baird, J R; Blackburn, K J; Cambridge, D; Constantine, J W; Ghaly, M S; Hayden, M L; McIlhenny, H M; Moore, P F; Olukotun, A Y; Pullman, L G; Salsburg, D S; Saxton, C A; Shevde, S

    1981-09-01

    The animal and human pharmacology of several new drugs (prazosin, trimazosin, pirbuterol, and carbazeran) useful in the treatment of congestive heart failure (CHF) is delineated in relation to the pharmacology of other agents employed for CHF management. Prazosin and trimazosin are selective alpha 1-blockers that cause a balanced increase in cardiac output (CO) and reduction in left ventricular filling pressure (LVFP); the reduction in diastolic blood pressure with these drugs is significantly related to increase in treadmill exercise, fall in LVFP, and increase in CO. Pirbuterol is a relatively selective beta 2-agonist with somewhat greater effects on CO than on LVFP. Early promise in CHF therapy is being shown by a novel series of cyclic adenosine monophosphate (cAMP) phosphodiesterase inhibitors with combined direct inotropic and vasodilator effects. Double-blind long-term studies demonstrate persistent efficacy of prazosin and trimazosin in CHF as measured by improvement in New York Heart Association functional class, treadmill exercise performance, and noninvasive measures of cardiac function; these data are supported by studies in which repeat cardiac catheterization has been performed after several months of therapy. Double-blind studies of other CHF drugs are in progress.

  3. Quality of life and disability in patients with treatment-failure gout.

    Science.gov (United States)

    Becker, Michael A; Schumacher, H Ralph; Benjamin, Katy L; Gorevic, Peter; Greenwald, Maria; Fessel, Jeffrey; Edwards, Lawrence; Kawata, Ariane K; Frank, Lori; Waltrip, Royce; Maroli, Allan; Huang, Bill; Sundy, John S

    2009-05-01

    The relationship between self-reported quality of life and disability and disease severity was evaluated in subjects with treatment-failure gout (n = 110) in a prospective, 52-week, observational study. Subjects had symptomatic crystal-proven gout of at least 2 years' duration and intolerance or refractoriness to conventional urate-lowering therapy. Serum uric acid (sUA) concentration, swollen and tender joint counts, frequency and severity of gout flares, tophus assessments, comorbidities, and patient-reported outcomes data [Medical Outcomes Study Short Form-36 (SF-36), Health Assessment Questionnaire-Damage Index] were collected. Analyses included correlations of patient-reported outcomes with clinical variables and changes in clinical status. Mean age of study subjects was 59 years. Mean scores on SF-36 physical functioning subscales were 34.2-46.8, analogous to persons aged >or= 75 years in the general population. Subjects with more severe gout at baseline had worse health-related quality of life (HRQOL) in all areas (p physical, but not mental, functioning. Severe gout is associated with poor HRQOL and disability, especially for patients who experience more gout flares and have a greater number of involved joints. Subject perceptions of gout-related functioning and pain severity appear to be highly sensitive indicators of HRQOL and disability.

  4. Ventricular resynchronization through biventricular cardiac pacing for the treatment of refractory heart failure in dilated cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Silas S. Galvão Fº

    2002-01-01

    Full Text Available OBJECTIVE: The biventricular pacing (BVP approach has good results in the treatment of congestive heart failure (CHF in patients (pts with disorders of intraventricular conduction. METHODS: We have applied BVP to 28 pts, with left ventricular pacing using minitoracotomy in 3 pts and the transvenous aproach via coronary sinus in 25 pts. The mean duration of the QRS complexes was 187 ms, in the presence of the left branch block in 22 pts, and right branch block + divisional hemiblock in 6 pts. All pts had been considerated candidates to cardiac transplantation, and were under optimized drug therapy. Sixteen pts were in Functional Class (NYHA IV, and 12 in class III. The ejection fraction varied from 22 to 46% (average = 34%. The pacing mode employed was biventricular triple-chamber in 22 pts, and bi-ventricular dual-chamber in 6 pts (one with ICD. RESULTS: The pts were followed up for a period that ranged from 10 days to 14 months (mean 5 months. All pts presented clinical improvement after implant, chaging the NYHA Functional Class at the end of follow-up to Class I (9pts, Class II (10 pts and Class III (6 pts. The initial mean ejection fraction have-raised to 37%. Two pts died suddenly. One patient died due to a pulmonary fungal infection. CONCLUSION: Ventricular resynchronization through BVP, improved significantly the Functional Class and, therefore, the quality of life. Assessments of myocardial function acutely performed do not reflect the clinical improvement observed.

  5. Heart failure treatment in adults with congenital heart disease: where do we stand in 2014?

    Science.gov (United States)

    Krieger, Eric V; Valente, Anne Marie

    2014-09-01

    Heart failure (HF) is the leading cause of death in adults with repaired congenital heart disease (CHD). However there is currently little evidence to guide treatment strategies in this growing group of patients. Unlike the majority of HF, which is usually caused by LV systolic or diastolic dysfunction, CHD-HF is more often a consequence of RV disease, valve dysfunction, shunting or pulmonary hypertension. It is therefore not appropriate to extrapolate from the acquired HF literature and apply it to this heterogeneous population of CHD patients. Additionally, patients with CHD have been excluded from most large trials of medical or device therapy of HF, which has resulted in small retrospective and underpowered studies in the CHD population. This article critically reviews the current knowledge about CHD-HF, paying particular attention to medical therapy in different CHD populations, cardiac resynchronisation therapy and implantable cardiac defibrillators, and the challenges of heart transplantation and mechanical circulatory support in CHD patients. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  6. Gene therapy by electroporation for the treatment of chronic renal failure in companion animals

    Directory of Open Access Journals (Sweden)

    Pope Melissa A

    2009-01-01

    Full Text Available Abstract Background Growth hormone-releasing hormone (GHRH plasmid-based therapy for the treatment of chronic renal failure and its complications was examined. Companion dogs (13.1 ± 0.8 years, 29.4 ± 5.01 kg and cats (13.2 ± 0.9 years, 8.5 ± 0.37 kg received a single 0.4 mg or 0.1 mg species-specific plasmid injection, respectively, intramuscularly followed by electroporation, and analyzed up to 75 days post-treatment; controls underwent electroporation without plasmid administration. Results Plasmid-treated animals showed an increase in body weight (dogs 22.5% and cats 3.2% compared to control animals, and displayed improved quality of life parameters including significant increases in appetite, activity, mentation and exercise tolerance levels. Insulin-like growth factor I (IGF-I, the downstream effector of GHRH levels were increased in the plasmid treated animals. Hematological parameters were also significantly improved. Protein metabolism changes were observed suggesting a shift from a catabolic to an anabolic state in the treated animals. Blood urea nitrogen and creatinine did not show any significant changes suggesting maintenance of kidney function whereas the control animal's renal function deteriorated. Treated animals survived longer than control animals with 70% of dogs and 80% of cats surviving until study day 75. Only 17% and 40% of the control dogs and cats, respectively, survived to day 75. Conclusion Improved quality of life, survival and general well-being indicate that further investigation is warranted, and show the potential of a plasmid-based therapy by electroporation in preventing and managing complications of renal insufficiency.

  7. Challenges in treatment of postinfarction ventricular septal defect and heart failure

    Directory of Open Access Journals (Sweden)

    Mangovski Ljupčo

    2015-01-01

    Full Text Available Introduction. Acquired ventricular septal defect (VSD is uncommon, but serious mechanical complication of acute myocardial infarction with poor outcome and high mortality rate in surgically or medically treated patients. Case report. We report a 58-year-old male patient admitted to our hospital six days following acute inferior myocardial infarction complicated by ventricular septal rupture with signs of heart failure. Coronary angiography revealed 3-vessel disease, with proximally occluded dominant right coronary artery. Transthoracic echo exam revealed aneurysm of a very thin inferior septum and the basal portion of the inferior left ventricular wall, with septal wall rupture. One of the VSD dimensions was 15 mm and left- to right shunt was calculated 2 : 1. Since the patient was at too high risk for surgical closure, transcatheter closure of VSD was chosen as a better option. Under short intravenous sedation, 24 mm Amplatzer device was implanted percutaneously with transesophageal echo guidance. The post-procedural result revealed a small residual shunt, but it was followed by significant improvement of the patient’s clinical status. A 24h Holter ECG monitoring did not show cardiac rhythm or conduction disturbances. Coronary angiography was repeated ten days following the procedure, after hemodynamic stabilization of the patient, with direct stenting of the circumflex artery and the intermediate artery. Ostial left descending artery lesion was left for further functional significance assessment. Conclusion: Percutaneous closure with a septal occluder device can be definitive primary treatment for anatomically suitable patients or it can serve as a bridge to surgical treatment.

  8. Treatment and prevention of hepatic failure in acute biliary pancreatitis in patients with diabetes mellitus

    Directory of Open Access Journals (Sweden)

    S.I. Savoliuk

    2017-10-01

    the products of purine nucleotide catabolism (xanthine oxidase, xanthine dehydrogenase capable of producing reactive oxygen species, stimulating oxidative stress. Conclusions. The course of acute biliary pancreatitis in patients with diabetes mellitus is accompanied by regular changes in the markers of the syndrome of cytopathic hypoxia, the erythron system and iron metabolism, the severity of these disorders has a direct correlation with the area of morphological changes in the pancreas and the dynamics of markers of liver failure. Using the methods of protocol therapy, you can not carry out preventive correction of existing metabolic disorders that requires the inclusion into the standard conservative treatment for edema form of acute biliary pancreatitis of systemic multifunctional metabolic corrector (Berlithion® for systemic preventive correction of homeostasis and mechanisms of escalation of hepatic insufficiency manifestations, which, in the presence of necrotic forms, requires additional application of low molecular weight heparins (Zibor® for the restoration of hemorheological and hemocoalogulative disorders on the systemic and intraorganic levels.

  9. ROLE OF THE METABOLITE THERAPY FOR THE TREATMENT OF CHRONIC HEART FAILURE

    Directory of Open Access Journals (Sweden)

    L. N. Maksimova

    2013-01-01

    Full Text Available Questions of metabolite therapy with drugs based on glutamic acid in patients with chronic heart failure are considered. Possible modes of action of these drugs are presented. Results of the proper study of glutamic acid based drug in chronic heart failure are presented as examples.

  10. COMPARISON OF TREATMENT WITH LISINOPRIL VERSUS ENALAPRIL FOR CONGESTIVE-HEART-FAILURE

    NARCIS (Netherlands)

    ZANNAD, F; VANDENBROEK, SAJ; BORY, M

    1992-01-01

    The effect of lisinopril 5-20 mg once daily or enalapril 5-20 mg once daily on exercise capacity, ventricular ectopic activity, and signs and symptoms of heart failure have been studied in 278 patients with mild-to-moderate (New York Heart Association [NYHA] classes II and III) heart failure in a

  11. Failure of cloxacillin in treatment of a patient with borderline oxacillin-resistant Staphylococcus aureus endocarditis.

    Science.gov (United States)

    Skinner, Stuart; Murray, Melanie; Walus, Tom; Karlowsky, James A

    2009-03-01

    Clinical evidence for failure with beta-lactam therapy has been lacking for patients with borderline oxacillin-resistant Staphylococcus aureus (BORSA) infections. We describe a failure of cloxacillin for a patient with endocarditis due to BORSA. The isolate also had false-negative thermonuclease and coagulase test results.

  12. Failure of Cloxacillin in Treatment of a Patient with Borderline Oxacillin-Resistant Staphylococcus aureus Endocarditis▿

    Science.gov (United States)

    Skinner, Stuart; Murray, Melanie; Walus, Tom; Karlowsky, James A.

