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Sample records for acceptable treatment option

  1. The Epidemiology of Psychiatric Disorders among Repeat DUI Offenders Accepting a Treatment-Sentencing Option

    ERIC Educational Resources Information Center

    Shaffer, Howard J.; Nelson, Sarah E.; LaPlante, Debi A.; LaBrie, Richard A.; Albanese, Mark; Caro, Gabriel

    2007-01-01

    Psychiatric comorbidity likely contributes to driving under the influence (DUI) of alcohol among repeat offenders. This study presents one of the first descriptions of the prevalence and comorbidity of psychiatric disorders among repeat DUI offenders in treatment. Participants included all consenting eligible admissions (N=729) to a 2-week…

  2. The Epidemiology of Psychiatric Disorders among Repeat DUI Offenders Accepting a Treatment-Sentencing Option

    ERIC Educational Resources Information Center

    Shaffer, Howard J.; Nelson, Sarah E.; LaPlante, Debi A.; LaBrie, Richard A.; Albanese, Mark; Caro, Gabriel

    2007-01-01

    Psychiatric comorbidity likely contributes to driving under the influence (DUI) of alcohol among repeat offenders. This study presents one of the first descriptions of the prevalence and comorbidity of psychiatric disorders among repeat DUI offenders in treatment. Participants included all consenting eligible admissions (N = 729) to a 2-week…

  3. Breast Cancer: Treatment Options

    MedlinePlus

    ... Cancer - Treatment Options Request Permissions Print to PDF Breast Cancer - Treatment Options Approved by the Cancer.Net Editorial ... recommendations for ovarian ablation . Hormonal therapy for metastatic breast cancer Hormonal therapies are also commonly used to treat ...

  4. Porphyria Treatment Options

    MedlinePlus

    ... only. For treatment options for Porphyria Cutanea Tarda (PCT) , Congenital Erythropoietic Protoporphyria (CEP) and Hepatoerythropoietic Porphyria (HEP) ... Contact Us About Porphyria AIP VP HCP ADP PCT EPP CEP HEP Diet and Nutrition History of ...

  5. Fluorosis varied treatment options

    PubMed Central

    Sherwood, I Anand

    2010-01-01

    Fluorosis has been reported way back in 1901. The treatment options for fluorosis are varied depending upon individual cases. This article comes from Madurai in India where its surrounding towns are fluorosis-prone zones. The purpose of this article is to report various treatment options available for dental fluorosis; this is the first time that complete full mouth rehabilitation for dental fluorosis is being reported. This article also dwells on the need for the dentists to be aware of their local indigenous pathologies to treat it in a better manner. PMID:20582220

  6. Treatment options for hyperhidrosis.

    PubMed

    Walling, Hobart W; Swick, Brian L

    2011-10-01

    Hyperhidrosis is a disorder of excessive sweating beyond what is expected for thermoregulatory needs and environmental conditions. Primary hyperhidrosis has an estimated prevalence of nearly 3% and is associated with significant medical and psychosocial consequences. Most cases of hyperhidrosis involve areas of high eccrine density, particularly the axillae, palms, and soles, and less often the craniofacial area. Multiple therapies are available for the treatment of hyperhidrosis. Options include topical medications (most commonly aluminum chloride), iontophoresis, botulinum toxin injections, systemic medications (including glycopyrrolate and clonidine), and surgery (most commonly endoscopic thoracic sympathectomy [ETS]). The purpose of this article is to comprehensively review the literature on the subject, with a focus on new and emerging treatment options. Updated therapeutic algorithms are proposed for each commonly affected anatomic site, with practical procedural guidelines. For axillary and palmoplantar hyperhidrosis, topical treatment is recommended as first-line treatment. For axillary hyperhidrosis, botulinum toxin injections are recommended as second-line treatment, oral medications as third-line treatment, local surgery as fourth-line treatment, and ETS as fifth-line treatment. For palmar and plantar hyperhidrosis, we consider a trial of oral medications (glycopyrrolate 1-2 mg once or twice daily preferred to clonidine 0.1 mg twice daily) as second-line therapy due to the low cost, convenience, and emerging literature supporting their excellent safety and reasonable efficacy. Iontophoresis is considered third-line therapy for palmoplantar hyperhidrosis; efficacy is high although so are the initial levels of cost and inconvenience. Botulinum toxin injections are considered fourth-line treatment for palmoplantar hyperhidrosis; efficacy is high though the treatment remains expensive, must be repeated every 3-6 months, and is associated with pain and

  7. Achilles Tendinosis: Treatment Options

    PubMed Central

    Lopez, Roberto Gabriel L.

    2015-01-01

    Athletes usually complain of an ongoing or chronic pain over the Achilles tendon, but recently even non-athletes are experiencing the same kind of pain which affects their daily activities. Achilles tendinosis refers to a degenerative process of the tendon without histologic or clinical signs of intratendinous inflammation. Treatment is based on whether to stimulate or prevent neovascularization. Thus, until now, there is no consensus as to the best treatment for this condition. This paper aims to review the common ways of treating this condition from the conservative to the surgical options. PMID:25729512

  8. Novel operative treatment options.

    PubMed

    Ricketts, D N J; Pitts, N B

    2009-01-01

    There are an increasing number of more novel options available for operative intervention. This chapter outlines a series of operative treatment options which are available to the modern clinician to select from once a decision has been made to treat a carious lesion operatively. A series of novel methods of caries removal have been described; including chemomechanical caries removal, air abrasion, sono-abrasion, polymer rotary burs and lasers. There are also novel approaches to ensure complete caries removal and novel approaches for the management of deep caries. A novel question increasingly asked by clinicians is: does all the caries need to be removed? Operative management options here include: therapeutic fissure sealants, ultraconservative caries removal, stepwise excavation and the Hall technique. In conclusion, there is now a growing wealth of evidence that questions the traditional methods of caries removal and restoring the tooth. In parallel, there is a growing movement exploring the merits of therapeutically sealing caries into the tooth. This philosophy is alien to many of today's dentists and, until further randomized controlled trials are carried out in primary care, prudent caution must be exercised with this promising approach. Research is required into techniques which will allow monitoring of sealed caries to detect any rare, but insidious, failures. These novel techniques are an alternative way of managing the later stages of the caries process from a sounder biological basis and have marked potential benefits to patients from treatment, pain and outcome perspectives.

  9. Novel preventive treatment options.

    PubMed

    Longbottom, C; Ekstrand, K; Zero, D; Kambara, M

    2009-01-01

    A number of novel preventive treatment options which, as with traditional methods, can be differentiated into 3 categories of prevention (primary, secondary and tertiary), have been and are being currently investigated. Those reviewed are either commercially available or appear relatively close to that point. These include: approximal sealants; fluoride applications, including slow-release devices; measures to help remineralize demineralized tissue, including 3 different methods of delivering amorphous calcium phosphate; measures to help modify the biofilm to reduce the cariogenic challenge, including ozone therapy and probiotics; measures to increase enamel resistance to demineralization, including laser treatment of enamel, and a novel 'hybrid' technique for the treatment of primary molar caries which involves 'overlapping' of secondary and tertiary prevention--the Hall technique. Although many of these techniques show considerable promise and dentists should be aware of these developments and follow their progress, the evidence for each of these novel preventive treatment options is currently insufficient to make widespread recommendations. Changes in dental practice should be explored to see how oral health can be best supported through novel preventive systems. Further research is also required involving double-blind randomized controlled trials in order to bring further benefits of more effective caries control to patients. Implementation in practice should follow promptly as new techniques are shown to be clinically valuable for individual patients.

  10. Traditional preventive treatment options.

    PubMed

    Longbottom, C; Ekstrand, K; Zero, D

    2009-01-01

    Preventive treatment options can be divided into primary, secondary and tertiary prevention techniques, which can involve patient- or professionally applied methods. These include: oral hygiene (instruction), pit and fissure sealants ('temporary' or 'permanent'), fluoride applications (patient- or professionally applied), dietary assessment and advice (modification), other measures to help remineralize demineralized tissue and other measures to help modify the biofilm to reduce the cariogenic challenge. There is a considerable body of strong evidence supporting the use of specific techniques for primary prevention of caries in children, e.g. pit and fissure sealants and topically applied fluorides (including patient-applied fluoride toothpastes and professionally applied fluoride varnishes), but limited strong evidence for these techniques for secondary prevention--i.e. where early to established lesions with ICDAS codes 1-4 (and also the severer lesions coded 5 or 6) are involved--and in relation to adults. This lack of evidence reflects a shortage of high-quality trials in the area, as opposed to a series of good studies showing no effect. Since there is also limited longitudinal evidence supporting conventional operative care, and since controlling the caries process prior to first restoration is the key to breaking the repair cycle and improving care for patients, future research should address the shortcomings in the current level of supporting evidence for the various traditional preventive treatment options.

  11. [Treatment options for brachymetatarsia].

    PubMed

    Wingenfeld, C; Arbab, D; Abbara-Czardybon, M

    2013-01-01

    Brachymetatarsia can be congenital, idiopathic or secondary and describes an abnormal shortening of a metatarsal bone. The indications for treatment are not only due to cosmesis. The shortening of a ray changes the biomechanics of the foot and can lead to metatarsalgia. A frequent clinical feature is dorsal dislocation of a toe causing painful shoe conflict and disturbed proprioception. There are three main options for operative correction: lengthening osteotomy, interposition of a tricortical bone and gradual lengthening by callus distraction. While one stage lengthening procedures such as osteotomy and interposition are more appropriate for correction of moderate length deficiencies, the callus distraction method is more suitable for larger elongation. Common to all procedures is a long-term treatment with a high risk of different complications whereby patient compliance can be problematical. PMID:23238881

  12. Treatment Options for Narcolepsy.

    PubMed

    Barateau, Lucie; Lopez, Régis; Dauvilliers, Yves

    2016-05-01

    Narcolepsy type 1 and narcolepsy type 2 are central disorders of hypersomnolence. Narcolepsy type 1 is characterized by excessive daytime sleepiness and cataplexy and is associated with hypocretin-1 deficiency. On the other hand, in narcolepsy type 2, cerebrospinal fluid hypocretin-1 levels are normal and cataplexy absent. Despite major advances in our understanding of narcolepsy mechanisms, its current management is only symptomatic. Treatment options may vary from a single drug that targets several symptoms, or multiple medications that each treats a specific symptom. In recent years, narcolepsy treatment has changed with the widespread use of modafinil/armodafinil for daytime sleepiness, antidepressants (selective serotonin and dual serotonin and noradrenalin reuptake inhibitors) for cataplexy, and sodium oxybate for both symptoms. Other psychostimulants can also be used, such as methylphenidate, pitolisant and rarely amphetamines, as third-line therapy. Importantly, clinically relevant subjective and objective measures of daytime sleepiness are required to monitor the treatment efficacy and to provide guidance on whether the treatment goals are met. Associated symptoms and comorbid conditions, such as hypnagogic/hypnopompic hallucinations, sleep paralysis, disturbed nighttime sleep, unpleasant dreams, REM- and non REM-related parasomnias, depressive symptoms, overweight/obesity, and obstructive sleep apnea, should also be taken into account and managed, if required. In the near future, the efficacy of new wake-promoting drugs, anticataplectic agents, hypocretin replacement therapy and immunotherapy at the early stages of the disease should also be evaluated. PMID:27155860

  13. Achalasia: current treatment options.

    PubMed

    Familiari, Pietro; Greco, Santi; Volkanovska, Ance; Gigante, Giovanni; Cali, Anna; Boškoski, Ivo; Costamagna, Guido

    2015-01-01

    Achalasia is a rare esophageal motility disorder, characterized by impaired swallow-induced, lower esophageal sphincter (LES) relaxation and defective esophageal peristalsis. Unfortunately, there are no etiological therapies for achalasia. Patients present with dysphagia, chest pain and regurgitation of undigested food, often leading to weight loss. The currently available treatments have the common aim of relieving symptoms by decreasing the pressure of the LES. This can be achieved with some medications, by inhibiting the cholinergic innervation (botulinum toxin), by stretching (endoscopic dilation) or cutting (surgery) the LES. Recently, other therapeutic options, including per-oral endoscopic myotomy have been developed and are gaining international consensus. The authors report on the benefits and weaknesses of the different therapies and provide an updated approach to the management of achalasia. PMID:26186641

  14. Traditional operative treatment options.

    PubMed

    Ricketts, D N J; Pitts, N B

    2009-01-01

    Operative intervention should be avoided, whenever possible, by adopting a preventive approach. Timely management of early caries can lead to arrest and possibly remineralization of the lesion rendering operative intervention unnecessary. The dentist must judge when the tooth tissue has become sufficiently demineralized to allow bacterial ingress leading to irreversible changes in the tissue. Once a decision has been made to restore a tooth, the clinician must decide, from a series of traditional operative treatment options, what materials should be used in the restoration and what preparation will achieve good retention and best preservation of tooth structure. With the development of new adhesive materials and a more conservative approach, a new era of minimally invasive dentistry has dawned. Improvements in the properties of composite materials have made them the choice for coronal aesthetic restorations: for posterior restorations involving load-bearing occlusal surfaces, amalgam is still the most commonly used material in UK dental practice; glass ionomer materials also have a place in minimally invasive dentistry--patterns of use differing in different counties. The numbers of studies investigating minimal caries removal are relatively limited; there are still scope and need for research in this field.

  15. Incontinence Treatment: Newer Treatment Options

    MedlinePlus

    ... Incontinence Managing Incontinence: A Survey The Patient's Perspective Barriers on Diagnosis and Treatment Personal Stories Contact Us ... Incontinence Managing Incontinence: A Survey The Patient's Perspective Barriers on Diagnosis and Treatment Personal Stories Contact Us ...

  16. Treatment Option Overview (Melanoma)

    MedlinePlus

    ... and treatments will also be taken. Lymph node mapping and sentinel lymph node biopsy : Procedures in which ... has spread to the lymph nodes . Lymph node mapping and sentinel lymph node biopsy are done to ...

  17. IBS Treatment Options

    MedlinePlus

    ... or bring on symptoms Stress management, gut-directed hypnosis, biofeedback, relaxation, or pain management techniques Consulting with ... Complimentary or Alternative Treatments Selecting a CAM Practitioner Hypnosis for IBS Yoga Medications Laxatives Anticholinergic/Antispasmodic Agents ...

  18. Treatment options for hyperthyroidism.

    PubMed

    Wartofsky, L

    1996-09-15

    Antithyroid drugs induce sustained remission in only 55% of cases. Radioiodine, the overwhelming choice of specialists, may pose risks, including aggravation of ophthalmopathy. Surgical ablation should be considered only if a highly skilled surgeon is available. Thyroid storm requires aggressive management, and definitive treatment is needed for toxic adenoma or toxic multinodular goiter.

  19. Optimizing treatment options.

    PubMed

    Naclerio, R M

    1998-12-01

    Full and accurate diagnosis of allergic rhinitis is important as a basis for treatment decisions, as many nasal disorders have similar signs and symptoms. Optimal allergen avoidance is the starting point of treatment, so causative allergens need to be identified. Oral antihistamines are effective in relieving the majority of symptoms of allergic rhinitis and allergic conjunctivitis, but provide only partial relief from nasal congestion. Topical alpha-adrenergic decongestants help to relieve congestion, but prolonged use leads to rhinitis medicamentosa. Systemic decongestants are less effective than topical agents and their use is limited by systemic and central side-effects. The value of leukotriene antagonists has yet to be fully evaluated. Intranasal ipratropium bromide helps to control watery secretions, and an aerosol may be more effective than an aqueous solution. Topical glucocorticosteroids, such as triamcinolone, are the most potent and effective agents available for treating allergic rhinitis. The available evidence indicates that there is very little systemic absorption. Sodium cromoglycate is effective in allergic rhinitis, though less so than topical steroids, and has the least adverse effects among the antiallergic agents. Immunotherapy can be effective and may be indicated in individuals who cannot avoid the causative allergen. Special considerations apply to the treatment of allergic rhinitis in elderly or pregnant patients. Finally, patients with long-standing allergic conditions should be re-assessed regularly.

  20. Wastewater treatment plant cogeneration options

    SciTech Connect

    Stringfield, J.G.

    1995-12-31

    This paper reviews municipal sewage cogeneration and digester gas utilization options available to wastewater treatment plants, and will focus on utilizing the digester gas in combustion turbines and engine-generator systems. Defining the digestion and gas generation process is crucial to understanding the best gas utilization system. In municipal wastewater treatment plants biosolids (sludge) reduction is accomplished using aerobic or anaerobic digestion. The basic process of treating sewage solids with digestion is not new and has been practiced as far back as the nineteenth century. High energy usage consumed by aerobic blow systems supplying air to the process and the potential ``free`` energy generated by anaerobic digesters sometimes sways designers to select anaerobic over aerobic digestion. The following areas will be covered in this paper: gas utilization and cogeneration; definition of digestion process; sizing the cogeneration system and reviewing the systems components; emissions requirements and options; and capital, and O and M cost analysis.

  1. [Treatment options for patellar tendinopathy].

    PubMed

    Duthon, V B; Borloz, S; Ziltener, J-L

    2012-07-25

    Patellar tendinopathy is also called jumper's knee because of its high incidence in athletes with jumping or cutting activities as soccer, basketball, volleyball. Many different treatment methods have been described. However, no consensus exists regarding the optimal treatment for this condition. According to the literature, eccentric exercise-based physical therapy should be proposed first because of its strong scientific evidence. Shockwave therapy and injections may be useful but their real efficacy still has to be proven by randomized controlled study. For patients recalcitrant to more conservative options, operative management may be indicated.

  2. Treatment Options in Maxillofacial Fractures.

    PubMed

    Guerrissi, Jorge Orlando

    2016-07-01

    From 2000 to 2010, 720 patients with facial trauma were admitted in Plastic Surgery Service of Argerich Hospital, Buenos Aires, Argentina; 58 of them with panfacial fractures were included in this study. Height velocity impact is the principal etiology, and most concomitant extrafacial injuries are neurocranium and cervical spine. Common affected areas were orbits, nose, and malar-zygoma. The timing of the treatment was airway evaluation, control of bleeding and consciousness, treatment of associated injuries, and finally facial reconstruction. The applications of craniofacial surgical techniques complete facial treatment in only operatory time by means of standard approaches like coronal, subciliar palpebral, upper and lower vestibular. The treatment was exploration to open sky; reduction and fijation with titanium plates; replacement of comminuted bones with bone autografts harvested iliac crest, calvary, and costal bones. The results were classificated acceptables in 48 (85%) and not acceptables in 9 (15%) according to successful reconstruction of the both form and armony facial, persistent esthetic and functional sequels, and postoperative complications. Postoperative complications were detected in 18 patients. According to most authors the use of internal rigid fixation and bone autograf permits obtaining the best aesthetic and functional results decreasing complications and sequels. The recuperation of tridimensional aspect of the face and aesthetic and functional pretrauma state must be the goal standard. PMID:27391510

  3. Treatment options for threatened miscarriage.

    PubMed

    Qureshi, N S

    2009-12-01

    Threatened miscarriage, as demonstrated by vaginal bleeding with or without abdominal cramps, is a common complication of pregnancy. It occurs in about 20% of recognised pregnancies. Risk of miscarriage is increased in older women and those with a history of miscarriage. Low serum levels of progesterone or human chorionic gonadotrophin (hCG) are a risk factor for miscarriage. Other risk factors include heavy bleeding, early gestational age and an empty gestational sac of >15-17 mm diameter. Clinical history and examination, maternal serum biochemistry and ultrasound findings provide valuable information about the prognosis and are important to establish in order to determine potential treatment options. Although bed rest is the most common choice of treatment, there is little evidence of its value. Other options include luteal support with progesterone, dydrogesterone or hCG. There is some evidence from clinical studies indicating that progesterone or dydrogesterone may reduce the rate of miscarriage, although further data from double-blind, randomised-controlled trials are necessary to confirm efficacy. PMID:19945236

  4. [Gastroparesis and its treatment options].

    PubMed

    Igaz, Péter; Tulassay, Zsolt

    2008-03-01

    Gastroparesis is a disorder of gastric emptying that occurs in the absence of mechanical obstruction. Its cardinal features include nausea, vomiting, bloating, early satiety and discomfort. Weight loss, dehydration, electrolyte disturbances and malnutrition may develop in severe cases. The majority of cases is idiopathic, long standing diabetes mellitus is responsible for about 25-30% of cases. Diabetic gastroparesis may render glucose control extremely difficult, its treatment represents a major challenge. Besides frequent, small meals and psychological support, several drug options are available, however, their efficacy is limited and only a few randomized studies have been performed to date. Prokinetic agents (erythromycin, domperidone, metoclopramide) and antiemetics (phenothiazines, serotonin antagonists, butyrophenones) are the most wide-spread medicaments. Among the novel, recently developed agents, 5-HT4 serotonin receptor agonists and dopamine D2 receptor antagonists are the most promising. Injection of botulinum toxin into the pyloric sphincter resulted in faster gastric emptying and symptom alleviation in some studies. Gastric electric stimulation appears to be one of the most effective options, both low and high-frequency stimulation may alleviate symptoms. Gastrostomy/jejunostomy and other surgical interventions are considered as "last resort". PMID:18292033

  5. ENVIROCARE OF UTAH: EXPANDING WASTE ACCEPTANCE CRITERIA TO PROVIDE LOW-LEVEL AND MIXED WASTE DISPOSAL OPTIONS

    SciTech Connect

    Rogers, B.; Loveland, K.

    2003-02-27

    Envirocare of Utah operates a low-level radioactive waste disposal facility 80 miles west of Salt Lake City in Clive, Utah. Accepted waste types includes NORM, 11e2 byproduct material, Class A low-level waste, and mixed waste. Since 1988, Envirocare has offered disposal options for environmental restoration waste for both government and commercial remediation projects. Annual waste receipts exceed 12 million cubic feet. The waste acceptance criteria (WAC) for the Envirocare facility have significantly expanded to accommodate the changing needs of restoration projects and waste generators since its inception, including acceptable physical waste forms, radiological acceptance criteria, RCRA requirements and treatment capabilities, PCB acceptance, and liquids acceptance. Additionally, there are many packaging, transportation, and waste management options for waste streams acceptable at Envirocare. Many subcontracting vehicles are also available to waste generators for both government and commercial activities.

  6. Treatment Options to Manage Wound Biofilm

    PubMed Central

    Jones, Curtis E.; Kennedy, John P.

    2012-01-01

    Background Bioburden is an accepted barrier to chronic wound healing. Defining the significance, phenotype, clinical classification, and treatment guidelines has been historically lacking of evidence and based on paradigms that do not represent the scientific or clinical reality. The Problem Chronic wound bioburden is typically abundant, polymicrobial, and extremely diverse. These microbes naturally adopt biofilm phenotypes, which are quite often viable but not culturable, thereby going undetected. The failures of culture-based detection have led to abandonment of routine bioburden evaluation and aggressive treatment or, worse, to assume bioburden is not a significant barrier. Predictably, treatment regimens to address biofilm phenotypes lagged behind our diagnostic tools and understanding. Basic/Clinical Science Advances Microbial DNA-based diagnostic tools and treatment regimens have emerged, which provide and leverage objective information, resulting in a dramatic impact on outcomes. Relevance to Clinical Care Modern medicine demands decisions based on objective evidence. The diagnostic and treatment protocols reviewed herein empower clinicians to practice modern medicine with regard to bioburden, with DNA level certainty. Conclusion Bioburden is a significant barrier to healing for all chronic wounds. Molecular diagnostics provide the first objective means of assessing wound bioburden. The accuracy and comprehensive data from such diagnostic methodologies provide clinicians with the ability to employ patient-specific treatment options, targeted to each patient's microbial wound census. Based on current outcomes data, the most effective therapeutic options are topical (TPL) antibiofilm agents (ABF) combined with TPL antibiotics (ABX). In specific patients, systemic ABX and selective biocides are also appropriate, but not exclusive of ABF combined with TPL ABX. PMID:24527291

  7. Novel Treatment Options for Fecal Incontinence

    PubMed Central

    Barker, Adam; Hurley, Jefferson

    2014-01-01

    Fecal incontinence (FI) is a devastating condition affecting a substantial portion of the population. The etiologies of FI are wide ranging, as are the treatment options. When conservative measures fail, often surgical intervention is required. As in any area where a wide range of treatment options exist, there is no one perfect solution. Fortunately, novel treatment options for FI are becoming available, namely, posterior tibial nerve stimulation, magnetic anal sphincter, stem cell transplant, pyloric transplantation, and acupuncture. PMID:25320572

  8. Treatment Option Overview (Myelodysplastic Syndromes)

    MedlinePlus

    ... Patient Myelo-proliferative Neoplasms Patient Myelodysplastic Syndromes Treatment Myeloproliferative Neoplasms Treatment Myelodysplastic/ Myeloproliferative Neoplasms Treatment Health Professional Myelodysplastic ...

  9. Treatment Options for Myelodysplastic Syndromes

    MedlinePlus

    ... Patient Myelo-proliferative Neoplasms Patient Myelodysplastic Syndromes Treatment Myeloproliferative Neoplasms Treatment Myelodysplastic/ Myeloproliferative Neoplasms Treatment Health Professional Myelodysplastic ...