    2009-01-01

    Clinical evidence for failure with β-lactam therapy has been lacking for patients with borderline oxacillin-resistant Staphylococcus aureus (BORSA) infections. We describe a failure of cloxacillin for a patient with endocarditis due to BORSA. The isolate also had false-negative thermonuclease and coagulase test results. PMID:19116360

  13. Volume Overload in Heart Failure: An Evidence-Based Review of Strategies for Treatment and Prevention.

    Science.gov (United States)

    Houston, Brian A; Kalathiya, Rohan J; Kim, Daniel A; Zakaria, Sammy

    2015-09-01

    Acute decompensated heart failure is the leading cause of hospital admission in the United States, with a high risk of readmission within 30 days. Most acute decompensated heart failure admissions are driven by congestive signs and symptoms resulting from fluid and sodium overload. We reviewed the evidence base addressing the management and prevention of fluid overload in heart failure, focusing on recent clinical trials. All the references in this review were obtained through PubMed and had at least 1 of the following key words: heart failure and volume overload, congestion, loop diuretics, thiazide diuretics, aldosterone antagonists, dopamine, cardiorenal syndrome, nesiritide, vasopressin antagonists, ultrafiltration, sodium restriction, fluid restriction, telemonitoring, and invasive hemodynamic monitoring. We also reviewed relevant references cited in the obtained articles, especially articles addressing methods of treating or preventing volume overload in patients with heart failure. Copyright © 2015 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  14. Exploring beliefs about heart failure treatment in adherent and nonadherent patients: use of the repertory grid technique

    Directory of Open Access Journals (Sweden)

    Cottrell WN

    2013-02-01

    Full Text Available William Neil Cottrell,1 Charles P Denaro,2,3 Lynne Emmerton1,41School of Pharmacy, University of Queensland, Brisbane, Qld, Australia; 2Department of Internal Medicine and Aged Care, The Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia; 3School of Medicine, University of Queensland, Brisbane, Qld, Australia; 4Curtin Health Innovation Research Institute, School of Pharmacy, Curtin University, Perth, WA, AustraliaPurpose: Beliefs about medicines impact on adherence, but eliciting core beliefs about medicines in individual patients is difficult. One method that has the potential to elicit individual core beliefs is the "repertory grid technique." This study utilized the repertory grid technique to elicit individuals' beliefs about their heart failure treatment and to investigate whether generated constructs were different between adherent and nonadherent patients.Methods: Ninety-two patients with heart failure were interviewed using a structured questionnaire that applied the repertory grid technique. Patients were asked to compare and contrast their medicines and self-care activities for their heart failure. This lead to the generation of individual constructs (perceptions towards medicines, and from these, beliefs were elicited about their heart failure treatment, resulting in the generation of a repertory grid. Adherence was measured using the Medication Adherence Report Scale (MARS. Patients with a MARS score ≥ 23 were categorized as "adherent" and those with a score ≤ 22 as "nonadherent." The generated grids were analyzed descriptively and constructs from all grids themed and the frequency of these constructs compared between adherent and nonadherent patients.Results: Individual grids provided insight into the different beliefs that patients held about their heart failure treatment. The themed constructs "related to water," "affect the heart," "related to weight," and "benefit to the heart" occurred more frequently in adherent

  15. Utilization of evidence-based treatment in elderly patients with chronic heart failure: using Korean Health Insurance claims database

    Directory of Open Access Journals (Sweden)

    Kim Ju-Young

    2012-07-01

    Full Text Available Abstract Background Chronic heart failure accounts for a great deal of the morbidity and mortality in the aging population. Evidence-based treatments include angiotensin-2 receptor blockers (ARBs, angiotensin-converting enzyme inhibitors (ACE-I, beta-blockers, and aldosterone antagonists. Underutilization of these treatments in heart failure patients were frequently reported, which could lead to increase morbidity and mortality. The aim of this study was to evaluate the utilization of evidence-based treatments and their related factors for elderly patients with chronic heart failure. Methods This is retrospective observational study using the Korean National Health Insurance claims database. We identified prescription of evidence based treatment to elderly patients who had been hospitalized for chronic heart failure between January 1, 2005, and June 30, 2006. Results Among the 28,922 elderly patients with chronic heart failure, beta-blockers were prescribed to 31.5%, and ACE-I or ARBs were prescribed to 54.7% of the total population. Multivariable logistic regression analyses revealed that the prescription from outpatient clinic (prevalent ratio, 4.02, 95% CI 3.31–4.72, specialty of the healthcare providers (prevalent ratio, 1.26, 95% CI, 1.12–1.54, residence in urban (prevalent ratio, 1.37, 95% CI, 1.23–1.52 and admission to tertiary hospital (prevalent ratio, 2.07, 95% CI, 1.85–2.31 were important factors associated with treatment underutilization. Patients not given evidence-based treatment were more likely to experience dementia, reside in rural areas, and have less-specialized healthcare providers and were less likely to have coexisting cardiovascular diseases or concomitant medications than patients in the evidence-based treatment group. Conclusions Healthcare system factors, such as hospital type, healthcare provider factors, such as specialty, and patient factors, such as comorbid cardiovascular disease, systemic disease with

  16. HIV-1 Antiretroviral Drug Resistance Mutations in Treatment Naïve and Experienced Panamanian Subjects: Impact on National Use of EFV-Based Schemes.

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    Yaxelis Mendoza

    Full Text Available The use of antiretroviral therapy in HIV infected subjects prevents AIDS-related illness and delayed occurrence of death. In Panama, rollout of ART started in 1999 and national coverage has reached 62.8% since then. The objective of this study was to determine the level and patterns of acquired drug resistance mutations of clinical relevance (ADR-CRM and surveillance drug resistance mutations (SDRMs from 717 HIV-1 pol gene sequences obtained from 467 ARV drug-experienced and 250 ARV drug-naïve HIV-1 subtypes B infected subjects during 2007-2013, respectively. The overall prevalence of SDRM and of ADR-CRM during the study period was 9.2% and 87.6%, respectively. The majority of subjects with ADR-CRM had a pattern of mutations that confer resistance to at least two classes of ARV inhibitors. The non-nucleoside reverse transcriptase inhibitor (NNRTI mutations K103N and P225H were more prevalent in both ARV drug-naïve and ARV drug-experienced subjects. The nucleoside reverse transcriptase inhibitor (NRTI mutation M184V was more frequent in ARV drug-experienced individuals, while T215YFrev and M41L were more frequent in ARV drug-naïve subjects. Prevalence of mutations associated to protease inhibitors (PI was lower than 4.1% in both types of subjects. Therefore, there is a high level of resistance (>73% to Efavirenz/Nevirapine, Lamivudine and Azidothymidine in ARV drug-experienced subjects, and an intermediate to high level of resistance (5-10% to Efavirenz/Nevirapine in ARV drug-naïve subjects. During the study period, we observed an increasing trend in the prevalence of ADR-CRM in subjects under first-line schemes, but not significant changes in the prevalence of SDRM. These results reinforce the paramount importance of a national surveillance system of ADR-CRM and SDRM for national management policies of subjects living with HIV.

  17. HIV-1 Antiretroviral Drug Resistance Mutations in Treatment Naïve and Experienced Panamanian Subjects: Impact on National Use of EFV-Based Schemes.

    Science.gov (United States)

    Mendoza, Yaxelis; Castillo Mewa, Juan; Martínez, Alexander A; Zaldívar, Yamitzel; Sosa, Néstor; Arteaga, Griselda; Armién, Blas; Bautista, Christian T; García-Morales, Claudia; Tapia-Trejo, Daniela; Ávila-Ríos, Santiago; Reyes-Terán, Gustavo; Bello, Gonzalo; Pascale, Juan M

    2016-01-01

    The use of antiretroviral therapy in HIV infected subjects prevents AIDS-related illness and delayed occurrence of death. In Panama, rollout of ART started in 1999 and national coverage has reached 62.8% since then. The objective of this study was to determine the level and patterns of acquired drug resistance mutations of clinical relevance (ADR-CRM) and surveillance drug resistance mutations (SDRMs) from 717 HIV-1 pol gene sequences obtained from 467 ARV drug-experienced and 250 ARV drug-naïve HIV-1 subtypes B infected subjects during 2007-2013, respectively. The overall prevalence of SDRM and of ADR-CRM during the study period was 9.2% and 87.6%, respectively. The majority of subjects with ADR-CRM had a pattern of mutations that confer resistance to at least two classes of ARV inhibitors. The non-nucleoside reverse transcriptase inhibitor (NNRTI) mutations K103N and P225H were more prevalent in both ARV drug-naïve and ARV drug-experienced subjects. The nucleoside reverse transcriptase inhibitor (NRTI) mutation M184V was more frequent in ARV drug-experienced individuals, while T215YFrev and M41L were more frequent in ARV drug-naïve subjects. Prevalence of mutations associated to protease inhibitors (PI) was lower than 4.1% in both types of subjects. Therefore, there is a high level of resistance (>73%) to Efavirenz/Nevirapine, Lamivudine and Azidothymidine in ARV drug-experienced subjects, and an intermediate to high level of resistance (5-10%) to Efavirenz/Nevirapine in ARV drug-naïve subjects. During the study period, we observed an increasing trend in the prevalence of ADR-CRM in subjects under first-line schemes, but not significant changes in the prevalence of SDRM. These results reinforce the paramount importance of a national surveillance system of ADR-CRM and SDRM for national management policies of subjects living with HIV.

  18. HIV-1 Antiretroviral Drug Resistance Mutations in Treatment Naïve and Experienced Panamanian Subjects: Impact on National Use of EFV-Based Schemes

    Science.gov (United States)

    Mendoza, Yaxelis; Castillo Mewa, Juan; Martínez, Alexander A.; Zaldívar, Yamitzel; Sosa, Néstor; Arteaga, Griselda; Armién, Blas; Bautista, Christian T.; García-Morales, Claudia; Tapia-Trejo, Daniela; Ávila-Ríos, Santiago; Reyes-Terán, Gustavo; Bello, Gonzalo; Pascale, Juan M.

    2016-01-01

    The use of antiretroviral therapy in HIV infected subjects prevents AIDS-related illness and delayed occurrence of death. In Panama, rollout of ART started in 1999 and national coverage has reached 62.8% since then. The objective of this study was to determine the level and patterns of acquired drug resistance mutations of clinical relevance (ADR-CRM) and surveillance drug resistance mutations (SDRMs) from 717 HIV-1 pol gene sequences obtained from 467 ARV drug-experienced and 250 ARV drug-naïve HIV-1 subtypes B infected subjects during 2007–2013, respectively. The overall prevalence of SDRM and of ADR-CRM during the study period was 9.2% and 87.6%, respectively. The majority of subjects with ADR-CRM had a pattern of mutations that confer resistance to at least two classes of ARV inhibitors. The non-nucleoside reverse transcriptase inhibitor (NNRTI) mutations K103N and P225H were more prevalent in both ARV drug-naïve and ARV drug-experienced subjects. The nucleoside reverse transcriptase inhibitor (NRTI) mutation M184V was more frequent in ARV drug-experienced individuals, while T215YFrev and M41L were more frequent in ARV drug-naïve subjects. Prevalence of mutations associated to protease inhibitors (PI) was lower than 4.1% in both types of subjects. Therefore, there is a high level of resistance (>73%) to Efavirenz/Nevirapine, Lamivudine and Azidothymidine in ARV drug-experienced subjects, and an intermediate to high level of resistance (5–10%) to Efavirenz/Nevirapine in ARV drug-naïve subjects. During the study period, we observed an increasing trend in the prevalence of ADR-CRM in subjects under first-line schemes, but not significant changes in the prevalence of SDRM. These results reinforce the paramount importance of a national surveillance system of ADR-CRM and SDRM for national management policies of subjects living with HIV. PMID:27119150

  19. Treatment of 5/6 nephrectomy rats with sulodexide: a novel therapy for chronic renal failure

    Science.gov (United States)

    Li, Ping; Ma, Lin-lin; Xie, Ru-juan; Xie, Yuan-sheng; Wei, Ri-bao; Yin, Min; Wang, Jian-zhong; Chen, Xiang-mei

    2012-01-01

    Aim: Sulodexide, a glycosaminoglycan, could reduce albuminuria in diabetic patients. The aim of this study was to determine whether sulodexide could be used to treat chronic kidney failure in rats. Methods: Sixty Wistar rats undergone 5/6 nephrectomy, then were randomly divided into 4 groups: the model group, sulodexide group (sulodexide 5 mg/kg per day, im), irbesartan group irbesartan (20 mg/kg per day, ig) and sulodexide plus irbesartan group. Another 12 rats were enrolled into the sham operation group. After the treatments for 4, 8 and 12 weeks, urinary protein and serum creatinine levels were measured. After 12 weeks, serum cholesterin and triglycerides levels were measured, and the degrees of glomerular sclerosis and renal tubulointerstitial fibrosis were scored. The expression of aminopeptidase P (JG-12) in the renal tissue was examined using immunohistochemical staining. The renal expressions of endothelial nitric oxide synthase (eNOS) and tissue type plasminogen activator (tPA) were detected with RT-PCR and Western blot. Results: Proteinuria was markedly attenuated in the sulodexide-treated groups. After 4 and 8 weeks only the sulodexide-treated groups showed significant reduction in serum creatinine; while after 12 weeks all the three treatment groups showed significant reduction in serum creatinine. Furthermore, all the three treatment groups showed significant reduction in the scores of glomerular sclerosis and tubulointerstitial fibrosis. The glomerular expression of JG-12 was increased in both the sulodexide group and the sulodexide plus irbesartan group, but not in the irbesartan group. The eNOS mRNA and protein expression was decreased and the tPA mRNA and protein expression was significantly increased in the model group compared with Sham group. Sulodexide, irbesartan, and their combination reversed the decrease of eNOS expression but increased the tPA expression much more compared with model group. Conclusion: Sulodexide was similar to irbesartan

  20. Interleukin-10 Gene Polymorphisms are Associated With Freedom From Treatment Failure for Patients With Hodgkin Lymphoma

    Science.gov (United States)

    Schoof, Nils; Franklin, Jeremy; Fürst, Robert; Zander, Thomas; von Bonin, Frederike; Peyrade, Frederic; Trümper, Lorenz; Diehl, Volker; Engert, Andreas

    2013-01-01

    Background. Hodgkin lymphoma (HL) is a lymphoid malignancy characterized by the production of various cytokines possibly involved in immune deregulation. Interleukin-10 (IL-10) serum levels have been associated with clinical outcome in patients with HL. Because host genetic variations are known to alter the expression and function of cytokines and their receptors, we investigated whether genetic variations influence clinical outcome of patients with HL. Methods. A total of 301 patients with HL who were treated within randomized trials by the German Hodgkin Study Group were included in this exploratory retrospective study. Gene variations of IL-10 (IL-10-597AC, rs1800872; IL-10-824CT, rs1800871; IL-10-1087AG, rs1800896; IL-10-3538AT, rs1800890; IL-10-6208CG, rs10494879; IL-10-6752AT, rs6676671; IL-10-7400InDel), IL-13 (IL-13-1069CT, rs1800925; IL-13Q144R, rs20541), and IL-4R (IL-4RI75V, rs1805010; IL-4RQ576R, rs1801275) were genotyped. Results. Inferior freedom from treatment failure (FFTF) was found in patients harboring the IL-10-597AA, IL-10-824TT, or the IL-10-1087AA genotype. In contrast, the IL-10-1087G-824C-597C haplotype present in about 48% of analyzed HL patients is nominally significant for a better FFTF in a Cox-Regression model accounting for stage and treatment. No associations were observed between the other IL-10 gene variations, IL-13-1069CT, IL-13Q144R, IL-4RI75V, IL-4RQ576R and the clinical outcome of patients with HL. Conclusions. Our study provides further evidence that proximal IL-10 promoter gene variations are associated with clinical course of patients with HL. However, treatment success and survival rates are already at a very high rate, supporting the need to design studies focusing on identification of predictors to reduce the side effects of therapy. PMID:23299779

  1. Interleukin-10 gene polymorphisms are associated with freedom from treatment failure for patients with Hodgkin lymphoma.

    Science.gov (United States)

    Schoof, Nils; Franklin, Jeremy; Fürst, Robert; Zander, Thomas; von Bonin, Frederike; Peyrade, Frederic; Trümper, Lorenz; Diehl, Volker; Engert, Andreas; Kube, Dieter; Re, Daniel

    2013-01-01

    Hodgkin lymphoma (HL) is a lymphoid malignancy characterized by the production of various cytokines possibly involved in immune deregulation. Interleukin-10 (IL-10) serum levels have been associated with clinical outcome in patients with HL. Because host genetic variations are known to alter the expression and function of cytokines and their receptors, we investigated whether genetic variations influence clinical outcome of patients with HL. A total of 301 patients with HL who were treated within randomized trials by the German Hodgkin Study Group were included in this exploratory retrospective study. Gene variations of IL-10 (IL-10(-597AC), rs1800872; IL-10(-824CT), rs1800871; IL-10(-1087AG), rs1800896; IL-10(-3538AT), rs1800890; IL-10(-6208CG), rs10494879; IL-10(-6752AT), rs6676671; IL-10(-7400InDel)), IL-13 (IL-13(-1069CT), rs1800925; IL-13(Q144R), rs20541), and IL-4R (IL-4R(I75V), rs1805010; IL-4R(Q576R), rs1801275) were genotyped. Inferior freedom from treatment failure (FFTF) was found in patients harboring the IL-10(-597AA), IL-10(-824TT), or the IL-10(-1087AA) genotype. In contrast, the IL-10(-1087G-824C-597C) haplotype present in about 48% of analyzed HL patients is nominally significant for a better FFTF in a Cox-Regression model accounting for stage and treatment. No associations were observed between the other IL-10 gene variations, IL-13(-1069CT), IL-13(Q144R), IL-4R(I75V), IL-4R(Q576R) and the clinical outcome of patients with HL. Our study provides further evidence that proximal IL-10 promoter gene variations are associated with clinical course of patients with HL. However, treatment success and survival rates are already at a very high rate, supporting the need to design studies focusing on identification of predictors to reduce the side effects of therapy.

  2. Percentage of adherence correlates with the risk of protease inhibitor (PI) treatment failure in HIV-infected patients.

    Science.gov (United States)

    Casado, J L; Sabido, R; Perez-Elías, M J; Antela, A; Oliva, J; Dronda, F; Mejía, B; Fortún, J

    1999-01-01

    To determine the effect of adherence on the rate of protease inhibitor (PI) treatment failure among human immunodeficiency virus (HIV)-infected patients. A prospective study of a cohort of 282 patients who initiated PI therapy from March 1996 to December 1997. Adherence was quantified as the percentage of prescribed doses reportedly taken and treatment failure was defined as HIV RNA levels above 200 copies/ml after 1 year on therapy. Overall, 190 patients (67%) missed prescribed doses. However, mean percentage of doses taken was 91% (range, 21-100%). Demographic, virological and immunological characteristics could not predict adherence outcomes. The causes of non-adherence included intolerance or side effects (35%), complexity of treatment (23%), or recurrence in active drug abuse (17%), whereas abandonment owing to HIV-related disease was uncommon (6%). A degree of adherence above 90% correlated significantly with viral suppression [relative risk (RR) 1.69; 95% confidence interval (CI) 1.1-2.56; PHIV viral load (RR, 2.03; P=0.0001), prior antiretroviral therapy (RR, 2.5; P=0.01), and use of saquinavir-hard gel capsules (saquinavir-HGC) (RR, 1.77; P=0.03) were strongly associated with treatment failure. The percentage of adherence and initial HIV viral load are the most important determinants of virological response to PI therapy and non-adherence is related to treatment-related factors in the majority of cases.

  3. Gonorrhea Treatment Failures With Oral and Injectable Expanded Spectrum Cephalosporin Monotherapy vs Dual Therapy at 4 Canadian Sexually Transmitted Infection Clinics, 2010-2013.

    Science.gov (United States)

    Singh, Ameeta E; Gratrix, Jennifer; Martin, Irene; Friedman, Dara S; Hoang, Linda; Lester, Richard; Metz, Gila; Ogilvie, Gina; Read, Ron; Wong, Tom

    2015-06-01

    Antimicrobial resistance has developed to all antibiotics used to treat gonorrhea (GC), and trends in GC antimicrobial resistance have prompted changes in treatment guidelines. We examined treatment failures in sexually transmitted infection clinics. Four Canadian sexually transmitted infection clinics reviewed treatment regimens, minimum inhibitory concentrations for cephalosporins and azithromycin, anatomical infection sites, and treatment outcomes for GC infections between January 2010 and September 2013, in individuals who returned for test of cure within 30 days of treatment. Treatment failure was defined as the absence of reported sexual contact during the posttreatment period and (i) positive for Neisseria gonorrhoeae on culture of specimens taken at least 72 hours after treatment or (ii) positive nucleic acid amplification test specimens taken at least 2 to 3 weeks after treatment, and matching sequence type pretreatment and posttreatment. χ Test and Fisher exact test were used to assess association of categorical variables. Of 389 specimens reviewed, GC treatment failures occurred in 13 specimens treated with cefixime 400-mg single dose (17.8% treatment failure rate regardless of anatomical site) and in 1 oropharyngeal specimen treated with cefixime 800-mg single dose. No treatment failures occurred using either ceftriaxone monotherapy or cefixime/ceftriaxone combined with azithromycin or doxycycline. In contrast to oral cefixime monotherapy, no treatment failures were identified with injectable ceftriaxone monotherapy or combination GC treatment. Our data support the use of combination treatment of GC with an extended spectrum cephalosporin (including oral cefixime) with azithromycin or doxycycline as well as ceftriaxone monotherapy.

  4. What is the optimal place for heart failure treatment and care: home or hospital?

    Science.gov (United States)

    Stewart, Simon

    2013-09-01

    This article examines the role of home versus hospital clinic-based management of heart failure to achieve the best outcomes for affected individuals and their carer/families. It also considers the role of remote management strategies. Overall, the evidence in favor of home-based strategies is quite compelling. However, persistently high levels of heart-failure-related morbidity and mortality, combined with inconsistent application of key components of care, mandate greater efforts to develop more standardized and cost-effective forms of heart failure support services.

  5. The frequency of anti-infliximab antibodies in patients with rheumatoid arthritis treated in routine care and the associations with adverse drug reactions and treatment failure

    DEFF Research Database (Denmark)

    Krintel, Sophine B; Grunert, Veit Peter; Hetland, Merete L

    2013-01-01

    To investigate the frequency of anti-infliximab antibodies in patients with RA and the associations with adverse drug reactions and treatment failure.......To investigate the frequency of anti-infliximab antibodies in patients with RA and the associations with adverse drug reactions and treatment failure....

  6. Cardiac structure and function in heart failure with preserved ejection fraction: baseline findings from the echocardiographic study of the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist trial

    National Research Council Canada - National Science Library

    Shah, Amil M; Shah, Sanjiv J; Anand, Inder S; Sweitzer, Nancy K; O'Meara, Eileen; Heitner, John F; Sopko, George; Li, Guichu; Assmann, Susan F; McKinlay, Sonja M; Pitt, Bertram; Pfeffer, Marc A; Solomon, Scott D

    2014-01-01

    .... Echocardiograms were obtained from 935 patients with HFpEF (left ventricular ejection fraction ≥45%) enrolled in the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist...

  7. [Analysis of the treatment failures for intertrochanteric fractures with dynamic hip screw (DHS)].

    Science.gov (United States)

    Zhou, Zhong; Xiong, Jin; Jiang, Ning; Xie, Lin; Huang, Hai-Tao; Tao, Yongfei

    2010-05-01

    To analyze the reasons and related factors of failures in the treatment of intertrochanteric fracture with dynamic hip screw (DHS) and to increase the therapeutic level of intertrochanteric fracture. All the 78 cases of intertrochanteric fractures were treated with dynamic hip screws from Dec. 1998 to Dec. 2007 included 42 males and 36 females with an average age of 62 years old ranging from 26 to 85 years. The disease course was from 1 to 49 hours (means 4 hours). According to Evans-Jensen classification of intertrochanteric fracture, 4 cases were type IA, 24 cases were type IB, 13 cases were type IIA, 22 cases were type IIB, 11 cases were type III, 4 cases were type IV. The fracture were fixed with dynamic hip screws following AO operative standard. To analyze the reasons and related factors of the 12 failed cases involving femur head and neck cut-off, tail pin exit, coxa vara, screw loosening, compress screw slip out of the tube, fracture displacement, respectively. All the cases were followed up for 13 months to 7 years with an average of 36 months, 12 cases were failed including 4 cases of femur head and neck cut-off, 1 case of coax vara, 2 cases of compress screw slip out of the plate tube, 2 cases of screws loosening, 2 cases of tail pin displacement 1 case of great trochanter fracture displacement. For intertrochanteric fracture, to interfix with dynamic hip screw is an effective method, the choice of indication, the type of fracture, the bone mineral density and the manipulative technique affect the results.