  10. Treatment acceptability among mexican american parents.

    PubMed

    Borrego, Joaquin; Ibanez, Elizabeth S; Spendlove, Stuart J; Pemberton, Joy R

    2007-09-01

    There is a void in the literature with regard to Hispanic parents' views about common interventions for children with behavior problems. The purpose of this study was to examine the treatment acceptability of child management techniques in a Mexican American sample. Parents' acculturation was also examined to determine if it would account for differences in treatment acceptability. Mexican American parents found response cost, a punishment-based technique, more acceptable than positive reinforcement-based techniques (e.g., differential attention). Results suggest that Mexican American parents' acculturation has little impact on acceptability of child management interventions. No association was found between mothers' acculturation and treatment acceptability. However, more acculturated Mexican American fathers viewed token economy as more acceptable than less acculturated fathers. Results are discussed in the context of clinical work and research with Mexican Americans.

  11. Treatment Options for Childhood Craniopharyngioma

    MedlinePlus

    ... before the cancer is diagnosed and continue for months or years. Signs or symptoms caused by the ... treatment. Some treatments for tumors cause side effects months or years after treatment has ended. Side effects ...

  12. Treatment Option Overview (Childhood Ependymoma)

    MedlinePlus

    ... before the cancer is diagnosed and continue for months or years. Childhood brain and spinal cord tumors ... after treatment. Some cancer treatments cause side effects months or years after treatment has ended. These are ...

  13. Treatment Options for Childhood Astrocytomas

    MedlinePlus

    ... before the cancer is diagnosed and continue for months or years. Signs or symptoms caused by the ... after treatment. Some cancer treatments cause side effects months or years after treatment has ended. Side effects ...

  14. Treatment Option Overview (Childhood Craniopharyngioma)

    MedlinePlus

    ... before the cancer is diagnosed and continue for months or years. Signs or symptoms caused by the ... treatment. Some treatments for tumors cause side effects months or years after treatment has ended. Side effects ...

  15. Review of Recent Treatment Acceptability Research

    ERIC Educational Resources Information Center

    Carter, Stacy L.

    2007-01-01

    With recent increases in the use of positive approaches to treatment for individuals with developmental disabilities, it seems appropriate to review the variables that have been found to influence the acceptability of various treatments. Programmatic treatments for problematic behaviors that incorporate primarily positive (reinforcement)…

  16. Zinc Bromide Waste Solution Treatment Options

    SciTech Connect

    Langston, C.A.

    2001-01-16

    The objective of this effort was to identify treatment options for 20,000 gallons of low-level radioactively contaminated zinc bromide solution currently stored in C-Area. These options will be relevant when the solutions are declared waste.

  17. Treatment Option Overview (Childhood Acute Lymphoblastic Leukemia)

    MedlinePlus

    ... recovery) and treatment options. Childhood acute lymphoblastic leukemia (ALL) is a type of cancer in which the ... genetic conditions affect the risk of having childhood ALL. Anything that increases your risk of getting a ...

  18. Treatment Options for Adult Acute Lymphoblastic Leukemia

    MedlinePlus

    ... recovery) and treatment options. Adult acute lymphoblastic leukemia (ALL) is a type of cancer in which the ... to radiation may increase the risk of developing ALL. Anything that increases your risk of getting a ...

  19. Treatment Options for Childhood Acute Lymphoblastic Leukemia

    MedlinePlus

    ... recovery) and treatment options. Childhood acute lymphoblastic leukemia (ALL) is a type of cancer in which the ... genetic conditions affect the risk of having childhood ALL. Anything that increases your risk of getting a ...

  20. Treatment Option Overview (Adult Acute Lymphoblastic Leukemia)

    MedlinePlus

    ... recovery) and treatment options. Adult acute lymphoblastic leukemia (ALL) is a type of cancer in which the ... to radiation may increase the risk of developing ALL. Anything that increases your risk of getting a ...

  1. Treatment Options for Pediatric Psoriasis.

    PubMed

    Madiraca, Dora; Šitum, Mirna; Prkačin, Ivana; Ožanić Bulić, Suzana

    2016-08-01

    Psoriasis is a multifactorial inflammatory papulosquamous disease affecting 0.5% to 2% of the pediatric population. Pediatric psoriasis, presenting similar to adult psoriasis, significantly reduces patient quality of life, often requiring an individualized treatment approach for each patient. Combination and rotational therapy are helpful in reducing toxicity and maximizing efficacy. Patients with mild and limited disease severity respond well to topical treatment with steroids or vitamin D analogues, unlike moderate and severe psoriasis where sufficient remission is rarely achieved. Therefore phototherapy, systemic immunomodulators, or biologic agents are the next line of treatment to be considered. There is limited data available on the use and long-term safety of biologics in the pediatric population. Biologic agents must be administered by experienced dermatologists, only in patients with moderate-to-severe plaque psoriasis who are intolerant or refractory to other systemic conventional disease-modifying treatment or phototherapy, or if those treatments are contraindicated. PMID:27663917

  2. Treatment Option Overview (Adrenocortical Carcinoma)

    MedlinePlus

    ... of Childhood Treatment for more information.) Having certain genetic conditions increases the risk of adrenocortical carcinoma. Anything ... can be a sign of disease. CT scan (CAT scan) : A procedure that makes a series of ...

  3. Treatment Option Overview (Vulvar Cancer)

    MedlinePlus

    ... for vulvar cancer may be applied to the skin in a cream or lotion. See Drugs Approved to Treat Vulvar ... treat vulvar lesions and is applied to the skin in a cream. New types of treatment are being tested in ...

  4. Treatment Options for Childhood Rhabdomyosarcoma

    MedlinePlus

    ... risk rhabdomyosarcoma. The following risk groups are used: Low-risk childhood rhabdomyosarcoma Low-risk childhood rhabdomyosarcoma is ... therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to ...

  5. Treatment Option Overview (Childhood Rhabdomyosarcoma)

    MedlinePlus

    ... risk rhabdomyosarcoma. The following risk groups are used: Low-risk childhood rhabdomyosarcoma Low-risk childhood rhabdomyosarcoma is ... therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to ...

  6. Treatment Option Overview (Oropharyngeal Cancer)

    MedlinePlus

    ... adjuvant therapy . New types of surgery, including transoral robotic surgery , are being studied for the treatment of oropharyngeal cancer. Transoral robotic surgery may be used to remove cancer from ...

  7. Treatment Options by Stage (Melanoma)

    MedlinePlus

    ... and treatments will also be taken. Lymph node mapping and sentinel lymph node biopsy : Procedures in which ... has spread to the lymph nodes . Lymph node mapping and sentinel lymph node biopsy are done to ...

  8. Soy Goes to School: Acceptance of Healthful, Vegetarian Options in Maryland Middle School Lunches

    ERIC Educational Resources Information Center

    Lazor, Kathleen; Chapman, Nancy; Levine, Elyse

    2010-01-01

    Background: Soyfoods provide healthful options for school breakfasts and lunches that are lower in saturated fat, cholesterol, fat, and calories and can help meet demands for vegetarian choices. Researchers tested acceptance of soy-based options substituted for popular lunch items with a diverse student population. Methods: Researchers conducted a…

  9. Effluent treatment options for nuclear thermal propulsion system ground tests

    SciTech Connect

    Shipers, L.R.; Brockmann, J.E.

    1992-10-16

    A variety of approaches for handling effluent from nuclear thermal propulsion system ground tests in an environmentally acceptable manner are discussed. The functional requirements of effluent treatment are defined and concept options are presented within the framework of these requirements. System concepts differ primarily in the choice of fission-product retention and waste handling concepts. The concept options considered range from closed cycle (venting the exhaust to a closed volume or recirculating the hydrogen in a closed loop) to open cycle (real time processing and venting of the effluent). This paper reviews the strengths and weaknesses of different methods to handle effluent from nuclear thermal propulsion system ground tests.

  10. Children acceptance of laser dental treatment

    NASA Astrophysics Data System (ADS)

    Lazea, Andreea; Todea, Carmen

    2016-03-01

    Objectives: To evaluate the dental anxiety level and the degree of acceptance of laser assisted pedodontic treatments from the children part. Also, we want to underline the advantages of laser use in pediatric dentistry, to make this technology widely used in treating dental problems of our children patients. Methods: Thirty pediatric dental patients presented in the Department of Pedodontics, University of Medicine and Pharmacy "Victor Babeş", Timişoara were evaluated using the Wong-Baker pain rating scale, wich was administered postoperatory to all patients, to assess their level of laser therapy acceptance. Results: Wong-Baker faces pain rating scale (WBFPS) has good validity and high specificity; generally it's easy for children to use, easy to compare and has good feasibility. Laser treatment has been accepted and tolerated by pediatric patients for its ability to reduce or eliminate pain. Around 70% of the total sample showed an excellent acceptance of laser dental treatment. Conclusions: Laser technology is useful and effective in many clinical situations encountered in pediatric dentistry and a good level of pacient acceptance is reported during all laser procedures on hard and soft tissues.

  11. Familial hypercholesterolaemia: new treatment options.

    PubMed

    Ezzahti, M; Sijbrands, E J G; Mulder, M T; Roeters van Lennep, J E

    2013-06-01

    Familial hypercholesterolaemia is a relatively frequently occurring disease that is strongly associated with vascular disease. Current treatment with cholesterol-lowering agents is partly effective but shows variable responses between patients with familial hypercholesterolaemia. Recently, new cholesterol-lowering drugs have been developed. Here we describe the most promising of these new agents for which results from phase 2 or phase 3 trials are available. We will discuss the data regarding lipid-lowering potential and safety issues and speculate about the potential reductions of the residual risk of statin-treated FH patients. PMID:23799308

  12. Treatment Acceptability among Mexican American Parents

    ERIC Educational Resources Information Center

    Borrego, Joaquin, Jr.; Ibanez, Elizabeth S.; Spendlove, Stuart J.; Pemberton, Joy R.

    2007-01-01

    There is a void in the literature with regard to Hispanic parents' views about common interventions for children with behavior problems. The purpose of this study was to examine the treatment acceptability of child management techniques in a Mexican American sample. Parents' acculturation was also examined to determine if it would account for…

  13. Pseudotumor cerebri: An update on treatment options

    PubMed Central

    Dave, Sarita B; Subramanian, Prem S

    2014-01-01

    Aims: The aim was to identify Pseudotumor cerebri treatment options and assess their efficacy. Setting and Design: Review article. Materials and Methods: Existing literature and the authors’ experience were reviewed. Results: Treatment options range from observation to surgical intervention. Weight loss and medical treatment may be utilized in cases without vision loss or in combination with surgical treatment. Cerebrospinal fluid shunting procedures and/or optic nerve sheath decompression is indicated for severe vision loss or headache unresponsive to medical management. The recent use of endovascular stenting of transverse sinus stenoses has also demonstrated benefit in patients with pseudotumor cerebri. Conclusion: While each treatment form may be successful individually, a multimodal approach is typically utilized with treatments selected on a case-by-case basis. PMID:25449933

  14. [Treatment Options for Executive Dysfunction].

    PubMed

    Müller, S V

    2016-09-01

    The concept of executive function is a so-called umbrella concept, so that it includes many different and in some cases mutually contradictory higher-level organizational abilities such as planning, monitoring, inhibition and control of action. Typically, the cause of an executive dysfunction is an underlying lesion in the prefrontal cortex or subcortical regions. Deficits in executive functions appear in the fields of cognition as well as behavior. Diagnosis requires the use of a wide-ranging repertoire of tests and questionnaires making it a time-consuming process. Different therapeutic approaches addressing the diverse symptoms of executive dysfunction, both positive and negative, are available. These include modification and manipulation of the environment and practice of cognitive repetitive procedures. The former are implemented particularly in cases of severely impaired persons. The latter are used in persons in whom cognitive dysfunctions are the dominating symptoms of the disorder.The operational area of therapeutic approaches using paper and pencil as well as computer programs limits them to treatment of cognitive dysfunction. If behavioral disturbances dominate the clinical picture, other procedures should be used.The effectiveness of cognitive therapy of executive dysfunction is well demonstrated according to the criteria of evidence-based medicine (EBM). PMID:27607068

  15. Pediatric obesity epidemic: treatment options.

    PubMed

    Kirk, Shelley; Scott, Barbara J; Daniels, Stephen R

    2005-05-01

    The increasing prevalence of overweight youth in the United States and the associated increase in medical comorbidities has created a growing need for effective weight-management interventions. The recommended treatment for an overweight child to achieve a more healthful weight uses four primary behavioral strategies: (a) reduce energy intake while maintaining optimal nutrient intake to protect growth and development, (b) increase energy expenditure by promoting more physical movement and less sedentary activity, (c) actively engage parents and primary caretakers as agents of change, and (d) facilitate a supportive family environment. Although this approach has the most empirical support, the impact on the pediatric obesity epidemic has been limited, particularly for adolescents with more severe obesity and for African-American, Native-American, and Hispanic children. This has prompted efforts to adapt strategies that have been effective in adult weight management for use in pediatric behavioral intervention programs. These include using motivational interviewing to increase readiness for health behavior changes, modifying the carbohydrate content of children's diets, using culturally appropriate messages and materials, improving cultural competency of health care providers, and using computer-based strategies. Randomized, controlled clinical trials are needed to test the safety and efficacy of these approaches before they can be recommended for clinical practice. Pharmacotherapy and bariatric surgery are more aggressive and historically adult interventions with greater risk that are being considered for severely obese adolescents who have serious obesity-related medical complications and who have failed other more conventional methods. PMID:15867895

  16. New Labor Pain Treatment Options.

    PubMed

    Koyyalamudi, Veerandra; Sidhu, Gurleen; Cornett, Elyse M; Nguyen, Viet; Labrie-Brown, Carmen; Fox, Charles J; Kaye, Alan D

    2016-02-01

    Presently, the gold standard for pain control in laboring patients is neuraxial blockade, which includes a spinal, epidural, or a combined spinal-epidural technique. In conjunction with neuraxial blockade or by itself, some of the other agents employed related to labor pain include opioids, non-opioids, nitrous oxide, patient-controlled analgesia (PCA), and distraction therapy. Alternative treatments include acupuncture, hypnotism, yoga, exercise during pregnancy, hydrotherapy, transcutaneous electronic nerve stimulation, massage, and relaxation techniques. This review will focus on current updates and recent trends in labor pain management. Neuraxial management, pharmacotherapy, and newer alternative methods to mitigate labor pain are reviewed. Newer techniques in epidural analgesia include the dural puncture epidural technique, which needs further evaluation. There are limited published data on the use of acupuncture, hypnotism, yoga, exercise during pregnancy, hydrotherapy, transcutaneous electronic nerve stimulation, massage, and relaxation techniques in the alleviation of labor pain. These alternative therapies maybe considered as an adjuvant as the analgesic efficiency is inferior to that provided by typical standard pharmacotherapy. Future studies are warranted to evaluate the role of immersion virtual reality in alleviating labor pain.

  17. New Labor Pain Treatment Options.

    PubMed

    Koyyalamudi, Veerandra; Sidhu, Gurleen; Cornett, Elyse M; Nguyen, Viet; Labrie-Brown, Carmen; Fox, Charles J; Kaye, Alan D

    2016-02-01

    Presently, the gold standard for pain control in laboring patients is neuraxial blockade, which includes a spinal, epidural, or a combined spinal-epidural technique. In conjunction with neuraxial blockade or by itself, some of the other agents employed related to labor pain include opioids, non-opioids, nitrous oxide, patient-controlled analgesia (PCA), and distraction therapy. Alternative treatments include acupuncture, hypnotism, yoga, exercise during pregnancy, hydrotherapy, transcutaneous electronic nerve stimulation, massage, and relaxation techniques. This review will focus on current updates and recent trends in labor pain management. Neuraxial management, pharmacotherapy, and newer alternative methods to mitigate labor pain are reviewed. Newer techniques in epidural analgesia include the dural puncture epidural technique, which needs further evaluation. There are limited published data on the use of acupuncture, hypnotism, yoga, exercise during pregnancy, hydrotherapy, transcutaneous electronic nerve stimulation, massage, and relaxation techniques in the alleviation of labor pain. These alternative therapies maybe considered as an adjuvant as the analgesic efficiency is inferior to that provided by typical standard pharmacotherapy. Future studies are warranted to evaluate the role of immersion virtual reality in alleviating labor pain. PMID:26780039

  18. Cyanide treatment options in coke plants

    SciTech Connect

    Minak, H.P.; Lepke, P.

    1997-12-31

    The paper discusses the formation of cyanides in coke oven gas and describes and compares waste processing options. These include desulfurization by aqueous ammonia solution, desulfurization using potash solution, desulfurization in oxide boxes, decomposition of NH{sub 3} and HCN for gas scrubbing. Waste water treatment methods include chemical oxidation, precipitation, ion exchange, reverse osmosis, and biological treatment. It is concluded that biological treatment is the most economical process, safe in operation and requires a minimum of manpower.

  19. Stereotactic Neurosurgical Treatment Options for Craniopharyngioma

    PubMed Central

    Trippel, Michael; Nikkhah, Guido

    2012-01-01

    Craniopharyngioma are the most common non-glial tumors in childhood. The results of different studies indicate that radical excision surgery is not an appropriate treatment strategy for childhood craniopharyngioma with hypothalamic involvement. Stereotactic neurosurgery provides save, minimal invasive and cost-efficient options in the treatment of childhood craniopharyngioma. In this review a summary of the contribution of the stereotactic neurosurgery in the interdisciplinary treatment regime of childhood craniopharyngioma will be given and discussed in detail. PMID:22654877

  20. [Treatment options for early miscarriage; new insights].

    PubMed

    Verschoor, Marianne A C; Lemmers, Marike; Wekker, Malu Z; Ankum, W M Pim; Mol, B W J Ben Willem; Goddijn, Mariëtte

    2014-01-01

    Miscarriage is the most common complication during the first trimester of pregnancy. Three treatment options are available for women who experience early miscarriage: expectant management, curettage, or medical treatment. Curettage has traditionally been the usual treatment, but both expectant management and medical management with misoprostol are more cost-effective. Curettage increases the risk of surgical complications and intra-uterine adhesions (Asherman syndrome), and is associated with preterm birth. After adequate counselling, the woman's preference is a decisive factor; the choice of treatment for early miscarriage lends itself ideally to shared decision making. The Netherlands lacks a multidisciplinary guideline on the treatment of women following miscarriage. PMID:25406815

  1. Treatment Option Overview (Extragonadal Germ Cell Tumors)

    MedlinePlus

    ... hCG and LDH may be at any level. Poor prognosis A nonseminoma extragonadal germ cell tumor is in the poor prognosis group if: the tumor is in the ... extragonadal germ cell tumor does not have a poor prognosis group. Treatment Option Overview Key Points There ...

  2. Medial tibial stress syndrome: conservative treatment options.

    PubMed

    Galbraith, R Michael; Lavallee, Mark E

    2009-10-07

    Medial tibial stress syndrome (MTSS), commonly known as "shin splints," is a frequent injury of the lower extremity and one of the most common causes of exertional leg pain in athletes (Willems T, Med Sci Sports Exerc 39(2):330-339, 2007; Korkola M, Amendola A, Phys Sportsmed 29(6):35-50, 2001; Hreljac A, Med Sci Sports Exerc 36(5):845-849, 2004). Although often not serious, it can be quite disabling and progress to more serious complications if not treated properly. Often, the cause of MTSS is multi-factorial and involves training errors and various biomechanical abnormalities. Few advances have been made in the treatment of MTSS over the last few decades. Current treatment options are mostly based on expert opinion and clinical experience. The purpose of this article is to review published literature regarding conservative treatment options for MTSS and provide recommendations for sports medicine clinicians for improved treatment and patient outcomes.

  3. Treatment Fidelity: Relation to Treatment Acceptability and Change over Time

    ERIC Educational Resources Information Center

    Tanol, Gizem

    2010-01-01

    The purpose of this study was: (a) to examine the relation between acceptability and fidelity of an intervention package in natural classroom settings, and (b) to examine how fidelity of implementation varies in relation to high vs. low treatment acceptability over the course of an academic school year. Participants were 44 teachers, from 15…

  4. Androgenetic Alopecia: An Update of Treatment Options.

    PubMed

    Kelly, Yanna; Blanco, Aline; Tosti, Antonella

    2016-09-01

    Androgenetic alopecia (AGA) is characterized by a non-scarring progressive miniaturization of the hair follicle in predisposed men and women with a pattern distribution. Although AGA is a very prevalent condition, approved therapeutic options are limited. This article discusses the current treatment alternatives including their efficacy, safety profile, and quality of evidence. Finasteride and minoxidil for male androgenetic alopecia and minoxidil for female androgenetic alopecia still are the therapeutic options with the highest level evidence. The role of antiandrogens for female patients, the importance of adjuvant therapies, as well as new drugs and procedures are also addressed. PMID:27554257

  5. Chemical fixation increases options for hazardous waste treatment

    SciTech Connect

    Indelicato, G.J.; Tipton, G.A.

    1996-05-01

    The Hazardous and Solid Waste Amendments (HSWA) to the Resource Conservation and Recovery Act (RCRA) govern the manner in which hazardous materials are managed. Disposing RCRA hazardous wastes on or in the land is no longer an accepted remedial option. This land disposal restriction requires that all listed and characteristic hazardous wastes must be treated according to specified standards before they are disposed. These treatment standards define technologies and concentration limits. Hazardous wastes that do not meet the standards are prohibited from being disposed on land, such as in landfills, surface impoundments, land treatment units, injection wells, and mines or caves.

  6. The Brustkrebs-Studien.de website for breast cancer patients: User acceptance of a German internet portal offering information on the disease and treatment options, and a clinical trials matching service

    PubMed Central

    2010-01-01

    Background The internet portal http://www.brustkrebs-studien.de (BKS) was launched in 2000 by the German Society of Senology (DGS) and the Baden-Württemberg Institute for Women's Health (IFG) to provide expert-written information on breast cancer online and to encourage and facilitate the participation of breast cancer patients in clinical trials. We describe the development of BKS and its applications, and report on website statistics and user acceptance. Methods Existing registries, including ClinicalTrials.gov, were analysed before we designed BKS, which combines a trial registry, a knowledge portal, and an online second opinion service. An advisory board guided the process. Log files and patient enquiries for trial participation and second opinions were analysed. A two-week user satisfaction survey was conducted online. Results During 10/2005-06/2010, the portal attracted 702,655 visitors, generating 15,507,454 page views. By 06/2010, the website's active scientific community consisted of 189 investigators and physicians, and the registry covered 163 clinical trial protocols. In 2009, 143 patients requested trial enrolment and 119 sought second opinions or individual treatment advice from the expert panel. During the two-week survey in 2008, 5,702 BKS visitors submitted 507 evaluable questionnaires. Portal acceptance was high. Respondents trusted information correctness (80%), welcomed self-matching to clinical trials (79%) and planned to use the portal in the future (76%) and recommend it to others (81%). Conclusions BKS is an established and trusted breast cancer information platform offering up-to-date resources and protocols to the growing physician and patient community to encourage participation in clinical trials. Further studies are needed to assess potential increases in trial enrolment by eligibility matching services. PMID:21126358

  7. Emerging treatment options for early mycosis fungoides

    PubMed Central

    Fernandez-Guarino, Montserrat

    2013-01-01

    Mycosis fungoides is a candidate for skin-directed therapies in its initial stages. In recent years, therapeutic options outside of the normal treatment recommendations such as topical imiquimod, topical tazarotene, topical methotrexate, excimer light sources, and photodynamic therapy have been published with variable results. These alternatives have been useful in cases of localized mycosis fungoides that do not respond to routine treatments; nevertheless, more studies on these methods are still needed. This article summarizes the literature and data that are known so far about these treatments. PMID:23450851

  8. Treatment options for benign prostatic hyperplasia.

    PubMed Central

    Portis, A. J.; Mador, D. R.

    1997-01-01

    OBJECTIVE: To examine current treatment options for benign prostatic hyperplasia with emphasis on randomized, clinical trials and our current management approach. QUALITY OF EVIDENCE: Benign prostatic hyperplasia remains difficult to define clinically or measure objectively. As a result, research has been fairly weak. With newer treatments, however, more definitive studies have been reported. MAIN FINDINGS: Transurethral resection of the prostate remains the criterion standard for severe disease. Watchful waiting, medical management, or early surgical intervention are all valid options for moderate disease and should be tailored to the characteristics and desires of individual patients. Recent minimally invasive surgical techniques, such as microwave and laser surgery, have not yet achieved the quality of evidence to be generally recommended. CONCLUSIONS: Management of benign prostatic hyperplasia should be individualized to patients' circumstances and personal choices. PMID:9266125

  9. Acceptance and Use of Eight Arsenic-Safe Drinking Water Options in Bangladesh

    PubMed Central

    Inauen, Jennifer; Hossain, Mohammad Mojahidul; Johnston, Richard B.; Mosler, Hans-Joachim

    2013-01-01

    Arsenic contamination of drinking water is a serious public health threat. In Bangladesh, eight major safe water options provide an alternative to contaminated shallow tubewells: piped water supply, deep tubewells, pond sand filters, community arsenic-removal, household arsenic removal, dug wells, well-sharing, and rainwater harvesting. However, it is uncertain how well these options are accepted and used by the at-risk population. Based on the RANAS model (risk, attitudes, norms, ability, and self-regulation) this study aimed to identify the acceptance and use of available safe water options. Cross-sectional face-to-face interviews were used to survey 1,268 households in Bangladesh in November 2009 (n = 872), and December 2010 (n = 396). The questionnaire assessed water consumption, acceptance factors from the RANAS model, and socioeconomic factors. Although all respondents had access to at least one arsenic-safe drinking water option, only 62.1% of participants were currently using these alternatives. The most regularly used options were household arsenic removal filters (92.9%) and piped water supply (85.6%). However, the former result may be positively biased due to high refusal rates of household filter owners. The least used option was household rainwater harvesting (36.6%). Those who reported not using an arsenic-safe source differed in terms of numerous acceptance factors from those who reported using arsenic-safe sources: non-users were characterized by greater vulnerability; showed less preference for the taste and temperature of alternative sources; found collecting safe water quite time-consuming; had lower levels of social norms, self-efficacy, and coping planning; and demonstrated lower levels of commitment to collecting safe water. Acceptance was particularly high for piped water supplies and deep tubewells, whereas dug wells and well-sharing were the least accepted sources. Intervention strategies were derived from the results in order to

  10. [Necessary and unnecessary treatment options for hemorrhoids].