  8. Pathophysiology, prevention, treatment, and outcomes of intestinal failure-associated liver disease.

    Science.gov (United States)

    Al-Shahwani, Noora H; Sigalet, David L

    2017-04-01

    Intestinal failure-associated liver disease (IFALD) remains a serious problem in the treatment of infants with nutritional problems and short bowel syndrome. A review of the recent literature from 2010 to 2016, concentrating on articles related to the pathophysiology of IFALD and to outcomes of novel nutritional and pharmacological therapies for neonatal cholestasis in the post-surgical neonate. The pathophysiology of IFALD relates to an increase sensitivity of the neonatal liver to cholestasis in the non-fed state; prolonged cholestasis almost inevitably results in liver damage which will progress from fibrosis to cirrhosis. Clinically discerned risk factors include premature birth, inflammation, sepsis, disruption of the enterohepatic circulation by creation of a proximal stoma, and the duration and type of parenteral nutritional support. Within the hepatocyte, the regulatory enzyme farsanoid receptor X (FXR) appears to play a pivotal role in the development of cholestasis. Recent studies have shown that its activity is suppressed by sepsis, and by plant phytosterols found in soy-based lipid preparations. This paradigm is reflected in the emerging consensus for the care of post-surgical neonates, which is based around a multi-disciplinary team approach. Using an algorithm-driven approach, an appropriate balance between caloric support and prevention of IFALD can be achieved. Further prospective studies are required to further refine the optimal sequence of use of these therapies and the long-term effects on neurological development and hepatic function. However, with optimal care, the number of IF patients progressing to end-stage liver disease because of IFALD should be very low.

  9. ACUTE RENAL FAILURE IN THE ELDERLY: PEARLS FOR ITS ASSESSMENT AND TREATMENT

    Directory of Open Access Journals (Sweden)

    Carlos G. Musso

    2005-01-01

    Full Text Available ABSTRACTAcute renal failure (ARF is a frequent disorder in the elderly, and this phenomenon is due to the senescence process, reduced metabolization of drugs, increased exposure to polypharmacy and systemic diseases of the aged group. The following are the main characteristics of the ARF in the elderly: mulfactorial, atypical presentation, tubular frailty, intermediate syndrome pattern, low reliable physical examination and urinary indeces. Profilaxis and rehydration are the best treatments for ARF in the old population. Renal biopsy and dialysis have the same role in young and old people.RESUMEN:INSUFICIENCIA RENAL AGUDA EN EL ANCIANO. CONSIDERACIONES ACERCA DE SU VALORACIÓN Y TRATAMIENTO.La insuficiencia renal aguda (IRA es un trastorno frecuente en los ancianos a raíz de la senescencia renal, la menor metabolización de los fármacos y la mayor exposición a la polifarmacia y enfermedades sistémicas que ellos padecen. Las siguientes son las principales características de la IRA en el anciano: carácter multifactorial, presentación clínica atípica, fragilidad tubular, patrón de síndrome intermedio y poca fiabilidad del examen físico y de los índices urinarios en la interpretación de su etiología. Las medidas de profilaxis y rehidratación siguen siendo los mejores tratamientos de la IRA en el geronte. La biopsia renal y la diálisis tienen el mismo rol tanto en el grupo senil como en el joven.

  10. [Current benefit of biological and non-biological methods in the treatment of acute liver failure].

    Science.gov (United States)

    Ryska, O; Pantoflícek, T; Lásziková, E; Prazák, J; Ryska, M

    2008-06-01

    There was an active interest in development of liver assist device in the last two decades. Using these devices to bridge patients with acute hepatic failure (AHF) to ortotopic liver transplantation (OLTx) or to liver regeneration might decrease the mortality rate. Several liver support systems have been described in different stages of experimental or clinical examination. PubMed (1986-2008) was searched using the keywords "artifitial livers", "liver support", "bioartifitial liver" and "cell transplantation". The own experience presenting by authors are the conclusions of their publications. Biological liver support (BAL) uses hepatocytes can support theoretically both detoxification and biosynthesis. Experimental study confirmed significant decrease in some of AHF metabolites. Nevertheless, randomized study didn't show any improvement in patient's survival. Source of viable hepatocytes and sufficient bioreactor capacity are some of unsolved problems. Nonbiological liver support as a plasma exchange, hemodialysis, hemofiltration, albumin dialysis or adsorbent recycling systems eliminate some of toxins, but other specific liver functions can't replace. MARS and Prometheus devices have been used successfully in treatment of AHF by human. However, the absence of randomized study still lasts. These devices remove some of toxins and cytokines unselectively and are also limited by adsorber capacity. Selective plasma filtration therapy and hybrid liver support systems which combine both of management advances present the possible solution. Authors themselves confirmed by application of both methods a significant decrease of bilirubin level. Intracranial pressure declines only by use of non-biological device - Prometheus. Effective liver assist device that gains a survival approval hasn't been developed till now. In confrontation with other current used cure possibilities, BAL didn't propose the original expectations. On the other hand, the non-biological devices seem to

  11. Background characteristics and treatment-related factors associated with treatment success or failure in a non-pharmacological intervention for dementia caregivers.

    Science.gov (United States)

    Rose, Karen C; Gitlin, Laura N

    2017-06-01

    Non-pharmacological interventions for persons with dementia often rely on family caregivers for implementation. However, caregivers differ in their readiness to use strategies. This study examines dyadic characteristics and treatment-related mechanisms associated with treatment success (high readiness to use strategies) and failure (low readiness to use strategies) at the conclusion of the Advancing Caregiver Training (ACT) intervention. Caregiver and person with dementia characteristics and treatment-related variables (treatment participation, number and type of strategies introduced and enacted) were examined in 110 caregivers in intervention. Interventionists rated readiness (1=precontemplation; 2=contemplation; 3=preparation; 4=action) of caregivers to use strategies at the final ACT session. Univariate analyses examined dyadic characteristics, and Multiple Analysis of Covariance (MANCOVA) and Analyses of Covariance (ANCOVA) examined treatment-related factors associated with readiness to use strategies at treatment completion. At treatment completion, 28.2% (N=31) scored in pre-action and 71.8% (N=79) at action. Caregivers at pre-action readiness levels were more likely than those at action to be a spouse, report greater financial difficulties and be managing fewer problem behaviors. Although both groups were introduced an equivalent number of non-pharmacological strategies, caregivers at pre-action were less likely than those at action to report enacting strategies. Certain dyadic characteristics and treatment-related factors were associated with treatment failure including financial strain and lack of strategy integration. Findings suggest that developing intervention components to address financial concerns and increase opportunities for practicing strategies and then using them between treatment sessions may be important for caregivers at risk of treatment failure.

  12. Capacity for diagnosis and treatment of heart failure in sub-Saharan Africa.

    Science.gov (United States)

    Carlson, Selma; Duber, Herbert C; Achan, Jane; Ikilezi, Gloria; Mokdad, Ali H; Stergachis, Andy; Wollum, Alexandra; Bukhman, Gene; Roth, Gregory A

    2017-12-01

    Heart failure is a major cause of disease burden in sub-Saharan Africa (SSA). There is an urgent need for better strategies for heart failure management in this region. However, there is little information on the capacity to diagnose and treat heart failure in SSA. We aim to provide a better understanding of the capacity to diagnose and treat heart failure in Kenya and Uganda to inform policy planning and interventions. We analysed data from a nationally representative survey of health facilities in Kenya and Uganda (197 health facilities in Uganda and 143 in Kenya). We report on the availability of cardiac diagnostic technologies and select medications for heart failure (β-blockers, ACE inhibitors and furosemide). Facility-level data were analysed by country and platform type (hospital vs ambulatory facilities). Functional and staffed radiography, ultrasound and ECG were available in less than half of hospitals in Kenya and Uganda combined. Of the hospitals surveyed, 49% of Kenyan and 77% of Ugandan hospitals reported availability of the heart failure medication package. ACE inhibitors were only available in 51% of Kenyan and 79% of Ugandan hospitals. Almost one-third of the hospitals in each country had a stock-out of at least one of the medication classes in the prior quarter. Few facilities in Kenya and Uganda were prepared to diagnose and manage heart failure. Medication shortages and stock-outs were common. Our findings call for increased investment in cardiac care to reduce the growing burden of heart failure. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  13. Drug treatment effects on outcomes in heart failure with preserved ejection fraction: a systematic review and meta-analysis.

    Science.gov (United States)

    Zheng, Sean Lee; Chan, Fiona T; Nabeebaccus, Adam A; Shah, Ajay M; McDonagh, Theresa; Okonko, Darlington O; Ayis, Salma

    2018-03-01

    Clinical drug trials in patients with heart failure and preserved ejection fraction have failed to demonstrate improvements in mortality. We systematically searched Medline, Embase and the Cochrane Central Register of Controlled Trials for randomised controlled trials (RCT) assessing pharmacological treatments in patients with heart failure with left ventricular (LV) ejection fraction≥40% from January 1996 to May 2016. The primary efficacy outcome was all-cause mortality. Secondary outcomes were cardiovascular mortality, heart failure hospitalisation, exercise capacity (6-min walk distance, exercise duration, VO 2 max), quality of life and biomarkers (B-type natriuretic peptide, N-terminal pro-B-type natriuretic peptide). Random-effects models were used to estimate pooled relative risks (RR) for the binary outcomes, and weighted mean differences for continuous outcomes, with 95% CI. We included data from 25 RCTs comprising data for 18101 patients. All-cause mortality was reduced with beta-blocker therapy compared with placebo (RR: 0.78, 95%CI 0.65 to 0.94, p=0.008). There was no effect seen with ACE inhibitors, aldosterone receptor blockers, mineralocorticoid receptor antagonists and other drug classes, compared with placebo. Similar results were observed for cardiovascular mortality. No single drug class reduced heart failure hospitalisation compared with placebo. The efficacy of treatments in patients with heart failure and an LV ejection fraction≥40% differ depending on the type of therapy, with beta-blockers demonstrating reductions in all-cause and cardiovascular mortality. Further trials are warranted to confirm treatment effects of beta-blockers in this patient group. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  14. Characteristics, Treatments, and Outcomes of Hospitalized Heart Failure Patients Stratified by Etiologies of Cardiomyopathy.

    Science.gov (United States)

    Shore, Supriya; Grau-Sepulveda, Maria V; Bhatt, Deepak L; Heidenreich, Paul A; Eapen, Zubin J; Hernandez, Adrian F; Yancy, Clyde W; Fonarow, Gregg C

    2015-11-01

    The authors sought to describe characteristics, treatments, and in-hospital outcomes of hospitalized heart failure (HF) patients stratified by etiology. Whether characteristics and outcomes of HF patients differ by cardiomyopathy etiology is unknown. The authors analyzed data on 156,013 hospitalized HF patients from 319 U.S. hospitals participating in Get With The Guidelines-HF between 2005 and 2013. Characteristics, treatments, and in-hospital outcomes were assessed by HF etiology. Standard regression techniques adjusted for site and patient-level characteristics were used to examine association between HF etiology and in-hospital outcomes. Median age was 75 years, 69.2% were white, and 49.5% were women. Overall, 92,361 patients (59.2%) had ischemic cardiomyopathy and 63,652 patients (40.8%) had nonischemic cardiomyopathy (NICM). Hypertensive (n = 28,141; 48.5%) and idiopathic (n = 17,808; 30.7%) cardiomyopathies accounted for the vast majority of NICM patients. Post-partum (n = 209; 0.4%), viral (n = 447; 0.8%), chemotherapy (n = 721; 1.2%), substance abuse (n = 2,653; 4.6%), familial (n = 556; 1.0%), and other (n = 7,523; 13.0%) etiologies were far less frequent. There were significant differences in baseline characteristics between those with ischemic cardiomyopathy compared with NICM with respect to age (76 years vs. 72 years), sex (44.4% vs. 56.9% women), and ejection fraction (38% vs. 45%). Risk-adjusted quality of care provided to eligible patients varied minimally by etiology. Similarly, in-hospital mortality did not differ among ischemic compared with NICM patients. However, among NICM patients, only hypertensive cardiomyopathy had a lower mortality rate compared with idiopathic NICM (adjusted odds ratio: 0.83; 95% confidence interval: 0.71 to 0.97). Characteristics of hospitalized HF patients vary by etiology. Both risk-adjusted quality of care and in-hospital outcomes did not differ by etiology. Copyright © 2015 American College of Cardiology

  15. Adverse events and treatment failure leading to discontinuation of recently approved antipsychotic drugs in schizophrenia: A network meta-analysis.