    PubMed

    Zindel, Joel; Inglin, Roman; Brügger, Lukas

    2014-12-01

    Up to one third of the general population suffers from symptoms caused by hemorrhoids. Conservative treatment comes first unless the patient presents with an acute hemorrhoidal prolapse or a thrombosis. A fiber enriched diet is the primary treatment option, recommended in the perioperative period as well as a long-term prophylaxis. A timely limited application of topical ointments or suppositories and/or flavonoids are further treatment options. When symptoms persist interventional procedures for grade I-II hemorrhoids, and surgery for grade III-IV hemorrhoids should be considered. Rubber band ligation is the interventional treatment of choice. A comparable efficacy using sclerosing or infrared therapy has not yet been demonstrated. We therefore do not recommend these treatment options for the cure of hemorrhoids. Self-treatment by anal insertion of bougies is of lowrisk and may be successful, particularly in the setting of an elevated sphincter pressure. Anal dilation, sphincterotomy, cryosurgery, bipolar diathermy, galvanic electrotherapy, and heat therapy should be regarded as obsolete given the poor or missing data reported for these methods. For a long time, the classic excisional hemorrhoidectomy was considered to be the gold standard as far as surgical procedures are concerned. Primary closure (Ferguson) seems to be superior compared to the "open" version (Milligan Morgan) with respect to postoperative pain and wound healing. The more recently proposed stapled hemorrhoidopexy (Longo) is particularly advisable for circular hemorrhoids. Compared to excisional hemorrhoidectomy the Longo-operation is associated with reduced postoperative pain, shorter operation time and hospital stay as well as a faster recovery, with the disadvantage though of a higher recurrence rate. Data from Hemorrhoidal Artery Ligation (HAL)-, if appropriate in combination with a Recto-Anal Repair (HAL/RAR)-, demonstrates a similar trend towards a better tolerance of the procedure at the

  11. Chronic rhinosinusitis and emerging treatment options

    PubMed Central

    Piromchai, Patorn; Kasemsiri, Pornthep; Laohasiriwong, Supawan; Thanaviratananich, Sanguansak

    2013-01-01

    This review describes the epidemiology and various treatments in chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). Evidence for short-term use of systemic corticosteroids has been shown to be favorable in CRSwNP, but still limited in CRSsNP. Topical corticosteroids improve symptom scores in both CRS subgroups. The role of microbes in CRS is still controversial. Culture-directed antibiotics are recommended for CRSsNP with exacerbation. Long-term use of low dosage antibiotics is recommended for CRSsNP for their anti-inflammatory effects. Other emerging treatment options are also discussed. PMID:23785241

  12. Current treatment options for Dientamoeba fragilis infections

    PubMed Central

    Nagata, Noriyuki; Marriott, Deborah; Harkness, John; Ellis, John T.; Stark, Damien

    2012-01-01

    Dientamoeba fragilis belongs to the trichomonad group of protozoan parasites and it has been implicated as a cause of gastrointestinal disease with world-wide prevalences ranging from 0.5% to 16%. The majority of patients with dientamoebiasis present with gastrointestinal complaints. Chronic symptoms are common with up to a third of patients exhibiting persistent diarrhoea. Numerous studies have successfully demonstrated parasite clearance, coupled with complete resolution of clinical symptoms following treatment with various antiparasitic compounds. Treatments reported to be successful for dientamoebiasis include carbarsone, diphetarsone, tetracyclines, paromomycin, erythromycin, hydroxyquinolines and the 5-nitroimidazoles, including metronidazole, secnidazole, tinidazole and ornidazole. It is of note that most current treatment data is based only on small number of case reports. No large scale double blind randomised placebo controlled trials testing the efficacy of antimicrobial agents against D. fragilis has been undertaken highlighting the need for further study. In addition there is very little in vitro susceptibility data available for the organism making some current treatment options questionable. The aim of this review is to critically discuss all treatment options currently available for dientamoebiasis. PMID:24533282

  13. Emerging treatment options for meibomian gland dysfunction

    PubMed Central

    Qiao, Jing; Yan, Xiaoming

    2013-01-01

    Meibomian gland dysfunction (MGD) is one of the most common diseases observed in clinics; it influences a great number of people, and is the leading cause of evaporative dry eye. Given the increased recognition of the importance of MGD, a great amount of attention has been paid to therapies targeting this condition. The traditional treatments of MGD consist of warm compresses and lid hygiene for removing an obstructed meibum, as well as antibiotics and anti-inflammatory agents to improve the quality of the meibum. However, each of these treatments has a different shortcoming and the treatment of MGD remains challenging. Despite the numerous possible treatment options for MGD, it is still difficult to obtain complete relief of signs and symptoms. This review focuses on current emerging treatment options for MGD including intraductal meibomian gland probing, emulsion eye drops containing lipids, the LipiFlow® thermal pulsation system, N-acetyl-cysteine, azithromycin, oral supplementation with omega-3 essential fatty acids, and cyclosporine A. PMID:24043929

  14. Emerging treatment options for meibomian gland dysfunction.

    PubMed

    Qiao, Jing; Yan, Xiaoming

    2013-01-01

    Meibomian gland dysfunction (MGD) is one of the most common diseases observed in clinics; it influences a great number of people, and is the leading cause of evaporative dry eye. Given the increased recognition of the importance of MGD, a great amount of attention has been paid to therapies targeting this condition. The traditional treatments of MGD consist of warm compresses and lid hygiene for removing an obstructed meibum, as well as antibiotics and anti-inflammatory agents to improve the quality of the meibum. However, each of these treatments has a different shortcoming and the treatment of MGD remains challenging. Despite the numerous possible treatment options for MGD, it is still difficult to obtain complete relief of signs and symptoms. This review focuses on current emerging treatment options for MGD including intraductal meibomian gland probing, emulsion eye drops containing lipids, the LipiFlow® thermal pulsation system, N-acetyl-cysteine, azithromycin, oral supplementation with omega-3 essential fatty acids, and cyclosporine A.

  15. Current treatment options for Dientamoeba fragilis infections.

    PubMed

    Nagata, Noriyuki; Marriott, Deborah; Harkness, John; Ellis, John T; Stark, Damien

    2012-12-01

    Dientamoeba fragilis belongs to the trichomonad group of protozoan parasites and it has been implicated as a cause of gastrointestinal disease with world-wide prevalences ranging from 0.5% to 16%. The majority of patients with dientamoebiasis present with gastrointestinal complaints. Chronic symptoms are common with up to a third of patients exhibiting persistent diarrhoea. Numerous studies have successfully demonstrated parasite clearance, coupled with complete resolution of clinical symptoms following treatment with various antiparasitic compounds. Treatments reported to be successful for dientamoebiasis include carbarsone, diphetarsone, tetracyclines, paromomycin, erythromycin, hydroxyquinolines and the 5-nitroimidazoles, including metronidazole, secnidazole, tinidazole and ornidazole. It is of note that most current treatment data is based only on small number of case reports. No large scale double blind randomised placebo controlled trials testing the efficacy of antimicrobial agents against D. fragilis has been undertaken highlighting the need for further study. In addition there is very little in vitro susceptibility data available for the organism making some current treatment options questionable. The aim of this review is to critically discuss all treatment options currently available for dientamoebiasis. PMID:24533282

  16. [Treatment options for age-related infertility].

    PubMed

    Belaisch-Allart, Joëlle

    2010-06-20

    There has been a consistent trend towards delayed childbearing in most Western countries. Treatment options for age-related infertility includes controlled ovarian hyperstimulation with intrauterine insemination and in vitro fertilization (IVF). A sharp decline in pregnancy rate with advancing female age is noted with assisted reproductive technologies (ART) including IVF. Evaluation and treatment of infertility should not be delayed in women 35 years and older. No treatment other than oocyte donation has been shown to be effective for women over 40 and for those with compromised ovarian reserve, but its pratice is not easy in France hence the procreative tourism. As an increasing number of couples choose to postpone childbearing, they should be informed that maternal age is an important risk factor for failure to conceive. PMID:20623902

  17. Microabrasion: a treatment option for white spots.

    PubMed

    Souza de Barros Vasconcelos, M Q; Almeida Vieira, K; da Consolação Canuto Salgueiro, M; Almeida Alfaya, T; Santos Ferreira, C; Bussadori, S K

    2014-01-01

    The aim of the present study was to describe a clinical protocol for the treatment of white spots with the use of an abrasive material. A four-year-old patient presented with a white spot on tooth 51 and a white spot associated with a carious lesion in the cervical region of tooth 52. Treatment was planned with microabrasion and restoration of the upper right lateral incisor. Prophylaxis was first performed, followed by protection with a dental dam and the application of the abrasive material (silicon carbide and hydrochloric acid 6%). Five applications were needed to remove the spots. The restoration of the upper right lateral incisor was then performed with a resin composite. A good esthetic outcome was achieved and both the patient and her guardians were satisfied with the results. Microabrasion is a conservative treatment option that achieves satisfactory results with regard to tooth color.

  18. Chronic Migraine – New Treatment Options

    PubMed Central

    ROCEANU, Adina; ANTOCHI, Florina; BAJENARU, Ovidiu

    2014-01-01

    Chronic migraine (CM) is defined as headache occurring more than fifteen days/month for at least three consecutive months, with headache having the clinical features of migraine without aura for at least eight days per month. Recently, new treatment options became available in chronic migraine patients. Topiramate is effective in chronic migraine, in the presence or absence of medication overuse, and/or other migraine prophylaxis. Efficacy of onabotulinumtoxin A as a preventive treatment of chronic migraine has been shown in the PREEMPT studies. Occipital nerve stimulation (ONS) is an invasive treatment for refractory chronic headaches. ONS has encouraging results in refractory chronic migraine patients in commercially funded, multi-centre randomized trials. PMID:25705314

  19. 24-h Efficacy of Glaucoma Treatment Options.

    PubMed

    Konstas, Anastasios G P; Quaranta, Luciano; Bozkurt, Banu; Katsanos, Andreas; Garcia-Feijoo, Julian; Rossetti, Luca; Shaarawy, Tarek; Pfeiffer, Norbert; Miglior, Stefano

    2016-04-01

    Current management of glaucoma entails the medical, laser, or surgical reduction of intraocular pressure (IOP) to a predetermined level of target IOP, which is commensurate with either stability or delayed progression of visual loss. In the published literature, the hypothesis is often made that IOP control implies a single IOP measurement over time. Although the follow-up of glaucoma patients with single IOP measurements is quick and convenient, such measurements often do not adequately reflect the untreated IOP characteristics, or indeed the quality of treated IOP control during the 24-h cycle. Since glaucoma is a 24-h disease and the damaging effect of elevated IOP is continuous, it is logical that we should aim to understand the efficacy of all treatment options throughout the 24-h period. This article first reviews the concept and value of diurnal and 24-h IOP monitoring. It then critically evaluates selected available evidence on the 24-h efficacy of medical, laser and surgical therapy options. During the past decade several controlled trials have significantly enhanced our understanding on the 24-h efficacy of all glaucoma therapy options. Nevertheless, more long-term evidence is needed to better evaluate the 24-h efficacy of glaucoma therapy and the precise impact of IOP characteristics on glaucomatous progression and visual prognosis.

  20. Current treatment options for recurrent nasopharyngeal cancer

    PubMed Central

    Suárez, Carlos; Rodrigo, Juan P.; Rinaldo, Alessandra; Langendijk, Johannes A.; Shaha, Ashok R.

    2010-01-01

    Loco-regional control rate of nasopharyngeal carcinoma (NPC) has improved significantly in the past decade. However, local recurrence still represents a major cause of mortality and morbidity in advanced stages, and management of local failure remains a challenging issue in NPC. The best salvage treatment for local recurrent NPC remains to be determined. The options include brachytherapy, external radiotherapy, stereotactic radiosurgery, and nasopharyngectomy, either alone or in different combinations. In this article we will discuss the different options for salvage of locally recurrent NPC. Retreatment of locally recurrent NPC using radiotherapy, alone or in combination with other treatment modalities, as well as surgery, can result in long-term local control and survival in a substantial proportion of patients. For small-volume recurrent tumors (T1–T2) treated with external radiotherapy, brachytherapy or stereotactic radiosurgery, comparable results to those obtained with surgery have been reported. In contrast, treatment results of advanced-stage locally recurrent NPC are generally more satisfactory with surgery (with or without postoperative radiotherapy) than with reirradiation. PMID:20865269

  1. [Sialorrhea--causes and treatment options].

    PubMed

    Reiss, Michael; Reiss, Gilfe

    2007-09-01

    Sialorrhea (drooling) is the involuntary spillage of saliva from the mouth. Drooling of saliva appears to be the consequence of a dysfunction in the coordination of the swallowing mechanism, resulting in excess pooling of saliva in the anterior portion of the oral cavity and the unintentional loss of saliva from the mouth. There are specific and symptomatic approaches to manage this condition. Treatment options range from conservative (i.e., observation, postural changes, biofeedback, motoric therapy of the mouth, acupuncture) to more aggressive measures such as medication, radiation, and surgical therapy.

  2. [Female sexual dysfunction: Drug treatment options].

    PubMed

    Alcántara Montero, A; Sánchez Carnerero, C I

    2016-01-01

    Many women will likely experience a sexual problem in their lifetime. Female sexual dysfunction is a broad term used to describe 3 categories of disorders of a multifactorial nature. Effective, but limited pharmacotherapeutic options exist to address female sexual dysfunction. The FDA recently approved the first agent for treatment of hypoactive sexual desire disorder in pre-menopausal women. Off-label use of hormonal therapies, particularly oestrogen and testosterone, are the most widely employed for female sexual dysfunction, particularly in post-menopausal women. Other drugs currently under investigation include phosphodiesterase inhibitors and agents that modulate dopamine or melanocortin receptors. PMID:27041639

  3. [New surgical treatment options for bone tumors].

    PubMed

    Andreou, D; Henrichs, M P; Gosheger, G; Nottrott, M; Streitbürger, A; Hardes, J

    2014-11-01

    Primary bone neoplasms can be classified into benign, locally/aggressive and rarely metastasizing and malignant tumors. Patients with benign tumors usually undergo surgical treatment in cases of local symptoms, mainly consisting of pain or functional deficits due to compression of important anatomical structures, such as nerves or blood vessels. Locally/aggressive and rarely metastasizing tumors exhibit an infiltrative growth pattern, so that surgical treatment is necessary to prevent further destruction of bone leading to local instability. Finally, the surgical treatment of malignant tumors is, with few exceptions, considered to be a prerequisite for long-term survival, either alone or in combination with systemic chemotherapy. Whereas the main objective of surgery in the treatment of benign tumors is relief of local symptoms with a minimum amount of damage to healthy tissue and minimizing the risk of local recurrence while ensuring bone stability in locally aggressive and rarely metastasizing tumors, the primary goal in the operative treatment of bone sarcomas is the resection of the tumor with clear surgical margins followed by defect reconstruction and the preservation of function. This review examines the current developments in the surgical treatment of primary bone neoplasms with respect to the management of the tumors and novel reconstructive options.

  4. Minimally invasive treatment options in fixed prosthodontics.

    PubMed

    Edelhoff, Daniel; Liebermann, Anja; Beuer, Florian; Stimmelmayr, Michael; Güth, Jan-Frederik

    2016-03-01

    Minimally invasive treatment options have become increasingly feasible in restorative dentistry, due to the introduction of the adhesive technique in combination with restorative materials featuring translucent properties similar to those of natural teeth. Mechanical anchoring of restorations via conventional cementation represents a predominantly subtractive treatment approach that is gradually being superseded by a primarily defect-oriented additive method in prosthodontics. Modifications of conventional treatment procedures have led to the development of an economical approach to the removal of healthy tooth structure. This is possible because the planned treatment outcome is defined in a wax-up before the treatment is commenced and this wax-up is subsequently used as a reference during tooth preparation. Similarly, resin- bonded FDPs and implants have made it possible to preserve the natural tooth structure of potential abutment teeth. This report describes a number of clinical cases to demonstrate the principles of modern prosthetic treatment strategies and discusses these approaches in the context of minimally invasive prosthetic dentistry.

  5. Minimally invasive treatment options in fixed prosthodontics.

    PubMed

    Edelhoff, Daniel; Liebermann, Anja; Beuer, Florian; Stimmelmayr, Michael; Güth, Jan-Frederik

    2016-03-01

    Minimally invasive treatment options have become increasingly feasible in restorative dentistry, due to the introduction of the adhesive technique in combination with restorative materials featuring translucent properties similar to those of natural teeth. Mechanical anchoring of restorations via conventional cementation represents a predominantly subtractive treatment approach that is gradually being superseded by a primarily defect-oriented additive method in prosthodontics. Modifications of conventional treatment procedures have led to the development of an economical approach to the removal of healthy tooth structure. This is possible because the planned treatment outcome is defined in a wax-up before the treatment is commenced and this wax-up is subsequently used as a reference during tooth preparation. Similarly, resin- bonded FDPs and implants have made it possible to preserve the natural tooth structure of potential abutment teeth. This report describes a number of clinical cases to demonstrate the principles of modern prosthetic treatment strategies and discusses these approaches in the context of minimally invasive prosthetic dentistry. PMID:26925471

  6. [Low and intermediate risk prostate cancer: Treatment options].

    PubMed

    Miñana-López, B; Reina-Alcaina, L; Rivero-Guerra, A; Rosino-Sánchez, A; Izquierdo-Morejón, E; Pietricica, B

    2016-07-01

    Patients with low and intermediate risk prostate cancer are the most frequently diagnosed group currently. In those with a life expectancy inferior to 10 years it is highly likely that treatment is not necessary so that observation must be the most appropriate approach. In patients in whom active therapy, in any of its forms, is indicated, it is necessary to balance between risk of dying or developing metastases from the disease and adverse effects of commonly accepted radical treatments, such as radical prostatectomy and external beam or interstitial radiotherapy. The significant incidence of associated morbidity, mainly erectile dysfunction and urinary incontinence, with high impact on quality of life, demands this approach in the field of decisions shared with patients. The risk of overtreatment in this group of patients has generated the introduction of more conservative approaches such as active surveillance and focal therapy. The first one tries to differ radical treatments as far as there are not enough aggressiveness criteria on the tumor or the patient requests them. The second, called to have a place between active surveillance and radical treatments, involves the performance of a partial ablation of the prostate to avoid the adverse effects of radical treatments, trying to achieve the closest oncological control to the radical options. We perform a review of the therapeutic options and their results in this type of patients. PMID:27416643

  7. New treatment options for alcoholic hepatitis

    PubMed Central

    Shasthry, Saggere Muralikrishna; Sarin, Shiv Kumar

    2016-01-01

    The burden of alcoholic liver disease has rapidly grown in the past two decades and is expected to increase further in the coming years. Alcoholic hepatitis, the most florid presentation of alcoholic liver disease, continues to have high morbidity and mortality, with significant financial and healthcare burden with limited treatment options. Steroids remain the current standard of care in severe alcoholic hepatitis in carefully selected patients. No specific treatments are available for those patients who are steroid ineligible, intolerant or unresponsive. Liver transplant has shown good short-term outcome; however, feasibility, ethical and economic concerns remain. Modification of gut microbiota composition and their products, such as lipopolysaccharide, nutritional interventions, immune modulation, increasing steroid sensitivity, genetic polymorphism and epigenetic modification of alcohol induced liver damage, augmenting hepatic regeneration using GCSF are potential therapeutic avenues in steroid non-responsive/ineligible patients. With better understanding of the pathophysiology, using “Omics” platforms, newer options for patients with alcoholic hepatitis are expected soon. PMID:27099434

  8. Treatment in juvenile rheumatoid arthritis and new treatment options

    PubMed Central

    Kasapçopur, Özgür; Barut, Kenan

    2015-01-01

    Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease of the childhood with the highest risk of disability. Active disease persists in the adulthood in a significant portion of children with juvenile rheumatoid arthritis despite many developments in the diagnosis and treatment. Therefore, initiation of efficient treatment in the early period of the disease may provide faster control of the inflammation and prevention of long-term harms. In recent years, treatment options have also increased in children with juvenile idiopathic arthritis owing to biological medications. All biological medications used in children have been produced to target the etiopathogenesis leading to disease including anti-tumor necrosis factor, anti-interleukin 1 and anti-interleukin 6 drugs. In this review, scientific data about biological medications used in the treatment of rheumatoid arthritis and new treatment options will be discussed. PMID:26078691

  9. Pelvic radiation disease: Updates on treatment options

    PubMed Central

    Frazzoni, Leonardo; La Marca, Marina; Guido, Alessandra; Morganti, Alessio Giuseppe; Bazzoli, Franco; Fuccio, Lorenzo

    2015-01-01

    Pelvic cancers are among the most frequently diagnosed neoplasms and radiotherapy represents one of the main treatment options. The irradiation field usually encompasses healthy intestinal tissue, especially of distal large bowel, thus inducing gastrointestinal (GI) radiation-induced toxicity. Indeed, up to half of radiation-treated patients say that their quality of life is affected by GI symptoms (e.g., rectal bleeding, diarrhoea). The constellation of GI symptoms - from transient to long-term, from mild to very severe - experienced by patients who underwent radiation treatment for a pelvic tumor have been comprised in the definition of pelvic radiation disease (PRD). A correct and evidence-based therapeutic approach of patients experiencing GI radiation-induced toxicity is mandatory. Therapeutic non-surgical strategies for PRD can be summarized in two broad categories, i.e., medical and endoscopic. Of note, most of the studies have investigated the management of radiation-induced rectal bleeding. Patients with clinically significant bleeding (i.e., causing chronic anemia) should firstly be considered for medical management (i.e., sucralfate enemas, metronidazole and hyperbaric oxygen); in case of failure, endoscopic treatment should be implemented. This latter should be considered the first choice in case of acute, transfusion requiring, bleeding. More well-performed, high quality studies should be performed, especially the role of medical treatments should be better investigated as well as the comparative studies between endoscopic and hyperbaric oxygen treatments. PMID:26677440

  10. Treatment options for polycystic ovary syndrome.

    PubMed

    Badawy, Ahmed; Elnashar, Abubaker

    2011-02-08

    Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women. The clinical manifestation of PCOS varies from a mild menstrual disorder to severe disturbance of reproductive and metabolic functions. Management of women with PCOS depends on the symptoms. These could be ovulatory dysfunction-related infertility, menstrual disorders, or androgen-related symptoms. Weight loss improves the endocrine profile and increases the likelihood of ovulation and pregnancy. Normalization of menstrual cycles and ovulation could occur with modest weight loss as little as 5% of the initial weight. The treatment of obesity includes modifications in lifestyle (diet and exercise) and medical and surgical treatment. In PCOS, anovulation relates to low follicle-stimulating hormone concentrations and the arrest of antral follicle growth in the final stages of maturation. This can be treated with medications such as clomiphene citrate, tamoxifen, aromatase inhibitors, metformin, glucocorticoids, or gonadotropins or surgically by laparoscopic ovarian drilling. In vitro fertilization will remain the last option to achieve pregnancy when others fail. Chronic anovulation over a long period of time is also associated with an increased risk of endometrial hyperplasia and carcinoma, which should be seriously investigated and treated. There are androgenic symptoms that will vary from patient to patient, such as hirsutism, acne, and/or alopecia. These are troublesome presentations to the patients and require adequate treatment. Alternative medicine has been emerging as one of the commonly practiced medicines for different health problems, including PCOS. This review underlines the contribution to the treatment of different symptoms.

  11. A treatment algorithm for managing Achilles tendinopathy: new treatment options

    PubMed Central

    Alfredson, Håkan; Cook, J

    2007-01-01

    Achilles tendinopathy affects athletes, recreational exercisers and even inactive people. The pathology is not inflammatory; it is a failed healing response. The source of pain in tendinopathy could be related to the neurovascular ingrowth seen in the tendon's response to injury. The treatment of Achilles tendinopathy is primarily conservative with an array of effective treatment options now available to the primary care practitioner. If conservative treatment is not successful, then surgery relieves pain in the majority of cases. Directing a patient through the algorithm presented here will maximise positive treatment outcomes. PMID:17311806

  12. ARSENIC REMOVAL TREATMENT OPTIONS FOR SINGLE FAMILY HOMES

    EPA Science Inventory

    The presentation provides information on POU and POE arsenic removal drinking water treatment systems. The presentation provides information on the arsenic rule, arsenic chemistry and arsenic treatment. The arsenic treatment options proposed for POU and POE treatment consist prim...

  13. Central precocious puberty: current treatment options.

    PubMed

    Antoniazzi, Franco; Zamboni, Giorgio

    2004-01-01

    . Although further data are need, there may be a role in the future for combining somatropin (growth hormone) and GnRH agonist treatment for some patients with significantly impaired growth velocity. The introduction of GnRH antagonists is likely to improve the treatment options for CPP.