    Science.gov (United States)

    Tonin, Fernanda S; Piazza, Thais; Wiens, Astrid; Fernandez-Llimos, Fernando; Pontarolo, Roberto

    2015-12-01

    Objective:We aimed to gather evidence of the discontinuation rates owing to adverse events or treatment failure for four recently approved antipsychotics (asenapine, blonanserin, iloperidone, and lurasidone).Methods: A systematic review followed by pairwise meta-analysis and mixed treatment comparison meta analysis(MTC) was performed, including randomized controlled trials (RCTs) that compared the use of the above-mentioned drugs versus placebo in patients with schizophrenia. An electronic search was conducted in PubMed, Scopus, Science Direct, Scielo, the Cochrane Library, and International Pharmaceutical Abstracts(January 2015). The included trials were at least single blinded. The main outcome measures extracted were discontinuation owing to adverse events and discontinuation owing to treatment failure.Results: Fifteen RCTs were identified (n = 5400 participants) and 13 of them were amenable for use in our meta-analyses. No significant differences were observed between any of the four drugs and placebo as regards discontinuation owing to adverse events, whether in pairwise meta-analysis or in MTC. All drugs presented a better profile than placebo on discontinuation owing to treatment failure, both in pairwise meta-analysis and MTC. Asenapine was found to be the best therapy in terms of tolerability owing to failure,while lurasidone was the worst treatment in terms of adverse events. The evidence around blonanserin is weak.Conclusion: MTCs allowed the creation of two different rank orders of these four antipsychotic drugs in two outcome measures. This evidence-generating method allows direct and indirect comparisons, supporting approval and pricing decisions when lacking sufficient, direct, head-to-head trials.

  16. Application of mobile blood purification system in the treatment of acute renal failure dog model in the field environment

    Directory of Open Access Journals (Sweden)

    Zhi-min ZHANG

    2014-01-01

    Full Text Available Objective To evaluate the stability, safety and efficacy of mobile blood purification system in the treatment of acute renal failure dog model in the field environment. Methods The acute renal failure model was established in 4 dogs by bilateral nephrectomy, which was thereafter treated with the mobile blood purification system. The evaluation of functional index of the mobile blood purification system was performed after a short-time (2 hours and conventional (4 hours dialysis treatment. Results The mobile blood purification system ran stably in the field environment at a blood flow of 150-180ml/min, a dialysate velocity of 2000ml/h, a replacement fluid velocity of 2000ml/h, and ultrafiltration rate of 100-200ml/h. All the functions of alarming system worked well, including static upper limit alarm of ultrafiltration pressure (>100 mmHg, upper limit alarm of ambulatory arterial pressure (>400mmHg, upper limit alarm of ambulatory venous pressure (>400mmHg, bubble alarm of vascular access, bubble alarm during the infusion of solutions, pressure alarm at the substitution pump segment and blood leaking alarm. The vital signs of the 4 dogs with acute renal failure kept stable during the treatment. After the treatment, a remarkable decrease was seen in the levels of serum urea nitrogen, creatinine and serum potassium (P0.05. Conclusions The mobile blood purification system runs normally even in a field environment. It is a flexible and portable device with a great performance in safety and stability in the treatment of acute renal failure. DOI: 10.11855/j.issn.0577-7402.2013.12.15

  17. Are you experienced?

    DEFF Research Database (Denmark)

    Dahl, Michael Slavensky; Reichstein, Toke

    . We also find that spin-offs from parent companies that exit are less likely to survive than either spin-offs from surviving parents or other start-ups. These findings support the theoretical arguments that organizational heritage is important for the survival of new organizations. We found no similar...... ranked members of start-ups prior to their founding, and follow the fate of these firms. More specifically, we compare the survival of spin-offs from surviving parents, spin-offs from exiting parents, and other start-ups. Moreover, we investigate whether firms managed and founded by more experienced...... teams with higher levels of industry-specific experience are more likely to survive. Distinguishing between survivors and firms that have been acquired, we find that spin-offs from a surviving parent company combined with and industry-specific experience, positively affects the likelihood of survival...

  18. Prehospital treatment with continuous positive airway pressure in patients with acute respiratory failure: a regional observational study.

    Science.gov (United States)

    Nielsen, Vibe Maria Laden; Madsen, Jacob; Aasen, Anette; Toft-Petersen, Anne Pernille; Lübcke, Kenneth; Rasmussen, Bodil Steen; Christensen, Erika Frischknecht

    2016-10-10

    Patients with acute respiratory failure are at risk of deterioration during prehospital transport. Ventilatory support with continuous positive airway pressure (CPAP) can be initiated in the prehospital setting. The objective of the study is to evaluate adherence to treatment and effectiveness of CPAP as an addition to standard care. In North Denmark Region, patients with acute respiratory failure, whom paramedics assessed as suffering from acute cardiopulmonary oedema, acute exacerbation of chronic obstructive pulmonary disease or asthma were treated with CPAP using 100 % O2 from 1 March 2014 to 3 May 2015. Adherence to treatment was evaluated by number of adverse events and discontinuation of treatment. Intensive care admissions and mortality were reported in this cohort. Effectiveness was evaluated by changes in peripheral oxygen saturation (SpO2) and respiratory rate during transport and compared to a historical control (non-CPAP) group treated with standard care only. Values were compared by hypothesis testing and linear modelling of SpO2 on arrival at scene and ΔSpO2 stratified according to treatment group. In fourteen months, 171 patients were treated with CPAP (mean treatment time 35 ± 18 min). Adverse events were reported in 15 patients (9 %), hereof six discontinued CPAP due to hypotension, nausea or worsening dyspnoea. One serious adverse event was reported, a suspected pneumothorax treated adequately by an anaesthesiologist called from a mobile emergency care unit. Among CPAP patients, 45 (27 %) were admitted to an intensive care unit and 24 (14 %) died before hospital discharge. The non-CPAP group consisted of 739 patients. From arrival at scene to arrival at hospital, CPAP patients had a larger increase in SpO2 than non-CPAP patients (87 to 96 % versus 92 to 96 %, p backup, adherence to CPAP treatment administered by paramedics was high and treatment was effective in patients with acute respiratory failure.

  19. The use of lisuride in the treatment of multiple system atrophy with autonomic failure (Shy-Drager syndrome).

    OpenAIRE

    Lees, A J; Bannister, R

    1981-01-01

    In a controlled trial lisuride, an ergolene derivative with dopamine receptor agonist properties was given maximum tolerated doses (2.4 mg/day) to seven patients with multiple system atrophy with autonomic failure (Shy-Drager syndrome). Improvement in Parkinsonian features occurred in only one patient and another patient who had been deriving marked benefit from levodopa treatment before the study began failed to respond to large doses of lisuride. Psychiatric side effects (including nightmar...

  20. Multicentre analysis of second-line antiretroviral treatment in HIV-infected children: adolescents at high risk of failure

    Directory of Open Access Journals (Sweden)

    Ragna S. Boerma

    2017-01-01

    Conclusions: In LMIC, paediatric PI-based second-line ART was associated with relatively low virologic failure rates. However, adolescents showed exceptionally poor virologic outcomes in LMIC, and optimizing their HIV care requires urgent attention. In addition, 16% of children and adolescents failed PI-based treatment and will require integrase inhibitors to construct salvage regimens. These drugs are currently not available in LMIC.

  1. Nkx2.5 enhances the efficacy of mesenchymal stem cells transplantation in treatment heart failure in rats.

    Science.gov (United States)

    Deng, Bo; Wang, Jin Xin; Hu, Xing Xing; Duan, Peng; Wang, Lin; Li, Yang; Zhu, Qing Lei

    2017-08-01

    The aim of this study is to determine whether Nkx2.5 transfection of transplanted bone marrow mesenchymal stem cells (MSCs) improves the efficacy of treatment of adriamycin-induced heart failure in a rat model. Nkx2.5 was transfected in MSCs by lentiviral vector transduction. The expressions of Nkx2.5 and cardiac specific genes in MSCs and Nkx2.5 transfected mesenchymal stem cells (MSCs-Nkx2.5) were analyzed with quantitative real-time PCR and Western blot in vitro. Heart failure models of rats were induced by adriamycin and were then randomly divided into 3 groups: injected saline, MSCs or MSCs-Nkx2.5 via the femoral vein respectively. Four weeks after injection, the cardiac function, expressions of cardiac specific gene, fibrosis formation and collagen volume fraction in the myocardium as well as the expressions of GATA4 and MEF2 in rats were analyzed with echocardiography, immunohistochemistry, Masson staining, quantitative real-time PCR and Western blot, respectively. Nkx2.5 enhanced cardiac specific gene expressions including α-MHC, TNI, CKMB, connexin-43 in MSCs-Nkx2.5 in vitro. Both MSCs and MSCs-Nkx2.5 improved cardiac function, promoted the differentiation of transplanted MSCs into cardiomyocyte-like cells, decreased fibrosis formation and collagen volume fraction in the myocardium, as well as increased the expressions of GATA4 and MEF2 in adriamycin-induced rat heart failure models. Moreover, the effect was much more remarkable in MSCs-Nkx2.5 than in MSCs group. This study has found that Nkx2.5 enhances the efficacy of MSCs transplantation in treatment adriamycin-induced heart failure in rats. Nkx2.5 transfected to transplanted MSCs provides a potential effective approach to heart failure. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Screening for mutations related to atovaquone/proguanil resistance in treatment failures and other imported isolates of Plasmodium falciparum in Europe

    DEFF Research Database (Denmark)

    Wichmann, Ole; Muehlberger, Nikolai; Jelinek, Tomas

    2004-01-01

    BACKGROUND: Two single-point mutations of the Plasmodium falciparum cytochrome b gene (Tyr268Asn and Tyr268Ser) were recently reported in cases of atovaquone/proguanil (Malarone) treatment failure. However, little is known about the prevalence of codon-268 mutations and their quantitative...... association with treatment failure. METHODS: We set out to assess the prevalence of codon-268 mutations in P. falciparum isolates imported into Europe and to quantify their association with atovaquone/proguanil treatment failure. Isolates of P. falciparum collected by the European Network on Imported...... failure but in 0 of 53 successfully treated patients. CONCLUSIONS: Tyr268Ser seems to be a sufficient, but not a necessary, cause for atovaquone/proguanil treatment failure. The prevalence of both codon-268 mutations is currently unlikely to be >1% in the European patient pool....

  3. Factors associated with the failure of arthroscopic surgery treatment in patients with femoroacetabular impingement: A cohort study.

    Science.gov (United States)

    Martínez, D; Gómez-Hoyos, J; Márquez, W; Gallo, J

    2015-01-01

    The aim of this study was to evaluate the association of the anatomical and functional characteristics with therapeutic failure in patients with femoroacetabular impingement, who underwent hip arthroscopy. A cohort study was performed on 179 patients with femoroacetabular impingement who underwent hip arthroscopy between 2004 and 2012. The demographic, anatomical, functional, and clinical information were recorded. A logistic regression model and ANCOVA were used in order to compare the described characteristics with the treatment outcomes of the hip arthroscopy. The median time of follow-up for symptoms was 13 months (8-30), and the mean time of follow-up after surgery was 23.83 ± 9.8 months. At the end of the follow-up 3.91% of the patients were considered as a therapeutic failure. The WOMAC score in pain and functional branches, as well as the total WOMAC score, showed significant differences (P<.05). The mean WOMAC score was higher (0 to 100 with 0 being a perfect score) in the group of patients who failed after surgery as compared with the group who meet the requirements for a successful treatment, 65.9 vs 48.8, respectively (mean difference 17.0; 95% CI; 1.3-32.6; P=.033). The poor functional state prior to arthroscopic treatment of femoroacetabular impingement, mainly due to preoperative pain, assessed using the WOMAC scale, is associated with a higher therapeutic failure rate. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

  4. Risk factors for treatment failure with antiosteoporosis medication: the global longitudinal study of osteoporosis in women (GLOW).

    Science.gov (United States)

    Díez-Pérez, Adolfo; Adachi, Jonathan D; Adami, Silvano; Anderson, Frederick A; Boonen, Steven; Chapurlat, Roland; Compston, Juliet E; Cooper, Cyrus; Gehlbach, Stephen H; Greenspan, Susan L; Hooven, Frederick H; LaCroix, Andrea Z; Nieves, Jeri W; Netelenbos, J Coen; Pfeilschifter, Johannes; Rossini, Maurizio; Roux, Christian; Saag, Kenneth G; Silverman, Stuart; Siris, Ethel S; Wyman, Allison; Rushton-Smith, Sophie K; Watts, Nelson B

    2014-01-01

    Antiosteoporosis medication (AOM) does not abolish fracture risk, and some individuals experience multiple fractures while on treatment. Therefore, criteria for treatment failure have recently been defined. Using data from the Global Longitudinal Study of Osteoporosis in Women (GLOW), we analyzed risk factors for treatment failure, defined as sustaining two or more fractures while on AOM. GLOW is a prospective, observational cohort study of women aged ≥55 years sampled from primary care practices in 10 countries. Self-administered questionnaires collected data on patient characteristics, fracture risk factors, previous fractures, AOM use, and health status. Data were analyzed from women who used the same class of AOM continuously over 3 survey years and had data available on fracture occurrence. Multivariable logistic regression was used to identify independent predictors of treatment failure. Data from 26,918 women were available, of whom 5550 were on AOM. During follow-up, 73 of 5550 women in the AOM group (1.3%) and 123 of 21,368 in the non-AOM group (0.6%) reported occurrence of two or more fractures. The following variables were associated with treatment failure: lower Short Form 36 Health Survey (SF-36) score (physical function and vitality) at baseline, higher Fracture Risk Assessment Tool (FRAX) score, falls in the past 12 months, selected comorbid conditions, prior fracture, current use of glucocorticoids, need of arms to assist to standing, and unexplained weight loss ≥10 lb (≥4.5 kg). Three variables remained predictive of treatment failure after multivariable analysis: worse SF-36 vitality score (odds ratio [OR] per 10-point increase, 0.85; 95% confidence interval [CI], 0.76-0.95; p = 0.004); two or more falls in the past year (OR, 2.40; 95% CI, 1.34-4.29; p = 0.011), and prior fracture (OR, 2.93; 95% CI, 1.81-4.75; p < 0.0001). The C statistic for the model was 0.712. Specific strategies for fracture prevention should therefore be

  5. Spine stereotactic radiosurgery for metastatic sarcoma: patterns of failure and radiation treatment volume considerations.

    Science.gov (United States)

    Bishop, Andrew J; Tao, Randa; Guadagnolo, B Ashleigh; Allen, Pamela K; Rebueno, Neal C; Wang, Xin A; Amini, Behrang; Tatsui, Claudio E; Rhines, Laurence D; Li, Jing; Chang, Eric L; Brown, Paul D; Ghia, Amol J

    2017-09-01

    OBJECTIVE Given the relatively lower radiosensitivity of sarcomas and the locally infiltrative patterns of spread, the authors sought to investigate spine stereotactic radiosurgery (SSRS) outcomes for metastatic sarcomas and to analyze patterns of failure. METHODS The records of 48 patients with 66 sarcoma spinal metastases consecutively treated with SSRS between 2002 and 2013 were reviewed. The Kaplan-Meier method was used to estimate rates of overall survival (OS) and local control (LC). Local recurrences were categorized as occurring infield (within the 95% isodose line [IDL]), marginally (between the 20% and 95% IDLs), or out of field. RESULTS Median follow-up time was 19 months (range 1-121 months), and median age was 53 years (range 17-85 years). The most commonly treated histology was leiomyosarcoma (42%). Approximately two-thirds of the patients were treated with definitive SSRS (44 [67%]) versus postoperatively (22 [33%]). The actuarial 1-year OS and LC rates were 67% and 81%, respectively. Eighteen patients had a local relapse, which was more significantly associated with postoperative SSRS (p = 0.04). On multivariate modeling, receipt of postoperative SSRS neared significance for poorer LC (p = 0.06, subhazard ratio [SHR] 2.33), while only 2 covariates emerged as significantly correlated with LC: 1) biological equivalent dose (BED) > 48 Gy (vs BED ≤ 48 Gy, p = 0.006, SHR 0.21) and 2) single vertebral body involvement (vs multiple bodies, p = 0.03, SHR 0.27). Of the 18 local recurrences, 14 (78%) occurred at the margin, and while the majority of these cases relapsed within the epidural space, 4 relapsed within the paraspinal soft tissue. In addition, 1 relapse occurred out of field. Finally, the most common acute toxicity was fatigue (15 cases), with few late toxicities (4 insufficiency fractures, 3 neuropathies). CONCLUSIONS For metastatic sarcomas, SSRS provides durable tumor control with minimal toxicity. High-dose single-fraction regimens offer

  6. Long-term compliance with nonpharmacologic treatment of patients with heart failure.

    Science.gov (United States)

    Nieuwenhuis, Maurice M W; Jaarsma, Tiny; van Veldhuisen, Dirk J; Postmus, Douwe; van der Wal, Martje H L

    2012-08-01

    The aim of this study was to examine long-term compliance with nonpharmacologic treatment of patients with heart failure (HF) and its associated variables. Data from 648 hospitalized patients with HF (mean age 69 ± 12 years, 38% women, mean left ventricular ejection fraction 33 ± 14%) were analyzed. Compliance was assessed by means of self-report at baseline and 1, 6, 12, and 18 months after discharge. Patients completed questionnaires on depressive symptoms, HF knowledge, and physical functioning at baseline. Logistic regression analyses were performed to examine independent associations with low long-term compliance. From baseline to 18-month follow-up, long-term compliance with diet and fluid restriction ranged from 77% to 91% and from 72% to 89%, respectively. In contrast, compliance with daily weighing (34% to 85%) and exercise (48% to 64%) was lower. Patients who were in New York Heart Association functional class II were more often noncompliant with fluid restriction (odds ratio [OR] 1.97, 95% confidence interval [CI] 1.25 to 3.08). A lower level of knowledge on HF was independently associated with low compliance with fluid restriction (OR 0.78, 95% CI 0.71 to 0.86) and daily weighing (OR 0.86, 95% CI 0.79 to 0.94). Educational support improved compliance with these recommendations. Female gender (OR 1.91, 95% CI 1.26 to 2.90), left ventricular ejection fraction ≥40% (OR 1.55, 95% CI 1.03 to 2.34), a history of stroke (OR 3.55, 95% CI 1.54 to 8.16), and less physical functioning (OR 0.99, 95% CI 0.98 to 0.99) were associated with low compliance with exercise. In conclusion, long-term compliance with exercise and daily weighing was lower than long-term compliance with advice on diet and fluid restriction. Although knowledge on HF and being offered educational support positively affected compliance with weighing and fluid restriction, these variables were not related to compliance with exercise. Therefore, new approaches to help patients with HF stay

  7. Changes in serum electrolytes during treatment of patients in liver failure with molecular adsorbent recirculating system.

    Science.gov (United States)

    Doria, C; Doyle, H R; Mandalà, L; Marino, I R; Caruana, G; Gruttadauria, S; Lauro, A; Magnone, M; Scotti Foglieni, C; Lamonaca, V; Scott, V L

    2003-10-01

    To study the effect of MARS on serum electrolytes during liver failure. Twenty-three patients admitted to a quaternary health care facility from September 2000 to May 2002, 22 adults and 1 child, 11 males (48%) and 12 females (52%), age 15-70 (median 53), treated with MARS for: 12 acute-on-chronic liver failure (52%); 4 fulminant hepatic failure (17%); 3 intractable pruritus (13%); 2 primary-non-function (9%); 2 following major liver resection (9%). Sodium, potassium, chloride, phosphorus, calcium, and magnesium were measured in the serum, ultrafiltrate and albumin circuit before and after MARS. A comparison of electrolyte concentrations, before and after MARS, was performed using a paired t test. Serum electrolyte concentrations before and after MARS, while statistically significant in some cases, were very small, and of no clinical relevance. MARS exchanges potassium, chloride, calcium, and magnesium by ultrafiltration; sodium by the albumin dialysis.

  8. Coenzyme Q10 - A new player in the treatment of heart failure?

    Science.gov (United States)

    Jankowski, Jerzy; Korzeniowska, Katarzyna; Cieślewicz, Artur; Jabłecka, Anna

    2016-10-01

    Coenzyme Q10 is the only endogenously synthesized lipid with a redox function which exhibits broad tissue and intracellular distribution in mammals. Beneficial effects of Coenzyme Q10 supplementation were observed in several age-related diseases including heart failure. CoQ10 (coenzyme Q10) level is significantly decreased in patients with this disease, which correlates with severity of clinical symptoms. Supplementation with various pharmaceutical formulations of CoQ10 improves impaired cardiac function and clinical course of heart failure. Current data from clinical trials indicate that CoQ10 can significantly reduce morbidity and mortality of heart failure patients in addition to guideline recommended pharmacotherapy. Copyright © 2016. Published by Elsevier Urban & Partner Sp. z o.o.

  9. Intensity-modulated radiotherapy in the treatment of oropharyngeal cancer: clinical outcomes and patterns of failure.

    Science.gov (United States)

    Daly, Megan E; Le, Quynh-Thu; Maxim, Peter G; Loo, Billy W; Kaplan, Michael J; Fischbein, Nancy J; Pinto, Harlan; Chang, Daniel T

    2010-04-01

    To report outcomes, failures, and toxicities in patients treated with intensity-modulated radiotherapy (IMRT) for squamous cell carcinoma of the oropharynx. Between Aug 2001 and Oct 2007, 107 patients were treated with IMRT with curative intent at Stanford University. Twenty-two patients were treated postoperatively, and 85 were treated definitively. Concurrent platinum-based chemotherapy was administered to 86 patients (80%) and cetuximab to 8 patients (7%). The prescribed dose was 66 Gy at 2.2 Gy/fraction for definitively treated cases and 60 Gy at 2 Gy/fraction for postoperative cases. Median follow-up was 29 months among surviving patients (range, 4-105 months). Eight patients had persistent disease or local-regional failure at a median of 6.5 months (range, 0-9.9 months). Six local failures occurred entirely within the high-risk clinical target volume (CTV) (one with simultaneous distant metastasis). One patient relapsed within the high- and intermediate-risk CTV. One patient had a recurrence at the junction between the IMRT and low-neck fields. Seven patients developed distant metastasis as the first site of failure. The 3-year local-regional control (LRC), freedom from distant metastasis, overall survival, and disease-free survival rates were 92%, 92%, 83%, and 81%, respectively. T stage (T4 vs. T1-T3) was predictive of poorer LRC (p = 0.001), overall survival (p = 0.001), and disease-free survival (p or=3 late complications. IMRT provides excellent LRC for oropharyngeal squamous cell carcinoma. Distant metastases are a major failure pattern. No marginal failures were observed.

  10. Bone marrow-derived mesenchymal stromal cell treatment in patients with severe ischaemic heart failure

    DEFF Research Database (Denmark)

    Mathiasen, Anders Bruun; Qayyum, Abbas Ali; Jørgensen, Erik

    2015-01-01

    ischaemic heart failure. METHODS AND RESULTS: The MSC-HF trial is a randomized, double-blind, placebo-controlled trial. Patients were randomized 2 : 1 to intra-myocardial injections of MSC or placebo, respectively. The primary endpoint was change in left ventricular end-systolic volume (LVESV), measured...... by magnetic resonance imaging or computed tomography at 6 months follow-up. Sixty patients aged 30-80 years with severe ischaemic heart failure, New York Heart Association (NYHA) classes II-III, left ventricular ejection fraction (LVEF)

  11. Diagnosis and treatment of melamine-associated urinary calculus complicated with acute renal failure in infants and young children.