  14. Pancreatic cancer, treatment options, and GI-4000

    PubMed Central

    Hartley, Marion L; Bade, Najeebah A; Prins, Petra A; Ampie, Leonel; Marshall, John L

    2015-01-01

    Although pancreatic cancer is but the eleventh most prevalent cancer in the US, it is predicted that of all the patients newly diagnosed with this disease in 2014, only 27% will still be alive at the end of the first year and only 6% will make it past 5 years. The choice of chemotherapy in the treatment of pancreatic cancer is dependent on disease stage and patient performance status but, in general, the most widely used approved regimens include 5-fluorouracil (5-FU) combinations and gemcitabine combinations. Recent therapeutic strategies have resulted in an improvement in survival of patients with pancreatic cancer but the magnitude of change is disappointing and vast improvements are still needed. The goal of immunotherapy is to enhance and guide the body's immune system to recognize tumor-specific antigens and mount an attack against the disease. Among newer immune therapies, GI-4000 consists of 4 different targeted molecular immunogens, each containing a different Ras protein (antigen) encoded by the most commonly found mutant RAS genes in solid tumors—RAS mutations exist in over 90% of pancreatic ductal adenocarcinomas. We will review pancreatic cancer epidemiology and its current treatment options, and consider the prospects of immunotherapy, focusing on GI-4000. We discuss the potential mechanism of action of GI-4000, and the performance of this vaccination series thus far in early phase clinical trials. PMID:25585100

  15. Pancreatic cancer, treatment options, and GI-4000

    PubMed Central

    Hartley, Marion L; Bade, Najeebah A; Prins, Petra A; Ampie, Leonel; Marshall, John L

    2015-01-01

    Although pancreatic cancer is but the eleventh most prevalent cancer in the US, it is predicted that of all the patients newly diagnosed with this disease in 2014, only 27% will still be alive at the end of the first year, which is reduced to 6% after 5 years. The choice of chemotherapy in the treatment of pancreatic cancer is dependent on disease stage and patient performance status but, in general, the most widely used approved regimens include 5-fluorouracil (5-FU) combinations and gemcitabine combinations. Recent therapeutic strategies have resulted in an improvement in survival of patients with pancreatic cancer but the magnitude of change is disappointing and vast improvements are still needed. The goal of immunotherapy is to enhance and guide the body's immune system to recognize tumor-specific antigens and mount an attack against the disease. Among newer immune therapies, GI-4000 consists of 4 different targeted molecular immunogens, each containing a different Ras protein (antigen) encoded by the most commonly found mutant RAS genes in solid tumors—RAS mutations exist in over 90% of pancreatic ductal adenocarcinomas. We will review pancreatic cancer epidemiology and its current treatment options, and consider the prospects of immunotherapy, focusing on GI-4000. We discuss the potential mechanism of action of GI-4000, and the performance of this vaccination series thus far in early phase clinical trials. PMID:25933185

  16. Obstructive sleep apnea: a palatable treatment option?

    PubMed

    Allison, C

    2007-01-01

    (1) The Pillar(R) Palatal Implant System consists of three polyester threads that are permanently implanted in the palate (the roof of the mouth) to reduce airway obstruction in individuals with mild to moderate obstructive sleep apnea (OSA) and snoring. (2) Three small, non-randomized uncontrolled trials reported a moderate reduction in the number of breathing interruptions during sleep, three to six months following palatal implant insertion. Statistically significant improvements in daytime sleepiness and snoring intensity were also reported. (3) The minimally invasive surgical procedure causes mild, transient discomfort. A potential complication is partial extrusion of the implant, requiring removal and replacement. (4) Currently, there is insufficient published evidence to determine whether palatal implants are an effective treatment option for patients with mild to moderate OSA due to palatal obstruction. (5) Larger, randomized controlled studies are needed to determine the long-term safety and efficacy of the implants in a more diverse patient population, including those who are obese or those with comorbid medical conditions. Comparisons with existing treatments for OSA are also needed.

  17. 28 CFR 549.65 - Refusal to accept treatment.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 28 Judicial Administration 2 2011-07-01 2011-07-01 false Refusal to accept treatment. 549.65... MEDICAL SERVICES Hunger Strikes, Inmate § 549.65 Refusal to accept treatment. (a) When, as a result of... threatened if treatment is not initiated immediately, the physician shall give consideration to...

  18. 28 CFR 549.65 - Refusal to accept treatment.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Refusal to accept treatment. 549.65... MEDICAL SERVICES Hunger Strikes, Inmate § 549.65 Refusal to accept treatment. (a) When, as a result of... threatened if treatment is not initiated immediately, the physician shall give consideration to...

  19. Abfraction lesions: etiology, diagnosis, and treatment options

    PubMed Central

    Nascimento, Marcelle M; Dilbone, Deborah A; Pereira, Patricia NR; Duarte, Wagner R; Geraldeli, Saulo; Delgado, Alex J

    2016-01-01

    Abfraction is a type of noncarious cervical lesion (NCCL) characterized by loss of tooth tissues with different clinical appearances. Evidence supports that abfraction lesions, as any NCCLs, have a multifactorial etiology. Particularly, the cervical wear of abfraction can occur as a result of normal and abnormal tooth function and may also be accompanied by pathological wear, such as abrasion and erosion. The interaction between chemical, biological, and behavioral factors is critical and helps to explain why some individuals exhibit more than one type of cervical wear mechanism than others. In an era of personalized dentistry, patient risk factors for NCCLs must be identified and addressed before any treatment is performed. Marked variations exist in dental practice concerning the diagnosis and management of these lesions. The lack of understanding about the prognosis of these lesions with or without intervention may be a major contributor to variations in dentists’ management decisions. This review focuses on the current knowledge and available treatment strategies for abfraction lesions. By recognizing that progressive changes in the cervical area of the tooth are part of a physiologically dynamic process that occurs with aging, premature and unnecessary intervention can be avoided. In cases of asymptomatic teeth, where tooth vitality and function are not compromised, abfraction lesions should be monitored for at least 6 months before any invasive procedure is planned. In cases of abfraction associated with gingival recession, a combined restorative-surgical approach may be performed. Restorative intervention and occlusal adjustment are not indicated as treatment options to prevent further tooth loss or progression of abfraction. The clinical decision to restore abfraction lesions may be based on the need to replace form and function or to relieve hypersensitivity of severely compromised teeth or for esthetic reasons. PMID:27217799

  20. Abfraction lesions: etiology, diagnosis, and treatment options.

    PubMed

    Nascimento, Marcelle M; Dilbone, Deborah A; Pereira, Patricia Nr; Duarte, Wagner R; Geraldeli, Saulo; Delgado, Alex J

    2016-01-01

    Abfraction is a type of noncarious cervical lesion (NCCL) characterized by loss of tooth tissues with different clinical appearances. Evidence supports that abfraction lesions, as any NCCLs, have a multifactorial etiology. Particularly, the cervical wear of abfraction can occur as a result of normal and abnormal tooth function and may also be accompanied by pathological wear, such as abrasion and erosion. The interaction between chemical, biological, and behavioral factors is critical and helps to explain why some individuals exhibit more than one type of cervical wear mechanism than others. In an era of personalized dentistry, patient risk factors for NCCLs must be identified and addressed before any treatment is performed. Marked variations exist in dental practice concerning the diagnosis and management of these lesions. The lack of understanding about the prognosis of these lesions with or without intervention may be a major contributor to variations in dentists' management decisions. This review focuses on the current knowledge and available treatment strategies for abfraction lesions. By recognizing that progressive changes in the cervical area of the tooth are part of a physiologically dynamic process that occurs with aging, premature and unnecessary intervention can be avoided. In cases of asymptomatic teeth, where tooth vitality and function are not compromised, abfraction lesions should be monitored for at least 6 months before any invasive procedure is planned. In cases of abfraction associated with gingival recession, a combined restorative-surgical approach may be performed. Restorative intervention and occlusal adjustment are not indicated as treatment options to prevent further tooth loss or progression of abfraction. The clinical decision to restore abfraction lesions may be based on the need to replace form and function or to relieve hypersensitivity of severely compromised teeth or for esthetic reasons. PMID:27217799

  1. Surgical options for treatment of atrial fibrillation.

    PubMed

    La Meir, Mark

    2014-01-01

    If we want to improve the outcomes, increase the success and reduce the complication rate of existing treatment strategies in concomitant and stand-alone atrial fibrillation (AF) procedures, we will have to increase our understanding of the pathophysiology, and of the disease, the limitations of current energy sources and ablation catheters, the different possible lesion sets, as well as improve communication between the electrophysiologist and cardiac surgeon. The technical limitations of percutaneous endocardial ablation procedures and the empirical techniques in surgical AF procedures necessitate new and innovative approaches. Surgeons should aim to improve the quality of the lesion set and minimize the invasiveness of existing techniques. The Maze procedure remains the basis upon which most of the more limited concomitant ablation procedures are and will be designed, but in stand-alone patients, recent progress has directed us towards either a single-step or sequential combined percutaneous endocardial procedure with a thoracoscopic epicardial procedure on the beating heart. A dedicated team of electrophysiologists and cardiothoracic surgeons can now work together to perform AF procedures. This can guide us to determine if there is an additional value of limiting the lesion set of the Maze procedure in concomitant surgery, and of an epicardial access in the treatment of stand-alone AF on the beating heart. If so, we will better understand which energy sources, lesion sets and surgical techniques are able to give us a three-dimensional knowledge and a three-dimensional treatment of AF. As a result, we can expect to obtain a higher single procedure long-term success rate with an acceptable low complication rate.

  2. Treatment Options for Myelodysplastic/Myeloproliferative Neoplasms

    MedlinePlus

    ... Myeloproliferative Neoplasms Treatment Myelodysplastic/ Myeloproliferative Neoplasms Treatment Myelodysplastic/ Myeloproliferative Neoplasms Treatment (PDQ®)–Patient Version General Information About Myelodysplastic/ ...

  3. Treatment Option Overview (Myelodysplastic/Myeloproliferative Neoplasms)

    MedlinePlus

    ... Myeloproliferative Neoplasms Treatment Myelodysplastic/ Myeloproliferative Neoplasms Treatment Myelodysplastic/ Myeloproliferative Neoplasms Treatment (PDQ®)–Patient Version General Information About Myelodysplastic/ ...

  4. Treatment Option Overview (Chronic Myeloproliferative Neoplasms)

    MedlinePlus

    ... Myeloproliferative Neoplasms Treatment Myelodysplastic/ Myeloproliferative Neoplasms Treatment Chronic Myeloproliferative Neoplasms Treatment (PDQ®)–Patient Version General Information About Chronic ...

  5. Treatment Options for Chronic Myeloproliferative Neoplasms

    MedlinePlus

    ... Myeloproliferative Neoplasms Treatment Myelodysplastic/ Myeloproliferative Neoplasms Treatment Chronic Myeloproliferative Neoplasms Treatment (PDQ®)–Patient Version General Information About Chronic ...

  6. Treatment Acceptability of Healthcare Services for Children with Cerebral Palsy

    ERIC Educational Resources Information Center

    Dahl, Norm; Tervo, Raymond; Symons, Frank J.

    2007-01-01

    Background: Although treatment acceptability scales in intellectual and developmental disabilities research have been used in large- and small-scale applications, large-scale application has been limited to analogue (i.e. contrived) investigations. This study extended the application of treatment acceptability by assessing a large sample of care…

  7. 28 CFR 549.65 - Refusal to accept treatment.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Refusal to accept treatment. 549.65 Section 549.65 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT MEDICAL SERVICES Hunger Strikes, Inmate § 549.65 Refusal to accept treatment. (a) When, as a result...

  8. 28 CFR 549.65 - Refusal to accept treatment.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Refusal to accept treatment. 549.65 Section 549.65 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT MEDICAL SERVICES Hunger Strikes, Inmate § 549.65 Refusal to accept treatment. (a) When, as a result...

  9. 28 CFR 549.65 - Refusal to accept treatment.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Refusal to accept treatment. 549.65 Section 549.65 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT MEDICAL SERVICES Hunger Strikes, Inmate § 549.65 Refusal to accept treatment. (a) When, as a result...

  10. Acceptance of nicotine dependence treatment among currently depressed smokers.

    PubMed

    Haug, Nancy A; Hall, Sharon M; Prochaska, Judith J; Rosen, Amy B; Tsoh, Janice Y; Humfleet, Gary; Delucchi, Kevin; Rossi, Joseph S; Redding, Colleen A; Eisendrath, Stuart

    2005-04-01

    This study reports on baseline characteristics associated with acceptance and refusal of available smoking treatment among currently depressed smokers in a psychiatric outpatient clinic who were enrolled in a larger clinical trial. The sample (N=154) was 68% female and 72% White, with a mean age of 41.4 years and average smoking rate of 17 cigarettes/day. All participants were assigned to a repeated contact experimental condition; received a stage-based expert system program to facilitate treatment acceptance; and were then offered smoking treatment, consisting of behavioral counseling, nicotine patch, and bupropion. Acceptors (n=53) were defined as those accepting behavioral counseling and pharmacological treatment at some point during the 18-month study, whereas refusers (n=101) received only the expert system. The number of days to treatment acceptance was significantly predicted by stage of change, with those in preparation entering treatment more quickly than contemplators or precontemplators. In a logistic regression, the variables most strongly associated with accepting treatment were current use of psychiatric medication and perceived success for quitting. Severity of depressive symptoms, duration of depression history, and history of recurrent depression were not related to treatment acceptance. Findings have implications for the psychiatric assessment and treatment of smokers in clinical settings. Psychiatric medication may play a significant role in smoking cessation treatment acceptance by currently depressed smokers. PMID:16036278

  11. Treatment Options by Stage (Laryngeal Cancer)

    MedlinePlus

    ... Patient Hypopharyngeal Cancer Treatment Laryngeal Cancer Treatment Lip & Oral Cavity Treatment Metastatic Squamous Neck Cancer with Occult Primary ... Nasal Cavity Cancer Treatment Salivary Gland Cancer Treatment Oral Cavity and Oropharyngeal Cancer Prevention Oral Cavity and Oropharyngeal ...

  12. College Student Receptiveness to Various Alcohol Treatment Options

    ERIC Educational Resources Information Center

    Epler, Amee J.; Sher, Kenneth J.; Loomis, Tiffany B.; O'Malley, Stephanie S.

    2009-01-01

    Objective: Heavy episodic drinking remains a significant problem on college campuses. Although most interventions for college students are behavioral, pharmacological treatments, such as naltrexone, could provide additional options. Participants: The authors evaluated receptivity to various alcohol treatment options in a general population of…

  13. Acceptability of child adoption as management option for infertility in Nigeria: evidence from focus group discussions.

    PubMed

    Oladokun, Adesina; Arulogun, Oyedunni; Oladokun, Regina; Morhason-Bello, Imran O; Bamgboye, Elijah A; Adewole, Isaac F; Ojengbede, Oladosu A

    2009-03-01

    Infertility remains a global health challenge with devastating psycho-social consequences in many African communities. Adoption that may serve as an alternative strategy for the affected couples is not widely practiced. This study was conceptualized to assess the acceptability of child adoption as a management option by Nigerians. Twelve focus group discussions were held involving three communities stratified into inner core, transitory and peripheral, within Ibadan metropolis, South-Western Nigeria from May to July 2008. The participants were purposively selected based on gender and age group. The barriers mentioned were cultural practices, stigmatization, financial implications, and procedural bottle-necks. Measures suggested to curb these negative attitudes were advocacy, community mobilization and enactment of supportive law that will protect all parties involved. PMID:20687267

  14. College students' acceptance of potential treatments for ADHD.

    PubMed

    Carter, Stacy L

    2005-08-01

    The purpose of the current study was to investigate the influence that the professional occupation of a consultant making a treatment recommendation may have on college students' (82 women and 52 men) acceptance of a proposed treatment for a child displaying characteristics of Attention Deficit/Hyperactivity Disorder. Consultants were special education teachers, school psychologists, or physicians. The study also examined college students' ratings of treatment acceptability associated with three frequently implemented interventions of either nonspecific medication, token economy with response cost, or time-out for children with characteristics of Attention Deficit/Hyperactivity Disorder. Analysis indicated college students found a token economy intervention was the least acceptable recommendation by a physician.

  15. Treatment Option Overview (Unusual Cancers of Childhood)

    MedlinePlus

    ... Cancer Treatment for more information. Esthesioneuroblastoma Esthesioneuroblastoma ( olfactory neuroblastoma ) is a tumor that begins in the olfactory ... first formed. Embryonal tumors such as rhabdomyosarcomas and neuroblastomas are most common in children. Treatment Treatment depends ...

  16. Treatment Options for Adult Acute Myeloid Leukemia

    MedlinePlus

    ... Treatment Childhood AML Treatment Research Adult Acute Myeloid Leukemia Treatment (PDQ®)–Patient Version General Information About Adult Acute Myeloid Leukemia Go to Health Professional Version Key Points Adult ...

  17. Treatment Option Overview (Adult Acute Myeloid Leukemia)

    MedlinePlus

    ... Treatment Childhood AML Treatment Research Adult Acute Myeloid Leukemia Treatment (PDQ®)–Patient Version General Information About Adult Acute Myeloid Leukemia Go to Health Professional Version Key Points Adult ...

  18. Hairy Cell Leukemia Treatment Option Overview

    MedlinePlus

    ... ALL Treatment Childhood AML Treatment Research Hairy Cell Leukemia Treatment (PDQ®)–Patient Version General Information About Hairy Cell Leukemia Go to Health Professional Version Key Points Hairy ...

  19. Treatment Options for Childhood Brain Stem Glioma

    MedlinePlus

    ... before the cancer is diagnosed and continue for months or years. Childhood brain stem gliomas may cause ... after treatment. Some cancer treatments cause side effects months or years after treatment has ended. These are ...

  20. Therapeutic options in the treatment of benign prostatic hyperplasia

    PubMed Central

    Sandhu, Jaspreet S

    2009-01-01

    Current theraputic options for the treatment of symptomatic benign prostatic hyperplasia (BPH) are reviewed. Therapeutic options for mild lower urinary tract symptoms (LUTS), as defined by the American Urological Association, are generally treated medically. Moderate to severe LUTS can be treated medically or with surgical therapy. Current medical and surgical treatments for LUTS secondary to BPH are reviewed and evolving treatments are explored. PMID:19936164

  1. Fibromyalgia: Timely diagnosis and treatment options.

    PubMed

    DʼArcy, Yvonne; Kraus, Susan; Clair, Andrew; Kiley, Deborah

    2016-09-22

    Fibromyalgia can be challenging to diagnose and treat, and patients often feel isolated and misunderstood. Surveys of patients with fibromyalgia suggest that patients would benefit from greater understanding and acceptance. NPs can provide this support and play a prominent role in helping patients manage their fibromyalgia.

  2. Fibromyalgia: Timely diagnosis and treatment options.

    PubMed

    DʼArcy, Yvonne; Kraus, Susan; Clair, Andrew; Kiley, Deborah

    2016-09-22

    Fibromyalgia can be challenging to diagnose and treat, and patients often feel isolated and misunderstood. Surveys of patients with fibromyalgia suggest that patients would benefit from greater understanding and acceptance. NPs can provide this support and play a prominent role in helping patients manage their fibromyalgia. PMID:27552689

  3. Treatment Acceptability of Alternative Marital Therapies: A Comparative Analysis.

    ERIC Educational Resources Information Center

    Bornstein, Philip H.; And Others

    1983-01-01

    Examined the acceptability of four therapeutic models (i.e., behavioral, psychoanalytic, systems, and eclectic) used in treatment of marital discord. Subjects (N=88) evaluated four treatment sequences as they applied to a marital case history. Results showed that, among varying treatments, behavioral and systems approaches were rated more…

  4. Light on Body Image Treatment: Acceptance Through Mindfulness

    ERIC Educational Resources Information Center

    Stewart, Tiffany M.

    2004-01-01

    The treatment of body image has to be multifaceted and should be directed toward the treatment of the whole individual - body, mind, and spirit - with an ultimate culmination of acceptance and compassion for the self. This article presents information on a mindful approach to the treatment of body image as it pertains to concerns with body size…

  5. Current and future treatment options in SIADH

    PubMed Central

    Zietse, Robert; van der Lubbe, Nils; Hoorn, Ewout J.

    2009-01-01

    The treatment of hyponatraemia due to SIADH is not always as straightforward as it seems. Although acute treatment with hypertonic saline and chronic treatment with fluid restriction are well established, both approaches have severe limitations. These limitations are not readily overcome by addition of furosemide, demeclocycline, lithium or urea to the therapy. In theory, vasopressin-receptor antagonists would provide a more effective method to treat hyponatraemia, by virtue of their ability to selectively increase solute-free water excretion by the kidneys (aquaresis). In this review we explore the limitations of the current treatment of SIADH and describe emerging therapies for the treatment of SIADH-induced hyponatraemia. PMID:19881932

  6. What Treatment Options Are Available for Male Infertility?

    MedlinePlus

    ... Publications What treatment options are available for male infertility? Skip sharing on social media links Share this: ... deliver a live-born infant, in most cases, infertility has no other outward symptoms. The evaluation of ...

  7. For Some Breast Cancers, New Drug May Be Treatment Option

    Cancer.gov

    Results from an international clinical trial suggest that women with metastatic, HER2-positive breast cancer that is no longer responding to the targeted therapy trastuzumab (Herceptin) may soon have a new treatment option.

  8. Tinea capitis: diagnostic criteria and treatment options.

    PubMed

    Meadows-Oliver, Mikki

    2009-01-01

    Tinea capitis is a fungal infection involving the hair shaft of the scalp. It is commonly referred to as ringworm and occurs primarily in children. Treatment with a systemic anti-fungal rather than topical treatment is required. Currently, two medications, griseofulvin (Grifulvin) and terbinafine (Lamisil Granules), are FDA-approved to treat tinea capitis. Treatment with griseofulvin is usually 6 to 8 weeks, while treatment with terbinafine requires 6 weeks. There are other medications currently not FDA-approved to treat tinea capitis that have similar cure rates and shorter durations of treatment for tinea capitis, and as a result, are being used off-label. This article reviews the research-based literature related to the treatment of tinea capitis with various pharmacologic agents.

  9. Natural Conception May Be an Acceptable Option in HIV-Serodiscordant Couples in Resource Limited Settings.

    PubMed

    Sun, Lijun; Wang, Fang; Liu, An; Xin, Ruolei; Zhu, Yunxia; Li, Jianwei; Shao, Ying; Ye, Jiangzhu; Chen, Danqing; Li, Zaicun

    2015-01-01

    Many HIV serodiscordant couples have a strong desire to have their own biological children. Natural conception may be the only choice in some resource limited settings but data about natural conception is limited. Here, we reported our findings of natural conception in HIV serodiscordant couples. Between January 2008 and June 2014, we retrospectively collected data on 91 HIV serodiscordant couples presenting to Beijing Youan Hospital with childbearing desires. HIV counseling, effective ART on HIV infected partners, pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) in negative female partners and timed intercourse were used to maximally reduce the risk of HIV transmission. Of the 91 HIV serodiscordant couples, 43 were positive in male partners and 48 were positive in female partners. There were 196 unprotected vaginal intercourses, 100 natural conception and 97 newborns. There were no cases of HIV seroconversion in uninfected sexual partners. Natural conception may be an acceptable option in HIV-serodiscordant couples in resource limited settings if HIV-positive individuals have undetectable viremia on HAART, combined with HIV counseling, PrEP, PEP and timed intercourse.

  10. Natural Conception May Be an Acceptable Option in HIV-Serodiscordant Couples in Resource Limited Settings

    PubMed Central

    Xin, Ruolei; Zhu, Yunxia; Li, Jianwei; Shao, Ying; Ye, Jiangzhu; Chen, Danqing; Li, Zaicun

    2015-01-01

    Many HIV serodiscordant couples have a strong desire to have their own biological children. Natural conception may be the only choice in some resource limited settings but data about natural conception is limited. Here, we reported our findings of natural conception in HIV serodiscordant couples. Between January 2008 and June 2014, we retrospectively collected data on 91 HIV serodiscordant couples presenting to Beijing Youan Hospital with childbearing desires. HIV counseling, effective ART on HIV infected partners, pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) in negative female partners and timed intercourse were used to maximally reduce the risk of HIV transmission. Of the 91 HIV serodiscordant couples, 43 were positive in male partners and 48 were positive in female partners. There were 196 unprotected vaginal intercourses, 100 natural conception and 97 newborns. There were no cases of HIV seroconversion in uninfected sexual partners. Natural conception may be an acceptable option in HIV-serodiscordant couples in resource limited settings if HIV-positive individuals have undetectable viremia on HAART, combined with HIV counseling, PrEP, PEP and timed intercourse. PMID:26540103

  11. Impetigo: aetiology, complications and treatment options.

    PubMed

    Watkins, Philip

    This article describes impetigo, and outlines differential diagnoses, likely complications associated with impetigo and signs and symptoms. Main treatments for impetigo are highlighted, with explanations of when these treatments are useful and when they may not be the best choice. Anxieties that accompany impetigo in a family context and ways in which an appreciation of these anxieties may enhance the care provided are examined.

  12. Options assessment report: Treatment of nitrate salt waste at Los Alamos National Laboratory

    SciTech Connect

    Robinson, Bruce Alan; Stevens, Patrice Ann

    2015-09-16

    This report documents the methodology used to select a method of treatment for the remediated nitrate salt (RNS) and unremediated nitrate salt (UNS) waste containers at Los Alamos National Laboratory (LANL). The method selected should treat the containerized waste in a manner that renders the waste safe and suitable for transport and final disposal in the Waste Isolation Pilot Plant (WIPP) repository, under specifications listed in the WIPP Waste Acceptance Criteria (DOE/CBFO, 2013). LANL recognized that the results must be thoroughly vetted with the New Mexico Environment Department (NMED) and the a modification to the LANL Hazardous Waste Facility Permit is a necessary step before implementation of this or any treatment option. Likewise, facility readiness and safety basis approvals must be received from the Department of Energy (DOE). This report presents LANL's preferred option, and the documentation of the process for reaching the recommended treatment option for RNS and UNS waste, and is presented for consideration by NMED and DOE.

  13. CURRENT OPTIONS FOR SURGICAL TREATMENT OF GLAUCOMA.

    PubMed

    Stefan, Cornel; Batras, Mehdi; Iliescu Daniela, Adriana; Timaru Cristina, Mihaela; De Simone, Algerino; Hosseini-Ramhormozi, Jalaladin

    2015-01-01

    The purpose of this study is to review current surgical treatment and new and better alternatives for patients with glaucoma. Glaucoma refers to a group of related eye disorders that have in common an optic neuropathy associated with visual function loss. It is one of the leading causes of irreversible blindness worldwide. Optic nerve damage and glaucoma-related vision loss can be prevented or limited by early diagnosis and treatment. Surgery offers a better control of the intraocular pressure then medical therapy. Nowadays, research continues for improving current surgical alternatives for treatment.

  14. Prostate cancer recurrence after Focal Therapy: Treatment options.

    PubMed

    Hamid, S; Guillaumier, S; Shah, T; Arya, M; Ahmed, H U

    2016-07-01

    Focal therapy is a novel treatment option in localised prostate cancer with or without a visible lesion on MRI. Treatment for low to intermediate risk prostate cancer with focal therapy has demonstrated good short to medium term outcomes with fewer undesirable genitourinary side effects. This has made focal therapy more appealing to men who find the implications of radical treatment unacceptable or are unable to tolerate active surveillance. In this paper we review the literature for treatment options in prostate cancer recurrence post focal therapy. We also cover the different definitions of failure agreed upon in previous consensus meetings, as well as their implications on future management focal therapy patients. PMID:27416641

  15. Treatment Option Overview (Pheochromocytoma and Paraganglioma)

    MedlinePlus

    ... is also called nuclear magnetic resonance imaging (NMRI). Genetic counseling is part of the treatment plan for ... to other parts of the body: CT scan (CAT scan) : A procedure that makes a series of ...

  16. Treatment Options by Stage (Adrenocortical Carcinoma)

    MedlinePlus

    ... of Childhood Treatment for more information.) Having certain genetic conditions increases the risk of adrenocortical carcinoma. Anything ... can be a sign of disease. CT scan (CAT scan) : A procedure that makes a series of ...

  17. Treatment Options for Pheochromocytoma and Paraganglioma

    MedlinePlus

    ... is also called nuclear magnetic resonance imaging (NMRI). Genetic counseling is part of the treatment plan for ... to other parts of the body: CT scan (CAT scan) : A procedure that makes a series of ...

  18. Treatment Options by Stage (Vulvar Cancer)

    MedlinePlus

    ... for vulvar cancer may be applied to the skin in a cream or lotion. See Drugs Approved to Treat Vulvar ... treat vulvar lesions and is applied to the skin in a cream. New types of treatment are being tested in ...

  19. Treatment Options by Stage (Oropharyngeal Cancer)

    MedlinePlus

    ... adjuvant therapy . New types of surgery, including transoral robotic surgery , are being studied for the treatment of oropharyngeal cancer. Transoral robotic surgery may be used to remove cancer from ...

  20. Treatment Options for Male Breast Cancer

    MedlinePlus

    ... Breast & Gynecologic Cancers Breast Cancer Screening Research Male Breast Cancer Treatment (PDQ®)–Patient Version General Information about Male Breast Cancer Go to Health Professional Version Key Points Male ...

  1. Treatment Option Overview (Male Breast Cancer)

    MedlinePlus

    ... Breast & Gynecologic Cancers Breast Cancer Screening Research Male Breast Cancer Treatment (PDQ®)–Patient Version General Information about Male Breast Cancer Go to Health Professional Version Key Points Male ...

  2. Treatment Option Overview (Small Cell Lung Cancer)

    MedlinePlus

    ... Cancer Prevention Lung Cancer Screening Research Small Cell Lung Cancer Treatment (PDQ®)–Patient Version General Information About Small Cell Lung Cancer Go to Health Professional Version Key Points ...

  3. Treatment Options for Gastrointestinal Carcinoid Tumors

    MedlinePlus

    ... symptoms of GI carcinoid tumors in the jejunum (middle part of the small intestine) and ileum (last part ... Treatment of GI carcinoid tumors in the jejunum (middle part of the small intestine) and ileum (last part ...

  4. Treatment Option Overview (Gastrointestinal Carcinoid Tumors)

    MedlinePlus

    ... symptoms of GI carcinoid tumors in the jejunum (middle part of the small intestine) and ileum (last part ... Treatment of GI carcinoid tumors in the jejunum (middle part of the small intestine) and ileum (last part ...

  5. Treatment Option Overview (Adult Brain Tumors)

    MedlinePlus

    ... on their chemical make-up. SPECT scan (single photon emission computed tomography scan) : A procedure that uses ... has come back after treatment: SPECT scan (single photon emission computed tomography scan) : A procedure that uses ...

  6. Treatment Acceptability of Interventions Published in Six School Psychology Journals

    ERIC Educational Resources Information Center

    Villarreal, Victor; Ponce, Christopher; Gutierrez, Heveli

    2015-01-01

    Treatment acceptability (TA) is critical when selecting and implementing an intervention, as TA is associated with treatment outcomes. The significance of TA is reflected in school psychology models for services that state that school psychologists should address TA during development, implementation, and evaluation of interventions. However, the…

  7. Acceptability of Alternative Treatments for Deviant Child Behavior.

    ERIC Educational Resources Information Center

    Kazdin, Alan E.

    1980-01-01

    Cases of deviant child behavior were described to 88 undergraduate students along with four different treatments (reinforcement of incompatible behavior, time out from reinforcement, drug therapy, and electric shock). Reinforcement of incompatible behavior was more acceptable than other treatments which followed, in order, time out from…

  8. [New treatment options for chronic pruritus].

    PubMed

    Zeidler, C; Pfleiderer, B; Ständer, S

    2016-08-01

    Prevalent in 14-17 % of the population, chronic pruritus is among the most common and stressful symptoms in medicine. In spite of new findings regarding the origin and chronification of the symptom, therapy remains a great challenge. There is a lack of approved therapies that provide rapid and efficient reduction of pruritus. As a result, the affected patients suffer a long time (even months to years), and somatic (scratch lesions, super infections, sleep disorders) and psychosomatic disorders develop. Interdisciplinary cooperation with various specialists is important not just for these reasons, but also due to different etiologies of the symptom and common comorbidities. In addition, there remains a great need for uniformly devised, clinically controlled studies, recommendations and guidelines. New therapeutic approaches are currently being verified in clinical trials. This allows for future prospects of possible new and partially targeted therapies. This article provides a summary of current therapeutic options based on case series, individual randomized controlled trials and the current S2K guideline. PMID:27351559

  9. A Treatment Option for Esophageal Intramural Pseudodiverticulosis.

    PubMed

    Tyberg, Amy; Jodorkovsky, Daniela

    2014-04-01

    Esophageal intramural pseudodiverticulosis (EIPD) is a rare condition often presenting with esophageal strictures. Treatment is often limited to endoscopic dilatation and treatment of the underlying esophageal pathology. We present a case of a patient with longstanding GERD on famotidine (she experienced anaphylaxis with proton pump inhibitors [PPIs]) who presented with dysphagia and weight loss. Work-up revealed a diagnosis of EIPD with a 5-mm mid-esophageal stricture. Therapy with dilatation was unsuccessful until the addition of sucralfate, after which dilatation was successful and symptoms resolved. In patients who are unable to take PPIs, the addition of sucralfate may enhance the success of dilatations of esophageal strictures and EIPD. PMID:26157852

  10. Hip Instability: Current Concepts and Treatment Options.

    PubMed

    Dumont, Guillaume D

    2016-07-01

    Instability of the hip can manifest in a wide range of settings, with presenting symptoms including subtle discomfort at end range of motion or more dramatic dislocation of the joint. It can result from traumatic injury with dislocation or subluxation; atraumatic capsular laxity; structural bony abnormality, such as acetabular dysplasia; and iatrogenic injury. Initial treatment of the concentrically reduced joint often begins with physical therapy to strengthen dynamic stabilizers and to allow time for resolution of acute symptoms. Surgical treatment is aimed at repairing injured soft tissue structures, including static stabilizers, and addressing underlying bony structural deficiencies. PMID:27343395

  11. [Extended options of anticoagulant treatment in thromboembolism].

    PubMed

    Karetová, Debora; Bultas, Jan

    2014-11-01

    Thromboembolic disease (TD) is a relatively common disease with acute risk of death and potential long-term consequences in term of postthrombotic syndrome or chronic pulmonary hypertension. Anticoagulant therapy is the basic therapeutic procedure; thrombolytic therapy and the introduction cava filter are appropriately indicated for individual cases. In past few years, new direct oral anticoagulant drugs (NOAC) have occurred - Xa factor or thrombin inhibitors which have demonstrated the same efficacy and even higher safety in comparison to conventional treatment. In mid 2014, 3 drugs of this group are registered in Czech Republic - rivaroxaban (Xarelto®), dabigatran (Pradaxa®) and apixaban (Eliquis®). These drugs have comparable efficacy and safety but they differ in schedule of dose administration. Rivaroxaban and apixaban can be administered immediately after diagnosis of venous thrombosis or hemodynamically stable pulmonary embolism. LMWH application has to precede few days the administration of dabigatran. Limitation of new drugs is their price. Unavailability of antidotes is temporary because current researches continue to find one for dabigatran and another for both of xabans. Duration of anticoagulant treatment after acute phase depends on the presence of thrombosis risk factors and the individual bleeding risk. Minimal duration of anticoagulant therapy is 3 months, commonly 6-12 months and in high risk patients it is "long term" treatment. Good results of new anticoagulant drugs in trials in term of thromboembolism recurrence prevention may change established habits in TD patients with long term treatment. PMID:25600045

  12. Urinary Incontinence: Management and Treatment Options

    ERIC Educational Resources Information Center

    Griebling, Tomas L.

    2009-01-01

    Urinary incontinence, defined as the involuntary leakage of urine, is a common health problem in both women and men. Children may also suffer from this condition. Management and treatment of urinary incontinence depends primarily on the specific type of incontinence and the underlying problem causing the leakage for a given patient. Because…

  13. Treatment Option Overview (Salivary Gland Cancer)

    MedlinePlus

    ... radiation therapy to be given in fewer treatments. Photon-beam radiation therapy : Photon-beam radiation therapy is a type of external ... with or without radiation therapy. Fast neutron or photon-beam radiation therapy . A clinical trial of radiation ...

  14. Treatment Options by Stage (Salivary Gland Cancer)

    MedlinePlus

    ... radiation therapy to be given in fewer treatments. Photon-beam radiation therapy : Photon-beam radiation therapy is a type of external ... with or without radiation therapy. Fast neutron or photon-beam radiation therapy . A clinical trial of radiation ...

  15. [Options for stress management in obesity treatment].

    PubMed

    Czeglédi, Edit

    2016-02-14

    Overeating and physical inactivity are of great importance in the etiology of obesity. Psychological factors are often found in the background of life style. Chronic stress can contribute to physical inactivity and behaviors that hinder the keeping of a diet (e.g., irregular eating pattern, emotional eating). Results of randomized controlled trials show that relaxation can reduce emotional eating, improve cognitive restraint, and thereby reduce weight. However, stress management is more than relaxation. It consists of adaptive emotion-focused and problem-focused coping strategies and skills to improve relationships. Deflection skills may help in replacing emotional eating with other behaviors. Cognitive restructuring, saying no, and problem solving help to prevent or manage conflicts and difficulties otherwise would result in overeating due to distress. Developing stress management skills may result in greater compliance with the treatment. The techniques presented in the study can be easily applied by general practitioners or specialists, and provide tools for optimizing obesity treatment. PMID:26853727

  16. New treatment options for hearing loss.

    PubMed

    Müller, Ulrich; Barr-Gillespie, Peter G

    2015-05-01

    Hearing loss is the most common form of sensory impairment in humans and affects more than 40 million people in the United States alone. No drug-based therapy has been approved by the Food and Drug Administration, and treatment mostly relies on devices such as hearing aids and cochlear implants. Over recent years, more than 100 genetic loci have been linked to hearing loss and many of the affected genes have been identified. This understanding of the genetic pathways that regulate auditory function has revealed new targets for pharmacological treatment of the disease. Moreover, approaches that are based on stem cells and gene therapy, which may have the potential to restore or maintain auditory function, are beginning to emerge. PMID:25792261

  17. [Options for stress management in obesity treatment].

    PubMed

    Czeglédi, Edit

    2016-02-14

    Overeating and physical inactivity are of great importance in the etiology of obesity. Psychological factors are often found in the background of life style. Chronic stress can contribute to physical inactivity and behaviors that hinder the keeping of a diet (e.g., irregular eating pattern, emotional eating). Results of randomized controlled trials show that relaxation can reduce emotional eating, improve cognitive restraint, and thereby reduce weight. However, stress management is more than relaxation. It consists of adaptive emotion-focused and problem-focused coping strategies and skills to improve relationships. Deflection skills may help in replacing emotional eating with other behaviors. Cognitive restructuring, saying no, and problem solving help to prevent or manage conflicts and difficulties otherwise would result in overeating due to distress. Developing stress management skills may result in greater compliance with the treatment. The techniques presented in the study can be easily applied by general practitioners or specialists, and provide tools for optimizing obesity treatment.

  18. Analgesic Placebo Treatment Perceptions: Acceptability, Efficacy, and Knowledge

    PubMed Central

    Kisaalita, Nkaku R.; Robinson, Michael E.

    2012-01-01

    Current evidence supports the efficacy of placebo analgesia and illustrates that patients may be open to placebo use despite uncertainty regarding its mechanisms. Debate persists, however, concerning the ethics of placebo treatments. The purpose of the present web-based study was to expand upon the empirical literature on placebo analgesia ethics and acceptability. Participants (n = 100) provided their definition of a placebo and responded to 24 questions addressing placebo analgesia perceived knowledge, acceptability, effectiveness, and likelihood of placebo use among different healthcare providers. Results support previous research on the effects of placebo on negative mood and healthcare provider attributions, with findings illustrating that negative consequences of administration were largely mitigated by a beneficial treatment outcome. Results showed that participants conceptualized placebo as predominately “inert” and were mixed regarding interpretations of placebo effectiveness. Though acceptability ratings were dependent on the context of placebo administration, participants endorsing even moderate placebo acceptability were more open to placebo interventions and reported overall more positive treatment outcomes. Participants believed that placebos were used differentially among healthcare providers. Additional studies are needed to determine if placebo education can beneficially impact perceptions of placebo analgesia knowledge, acceptability, and treatment effectiveness. PMID:22854011

  19. Bacteriophages as potential treatment option for antibiotic resistant bacteria.

    PubMed

    Bragg, Robert; van der Westhuizen, Wouter; Lee, Ji-Yun; Coetsee, Elke; Boucher, Charlotte

    2014-01-01

    The world is facing an ever-increasing problem with antibiotic resistant bacteria and we are rapidly heading for a post-antibiotic era. There is an urgent need to investigate alterative treatment options while there are still a few antibiotics left. Bacteriophages are viruses that specifically target bacteria. Before the development of antibiotics, some efforts were made to use bacteriophages as a treatment option, but most of this research stopped soon after the discovery of antibiotics. There are two different replication options which bacteriophages employ. These are the lytic and lysogenic life cycles. Both these life cycles have potential as treatment options. There are various advantages and disadvantages to the use of bacteriophages as treatment options. The main advantage is the specificity of bacteriophages and treatments can be designed to specifically target pathogenic bacteria while not negatively affecting the normal microbiota. There are various advantages to this. However, the high level of specificity also creates potential problems, the main being the requirement of highly specific diagnostic procedures. Another potential problem with phage therapy includes the development of immunity and limitations with the registration of phage therapy options. The latter is driving research toward the expression of phage genes which break the bacterial cell wall, which could then be used as a treatment option. Various aspects of phage therapy have been investigated in studies undertaken by our research group. We have investigated specificity of phages to various avian pathogenic E. coli isolates. Furthermore, the exciting NanoSAM technology has been employed to investigate bacteriophage replication and aspects of this will be discussed. PMID:24619620

  20. Bacteriophages as potential treatment option for antibiotic resistant bacteria.

    PubMed

    Bragg, Robert; van der Westhuizen, Wouter; Lee, Ji-Yun; Coetsee, Elke; Boucher, Charlotte

    2014-01-01

    The world is facing an ever-increasing problem with antibiotic resistant bacteria and we are rapidly heading for a post-antibiotic era. There is an urgent need to investigate alterative treatment options while there are still a few antibiotics left. Bacteriophages are viruses that specifically target bacteria. Before the development of antibiotics, some efforts were made to use bacteriophages as a treatment option, but most of this research stopped soon after the discovery of antibiotics. There are two different replication options which bacteriophages employ. These are the lytic and lysogenic life cycles. Both these life cycles have potential as treatment options. There are various advantages and disadvantages to the use of bacteriophages as treatment options. The main advantage is the specificity of bacteriophages and treatments can be designed to specifically target pathogenic bacteria while not negatively affecting the normal microbiota. There are various advantages to this. However, the high level of specificity also creates potential problems, the main being the requirement of highly specific diagnostic procedures. Another potential problem with phage therapy includes the development of immunity and limitations with the registration of phage therapy options. The latter is driving research toward the expression of phage genes which break the bacterial cell wall, which could then be used as a treatment option. Various aspects of phage therapy have been investigated in studies undertaken by our research group. We have investigated specificity of phages to various avian pathogenic E. coli isolates. Furthermore, the exciting NanoSAM technology has been employed to investigate bacteriophage replication and aspects of this will be discussed.

  1. Novel treatment options of binge eating disorder.

    PubMed

    Marazziti, D; Rossi, L; Baroni, S; Consoli, G; Hollander, E; Catena-Dell'Osso, M

    2011-01-01

    Obesity is a major problem of modern societies that sometimes, but not necessarily, is associated with binge-eating disorder (BED), a relatively new disorder characterized by binge eating without purging. The purpose of this article is to review the rationale for the potential use of pharmacological treatments in BED, and the potential use of the recently proposed compounds. Therefore, a careful medline of published articles from 1980 to December 2010 was carried out using the following keywords: BED and treatment, topiramate, zonisamide, sibutramine, venlafaxine, duloxetine, ghrelin, opiate blockers. Single case reports, observational studies, opinion articles, and studies concerning adults with syndromes resulting in BED (i.e., night eating syndrome) were also reviewed. All examined papers would indicate that the pharmacological treatment of BED is still heterogenous and poorly established, mainly for the lack of controlled studies in large samples of patients. In any case, the data on serotonin and norepinephrine reuptake inhibitors and on novel anticonvulsants seem quite promising in terms of efficacy and tolerability. In addition, the preliminary findings on the possibility of modulating appetite through the interference with the ghrelin system suggest new and intriguing ways of intervention in BED.

  2. Current treatment options for primary immune thrombocytopenia.

    PubMed

    Salama, Abdulgabar

    2011-02-01

    Traditional treatment of primary (idiopathic) immune thrombocytopenia (ITP) predominantly consists of immune suppression and/or modulation. In addition, many treated patients develop severe adverse effects, and approximately a third of patients do not respond. Two of the newly developed thrombopoietin-receptor agonists, romiplostim and eltrombopag, are now available for the treatment of ITP. Both drugs have been shown to increase the production of platelets in a dose-dependent manner, and to compensate, at least partly, for thrombocytopenia in the majority of ITP patients. The reported adverse effects are predominantly mild, although serious and long-term side effects cannot be excluded. Nevertheless, these drugs are increasingly used in the treatment of patients with thrombocytopenias. Thrombopoietin-receptor agonists do not appear to stop either the production of autoantibodies or the accelerated platelet destruction observed in ITP. Thus, the need for a specific therapy is essential, and the ultimate solution is to clarify and halt the mechanism(s) that lead to the development of ITP.

  3. Current and future treatment options for gonorrhoea.

    PubMed

    Ison, Catherine A; Deal, Carolyn; Unemo, Magnus

    2013-12-01

    The delivery of effective antimicrobial therapy is essential for public health control of gonorrhoea, in the absence of a suitable vaccine. The antimicrobial agent chosen should have high efficacy and quality, lack toxicity and give >95% success when given empirically. Guidelines, which are informed by surveillance data, are used to aid clinicians in their choice of appropriate agent. Historically, gonorrhoea treatment has been delivered as a single, directly observed dose but this has resulted in failure of successive antimicrobial agents which have been replaced by a new antimicrobial to which resistance has been rare or non-existing. Following the drift towards decreased susceptibility and treatment failure to the extended spectrum cephalosporins, and the lack of 'new' alternative antimicrobials, the threat of difficult to treat or untreatable gonorrhoea has emerged. The challenge of maintaining gonorrhoea as a treatable infection has resulted in national, regional and global response or action plans. This review discusses different approaches to the future treatment of gonorrhoea including; use of ceftriaxone, the injectable cephalosporin at increased dosage; dual antimicrobial therapy; use of drugs developed for other infections and use of older agents, directed by rapid point of care tests, to susceptible infections. Finally, it is considered whether the time is right to readdress the possibility of developing an effective gonococcal vaccine, given the major advances in our understanding of natural infection, molecular pathogenesis and the revolution in molecular biology techniques.

  4. Current options for the treatment of pathological scarring.

    PubMed

    Poetschke, Julian; Gauglitz, Gerd G

    2016-05-01

    Scarring is the consequence of surgery, trauma or different skin diseases. Apart from fresh, immature scars,that transform into mature scars over the course of would healing and that do not require further treatment,linear hypertrophic scars, widespread hypertrophic scars, keloids and atrophic scars exist. Symptoms like pruritusand pain, stigmatization as well as functional and aesthetic impairments that are very disturbing for the affected patients can bethe basis for the desire for treatment. Today, a multitude of options for the treatment and prevention of scars exists. Topical agents based on silicone or onion extract, intralesional injections of cristalline glucocorticoids (oftentimes in combinationwith cryotherapy) or 5-Fluorouracil as well as ablative and nonablative laser treatment are used. Current guidelines summarize the multitude of available treatment options and the currently available datafor the treating physicians, allowing them to make clear therapy recommendations for every single scar type. Relieving patients of their discomfort and doing their aesthetic demands justice is thus possible. Apart from scar prevention becoming more and more important, the increased use of modernlaser treatment options constitutes a key point in clinical scar treatment. At the same time the attention is turned to evaluating current therapeutic options with the help of contemporary study designs so as to graduallyimprove the level of evidence in scar treatment. PMID:27119465

  5. Acute intermittent porphyria: Diagnostic dilemma and treatment options

    PubMed Central

    Kaur, Mohan Deep; Hazarika, Nita; Saraswat, Namita; Sood, Rajesh

    2015-01-01

    Acute intermittent porphyria (AIP) presents with diverse group of symptoms making its early diagnosis difficult. Delaying diagnosis and treatment of AIP can be fatal or can cause long term or permanent neurological damage. We present here a case report of AIP where the diagnosis was missed. The diversity of symptoms and details concerning the treatment options for AIP are discussed. PMID:26330726

  6. Drug-resistant tuberculosis: emerging treatment options

    PubMed Central

    Adhvaryu, Meghna; Vakharia, Bhasker

    2011-01-01

    Multidrug-resistant tuberculosis has emerged worldwide, with an increasing incidence due to failure of implementation of apparently effective first-line antituberculous therapy as well as primary infection with drug-resistant strains. Failure of current therapy is attributed to a long duration of treatment leading to nonadherence and irregular therapy, lack of patient education about the disease, poverty, irregular supply by care providers, drug–drug interactions in patients coinfected with human immunodeficiency virus (HIV), inadequate regulations causing market overlap and irresponsible drug usage in the private sector, and lack of research, with no addition of new drugs in the last four decades. Present standards of care for the treatment of drugsusceptible tuberculosis, multidrug-resistant tuberculosis, tuberculosis-HIV coinfection, and latent tuberculosis infection are all unsatisfactory. Since 2000, the World Health Organization (WHO) has focused on drug development for tuberculosis, as well as research in all relevant aspects to discover new regimens by 2015 and to eliminate tuberculosis as a public health concern by 2050. As a result, some 20 promising compounds from 14 groups of drugs have been discovered. Twelve candidates from eight classes are currently being evaluated in clinical trials. Ongoing research should prioritize identification of novel targets and newer application of existing drugs, discovery of multitargeted drugs from natural compounds, strengthening host factors by immunopotentiation with herbal immunomodulators, as well as protective vaccines before and after exposure, consideration of surgical measures when indicated, development of tools for rapid diagnosis, early identification of resistant strains, and markers for adequacy of treatment and an integrative approach to fulfill WHO goals. However, regulatory control over the drug market, as well as public-private partnership to use health program facilities to track patients and ensure

  7. Pathogenesis and treatment options for intradialytic hypertension.

    PubMed

    Rocha, Ana

    2016-09-01

    Controversy surrounds the diagnosis and treatment of intradialytic hypertension. Here, we describe the definition, epidemiology and management of intradialytic hypertension. Although this hemodialysis complication has long been recognized, only recently it was associated with increased morbidity and mortality in dialysis patients. Endothelial cell dysfunction appears to be the major mechanism underlying this blood pressure phenomenon, and the role of extracellular volume and sodium overload remains to be better defined. To treat this potential cardiovascular health threat is necessary to identify and understand the factors that influence it.