    Science.gov (United States)

    Sun, Ning; Shen, Ying; Sun, Qiang; Li, Xu-ran; Jia, Li-qun; Zhang, Gui-ju; Zhang, Wei-ping; Chen, Zhi; Fan, Jian-feng; Jiang, Ye-ping; Feng, Dong-chuan; Zhang, Rui-feng; Zhu, Xiao-yu; Xiao, Hong-zhan

    2009-02-05

    Infants in some areas of China developed urinary lithiasis after being fed with powdered milk that was tainted with melamine in 2008 and very small proportion of the infants developed acute renal failure caused by urinary tract calculus obstruction. The aim of this article was to summarize clinical characteristics, diagnosis and treatment of infants with urinary calculus and acute renal failure developed after being fed with melamine tainted formula milk. Data of infant patients with urinary calculus and acute renal failure due to melamine tainted formula milk admitted to the Beijing Children's Hospital Affiliated to the Capital Medical University and the Xuzhou Children's Hospital in 2008 were used to analyze the epidemiological characteristics, clinical manifestations, imaging features as well as effects of 4 types of therapies. All the 34 infants with urinary calculus were complicated with acute renal failure, their blood urea nitrogen (BUN) was (24.1+/-8.2) mmol/L and creatinine (Cr) was (384.2+/-201.2) micromol/L. The chemical analysis on the urinary calculus sampled from 15 of the infants showed that the calculus contained melamine and acidum uricum. The time needed for the four types of therapies for returning Cr to normal was (3.5+/-1.9) days for cystoscopy group, (2.7+/-1.1) days for lithotomy group, (3.8+/-2.3) days for dialysis group, and (2.7+/-1.6) days for medical treatment group, which had no statistically significant difference (P=0.508). Renal failure of all the 34 infants was relieved within 1 to 7 days, averaging (3.00+/-1.78) days. Melamine tainted formula milk may cause urinary calculus and obstructive acute renal failure. It is suggested that firstly the patients with urinary calculus complicated with acute renal failure should be treated with dialysis or medication to correct electrolyte disturbance, in particular hyperkalemia, and then relieve the obstruction with available medical and surgical methods as soon as possible. It was observed

  12. Impact of treatment on myocardial lysyl oxidase expression and collagen cross-linking in patients with heart failure.

    Science.gov (United States)

    López, Begoña; Querejeta, Ramón; González, Arantxa; Beaumont, Javier; Larman, Mariano; Díez, Javier

    2009-02-01

    The aim of this study was to investigate whether torasemide modifies collagen cross-linking in the failing human heart. We analyzed the degree of cross-linking and the expression of the enzyme lysyl oxidase, which regulates cross-linking, in the myocardium of patients with chronic heart failure at baseline and after 8 months of treatment with either torasemide or furosemide in addition to their standard heart failure therapy. Whereas lysyl oxidase protein expression was very scarce in normal hearts, it was highly expressed in failing hearts. Cross-linking was increased (Pcross-linking (r=0.661; Pcross-linking correlated with left ventricular chamber stiffness (r=0.452; P=0.002) in all patients. These findings show for the first time that lysyl oxidase overexpression is associated with enhanced collagen cross-linking in the failing human heart. In addition, we report that the ability of torasemide to correct both lysyl oxidase overexpression and enhanced collagen cross-linking results in normalization of left ventricular chamber stiffness in patients with heart failure. Lysyl oxidase may thus represent a target for reduction of stiff collagen and improvement of left ventricular mechanical properties in heart failure patients.

  13. The impact of initial antibiotic treatment failure: Real-world insights in patients with complicated urinary tract infection.

    Science.gov (United States)

    Karve, Sudeep; Ryan, Kellie; Peeters, Pascale; Baelen, Elisa; Rojas-Farreras, Sonia; Potter, Danielle; Rodríguez-Baño, Jesús

    2018-02-01

    RECOMMEND (NCT02364284; D4280R00005) assessed treatment patterns and outcomes associated with initial antibiotic therapy (IAT; antibiotics received infections across five countries. Data from medical records of hospitalized patients aged ≥18 years with healthcare-associated complicated urinary tract infections (cUTI) are presented. Univariate and multivariate logistic regression analyses identified potential risk factors associated with IAT failure. Mean (SD) age was 68.7 (17.4) years (n = 408). In patients with microbiological documentation (357/408), Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa were most common (47.1%, 21.6% and 11.8%, respectively); 46.1% of patients had a multidrug resistant (MDR) pathogen isolated. Most patients received monotherapy IAT (72.5%). Mean IAT duration was 7.8 days. IAT failure, in-hospital mortality, and mortality 30-day post-discharge were 54.4%, 35.0% and 37.3%, respectively. IAT failure was associated with age, Deyo-Charlson comorbidity score, country, MDR status and ICU admission in the univariate analysis; and country and age in the multivariate analysis. This study provides real-world insights into the high rates of IAT failure and morbidity observed in patients with cUTI. Further study is imperative to understand the epidemiology of cUTI, support appropriate IAT selection and management, and reduce the burden of this disease. Copyright © 2017 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

  14. The relevance of comorbidities for heart failure treatment in primary care : A European survey

    NARCIS (Netherlands)

    Sturm, HB; Haaijer-Ruskamp, FM; Veeger, NJ; Balje-Volkers, CP; Swedberg, K; van Gilst, WH

    Aim: To assess the impact of comorbidities on chronic heart failure (CHF) therapy. Methods: The IMPROVEMENT-HF survey included 11,062 patients from 100 primary care practices in 14 European countries. The influence of patient characteristics on drug regimes was assessed with multinomial logistical

  15. Current Evidence on Treatment of Patients With Chronic Systolic Heart Failure and Renal Insufficiency

    NARCIS (Netherlands)

    Damman, Kevin; Tang, W. H. Wilson; Felker, G. Michael; Lassus, Johan; Zannad, Faiez; Krum, Henry; McMurray, John J. V.

    2014-01-01

    Chronic kidney disease (CKD) is increasingly prevalent in patients with chronic systolic heart failure. Therefore, evidence-based therapies are more and more being used in patients with some degree of renal dysfunction. However, most pivotal randomized clinical trials specifically excluded patients

  16. Fulminate Hepatic Failure in a 5 Year Old Female after Inappropriate Acetaminophen Treatment

    Directory of Open Access Journals (Sweden)

    Irena Kasmi

    2015-09-01

    CONCLUSION: Healthcare providers should considered probable acetaminophen toxicity in any child who has received the drug and presented with liver failure. When there is a high index of suspicion of acetaminophen toxicity NAC should be initiated and continued until there are no signs of hepatic dysfunction.

  17. Statins in the treatment of chronic heart failure: A systematic review

    NARCIS (Netherlands)

    Harst, van der Pim; Voors, Adriaan; van Gilst, W.H.; Bohm, M.; Van Veldhuisen, D.J.

    Background The efficacy of statin therapy in patients with established chronic heart failure (CHF) is a subject of much debate. Methods and Findings We conducted three systematic literature searches to assess the evidence supporting the prescription of statins in CHF. First, we investigated the

  18. Treatment of acute liver failure in pigs reduces hepatocyte function in a bioartificial liver support system

    NARCIS (Netherlands)

    Abrahamse, S. L.; van de Kerkhove, M. P.; Sosef, M. N.; Hartman, R.; Chamuleau, R. A. F. M.; van Gulik, T. M.

    2002-01-01

    Several different types of bioartificial liver (BAL) support systems have been developed to bridge patients suffering from acute liver failure (ALF) to transplantation or liver regeneration. In this study we assessed the effects of ALF plasma on hepatocyte function in the BAL system that has been

  19. Risk factors for treatment failure after allogeneic transplantation of patients with CLL

    DEFF Research Database (Denmark)

    Schetelig, J; de Wreede, L C; van Gelder, M

    2017-01-01

    For young patients with high-risk CLL, BTK-/PI3K-inhibitors or allogeneic stem cell transplantation (alloHCT) are considered. Patients with a low risk of non-relapse mortality (NRM) but a high risk of failure of targeted therapy may benefit most from alloHCT. We performed Cox regression analyses ...

  20. Heart failure: optimizing early detection and subsequent drug treatment in older people

    NARCIS (Netherlands)

    Riet, E.E.S. van

    2016-01-01

    Heart failure (HF) is a progressive syndrome mainly and often encountered in older people, and has been called ‘the cardiovascular epidemic of the 21st century’. With extrapolation of the results of our literature review about the prevalence of HF in the older population at large, we even think the

  1. Predictors of teriparatide treatment failure in patients with low bone mass

    Directory of Open Access Journals (Sweden)

    Tarig Elraiyah

    2016-06-01

    Conclusion: These data suggest that prior bisphosphonate or vitamin D exposure may predict response failure to teriparatide therapy. Although these findings may, in part, reflect increased severity or longer duration of disease, this knowledge should help guide clinicians and patients when therapy choices are made.

  2. Awareness of cancer screening during treatment of patients with renal failure: a physician survey in Turkey.

    Science.gov (United States)

    Uysal-Sonmez, Ozlem; Tanriverdi, Ozgur; Uyeturk, Ummugul; Budakoglu, Isil Irem; Kazancioglu, Rumeyza; Turker, Ibrahim; Budakoglu, Burcin; Yalcintas-Arslan, Ulku; Oksuzoglu, Berna

    2014-01-01

    Today, survival rate of patients with chronic renal failure/hemodialysis has increased so that chronic illnesses are more likely to occur. Cancer is the main cause of morbidity and mortality in such patients. In this study, physician attitudes were examined about cancer screening in patients with renal failure. This study was done by face to face questionnaire in the 27th National Nephrology Congress to determine if the physicians dealing with chronic renal failure, hemodialysis or renal transplanted patients, recommend cancer screening or not and the methods of screening for cervix, prostate, breast and colon cancer. One hundred and fifty six physicians were included in the survey. A total of 105 (67%) participants were male and the age of responders was 48 ± 9 years. About 29% were specialists in nephrology, 28% internal medicine, and 5% were other areas of expertise. Some 48% of participants were hemodialysis certified general practitioners. Patients were grouped as compensated chronic renal failure, hemodialysis or renal transplanted. Of the 156 responders, 128 (82%) physicians recommended breast cancer screening and the most recommended subgroup was hemodialysis patients (15%). The most preferred methods of screening were combinations of mammography, self breast examination and physician breast examination. 112 (72%) physicians recommended cervix cancer screening, and the most preferred method of screening was pap-smear. Colon cancer screening was recommended by 102 (65%) physicians and prostate screening by 109 (70%) physicians. The most preferred methods of screening were fecal occult blood test and PSA plus rectal digital test, respectively. It is not obvious whether cancer screening in renal failure patients is different from the rest of society. There is a variety of screening methods. An answer can be found to these questions as a result of studies by a common follow-up protocol and cooperation of nephrologists and oncologists.