  8. Osteoporosis in the aging male: treatment options.

    PubMed

    Tuck, Stephen P; Datta, Harish K

    2007-01-01

    In elderly women, loss in bone mass and micro-architectural changes are generally attributed to the onset of menopause. Men do not experience menopause, they do, however, experience age-related acceleration in bone loss and micro-architecture deterioration. The incidence of osteoporotic fractures in elderly men, just as in aged women, increases exponen-tially with age; the rise in men, however, is some 5-10 years later than in women. Up to 50% of male osteoporotics have no identifiable etiology; however elderly males have much higher likelihood of having an identifiable secondary cause than younger men. Therefore, clinical and laboratory evaluation of aged male osteoporotics must be thorough and should be aimed at identifying lifestyle or conditions contributing to bone loss and fragility. It is essential to identify and treat secondary causes and ensure adequate vitamin D and calcium intake before embarking upon treatment with pharmacological agents. The evidence from a limited number of trials suggests that bisphosphonates, especially alendronate and risedronate, are effective in improving BMD, and seem to be the treatments of choice in aged men with osteoporosis. In cases where bisphosphonates are contra-indicated or ineffective, teriparatide or alternatives such as strontium should be considered. PMID:18225452

  9. Treatment options for small cell lung cancer.

    PubMed

    Wolf, Todd; Gillenwater, Heidi H

    2004-07-01

    Lung cancer remains the leading cause of cancer-related death in the United States. Small cell lung cancer (SCLC) comprises 15% to 25% of all lung cancers. The leading cause of lung cancer remains smoking, and rates of smoking continue to rise in women, whereas rates in other subgroups have slowed. In this article we review recent advances in the treatment of limited-stage as well as extensive-stage small cell lung cancer. In limited-stage disease, the best survival results are observed when patients are treated with twice-daily thoracic radiotherapy given concurrently with chemotherapy. Patients who have been successful in smoking cessation during therapy for limited-stage disease may have a survival benefit over those who are unable to quit smoking during treatment. In extensive-stage disease, the most significant trial is one comparing irinotecan plus cisplatin and etoposide plus cisplatin, showing a survival advantage for the irinotecan arm. This trial may change the standard of care for patients with extensive-stage disease. A similar ongoing trial in the United States is attempting to confirm these results.

  10. Pediatric Ureteroceles: Diagnosis, Management and Treatment Options

    PubMed Central

    Günşar, Cüneyt; Mir, Erol; Şencan, Aydin; Ertan, Pelin; Özcan, Cansu Ünden

    2010-01-01

    Objective The aim of the study was to evaluate clinical characteristics of ureteroceles particularly for diagnostic and treatment challenges. Methods Data about patients treated for ureterocele in the two hospital clinics during 1996- 2009 are retrospectively evaluated. Findings There were 12 girls and 7 boys. Symptomatic urinary tract infection was found in twelve cases. Ureterocele was associated with duplex systems in eleven cases. Vesicoureteral reflux was detected in 4 patients. Bladder diverticulum complicated with ureterocele in 1 patient. Ultrasonography diagnosed ureterocele in 12 patients. Renal scarring was detected in 6 patients at the side of ureterocele. Fifteen patients showed varying degrees of hydro-ureteronephrosis. Surgical therapy included upper pole nephrectomy in 3 cases. Bladder level reconstruction was performed in 11 cases. Five patients were treated only by endoscopic incision. In the follow up period 4 patients showed long term urinary tract infections whereas 3 of them were treated endoscopically. Postoperative reflux was still present in two patients who were treated by endoscopic incision. Conclusion Ureterocele diagnosis and treatment show challenges. Urinary tract infection is important marker for urinary system evaluation. Preoperative management generally depends on a combination of diagnostic methods. Endoscopic incision needs serious follow up for postoperative problems. PMID:23056740

  11. Brexpiprazole: A New Treatment Option for Schizophrenia

    PubMed Central

    2016-01-01

    Schizophrenia occurs in approximately 0.3 to 0.7 percent of the world’s population and is associated with significant morbidity and mortality. Although atypical antipsychotics reduce positive and negative symptoms, they are associated with varying degrees of metabolic adverse effects. This necessitates continued development of efficacious yet metabolically favorable treatments. This article reviews brexpiprazole, a medication recently approved to treat patients with schizophrenia. Brexpiprazole was well-tolerated, and adverse reactions were statistically insignificant. They included nausea; insomnia; headache; agitation; akathisia; and weight gain or changes in lipid, creatine phosphokinase, glucose, or prolactin levels. Brexpiprazole is taken once daily without regard to food, and the dose should be adjusted in patients who receive moderate or strong CYP450 inhibitors or inducers and in patients with hepatic or renal disease. PMID:27672485

  12. Future treatment options for human African trypanosomiasis.

    PubMed

    Jones, Amy J; Avery, Vicky M

    2015-01-01

    Over the past 17 years, the number of reported cases of human African trypanosomiasis (HAT) has declined by over 90%, a significant result since the disease was highlighted as a public health problem by the WHO in 1995. However, if the goal of eliminating HAT by 2020 is to be achieved, then new treatments need to be identified and developed. A plethora of compound collections has been screened against Trypanosoma brucei spp, the etiological agents of HAT, resulting in three compounds progressing to clinical development. However, due to the high attrition rates in drug discovery, it is essential that research continues to identify novel molecules. Failure to do so, will result in the absence of molecules in the pipeline to fall back on should the current clinical trials be unsuccessful. This could seriously compromise control efforts to date, resulting in a resurgence in the number of HAT cases.

  13. Brexpiprazole: A New Treatment Option for Schizophrenia.

    PubMed

    Scarff, Jonathan R

    2016-01-01

    Schizophrenia occurs in approximately 0.3 to 0.7 percent of the world's population and is associated with significant morbidity and mortality. Although atypical antipsychotics reduce positive and negative symptoms, they are associated with varying degrees of metabolic adverse effects. This necessitates continued development of efficacious yet metabolically favorable treatments. This article reviews brexpiprazole, a medication recently approved to treat patients with schizophrenia. Brexpiprazole was well-tolerated, and adverse reactions were statistically insignificant. They included nausea; insomnia; headache; agitation; akathisia; and weight gain or changes in lipid, creatine phosphokinase, glucose, or prolactin levels. Brexpiprazole is taken once daily without regard to food, and the dose should be adjusted in patients who receive moderate or strong CYP450 inhibitors or inducers and in patients with hepatic or renal disease. PMID:27672485

  14. Treatment Options for Distal Femur Fractures.

    PubMed

    von Keudell, Arvind; Shoji, Kristin; Nasr, Michael; Lucas, Robert; Dolan, Robert; Weaver, Michael J

    2016-08-01

    Despite advances in implant design, the management of distal femur fractures remains challenging. Fracture comminution and intra-articular extension can make it difficult to obtain an adequate reduction while preserving the soft tissue attachments to bone fragments to allow for bone healing. Many implant manufacturers have developed optimal anatomically contoured, distal femoral locking plates with percutaneous guides. This environment allows for the application of lateral locked plates in a biologically friendly manner. Although initial reports had high success rates, more recently a high rate of nonunion has been found, particularly in elderly patients. Limited literature is available for the treatment of patients with osteoporotic bone and associated ipsilateral total knee replacement and hip replacement. We present a patient with a distal femur fracture with significant comminution in the setting of an ipsilateral total hip replacement. PMID:27441931

  15. Degenerative meniscus: Pathogenesis, diagnosis, and treatment options

    PubMed Central

    Howell, Richard; Kumar, Neil S; Patel, Nimit; Tom, James

    2014-01-01

    The symptomatic degenerative meniscus continues to be a source of discomfort for a significant number of patients. With vascular penetration of less than one-third of the adult meniscus, healing potential in the setting of chronic degeneration remains low. Continued hoop and shear stresses upon the degenerative meniscus results in gross failure, often in the form of complex tears in the posterior horn and midbody. Patient history and physical examination are critical to determine the true source of pain, particularly with the significant incidence of simultaneous articular pathology. Joint line tenderness, a positive McMurray test, and mechanical catching or locking can be highly suggestive of a meniscal source of knee pain and dysfunction. Radiographs and magnetic resonance imaging are frequently utilized to examine for osteoarthritis and to verify the presence of meniscal tears, in addition to ruling out other sources of pain. Non-operative therapy focused on non-steroidal anti-inflammatory drugs and physical therapy may be able to provide pain relief as well as improve mechanical function of the knee joint. For patients refractory to conservative therapy, arthroscopic partial meniscectomy can provide short-term gains regarding pain relief, especially when combined with an effective, regular physiotherapy program. Patients with clear mechanical symptoms and meniscal pathology may benefit from arthroscopic partial meniscectomy, but surgery is not a guaranteed success, especially with concomitant articular pathology. Ultimately, the long-term outcomes of either treatment arm provide similar results for most patients. Further study is needed regarding the short and long-term outcomes regarding conservative and surgical therapy, with a particular focus on the economic impact of treatment as well. PMID:25405088

  16. Korean-Americans' Knowledge about Depression and Attitudes about Treatment Options.

    PubMed

    Kim, Eunjung; Im, Eun-Ok

    2015-06-01

    The purpose of this pilot study was to explore first-generation Korean-Americans' knowledge about depression and attitudes about depression treatment options. Self-report survey data were gathered from 73 first-generation Korean-Americans (KAs) using instruments developed for this study. The data were analyzed using descriptive and inferential statistics including t-tests. Data indicated participants lacked knowledge about depression. Among all depression treatment options, exercise was the option that first-generation KAs were most willing to try and was rated as having the least shame attached to it. Taking an antidepressant was the option KAs reported being most unwilling to try and had the highest shame attached to it. No significant differences in knowledge about depression and attitudes about depression treatment options were found between low and high acculturation groups, with the exception that the high acculturation group demonstrated more agreement than the low acculturation group with the item that emotional symptoms, such as mood changes, can be depression symptoms. These results suggest that initiating depression treatment with exercise may be the most acceptable starting point in treating depression in first-generation KA immigrants. PMID:26241572

  17. Update on Treatment Options for Gonococcal Infections.

    PubMed

    Lancaster, Jason W; Mahoney, Monica V; Mandal, Sana; Lawrence, Kenneth R

    2015-09-01

    The incidence of Neisseria gonorrhoeae infections in the United States has grown over the past decade. The most recent data provided by the Centers for Disease Control and Prevention (CDC) indicate that reported cases have increased by almost 10% over the last 5 years. In conjunction with this rise, the presence of multidrug-resistant strains of N. gonorrhoeae has also emerged. The 2015 CDC guidelines recommend dual therapy with intramuscular ceftriaxone and oral azithromycin as first-line treatment, although components of this regimen are met with a high level of resistance. Although ceftriaxone resistance has not yet been reported in the United States, it is only a matter of time before such isolates are detected, thus ushering in a new era of difficult-to-manage uncomplicated gonococcal infection. The potential public health crisis and patient-associated sequelae (e.g., pelvic inflammatory disease, epididymitis, and human immunodeficiency virus infection) linked with untreatable gonorrhea are cause for great concern. To try to stem this tide, a number of new agents targeted against N. gonorrhoeae are being investigated in clinical trials. In this article, we review the various agents, both currently available and under clinical investigation, and provide recommendations for the management of gonococcal infections. PMID:26343813

  18. Naegleria fowleri: pathogenesis, diagnosis, and treatment options.

    PubMed

    Grace, Eddie; Asbill, Scott; Virga, Kris

    2015-11-01

    Naegleria fowleri has generated tremendous media attention over the last 5 years due to several high-profile cases. Several of these cases were followed very closely by the general public. N. fowleri is a eukaryotic, free-living amoeba belonging to the phylum Percolozoa. Naegleria amoebae are ubiquitous in the environment, being found in soil and bodies of freshwater, and feed on bacteria found in those locations. While N. fowleri infection appears to be quite rare compared to other diseases, the clinical manifestations of primary amoebic meningoencephalitis are devastating and nearly always fatal. Due to the rarity of N. fowleri infections in humans, there are no clinical trials to date that assess the efficacy of one treatment regimen over another. Most of the information regarding medication efficacy is based on either case reports or in vitro studies. This review will discuss the pathogenesis, diagnosis, pharmacotherapy, and prevention of N. fowleri infections in humans, including a brief review of all survivor cases in North America.

  19. Naegleria fowleri: Pathogenesis, Diagnosis, and Treatment Options

    PubMed Central

    Grace, Eddie; Asbill, Scott

    2015-01-01

    Naegleria fowleri has generated tremendous media attention over the last 5 years due to several high-profile cases. Several of these cases were followed very closely by the general public. N. fowleri is a eukaryotic, free-living amoeba belonging to the phylum Percolozoa. Naegleria amoebae are ubiquitous in the environment, being found in soil and bodies of freshwater, and feed on bacteria found in those locations. While N. fowleri infection appears to be quite rare compared to other diseases, the clinical manifestations of primary amoebic meningoencephalitis are devastating and nearly always fatal. Due to the rarity of N. fowleri infections in humans, there are no clinical trials to date that assess the efficacy of one treatment regimen over another. Most of the information regarding medication efficacy is based on either case reports or in vitro studies. This review will discuss the pathogenesis, diagnosis, pharmacotherapy, and prevention of N. fowleri infections in humans, including a brief review of all survivor cases in North America. PMID:26259797

  20. Naegleria fowleri: pathogenesis, diagnosis, and treatment options.

    PubMed

    Grace, Eddie; Asbill, Scott; Virga, Kris

    2015-11-01

    Naegleria fowleri has generated tremendous media attention over the last 5 years due to several high-profile cases. Several of these cases were followed very closely by the general public. N. fowleri is a eukaryotic, free-living amoeba belonging to the phylum Percolozoa. Naegleria amoebae are ubiquitous in the environment, being found in soil and bodies of freshwater, and feed on bacteria found in those locations. While N. fowleri infection appears to be quite rare compared to other diseases, the clinical manifestations of primary amoebic meningoencephalitis are devastating and nearly always fatal. Due to the rarity of N. fowleri infections in humans, there are no clinical trials to date that assess the efficacy of one treatment regimen over another. Most of the information regarding medication efficacy is based on either case reports or in vitro studies. This review will discuss the pathogenesis, diagnosis, pharmacotherapy, and prevention of N. fowleri infections in humans, including a brief review of all survivor cases in North America. PMID:26259797

  1. Current treatment options in smoking cessation.

    PubMed

    Crain, Dominique; Bhat, Abid

    2010-02-01

    Cigarette smoking is the most important modifiable risk factor for premature mortality. Many common and serious diseases, including coronary artery disease, chronic obstructive lung disease, stroke, and cancer, are strongly linked to cigarette smoking. Smoking cessation is difficult due to nicotine addiction and withdrawal symptoms. Comprehensive programs for tobacco control can substantially reduce the frequency of tobacco use. Physicians can improve screening and increase cessation rates by asking patients about tobacco use at every office visit. The spectrum of available smoking cessation interventions ranges from simple advice to intensive behavioral support and pharmacological treatment. Medications currently approved by the US Food and Drug Administration for smoking cessation include nicotine replacement therapy (patch, gum, lozenge, inhaler, and nasal spray), bupropion, and varenicline. Nortriptyline and clonidine have been used in patients who do not tolerate first-line agents. New drug therapies, such as nicotine vaccines, are being developed. The US Public Health Service Guideline, published in 2008, recommends a combination of behavioral support and pharmacologic therapy. In summary, smoking cessation should be based on a patient's coexisting medical conditions, level of smoking, compliance, previous experience with cessation agents, and the cost of therapy. PMID:20469625

  2. Update on the pathogenic potential and treatment options for Blastocystis sp

    PubMed Central

    2014-01-01

    Although Blastocystis is one of the most common enteric parasites, there is still much controversy surrounding the pathogenicity and potential treatment options for this parasite. In this review we look at the evidence supporting Blastocystis as an intestinal pathogen as shown by numerous case studies and several in vivo studies and the evidence against. We describe the chronic nature of some infections and show the role of Blastocystis in immunocompromised patients and the relationship between irritable bowel syndrome and Blastocystis infection. There have been several studies that have suggested that pathogenicity may be subtype related. Metronidazole is the most widely accepted treatment for Blastocystis but several cases of treatment failure and resistance have been described. Other treatment options which have been suggested include paromomycin and trimethroprim- sulfamethoxazole. PMID:24883113

  3. Hypercalcemia of malignancy and new treatment options.

    PubMed

    Sternlicht, Hillel; Glezerman, Ilya G

    2015-01-01

    Hypercalcemia of malignancy affects up to one in five cancer patients during the course of their disease. It is associated with both liquid malignancies, commonly multiple myeloma, leukemia, and non-Hodgkins lymphoma and solid cancers, particularly breast and renal carcinomas as well as squamous cell carcinomas of any organ. The clinical manifestations of hypercalcemia are generally constitutional in nature and not specific to the inciting malignancy. Such physical manifestations can range from malaise to lethargy and confusion. Constipation and anorexia are common. Acute kidney injury is likely the most frequently encountered manifestation of end organ damage. Symptomatology is closely linked to both the absolute elevation of serum calcium levels and the rapidity of calcium rise. The majority of cases are humoral in etiology and related to parathyroid hormone-related protein (PTHrP). Approximately 20% of cases are the result of direct bone metastasis with extra-renal 1,25-dihydroxyvitamin D (calcitriol) and ectopic parathyroid hormone production likely accounting for less than 1% of cases. The diagnosis of hypercalcemia of malignancy is confirmed either by an elevated PTHrP or by an evidence of bone metastasis in the appropriate clinical setting. Treatment is predicated on the patient's symptoms and absolute serum calcium level. Interventions are aimed at lowering the serum calcium concentration by inhibiting bone resorption and increasing urinary calcium excretion, the former accomplished via bisphosphonate therapy and the latter with aggressive hydration. Novel therapies for refractory disease include denosumab, a monoclonal antibody against the receptor activator of nuclear factor κB ligand, and the calcimimetic cinacalcet. Finally, anti-PTHrP antibodies have been successfully deployed in animal models of disease. Despite the efficacy of the above therapies, hypercalcemia of malignancy portends an ominous prognosis, indicating advanced and often refractory

  4. Update on treatment options for spinal brucellosis.

    PubMed

    Ulu-Kilic, A; Karakas, A; Erdem, H; Turker, T; Inal, A S; Ak, O; Turan, H; Kazak, E; Inan, A; Duygu, F; Demiraslan, H; Kader, C; Sener, A; Dayan, S; Deveci, O; Tekin, R; Saltoglu, N; Aydın, M; Horasan, E S; Gul, H C; Ceylan, B; Kadanalı, A; Karabay, O; Karagoz, G; Kayabas, U; Turhan, V; Engin, D; Gulsun, S; Elaldı, N; Alabay, S

    2014-02-01

    We evaluated the efficacy and tolerability of antibiotic regimens and optimal duration of therapy in complicated and uncomplicated forms of spinal brucellosis. This is a multicentre, retrospective and comparative study involving a total of 293 patients with spinal brucellosis from 19 health institutions. Comparison of complicated and uncomplicated spinal brucellosis was statistically analysed. Complicated spinal brucellosis was diagnosed in 78 (26.6%) of our patients. Clinical presentation was found to be significantly more acute, with fever and weight loss, in patients in the complicated group. They had significantly higher leukocyte and platelet counts, erythrocyte sedimentation rates and C-reactive protein levels, and lower haemoglobulin levels. The involvement of the thoracic spine was significantly more frequent in complicated cases. Spondylodiscitis was complicated, with paravertebral abscess in 38 (13.0%), prevertebral abscess in 13 (4.4%), epidural abscess in 30 (10.2%), psoas abscess in 10 (3.4%) and radiculitis in 8 (2.7%) patients. The five major combination regimens were: doxycycline 200 mg/day, rifampicin 600 mg/day and streptomycin 1 g/day; doxycycline 200 mg/day, rifampicin 600 mg/day and gentamicin 5 mg/kg; doxycycline 200 mg/day and rifampicin 600 mg/day; doxycycline 200 mg/day and streptomycin 1 g/day; and doxycycline 200 mg/day, rifampicin 600 mg/day and ciprofloxacin 1 g/day. There were no significant therapeutic differences between these antibiotic groups; the results were similar regarding the complicated and uncomplicated groups. Patients were mostly treated with doxycycline and rifampicin with or without an aminoglycoside. In the former subgroup, complicated cases received antibiotics for a longer duration than uncomplicated cases. Early recognition of complicated cases is critical in preventing devastating complications. Antimicrobial treatment should be prolonged in complicated spinal brucellosis in particular.

  5. [Intracerebral aneurysm--treatment options, informed consent, and legal aspects].

    PubMed

    Burkhardt, Jan-Karl; Burkhardt, Werner Friedrich; Zinn, Pascal Olivier; Bozinov, Oliver; Bertalanffy, Helmut

    2011-01-01

    All medical subspecialties and, in particular, high-tech field neurosurgery are subject to continuous change in therapeutic concepts due to novel treatment options emerging through research and evolution in the field. Hence, the question arises if the patient's informed consent needs to be adjusted in the face of multiple therapeutic options with different configurations of risk/benefit relationships. In this paper we discuss different therapeutic scenarios with regard to ruptured intracerebral aneurysms (RIA) and unruptured intracerebral aneurysms (UIA), and we advise the medical doctor involved in the process. Indeed, experienced neurosurgeons and endovascular interventionalists are very familiar with the management of these scenarios; likewise, interns, residents, and otherwise affiliated physicians may be faced with these situations. In general, asymptomatic and mentally capacitated patients as well as legal guardians of minor patients and of mentally incapacitated patients with incidental aneurysms and more than one therapeutic option need to be accurately informed about the advantages and disadvantages of the treatment options available to them. In case of emergency or when treating a mentally disabled patient who is incapable of making a sound judgment and has no legal guardian, the attending doctor will have to choose the best possible treatment option. PMID:21958620

  6. Movement Disorders Following Cerebrovascular Lesions: Etiology, Treatment Options and Prognosis

    PubMed Central

    Kwon, Do-Young

    2016-01-01

    Post-stroke movement disorders are uncommon, but comprise an important part of secondary movement disorders. These exert variable and heterogeneous clinical courses according to the stroke lesion and its temporal relationships. Moreover, the predominant stroke symptoms hinder a proper diagnosis in clinical practice. This article describes the etiology, treatment options and prognosis of post-stroke movement disorders. PMID:27240807

  7. Natural history of hepatocellular carcinoma and current treatment options.

    PubMed

    Raoul, Jean-Luc

    2008-03-01

    Hepatocellular carcinoma (HCC) is the most frequent primary liver cancer and the most severe complication of chronic liver disease. The annual number of new cases worldwide is approximately 550,000, representing more than 5% of human cancers and is the third leading cause of cancer-related deaths. The stages of the malignancy as well as the severity of the underlying liver disease are essential factors in planning the therapeutic approach. Curative treatment options are represented mainly by surgery (ie, resection or transplantation), but most patients are not candidates for a curative option, and only palliative treatment could be given to these patients. Among palliative treatments, only chemoembolization has been proven to be effective, but other options are currently being investigated. Major risk factors for HCC are well known and are dependent on the geographic area. In Europe, the United States, and Japan, the main risk factors are liver cirrhosis, hepatitis B and C virus, alcohol, and tobacco; in contrast, in Africa and Asia, these factors are hepatitis B and C virus, tobacco use, and aflatoxin exposure. Cirrhosis from any cause is a predisposing factor for HCC and could be considered as a premalignant condition. The present concept of carcinogenesis in HCC is a multistage process. This article describes the natural history of HCC and discusses the various treatment options available at present. PMID:18243838

  8. Acne vulgaris: A review of causes and treatment options.

    PubMed

    Well, Danielle

    2013-10-10

    Acne vulgaris is a disorder of the sebaceous follicle. The cause is multifactorial, and both adolescents and adults can be affected. Acne is associated with a significant financial burden and considerable psychological distress. Treatment options are reviewed, including over-the-counter medications, prescription medications, and in-office procedures.

  9. Uterine artery embolization as a treatment option for uterine myomas.

    PubMed

    Marshburn, Paul B; Matthews, Michelle L; Hurst, Bradley S

    2006-03-01

    Information is still being collected on the long-term clinical responses and appropriate patient selection for UAE. Prospective RCTs have not been performed to compare the clinical results from UAE with more conventional therapies for symptomatic uterine leiomyomata. At least three attempts at conducting such RCTs have been unsuccessful because of poor patient accrual that related to differing patient expectation and desires, clinical bias, insurance coverage, and the tendency that patients who have exhausted other treatment options may be disposed more favorably to less invasive treatments. Other comparative studies have serious limitations. For example, the retrospective study that compared outcomes after abdominal myomectomy with UAE suggested that patients who received UAE were more likely to require further invasive treatment by 3 years than were recipients of myomectomy. Lack of randomization introduced a selection bias because women in the group that underwent UAEwere older and were more likely to have had previous surgeries. A prospective study of "contemporaneous cohorts," which excluded patients who had sub-mucosal and pedunculated subserosal myomas, sought to compare quality of life measures and adverse events in patients who underwent UAE or hysterectomy. The investigators concluded that both treatments resulted in marked improvement in symptoms and quality of life scores, but complications were higher in the group that underwent hysterectomy over 1 year. In this study,however, a greater proportion of patients who underwent hysterectomy had improved pelvic pain scores. Furthermore, hysterectomy eliminates uterine bleeding and the risk for recurrence of myomas. Despite the lack of controlled studies that compared UAE with conventional surgery, and despite limited extended outcome data, UAE has gained rapid acceptance, primarily because the procedure preserves the uterus, is less invasive, and has less short-term morbidity than do most surgical options

  10. Treatment Option Overview (Childhood Brain Stem Glioma Treatment)

    MedlinePlus

    ... before the cancer is diagnosed and continue for months or years. Childhood brain stem gliomas may cause ... after treatment. Some cancer treatments cause side effects months or years after treatment has ended. These are ...

  11. Current options for the treatment of facial angiofibromas.

    PubMed

    Salido-Vallejo, R; Garnacho-Saucedo, G; Moreno-Giménez, J C

    2014-01-01

    Facial angiofibromas are hamartomatous growths that are closely associated with tuberous sclerosis complex and, in fact, they constitute one of the main diagnostic criteria for that disease. These lesions composed of blood vessels and fibrous tissue appear on the face at an early age. Since they have important physical and psychological repercussions for patients, several treatment options have been used to remove them or improve their appearance. However, the lack of treatment guidelines prevents us from developing a common protocol for patients with this condition. The present article aims to review the treatments for facial angiofibromas used to date and to propose a new evidence-based treatment protocol.

  12. Waste battery treatment options: comparing their environmental performance.

    PubMed

    Briffaerts, K; Spirinckx, C; Van der Linden, A; Vrancken, K

    2009-08-01

    Waste consumer batteries are recycled using different routes based on hydrometallurgical and pyrometallurgical processes. Two hydrometallurgical and two pyrometallurgical treatment scenarios are compared starting from an average composition of Belgian waste batteries. The environmental performance is compared using life cycle analysis (LCA). The recycling rate is studied through mass balance calculation. Each treatment scenario results in a specific recycling rate. The environmental impact and benefits also vary between the treatment options. There is no such thing as a typical hydrometallurgical or pyrometallurgical treatment. When applying a hydrometallurgical treatment scenario, the focus lies on zinc and iron recycling. When allowing manganese recycling, the energy demand of the hydrometallurgical process increases considerably. Both pyrometallurgical options recycle zinc, iron and manganese. According to the LCA, none of the treatment scenarios performs generally better or worse than the others. Each option has specific advantages and disadvantages. The Batteries Directive 2006/66/EC sets out a recycling rate of 50% for consumer waste batteries. Based on metal recycling alone, the mass balances show that the target is difficult to obtain.

  13. Emerging treatment options for refractory angina pectoris: ranolazine, shock wave treatment, and cell-based therapies.

    PubMed

    Gennari, Marco; Gambini, Elisa; Bassetti, Beatrice; Capogrossi, Maurizio; Pompilio, Giulio

    2014-01-01

    A challenge of modern cardiovascular medicine is to find new, effective treatments for patients with refractory angina pectoris, a clinical condition characterized by severe angina despite optimal medical therapy. These patients are not candidates for surgical or percutaneous revascularization. Herein we review the most up-to-date information regarding the modern approach to the patient with refractory angina pectoris, from conventional medical management to new medications and shock wave therapy, focusing on the use of endothelial precursor cells (EPCs) in the treatment of this condition. Clinical limitations of the efficiency of conventional approaches justify the search for new therapeutic options. Regenerative medicine is considered the next step in the evolution of organ replacement therapy. It is driven largely by the same health needs as transplantation and replacement therapies, but it aims further than traditional approaches, such as cell-based therapy. Increasing knowledge of the role of circulating cells derived from bone marrow (EPCs) on cardiovascular homeostasis in physiologic and pathologic conditions has prompted the clinical use of these cells to relieve ischemia. The current state of therapeutic angiogenesis still leaves many questions unanswered. It is of paramount importance that the treatment is delivered safely. Direct intramyocardial and intracoronary administration has demonstrated acceptable safety profiles in early trials, and may represent a major advance over surgical thoracotomy. The combined efforts of bench and clinical researchers will ultimately answer the question of whether cell therapy is a suitable strategy for treatment of patients with refractory angina.

  14. Lack of tolerable treatment options for patients with schizophrenia

    PubMed Central

    Citrome, Leslie; Eramo, Anna; Francois, Clement; Duffy, Ruth; Legacy, Susan N; Offord, Steve J; Krasa, Holly B; Johnston, Stephen S; Guiraud-Diawara, Alice; Kamat, Siddhesh A; Rohman, Patricia

    2015-01-01

    Purpose Atypical antipsychotics (AAs), an effective treatment for schizophrenia, have a range of pharmacologic properties leading to differences in tolerability as well as heterogeneity in treatment response. Individual patient characteristics must be considered when making treatment choices, especially from an adverse event (AE) or tolerability perspective. Despite the availability of numerous AAs, after appraising patient characteristics at the time of treatment selection, physicians may quickly run out of tolerable treatment options. Patients and methods AE risk factors, defined as having either a prior history of an AE or a risk factor for that AE, were determined for Medicaid-insured and Commercially insured patients using database analysis. Patients receiving AA treatment between January 1, 2010 and December 31, 2012 defined the index date of first observed AA prescription during this period. Nine AAs were evaluated for association with AE risk factors as informed by drug prescribing information from the different manufacturers and published meta-analyses. The proportion of patients with pre-index AE risk factors prescribed an AA associated with that risk factor was then determined. Results A high proportion of patients (>80%) were prescribed an AA associated with extrapyramidal symptoms or akathisia despite experiencing extrapyramidal symptoms or akathisia prior to AA treatment initiation. Similar trends were observed among patients with diabetes (>60%) and obesity (>40%). From the nine treatment options available, the number of optimal choices for individual patient segments were limited based on their prior history, including those with cardiometabolic and cardiovascular comorbidities (four); experiencing prolactin elevation-related problems (seven); needing to avoid excessive sedation (four); or at risk of extrapyramidal symptoms or akathisia (two). Options were then further restricted among patients in more than one segment when multiple pre-index AE

  15. The limits of parental authority to accept or refuse medical treatment.

    PubMed

    Miller, Geoffrey

    2011-06-01

    The legal and ethical right of parents to refuse medical treatment for their children differs from the authority possessed by competent adults with decisional capacity. Parents have a duty to act in the best interests of their children from the children's perspective and not to inflict harm. Best interests are determined by weighing benefits and burdens, which includes using evidence-based outcomes and value judgments. The result is placed along a risk/benefit spectrum. If the result is close to low risk/high benefit, the parents have a strong obligation to accept a health care team recommendation. Otherwise, parents may choose between reasonable medical options without threat or coercion.

  16. Current and emerging treatment options for myopic choroidal neovascularization

    PubMed Central

    El Matri, Leila; Chebil, Ahmed; Kort, Fedra

    2015-01-01

    Choroidal neovascularization (CNV) is the main cause of visual impairment in highly myopic patients younger than 50 years of age. There are different treatments for myopic CNV (mCNV), with 5- to 10-year outcomes currently. Chorioretinal atrophy is still the most important determinant factor for visual outcome. The purpose of this study is to provide an overview of the current treatments for mCNV, including laser, surgical management, verteporfin photodynamic therapy, and mainly anti-vascular endothelial growth factor therapy. Emerging treatment options are also discussed. PMID:25987831

  17. Parents’ Online Portrayals of Pediatric Treatment and Research Options

    PubMed Central

    Schaffer, Rebecca; Henderson, Gail E.; Churchill, Larry R.; King, Nancy M. P.; Rothschild, Barbra B.; Lohser, Sara; Davis, Arlene M.

    2012-01-01

    Parents of seriously ill children face difficult decisions when standard therapies are limited or ineffective. In their search for information, they may turn to websites created by other parents facing similar experiences. We conducted a qualitative content analysis of 21 websites created by families with children affected by cancer or genetic disease, two serious conditions with a range of treatment and clinical trial options. Our research questions address how parent authors portray serious pediatric illness, available options, parties to decision making, and sources of influence. In addition, we examine what these sites reveal about family vulnerability to various risks, particularly the risk of misunderstanding the distinction between standard treatment and research and the risk of overestimating the likely benefits of research participation, as well as whether vulnerability varies by type of condition. Our results demonstrate typically favorable views on research, but with inadequate distinctions between research and treatment and a complex set of trade-offs in consideration of research risks and potential benefits. While portraits of vulnerability emerge for both parents and children, so do portraits of strength and resilience. As a result, parents describe frustration with both under- and over-protection from research participation. Our discussion of these findings clarifies the potential for parent-authored websites to inform and influence families considering research and treatment options for their seriously ill children. PMID:19754237

  18. Second and third line treatment options for Helicobacter pylori eradication.

    PubMed

    Song, Mingjun; Ang, Tiing Leong

    2014-02-14

    Helicobacter pylori is a highly successful bacterium with a high global prevalence and the infection carries significant disease burden. It is also becoming increasingly difficult to eradicate and the main reason for this is growing primary antibiotic resistance rates in a world where antibiotics are frequently prescribed and readily available. Despite knowing much more about the bacterium since its discovery, such as its genomic makeup and pathogenesis, we have seen declining treatment success. Therefore, clinicians today must be prepared to face one, two or even multiple treatment failures, and should be equipped with sufficient knowledge to decide on the appropriate salvage therapy when this happens. This article discusses the factors contributing to treatment failure and reviews the second and third-line treatment strategies that have been investigated. Established empiric second line treatment options include both bismuth based quadruple therapy and levofloxacin based triple therapy. Antibiotic testing is recommended prior to initiating third line treatment. In the event that antibiotic susceptibility testing is unavailable, third line treatment options include rifabutin, rifaximin and sitafloxacin based therapies. PMID:24587627

  19. A Pilot Study of an Acceptance-Based Separated Family Treatment for Adolescent Anorexia Nervosa

    PubMed Central

    Merwin, Rhonda M.; Zucker, Nancy L.; Timko, C. Alix

    2016-01-01

    The treatment of adolescent anorexia nervosa (AN) has improved significantly with the increased emphasis on family-based intervention. Yet despite advances, a substantial number of adolescents do not respond optimally to existing treatment models and thus there is a need for treatment alternatives that address barriers to recovery. We developed and piloted an acceptance-based separated family treatment (ASFT) with 6 adolescents with AN or subthreshold AN (eating disorder not otherwise specified, with the primary symptoms of restriction and severe weight loss). Treatment acceptability was adequate. Overall, parents rated the treatment as credible and expected improvement in their child's condition. Five of the 6 adolescents treated with ASFT restored weight to their ideal body mass index as indicated by age, height, and sex and determined by individual growth charts. Many demonstrated improved psychological health and adaptive functioning. There was evidence of broad effects, with parents reporting decreased anxiety and caregiver burden. ASFT holds promise as a treatment option for AN. The efficacy of this therapeutic approach should be tested in larger trials and compared to current family-based interventions to determine unique effects. PMID:27307691

  20. Angina pectoris: current therapy and future treatment options.

    PubMed

    Parikh, Raj; Kadowitz, Philip J

    2014-02-01

    Angina pectoris is the consequence of an inequality between the demand and supply of blood to the heart. Angina manifests itself as chest pain or discomfort and is a common complaint of patients in the hospital and in the clinic. There are, in fact, roughly half a million new cases of angina per year. Chest pain, while having many etiologies, is generally considered to be most lethal when related to a cardiac cause. In this review, the authors outline the current medical and surgical therapies that are used in the management of angina. Highlights of the various clinical trials that have assisted in the investigation of these therapies are summarized also. Then, the authors provide a focused review of the novel therapy options for angina that are currently being explored. From new medical treatments to revised surgical techniques to the discovery of stem cell therapy, many innovative options are being investigated for the treatment of angina.

  1. Carotid Stump Syndrome: Pathophysiology and Endovascular Treatment Options

    SciTech Connect

    Lakshminarayan, Raghuram; Scott, Paul M.; Robinson, Graham J.; Ettles, Duncan F.

    2011-02-15

    Carotid stump syndrome is one of the recognised causes of recurrent ipsilateral cerebrovascular events after occlusion of the internal carotid artery. It is believed that microemboli arising from the stump of the occluded internal carotid artery or the ipsilateral external carotid artery can pass into the middle cerebral artery circulation as a result of patent external carotid-internal carotid anastomotic channels. Different pathophysiologic causes of this syndrome and endovascular options for treatment are discussed.

  2. Onychomycosis: Evaluation, Treatment Options, Managing Recurrence, and Patient Outcomes.

    PubMed

    Vlahovic, Tracey C

    2016-07-01

    Onychomycosis is the most common nail disease seen in podiatric practice. Effective long-term management remains problematic. We need to treat onychomycosis effectively to prevent its progression into a severe, debilitating, and painful condition, and to manage recurrence. With new agents now available and greater discussion on management strategies, this article reviews the appropriate evaluation of the disease, treatment options, and optimal patient outcomes. PMID:27215153

  3. Complementary and Alternative Medicine Treatment Options for Otitis Media

    PubMed Central

    Marom, Tal; Marchisio, Paola; Tamir, Sharon Ovnat; Torretta, Sara; Gavriel, Haim; Esposito, Susanna

    2016-01-01

    Abstract Otitis media (OM) has numerous presentations in children. Together with conventional medical therapies aimed to prevent and/or treat OM, a rising number of complementary and alternative medicine (CAM) treatment options can be offered. Since OM is common in children, parents may ask healthcare professionals about possible CAM therapies. Many physicians feel that their knowledge is limited regarding these therapies, and that they desire some information. Therefore, we conducted a literature review of CAM therapies for OM, taking into account that many of these treatments, their validity and efficacy and have not been scientifically demonstrated. We performed a search in MEDLINE (accessed via PubMed) using the following terms: “CAM” in conjunction with “OM” and “children. Retrieved publications regarding treatment of OM in children which included these terms included randomized controlled trials, prospective/retrospective studies, and case studies. The following CAM options for OM treatment in children were considered: acupuncture, homeopathy, herbal medicine/phytotherapy, osteopathy, chiropractic, xylitol, ear candling, vitamin D supplement, and systemic and topical probiotics. We reviewed each treatment and described the level of scientific evidence of the relevant publications. The therapeutic approaches commonly associated with CAM are usually conservative, and do not include drugs or surgery. Currently, CAM is not considered by physicians a potential treatment of OM, as there is limited supporting evidence. Further studies are warranted in order to evaluate the potential value of CAM therapies for OM. PMID:26871802

  4. Treatment of keratoacanthoma: Is intralesional methotrexate an option?

    PubMed Central

    Patel, Nima P; Cervino, A Lawrence

    2011-01-01

    BACKGROUND: Keratoacanthomas (KAs) are a variant of squamous cell carcinomas. Some KAs have shown aggressive behaviour, leading to metastasis and death. Surgical excision is the treatment of choice for most KA patients. Intralesional methotrexate (MTX) may also be a potential treatment option for KAs. OBJECTIVE: To evaluate intralesional MTX as a treatment modality for KA. METHODS: A retrospective chart review of nine patients with KAs treated with intralesional MTX was performed. Each patient had biopsy-proven KA. The lesion was initially debulked, and MTX was injected at the base. Patients were seen weekly in the office, and reinjected with intralesional MTX depending on the response of the lesion. Each patient was evaluated for their response to the intralesional MTX injections, the number of injections required and complications. RESULTS: Patients required approximately two to four intralesional injections (12.5 mg to 25 mg per injection) before KA resolution. Eight of nine (88.9%) patients experienced complete resolution of their tumours. One patient experienced treatment failure, and underwent surgical excision of the KA. The average follow-up period was 2.8 years, and there were no recurrences. CONCLUSION: The results from the present retrospective study show that intralesional MTX injection is an effective treatment option for KAs. The authors propose that intralesional MTX injection with initial debulking of the KA should be used as a first line of treatment when KAs present on the extremities, in cosmetically sensitive areas and in elderly patients with multiple comorbities. PMID:22654538

  5. The Nuclear Energy Option for the U.S.--How Far Are We from Public Acceptance?

    SciTech Connect

    Biedscheid, J.A.; Devarakonda, M.

    2004-10-03

    The recent rise of oil and gasoline prices accompanied by reluctant acknowledgement that traditional sources of energy are limited has renewed public interest in renewable energy sources. This perspective on energy is focusing attention on and facilitating acceptance of alternative energy concepts, such as solar, wind, and biomass. The nuclear energy alternative, while clean with potentially abundant fuel supplies and associated with low costs, is burdened with the frequently negative public opinion reserved for things nuclear. Coincident with the heightened examination of alternative energy concepts, 2004 marks the 25-year anniversary of the Three Mile Island accident. Since this pivotal accident in 1979, no new reactor licenses have been granted in the U.S. The resolution of the issues of nuclear waste management and disposition are central to and may advance public discussions of the future use of nuclear energy. The U.S. Department of Energy (DOE) is currently preparing the licensing application for Yucca Mountain, which was designated in 2003 as the site for a high-level waste and spent nuclear fuel repository in the U.S. The DOE also has been operating a deep geologic repository for the permanent disposal of transuranic (TRU) waste since 1999. The operational status of the Waste Isolation Pilot Plant (WIPP) as a repository for TRU waste was successfully realized along with the lesson learned that stakeholder trust and acceptance are as critical to the success of a repository program as the resolution of technical issues and obtaining regulatory approvals. For the five years of its operation and for decades prior, the challenge of attaining public acceptance of the WIPP has persisted for reasons aligned with the opposition to nuclear energy. Due to this commonality, the nuclear waste approach to public acceptance, with its pros and cons, provides a baseline for the examination of an approach for the public acceptance of nuclear energy in the U.S. This paper

  6. Current options for treatment of hypothenar hammer syndrome.

    PubMed

    Hui-Chou, Helen G; McClinton, Michael A

    2015-02-01

    Hypothenar hammer syndrome is a rare vascular condition resulting from injury to the ulnar artery at the level of Guyon canal. The ulnar artery at the wrist is the most common site of arterial aneurysms of the upper extremity and is particularly prone to injury. Signs and symptoms include a palpable mass, distal digital embolization to long, ring, or small fingers, pain, cyanosis, pallor, coolness, and recurrent episodes of vasospasm. Modalities for diagnosis, evaluation, and surgical planning include duplex study, contrast arteriography, and computerized tomographic angiography (CTA). Management includes medical, nonoperative, or operative treatments. Appropriate treatment options are reviewed. PMID:25455356

  7. Oral vitamin D, still a viable treatment option for psoriasis.

    PubMed

    Kamangar, Faranak; Koo, John; Heller, Misha; Lee, Eric; Bhutani, Tina

    2013-08-01

    Vitamin D as a topical treatment has become one of the mainstays for treatment of psoriasis vulgaris. Oral vitamin D on the other hand has for the most part become a forgotten option. But a review of the literature on oral vitamin D as a treatment for psoriasis reveals that this treatment is efficacious. The main side effect of this therapy is hypercalcemia, which appears to be easily monitored and avoidable with proper dosing and monitoring. The literature also suggests a correlation between low levels of serum vitamin D in this patient population associated with increased severity of disease involvement. In addition, oral vitamin D improves psoriatic arthropathy. Moreover, vitamin D has been proven to have many health benefits such as prevention of cancer, improved cardiovascular health among many others. Psoriatic patients as a population are at increased risk of developing adverse health complications such as cardiovascular disease, and oral vitamin D may prove to be of benefit in this population. Oral vitamin D is inexpensive and easily available. It is still a viable option and should not be forgotten as a possible treatment for psoriasis.

  8. Is Entombment an Acceptable Option for Decommissioning? An International Perspective - 13488

    SciTech Connect

    Belencan, Helen; Nys, Vincent; Guskov, Andrey; Francois, Patrice; Watson, Bruce; Ljubenov, Vladan

    2013-07-01

    Selection of a decommissioning strategy is one of the key steps in the preparation for decommissioning of nuclear facilities and other facilities using radioactive material. Approaches being implemented or considered by Member States include immediate dismantling, deferred dismantling and entombment. Other options or slight modifications of these strategies are also possible. Entombment has been identified in the current International Atomic Energy Agency (IAEA) Safety Standards as one of the three basic decommissioning strategies and has been defined as a decommissioning strategy by which radioactive contaminants are encased in a structurally long lived material until radioactivity decays to a level permitting the unrestricted release of the facility, or release with restrictions imposed by the regulatory body. Although all three strategies have been considered, in principle, applicable to all facilities, their application to some facilities may not be appropriate owing to political concerns, safety or environmental requirements, technical considerations, local conditions or financial considerations. The IAEA is currently revising the decommissioning Safety Standards and one of the issues widely discussed has been the applicability of entombment in the context of decommissioning and its general objective to enable removal of regulatory control from the decommissioned facility. The IAEA recently established a consultancy to collect and discuss experience and lessons learned from entombment projects, to identify regulatory requirements and expectations for applying entombment as a decommissioning option strategy, in compliance with the internationally agreed standards. (authors)

  9. Helping Women Understand Treatment Options for Vulvar and Vaginal Atrophy.

    PubMed

    Parks, Diane M; Levine, Jeffrey

    2015-01-01

    Vulvar and vaginal atrophy (VVA) is a common and progressive medical condition in postmenopausal women. The REVIVE (REal Women's VIews of Treatment Options for Menopausal Vaginal ChangEs) survey assessed knowledge about VVA and its impact in 3,046 postmenopausal U.S. women, and recorded women's attitudes about their interactions with health care providers and about available treatments. REVIVE identified poor disease awareness and understanding among women, failure of health care professionals to evaluate women for VVA signs and symptoms, low treatment rates and concerns about the safety and efficacy of available therapies. Strategies to address these needs include proactive screening, education for women and clinicians about VVA and recommendations for treatment and follow-up.

  10. Periocular Capillary Hemangiomas: Indications and Options for Treatment

    PubMed Central

    Bang, Genie M.; Setabutr, Pete

    2010-01-01

    Capillary hemangiomas are the most common periocular and orbital tumors of childhood that typically arise in infancy. Though the diagnosis is frequently made on clinical examination, various diagnostic modalities may be helpful in initial evaluation and follow-up. Tests may be necessary in diagnosing suspect cases or aid in the differentiation of potential malignant tumors. In the vast majority of cases these tumors undergo spontaneous involution without sequelae. However, some periocular and orbital capillary hemangiomas require intervention to prevent serious complications. Other tumors require treatment to lessen the surgical burden for cosmetic repair. When treatment is necessary, there are a number of therapeutic options available. As there is no standard, potential risks and benefits must be discussed with the family and treatment should be specific in each case. A complete understanding of the natural history of the tumor, indications for treatment, and response to different therapies is imperative in managing this common lesion. PMID:20616917

  11. Adult osteochondritis dissecans and focussed ESWT: A successful treatment option.

    PubMed

    Thiele, S; Thiele, R; Gerdesmeyer, L

    2015-12-01

    Extracorporeal shockwave therapy (ESWT) has gained acceptance in the medical field and in the treatment of non-unions and delayed bone healing. ESWT has been used effectively for many years as a noninvasive surgical procedure. The idea of treating Osteochondritis dissecans of knee and talus arose in the middle of the 1990's. OCD is known as a pre-arthritic factor in the long-term and still there is no consistent treatment. In the literature there is still only a small number of publications but international societies for shockwave treatment are convinced that ESWT on OCD shows to be an effective and safe method in the treatment of OCD in the early stages. We want to summarize the actual data on the treatment of OCD by ESWT.

  12. Non-invasive treatment options for focal cortical dysplasia

    PubMed Central

    WANG, TING-TING; ZHOU, DONG

    2016-01-01

    Focal cortical dysplasia (FCD) presents a strong clinical challenge especially for the treatment of the associated epilepsy. Epilepsy in FCD is often treatment-resistant and constitutes 50% of treatment-resistant cases. Antiepileptic drugs (AEDs) have been widely used in the treatment of FCD. However, evidence to suggest their specific effect on the treatment of FCD remains to be established. In view of this resistance, several alternative treatments have been suggested. Although treatment currently involves surgical management, non-invasive treatments have been identified. The aim of the present review, was to assess non-invasive management strategies including, i) mammalian target of rapamycin (mTOR) inhibitors, ii) ketogenic diet (KD), and iii) vagus nerve stimulation (VNS). In addition, we discussed the literature available regarding the use of AEDs in FCD. Experiments conducted with mammals detailing rapamycin gene mutations in FCD have produced vital information for exploring treatment options using mTOR inhibitors. Of note is the importance of KD in children with FCD. This diet has been shown to modify disease progression by attenuating chromatin modification, a master regulator for gene expression and functional adaptation of the cell. FCD has also been studied widely with neurostimulation techniques. The outcomes of these techniques have been found to be variable. For widespread dysplasias, VNS has been shown to produce responder rates of >50%. Nevertheless, non-invasive cranial nerve stimulation techniques such as transcutaneous VNS and non-invasive VNS are gaining better patient compatibility, albeit their efficacy remains to be established. PMID:27168769

  13. Intracranial Aneurysms: Review of Current Treatment Options and Outcomes

    PubMed Central

    Seibert, Brad; Tummala, Ramachandra P.; Chow, Ricky; Faridar, Alireza; Mousavi, Seyed A.; Divani, Afshin A.