  3. Comparison of High Frequency Positive Pressure Mechanical Ventilation (HFPPV) With Conventional Method in the Treatment of Neonatal Respiratory Failure

    Science.gov (United States)

    Amini, Elahe; Nayeri, Fatemeh Sadat; Hemati, Arezu; Esmaeilinia, Tahere; Nili, Firuzeh; Dalili, Hossein; Aminnejad, Majid

    2013-01-01

    Background Respiratory failure is a major problem in neonatal medicine in all over the world and has different causes. Using mechanical ventilation is one of its major treatments. Objectives Different strategies have been expressed in this context, including high frequency mechanical ventilation. Patients and Methods This study is a prospective randomized clinical trial conducted on all newborns with respiratory failure hospitalized in the NICU of Tehran vali-asr Hospital during 2009.These patients were divided in to two groups through block Randomization method; conventional mechanical ventilation group and high frequency ventilation group. Results Intraventricular hemorrhage (IVH) and air leak (e.g. pneumothorax) were less in HFPPV group than conventional group (P = 0.012 and P = 0.038). The mean time needed for mechanical ventilation was lower in HFPPV group, but this difference was not statistically significant (P = 0.922). Needing to O2 in 28 days of age was almost equal in both groups (P = 0. 99). Mortality, and refractory hypoxia and PVL were lower in HFPPV group, but the difference was not statistically significant (P = 0.301, P = 0. 508, P = 0. 113). Conclusions Treatment of neonatal respiratory failure with high rate mechanical ventilation may reduce some complications. PMID:23983995

  4. Preliminary investigation of hybrid bioartificial liver support system in treatment of HBV-related acute-on-chronic liver failure

    Directory of Open Access Journals (Sweden)

    YOU Shaoli

    2013-09-01

    Full Text Available ObjectiveTo construct a hybrid bioartificial liver support system and to investigate its safety and efficacy in patients with hepatitis B virus (HBV-related acute-on-chronic liver failure (ACLF. MethodsA hollow fiber bioreactor was constructed using cultured HepG2 cells transfected with human augmenter of liver regeneration gene. Patients with HBV-related ACLF who were hospitalized in our hospital from May 2009 to August 2011 were randomly divided into treatment group (n=10 and control group (n=10. The treatment group was treated using the hybrid bioartificial liver support system, while the control group was treated with conventional plasma exchange. Comparison of means between the two groups was made by independent-samples t test, and comparison of variables before and after treatment was made by paired t test. ResultsOf the 10 patients in treatment group, 7 had improvement in clinical symptoms and were discharged, 1 died of hepatic encephalopathy, 1 died of hepatorenal syndrome, and 1 died of liver failure after discharge. Of the 10 patients in control group, 5 survived, 1 underwent liver transplantation, and 4 died of liver failure. Before treatment, the treatment group and control group had model for end-stage liver disease (MELD scores of 24.26±2.54 and 24.71±2.79, respectively, without significant difference between the two groups (t=1.971, P=0.064. The treatment group had MELD scores of 21.71±2.92, 22.10±4.46, and 19.90±5.43 after 3 days, 1 week, and 4 weeks, respectively, of treatment. At the end of one-year follow-up, the mean serum alpha-fetoprotein levels were 14.24 ng/ml in treatment group and 11.32 ng/ml in control group, and no space-occupying lesions in the liver were found through abdominal ultrasound. ConclusionThe constructed hybrid bioartificial liver support system is effective and safe in the treatment of HBV-related ACLF.

  5. Recompensation of Heart and Kidney Function after Treatment with Peritoneal Dialysis in a Case of Congestive Heart Failure

    Directory of Open Access Journals (Sweden)

    Lars P. Kihm

    2011-01-01

    Full Text Available We report the case of a 57-year-old woman suffering from congestive heart failure. Due to refractory congestions despite optimised medical treatment, the patient was listed for heart transplantation and peritoneal dialysis was initiated. Peritoneal dialysis led to a significant weight loss, reduction of hyperhydration and extracellular water obtained by bioimpedance measurement, and a significant improvement in clinical and echocardiographic examination. Furthermore, residual kidney function increased during the long-term followup, and subsequently peritoneal dialysis was ceased. Pulmonary artery pressure and left ventricular ejection fraction remained stable and the patient did well. This case demonstrates the possibility of treating hyperhydration due to congestive heart failure with peritoneal dialysis resulting in recompensation of both heart and kidney functions.

  6. SU-E-T-421: Failure Mode and Effects Analysis (FMEA) of Xoft Electronic Brachytherapy for the Treatment of Superficial Skin Cancers

    Energy Technology Data Exchange (ETDEWEB)

    Hoisak, J; Manger, R; Dragojevic, I [University of California San Diego, La Jolla, CA (United States)

    2015-06-15

    Purpose: To perform a failure mode and effects analysis (FMEA) of the process for treating superficial skin cancers with the Xoft Axxent electronic brachytherapy (eBx) system, given the recent introduction of expanded quality control (QC) initiatives at our institution. Methods: A process map was developed listing all steps in superficial treatments with Xoft eBx, from the initial patient consult to the completion of the treatment course. The process map guided the FMEA to identify the failure modes for each step in the treatment workflow and assign Risk Priority Numbers (RPN), calculated as the product of the failure mode’s probability of occurrence (O), severity (S) and lack of detectability (D). FMEA was done with and without the inclusion of recent QC initiatives such as increased staffing, physics oversight, standardized source calibration, treatment planning and documentation. The failure modes with the highest RPNs were identified and contrasted before and after introduction of the QC initiatives. Results: Based on the FMEA, the failure modes with the highest RPN were related to source calibration, treatment planning, and patient setup/treatment delivery (Fig. 1). The introduction of additional physics oversight, standardized planning and safety initiatives such as checklists and time-outs reduced the RPNs of these failure modes. High-risk failure modes that could be mitigated with improved hardware and software interlocks were identified. Conclusion: The FMEA analysis identified the steps in the treatment process presenting the highest risk. The introduction of enhanced QC initiatives mitigated the risk of some of these failure modes by decreasing their probability of occurrence and increasing their detectability. This analysis demonstrates the importance of well-designed QC policies, procedures and oversight in a Xoft eBx programme for treatment of superficial skin cancers. Unresolved high risk failure modes highlight the need for non-procedural quality

  7. Electrical treatment of atrial arrhythmias in heart failure patients implanted with a dual defibrillator CRT device. Results from the TRADE-HF study.

    Science.gov (United States)

    Botto, Giovanni Luca; Padeletti, Luigi; Covino, Gregorio; Pieragnoli, Paolo; Liccardo, Mattia; Mariconti, Barbara; Favale, Stefano; Molon, Giulio; De Filippo, Paolo; Bolognese, Leonardo; Landolina, Maurizio; Raciti, Giovanni; Boriani, Giuseppe

    2017-06-01

    Ventricular and atrial arrhythmias commonly occur in heart failure patients and are a significant source of symptoms, morbidity and mortality. Some specific generators referred to as dual defibrillators, Dual CRT-Ds, have the ability to treat atrial and ventricular arrhythmias. TRADE-HF is a prospective two-arm randomized study aimed at assessing the benefits of complete automatic management of atrial arrhythmias in patients implanted with a dual CRT-D. Primary objective of the TRADE-HF study was to document reduction of unplanned hospital admission for cardiac reasons or death for cardiovascular causes or progression to permanent AF, by comparing fully-automatic device driven therapy for atrial tachycardia or fibrillation (AT/AF) to an in-hospital approach for treatment of symptomatic AT/AF. Randomized Patients were followed every 6months for 3years to assess the primary objective. Four-hundred-twenty patients have been enrolled in the study. At the end of the study 30 subjects died for cardiovascular causes, 60 had at least one hospitalization for cardiovascular causes and 14 developed permanent AF. Eighty-seven patients experienced a composite event. Hazard Ratio for device-managed automatic therapy arm compared to traditional was 0.987 (95% CI: 0.684-1.503; p=0.951). The primary endpoint analysis resulted in no difference between the device managed and in-hospital treatment arm. The TRADE-HF study failed to demonstrate a reduction in the composite of unplanned hospitalizations for cardiovascular causes or death for cardiovascular causes or progression to permanent AF using automatic atrial therapy compared to a traditional approach including hospitalization for symptomatic episodes and/or in-hospital treatment of AT/AF. Copyright © 2017 Elsevier B.V. All rights reserved.

  8. Clinical Holistic Medicine (Mindful, Short-Term Psychodynamic Psychotherapy Complemented with Bodywork in the Treatment of Experienced Physical Illness and Chronic Pain

    Directory of Open Access Journals (Sweden)

    Søren Ventegodt

    2007-01-01

    Full Text Available We investigated the treatment effect of psychodynamic short-term therapy complemented with bodywork on patients who presented with physical illness at the Research Clinic for Holistic Medicine in Copenhagen. Psychodynamic short-term therapy was complemented with bodywork (Marion Rosen to help patients confront old emotional pain from childhood trauma(s. Patients were measured with a five-item quality of life and health questionnaire (QOL5, a one-item questionnaire of self-assessed quality of life (QOL1, and four questions on self-rated ability to love and to function sexually, socially, and at work (ability to sustain a full-time job. Most of the patients had chronic pain that could not be alleviated with drugs. Results showed that 31 patients with the experience of being severely physically ill (mostly from chronic pain, in spite of having consulted their own general practitioner, entered the study. The holistic approach and body therapy accelerated the therapy dramatically and no significant side effects were detected. After the intervention, 38.7% did not feel ill (1.73 < NNT < 4.58 (p = 0.05. Psychodynamic short-term therapy complemented with bodywork can help patients. When the patients responded to the therapy, the self-assessed mental health, relationship with partner, ability to work, self-assessed quality of life, relationships in general, measured QOL (with the validated questionnaire QOL5, and life's total state (mean of health, QOL and ability were significantly improved, statistically and clinically. Most importantly, all aspects of life were improved simultaneously, due to induction of Antonovsky-salutogenesis. The patients received in average 20 sessions over 14 months at a cost of 1600 EURO. For the treatment responders, the treatment seemingly provided lasting benefits.

  9. Efficacy and safety of darunavir-ritonavir compared with that of lopinavir-ritonavir at 48 weeks in treatment-experienced, HIV-infected patients in TITAN: a randomised controlled phase III trial

    DEFF Research Database (Denmark)

    Madruga, José Valdez; Berger, Daniel; McMurchie, Marilyn

    2007-01-01

    BACKGROUND: The protease inhibitor darunavir has been shown to be efficacious in highly treatment-experienced patients with HIV infection, but needs to be assessed in patients with a broader range of treatment experience. We did a randomised, controlled, phase III trial (TITAN) to compare 48-week...... patients randomised and treated, 187 (31%) were protease inhibitor naive; 476 of 582 (82%) were susceptible to four or more protease inhibitors. At week 48, significantly more darunavir-ritonavir than lopinavir-ritonavir patients had HIV RNA of less than 400 copies per mL (77% [220 of 286] vs 68% [199....... The primary endpoint was non-inferiority (95% CI lower limit for the difference in treatment response -12% or greater) for HIV RNA of less than 400 copies per mL in plasma at week 48 (per-protocol analysis). TITAN (TMC114-C214) is registered with ClinicalTrials.gov, number NCT00110877. FINDINGS: Of 595...

  10. Bio-artificial heart as ultimate treatment of end-stage heart failure.

    Science.gov (United States)

    Smit, Francis E; Dohmen, Pascal M

    2014-10-16

    End-stage heart failure is a major health problem, but implementation of guidelines and optimizing medical therapy for this devastating disease should decrease mortality. If optimal conservative therapy is no longer sufficient, a mechanical support system may be required as final destination therapy or as bridge-to-transplant. Since the first heart transplantation in 1967, this therapy has become the criterion standard for end-stage heart failure, but is limited due to organ shortage. Tissue engineering could help overcome this limitation and provide regeneration, remodeling, and growth potential. This so-called bio-artificial heart would be available, created by a decellularized extracellular matrix and seeded with in vitro proliferated autologous cardiovascular cells. Results of the first experimental studies have been promising, but numerous challenges must be met before this procedure will be available.

  11. Effects of combined exercise training and electromyostimulation treatments in chronic heart failure: A prospective multicentre study.

    Science.gov (United States)

    Iliou, Marie C; Vergès-Patois, Bénédicte; Pavy, Bruno; Charles-Nelson, Anais; Monpère, Catherine; Richard, Rudy; Verdier, Jean C

    2017-08-01

    Background Exercise training as part of a comprehensive cardiac rehabilitation is recommended for patients with cardiac heart failure. It is a valuable method for the improvement of exercise tolerance. Some studies reported a similar improvement with quadricipital electrical myostimulation, but the effect of combined exercise training and electrical myostimulation in cardiac heart failure has not been yet evaluated in a large prospective multicentre study. Purpose The aim of this study was to determine whether the addition of low frequency electrical myostimulation to exercise training may improve exercise capacity and/or muscular strength in cardiac heart failure patients. Methods Ninety-one patients were included (mean age: 58 ± 9 years; New York Heart Association II/III: 52/48%, left ventricular ejection fraction: 30 ± 7%) in a prospective French study. The patients were randomised into two groups: 41 patients in exercise training and 50 in exercise training + electrical myostimulation. All patients underwent 20 exercise training sessions. In addition, in the exercise training + electrical myostimulation group, patients underwent 20 low frequency (10 Hz) quadricipital electrical myostimulation sessions. Each patient underwent a cardiopulmonary exercise test, a six-minute walk test, a muscular function evaluation and a quality of life questionnaire, before and at the end of the s