    2011-01-01

    Intracranial aneurysms are present in roughly 5% of the population, yet most are often asymptomatic and never detected. Development of an aneurysm typically occurs during adulthood, while formation and growth are associated with risk factors such as age, hypertension, pre-existing familial conditions, and smoking. Subarachnoid hemorrhage, the most common presentation due to aneurysm rupture, represents a serious medical condition often leading to severe neurological deficit or death. Recent technological advances in imaging modalities, along with increased understanding of natural history and prevalence of aneurysms, have increased detection of asymptomatic unruptured intracranial aneurysms (UIA). Studies reporting on the risk of rupture and outcomes have provided much insight, but the debate remains of how and when unruptured aneurysms should be managed. Treatment methods include two major intervention options: clipping of the aneurysm and endovascular methods such as coiling, stent-assisted coiling, and flow diversion stents. The studies reviewed here support the generalized notion that endovascular treatment of UIA provides a safe and effective alternative to surgical treatment. The risks associated with endovascular repair are lower and incur shorter hospital stays for appropriately selected patients. The endovascular treatment option should be considered based on factors such as aneurysm size, location, patient medical history, and operator experience. PMID:21779274

  14. Options and opportunities for clinical management and treatment of psoriasis.

    PubMed

    Agrawal, Udita; Gupta, Madhu; Dube, Devyani; Vyas, Suresh P

    2013-01-01

    Psoriasis is a complex, multifactorial disease that appears to be influenced by immune-mediated components. For many years the pathogenesis of psoriasis has been discordant; the clinical picture suggested that the psoriasis was secondary to abnormal keratinocyte proliferation and differentiation, but later the role of the T cell was revealed. A variety of treatment options range from topical agents (e.g., coal tar, dithranol, and emollients for milder forms) to systemic agents (i.e., methotrexate or cyclosporin), and phototherapy. Recently, biologics have been added to this list that target particular steps in the immune or inflammatory pathways. Various nanocarriers (e.g., liposomes, niosomes, and microemulsions) have been successfully exploited for the delivery of several antipsoriatic drugs. This review provides insight into various psoriasis treatment strategies-from conventional to novel-currently in use or in development as well as the novel targets that have been explored and/or investigated for anti-psoriatic therapy. The pathogenesis of psoriasis and some of the topical, systemic biological, and novel approaches currently in use or in development are reviewed here. The pros and cons of each treatment strategy are presented, as are some of the animal models used to study features reminiscent of psoriasis. This information can be used to better the understanding of treatment options for this disease. PMID:23510110

  15. Treatment options for post-transplantation diabetes mellitus.

    PubMed

    Sharif, Adnan

    2015-01-01

    Treatment options for management of post-transplantation diabetes mellitus (PTDM) are limited with regards to the availability of strong clinical evidence base. This is a concern as PTDM is common after solid organ transplantation and associated with poor clinical outcomes. PTDM and type 2 diabetes mellitus are distinct pathophysiological entities that have important differences with regards to aetiology, clinical course and management. Therefore, any clinical evidence of treatment benefit from the general population with type 2 diabetes mellitus may not be directly translated to the solid organ transplant recipient. In addition, the potential risk and benefit of using many of these therapeutic agents must take account of the complicated post-transplantation milieu of immunosuppression. While there is reasonable evidence base for treatment of diabetes mellitus in the general population, the same is not true in a post-transplantation setting. In this article the treatment options available for PTDM will be discussed, with a transplant-specific focus on the pros and cons of each particular component of the glucose lowering therapy armoury.

  16. Current and emerging treatment options for nasopharyngeal carcinoma

    PubMed Central

    Spratt, Daniel E; Lee, Nancy

    2012-01-01

    In this article, we focus on the current and emerging treatments in nasopharyngeal cancer (NPC). A detailed evolution of the current standard of care, and new techniques and treatment options will be reviewed. Intergroup 0099 established the role for chemoradiotherapy (chemo-RT) in the treatment of nasopharyngeal carcinoma. Multiple randomized Phase III trials have shown the benefit of chemo-RT; however, none of these studies utilized modern radiotherapy (RT) techniques of intensity-modulated radiation therapy (IMRT). IMRT has the ability to deliver high doses of radiation to the target structures while sparing adjacent bystander healthy tissues, and has now become the preferred RT treatment modality. Chemotherapy also has had a shifting paradigm of induction and/or adjuvant chemotherapy combined with RT alone, to the investigation with concurrent chemo-RT. New treatment options including targeted monoclonal antibodies and small molecule tyrosine kinase inhibitors are being studied in NPC. These new biologic therapies have promising in vitro activity for NPC, and emerging clinical studies are beginning to define their role. RT continues to expand its capabilities, and since IMRT and particle therapy, specifically intensity-modulated proton therapy (IMPT), has reports of impressive dosimetric efficacy in-silica. Adaptive RT is attempting to reduce toxicity while maintaining treatment efficacy, and the clinical results are still in their youth. Lastly, Epstein– Barr virus (EBV) DNA has recently been studied for prediction of tumor response and its use as a biomarker is increasingly promising to aid in early detection as well as supplementing the current staging system. RT with or without chemotherapy remains the standard of care for nasopharyngeal carcinoma. Advances in RT technique, timing of chemotherapy, biologically targeted agents, particle therapy, adaptive RT, and the incorporation of EBV DNA as a biomarker may aid in the current and future treatment of

  17. Ragweed-induced allergic rhinoconjunctivitis: current and emerging treatment options

    PubMed Central

    Ihler, Friedrich; Canis, Martin

    2015-01-01

    Ragweed (Ambrosia spp.) is an annually flowering plant whose pollen bears high allergenic potential. Ragweed-induced allergic rhinoconjunctivitis has long been seen as a major immunologic condition in Northern America with high exposure and sensitization rates in the general population. The invasive occurrence of ragweed (A. artemisiifolia) poses an increasing challenge to public health in Europe and Asia as well. Possible explanations for its worldwide spread are climate change and urbanization, as well as pollen transport over long distances by globalized traffic and winds. Due to the increasing disease burden worldwide, and to the lack of a current and comprehensive overview, this study aims to review the current and emerging treatment options for ragweed-induced rhinoconjunctivitis. Sound clinical evidence is present for the symptomatic treatment of ragweed-induced allergic rhinoconjunctivitis with oral third-generation H1-antihistamines and leukotriene antagonists. The topical application of glucocorticoids has also been efficient in randomized controlled clinical trials. Combined approaches employing multiple agents are common. The mainstay of causal treatment to date, especially in Northern America, is subcutaneous immunotherapy with the focus on the major allergen, Amb a 1. Beyond this, growing evidence from several geographical regions documents the benefit of sublingual immunotherapy. Future treatment options promise more specific symptomatic treatment and fewer side effects during causal therapy. Novel antihistamines for symptomatic treatment are aimed at the histamine H3-receptor. New adjuvants with toll-like receptor 4 activity or the application of the monoclonal anti-immunoglobulin E antibody, omalizumab, are supposed to enhance conventional immunotherapy. An approach targeting toll-like receptor 9 by synthetic cytosine phosphate–guanosine oligodeoxynucleotides promises a new treatment paradigm that aims to modulate the immune response, but it has

  18. Nanotechnology Treatment Options for Osteoporosis and Its Corresponding Consequences.

    PubMed

    Wei, Donglei; Jung, Jinsuh; Yang, Huilin; Stout, David A; Yang, Lei

    2016-10-01

    Unfortunately, osteoporosis, as a worldwide disease, is challenging human health with treatment only available for the symptoms of osteoporosis without managing the disease itself. Osteoporosis can be linked as the common cause of fractures and increased mortality among post-menopausal women, men, and the elderly. Regrettably, due to osteoporosis, incidents of fractures are more frequent among the presented populations and can be afflictive for carrying out everyday life activities. Current treatments of osteoporosis encompass changing lifestyles, taking orthopedic drugs, and invasive surgeries. However, these treatment options are not long lasting and can lead to complications after post-surgical life. Therefore, to solve this impairment, researchers have turned to nanotechnologies and nanomaterials to create innovative and alternative treatments associated with the consequences of osteoporosis. This review article provides an introduction to osteoporotic compression vertebral fractures (OVCFs) and current clinical treatments, along with the rationale and efficacy of utilizing nanomaterials to modify and improve biomaterials or instruments. The methods of applying bioactive agents (bone morphogenetic protein-2 (BMP-2), parathyroid hormone 1-34 (PTH 1-34)), as well as 3D printing will be presented from an osteoporosis treatment perspective. Additionally, the application of nanoparticles and nanotube arrays onto the current surgical treatments and orthopedic drug administration methods addressed will show that these systems reinforce a better mechanical performance and provide precise and slow-releasing drug delivery for better osseointegration, bone regeneration, and bone strength. In summary, nanomaterials can be seen as an alternative and more effective treatment for individuals with osteoporosis.

  19. Options Assessment Report: Treatment of Nitrate Salt Waste at Los Alamos National Laboratory

    SciTech Connect

    Robinson, Bruce Alan; Stevens, Patrice Ann

    2015-12-17

    This report documents the methodology used to select a method of treatment for the remediated nitrate salt (RNS) and unremediated nitrate salt (UNS) waste containers at Los Alamos National Laboratory (LANL). The method selected should treat the containerized waste in a manner that renders the waste safe and suitable for transport and final disposal in the Waste Isolation Pilot Plant (WIPP) repository, under specifications listed in the WIPP Waste Acceptance Criteria (DOE/CBFO, 2013). LANL recognizes that the results must be thoroughly vetted with the New Mexico Environment Department (NMED) and that a modification to the LANL Hazardous Waste Facility Permit is a necessary step before implementation of this or any treatment option. Likewise, facility readiness and safety basis approvals must be received from the Department of Energy (DOE). This report presents LANL’s preferred option, and the documentation of the process for reaching the recommended treatment option for RNS and UNS waste, and is presented for consideration by NMED and DOE.

  20. Medical and Surgical Treatment Options for Nonalcoholic Steatohepatitis.

    PubMed

    Corey, Kathleen E; Rinella, Mary E

    2016-05-01

    Nonalcoholic fatty liver disease (NAFLD) is the most common cause of liver disease in the USA with a growing prevalence worldwide. Nonalcoholic steatohepatitis (NASH), progressive form of NAFLD, can lead to the development of cirrhosis, hepatocellular carcinoma, and the need for liver transplantation. Treatment of NASH may decrease the risk of progressive disease. Treatment for NAFLD should center around weight loss and exercise. Pharmacotherapy with vitamin E and pioglitazone should be considered for those with NASH, especially those with fibrosis. Weight loss surgery is also an effective treatment for NASH in individuals with other indications for surgery. In this review, we will discuss the currently available therapies for NASH including lifestyle, pharmacologic, and surgical options.

  1. Depression in Parkinson's disease: health risks, etiology, and treatment options.

    PubMed

    Frisina, Pasquale G; Borod, Joan C; Foldi, Nancy S; Tenenbaum, Harriet R

    2008-02-01

    Depression is found in about 30%-40% of all patients with Parkinson's disease (PD), but only a small percentage (about 20%) receive treatment. As a consequence, many PD patients suffer with reduced health-related quality of life. To address quality of life in depressed PD patients, we reviewed the literature on the health correlates of depression in PD (eg, cognitive function), etiology of depression in PD, and treatment options (ie, antidepressants, electroconvulsive therapy, and psychotherapy). The current review is unique in its focus on psychosocial aspects, as well as neuropathological factors, of depression in PD. Overall, we conclude that neurochemical (eg, serotonin) and psychosocial factors (eg, coping style, self-esteem, and social support) contribute to the affective disturbances found in this neuropsychiatric population. Therefore, we recommend that a multidisciplinary (eg, pharmacotherapeutic, psychoeducational, and/or psychotherapeutic) approach to treatment be taken with depressed PD patients.

  2. Treatment options for vasomotor symptoms in menopause: focus on desvenlafaxine

    PubMed Central

    Umland, Elena M; Falconieri, Laura

    2012-01-01

    Vasomotor symptoms (VMS), including hot flashes and night sweats, occur in as many as 68.5% of women as a result of menopause. While the median duration of these symptoms is 4 years, approximately 10% of women continue to experience VMS as many as 12 years after their final menstrual period. As such, VMS have a significant impact on the quality of life and overall physical health of women experiencing VMS, leading to their pursuance of treatment to alleviate these symptoms. Management of VMS includes lifestyle modifications, some herbal and vitamin supplements, hormonal therapies including estrogen and tibolone, and nonhormonal therapies including clonidine, gabapentin, and some of the serotonin and serotonin–norepinephrine reuptake inhibitors. The latter agents, including desvenlafaxine, have been the focus of increased research as more is discovered about the roles of serotonin and norepinephrine in the thermoregulatory control system. This review will include an overview of VMS as they relate to menopause. It will discuss the risk factors for VMS as well as the proposed pathophysiology behind their occurrence. The variety of treatment options for VMS will be discussed. Focus will be given to the role of desvenlafaxine as a treatment option for VMS management. PMID:22870045

  3. Economic analyses of pig manure treatment options in Ireland.

    PubMed

    Nolan, Tereza; Troy, Shane M; Gilkinson, Stephen; Frost, Peter; Xie, Sihuang; Zhan, Xinmin; Harrington, Caolan; Healy, Mark G; Lawlor, Peadar G

    2012-02-01

    An economic analysis was performed on treatment options for pig manure in Ireland. Costs were based on a 500 sow integrated pig farm producing 10,500 m(3) of manure per year at 4.8% dry matter. The anaerobic digestion of pig manure and grass silage (1:1; volatile solids basis) was unviable under the proposed tariffs, with costs at € 5.2 m(-3) manure. Subsequent solid-liquid separation of the digestate would cost an additional € 12.8 m(-3) manure. The treatment of the separated solid fraction by composting and of the liquid fraction by integrated constructed wetlands, would add € 2.8 and € 4.6 m(-3) manure, respectively to the treatment costs. The cost analysis presented showed that the technologies investigated are currently not cost effective in Ireland. Transport and spreading of raw manure, at € 4.9 m(-3) manure (15 km maximum distance from farm) is the most cost effective option.

  4. Treatment options for vasomotor symptoms in menopause: focus on desvenlafaxine.

    PubMed

    Umland, Elena M; Falconieri, Laura

    2012-01-01

    Vasomotor symptoms (VMS), including hot flashes and night sweats, occur in as many as 68.5% of women as a result of menopause. While the median duration of these symptoms is 4 years, approximately 10% of women continue to experience VMS as many as 12 years after their final menstrual period. As such, VMS have a significant impact on the quality of life and overall physical health of women experiencing VMS, leading to their pursuance of treatment to alleviate these symptoms. Management of VMS includes lifestyle modifications, some herbal and vitamin supplements, hormonal therapies including estrogen and tibolone, and nonhormonal therapies including clonidine, gabapentin, and some of the serotonin and serotonin-norepinephrine reuptake inhibitors. The latter agents, including desvenlafaxine, have been the focus of increased research as more is discovered about the roles of serotonin and norepinephrine in the thermoregulatory control system. This review will include an overview of VMS as they relate to menopause. It will discuss the risk factors for VMS as well as the proposed pathophysiology behind their occurrence. The variety of treatment options for VMS will be discussed. Focus will be given to the role of desvenlafaxine as a treatment option for VMS management.

  5. Is deep brain stimulation a treatment option for anorexia nervosa?

    PubMed Central

    2013-01-01

    Anorexia nervosa (AN) is a severe psychiatric disorder with high rates of morbidity, comorbidity and mortality, which in a subset of patients (21%) takes on a chronic course. Since an evidence based treatment for AN is scarce, it is crucial to investigate new treatment options, preferably focused on influencing the underlying neurobiological mechanisms of AN. The objective of the present paper was to review the evidence for possible neurobiological correlates of AN, and to hypothesize about potential targets for Deep brain stimulation (DBS) as a treatment for chronic, therapy-refractory AN. One avenue for exploring new treatment options based on the neurobiological correlates of AN, is the search for symptomatologic and neurobiologic parallels between AN and other compulsivity- or reward-related disorders. As in other compulsive disorders, the fronto-striatal circuitry, in particular the insula, the ventral striatum (VS) and the prefrontal, orbitofrontal, temporal, parietal and anterior cingulate cortices, are likely to be implicated in the neuropathogenesis of AN. In this paper we will review the few available cases in which DBS has been performed in patients with AN (either as primary diagnosis or as comorbid condition). Given the overlap in symptomatology and neurocircuitry between reward-related disorders such as obsessive compulsive disorder (OCD) and AN, and the established efficacy of accumbal DBS in OCD, we hypothesize that DBS of the nucleus accumbens (NAc) and other areas associated with reward, e.g. the anterior cingulated cortex (ACC), might be an effective treatment for patients with chronic, treatment refractory AN, providing not only weight restoration, but also significant and sustained improvement in AN core symptoms and associated comorbidities and complications. Possible targets for DBS in AN are the ACC, the ventral anterior limb of the capsula interna (vALIC) and the VS. We suggest conducting larger efficacy studies that also explore the

  6. Modern treatment planning approach facing a failure of conventional treatment. Part I: Analysis of treatment options.

    PubMed

    Garavaglia, Giovanni; Mojon, Philippe; Belser, Urs

    2012-01-01

    In this two-part case presentation, the benchmarks of our treatment planning principles are briefly explained and their application is discussed in the case of a 35-year old patient with multiple failing restorations and an esthetic complaint regarding the maxillary anterior teeth. In this first part, the four principles are proposed, the patient's main problems are presented and three treatment options are discussed. In the second part, the treatment choice will be disclosed as well as the decision making process, the respective diagnostic procedures involved, and finally the sequential treatment. The aim of these articles is to stimulate the debate and to promote therapeutic choices that take into account evolution of contemporary dental medicine.

  7. Current treatment options for management of anal intraepithelial neoplasia

    PubMed Central

    Weis, Stephen E

    2013-01-01

    inflammatory response. Successful treatment requires adherence to a regime that is uncomfortable at best and at worst painful. Topical treatments can be successful in motivated adherent patients willing to accept these side effects. PMID:23788834

  8. Facial Erythema of Rosacea - Aetiology, Different Pathophysiologies and Treatment Options.

    PubMed

    Steinhoff, Martin; Schmelz, Martin; Schauber, Jürgen

    2016-06-15

    Rosacea is a common chronic skin condition that displays a broad diversity of clinical manifestations. Although the pathophysiological mechanisms of the four subtypes are not completely elucidated, the key elements often present are augmented immune responses of the innate and adaptive immune system, and neurovascular dysregulation. The most common primary feature of all cutaneous subtypes of rosacea is transient or persistent facial erythema. Perilesional erythema of papules or pustules is based on the sustained vasodilation and plasma extravasation induced by the inflammatory infiltrates. In contrast, transient erythema has rapid kinetics induced by trigger factors independent of papules or pustules. Amongst the current treatments for facial erythema of rosacea, only the selective α2-adrenergic receptor agonist brimonidine 0.33% topical gel (Mirvaso®) is approved. This review aims to discuss the potential causes, different pathophysiologies and current treatment options to address the unmet medical needs of patients with facial erythema of rosacea. PMID:26714888

  9. Pediatric insomnia: new insights in clinical assessment and treatment options.

    PubMed

    Bruni, Oliviero; Angriman, Marco

    2015-01-01

    Sleep disorders in children can compromise quality of life of both children and families and chronic sleep deprivations is associated with poorer developmental outcome, overweight and behavioral disturbances. Clinicians should incorporate questions about sleep into their routine health assessment, and the assessment of insomnia should follow a medical approach primary and secondary contributing factors should be assessed, as well as maladaptive behaviors related to sleep. A careful examination of sleep/wake schedule, abnormal movements or behavior during sleep, and daytime consequences of sleep disruption or deprivation is mandatory. Sleeping environment, and bedtime routines should be examined to identify behavioral issues related to sleep. Polysomnography is not routinely indicated for children with insomnia, but actigraphy can give an objective estimation of sleep parameters. The Authors propose a new classification of pediatric insomnia, based on both genetic and clinical aspects, and suggest specific treatment options, including sleep hygiene, behavioral strategies and pharmacological treatment. PMID:26742668

  10. 17 CFR 30.7 - Treatment of foreign futures or foreign options secured amount.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... FUTURES TRADING COMMISSION FOREIGN FUTURES AND FOREIGN OPTIONS TRANSACTIONS § 30.7 Treatment of foreign futures or foreign options secured amount. (a) Except as provided in this section, a futures commission... options customers denominated as the foreign futures or foreign options secured amount. Such...

  11. Teachers' Knowledge of ADHD, Treatments for ADHD, and Treatment Acceptability: An Initial Investigation. Research Brief

    ERIC Educational Resources Information Center

    Vereb, Rebecca L.; DiPerna, James C.

    2004-01-01

    The purpose of this study was to begin to explore the relationship among teachers' knowledge of Attention Deficit Hyperactivity Disorder (ADHD), knowledge of common treatments for ADHD, and acceptability of different approaches to treatment for ADHD (medication and behavior management). Relationships also were explored between these variables and…

  12. Nanotechnology Treatment Options for Osteoporosis and Its Corresponding Consequences.

    PubMed

    Wei, Donglei; Jung, Jinsuh; Yang, Huilin; Stout, David A; Yang, Lei

    2016-10-01

    Unfortunately, osteoporosis, as a worldwide disease, is challenging human health with treatment only available for the symptoms of osteoporosis without managing the disease itself. Osteoporosis can be linked as the common cause of fractures and increased mortality among post-menopausal women, men, and the elderly. Regrettably, due to osteoporosis, incidents of fractures are more frequent among the presented populations and can be afflictive for carrying out everyday life activities. Current treatments of osteoporosis encompass changing lifestyles, taking orthopedic drugs, and invasive surgeries. However, these treatment options are not long lasting and can lead to complications after post-surgical life. Therefore, to solve this impairment, researchers have turned to nanotechnologies and nanomaterials to create innovative and alternative treatments associated with the consequences of osteoporosis. This review article provides an introduction to osteoporotic compression vertebral fractures (OVCFs) and current clinical treatments, along with the rationale and efficacy of utilizing nanomaterials to modify and improve biomaterials or instruments. The methods of applying bioactive agents (bone morphogenetic protein-2 (BMP-2), parathyroid hormone 1-34 (PTH 1-34)), as well as 3D printing will be presented from an osteoporosis treatment perspective. Additionally, the application of nanoparticles and nanotube arrays onto the current surgical treatments and orthopedic drug administration methods addressed will show that these systems reinforce a better mechanical performance and provide precise and slow-releasing drug delivery for better osseointegration, bone regeneration, and bone strength. In summary, nanomaterials can be seen as an alternative and more effective treatment for individuals with osteoporosis. PMID:27542011

  13. Guanfacine Extended Release: A New Pharmacological Treatment Option in Europe.

    PubMed

    Huss, Michael; Chen, Wai; Ludolph, Andrea G

    2016-01-01

    Children/adolescents with attention-deficit/hyperactivity disorder (ADHD) may have a poor or inadequate response to psychostimulants or be unable to tolerate their side-effects; furthermore, stimulants may be inappropriate because of co-existing conditions. Only one non-stimulant ADHD pharmacotherapy, the noradrenaline transporter inhibitor atomoxetine, is currently approved for use in Europe. We review recent advances in understanding of the pathophysiology of ADHD with a focus on the roles of catecholamine receptors in context of the α2A-adrenergic receptor agonist guanfacine extended release (GXR), a new non-stimulant treatment option in Europe. Neuroimaging studies of children/adolescents with ADHD show impaired brain maturation, and structural and functional anomalies in brain regions and networks. Neurobiological studies in ADHD and medication response patterns support involvement of monoaminergic neurotransmitters (primarily dopamine and noradrenaline). Guanfacine is a selective α2A-adrenergic receptor agonist that has been shown to improve prefrontal cortical cognitive function, including working memory. The hypothesized mode of action of guanfacine centres on direct stimulation of post-synaptic α2A-adrenergic receptors to enhance noradrenaline neurotransmission. Preclinical data suggest that guanfacine also influences dendritic spine growth and maturation. Clinical trials have demonstrated the efficacy of GXR in ADHD, and it is approved as monotherapy or adjunctive therapy to stimulants in Canada and the USA (for children and adolescents). GXR was approved recently in Europe for the treatment of ADHD in children and adolescents for whom stimulants are not suitable, not tolerated or have been shown to be ineffective. GXR may provide particular benefit for children/adolescents who have specific co-morbidities such as chronic tic disorders or oppositional defiant disorder (or oppositional symptoms) that have failed to respond to first-line treatment

  14. [Treatment options for chronic inflammatory demyelinating polyradiculoneuropathy (CIDP)].

    PubMed

    Kuntzer, T

    2006-04-01

    Limits of treatment in chronic inflammatory demyelinating poly(radiculo)neuropathies (CIDP) patients are better known thanks to recent Cochrane reviews. (1) Randomized controlled trials have only focused on short-term effects, but most patients need long-term therapy, (2) There are three proven effective treatments available (prednisone; intravenous immunoglobulin or IVIg and plasma exchange or PE) which are useful in more than 60 p. 100 of patients, (3) New open studies indicated possible efficacy for mycophenolate, rituximab, etanercept, ciclosporine and interferons, and (4) Whether CIDP variants need specific treatment is still unknown. Many CIDP patients need treatment for years. The fear of side effects during long-term steroid treatment, the high costs of IVIg, the necessity for specialized equipment and the invasive nature of PE, are important factors determining the choice for one of these treatments. In most up-to-date treatment options, patients are initially treated with IVIg at a dosage of 2 g/kg administered for 25 days, clinical improvement can be judged within 10 days. The percentage of patients responding seems to be approximately 70 percent, with a very high chance (approximately 85 percent) that repeated administration of IVIg will be necessary, explaining why most neurologists add an immunosuppressive drug at this stage, but there is no consensus concerning the best drug to be used. Combinations of drugs are most likely to be useful in the next future, using IVIg, prednisone, and a immunosuppressor agent, such as mycophenolate, rituximab, etanercept, or ciclosporine. General measures to rehabilitate patients and to manage symptoms like fatigue and other residual findings are important.

  15. Current and emerging treatment options for Peyronie's disease.

    PubMed

    Gokce, Ahmet; Wang, Julie C; Powers, Mary K; Hellstrom, Wayne Jg

    2013-01-01

    Peyronie's disease (PD) is a condition of the penis, characterized by the presence of localized fibrotic plaque in the tunica albuginea. PD is not an uncommon disorder, with recent epidemiologic studies documenting a prevalence of 3-9% of adult men affected. The actual prevalence of PD may be even higher. It is often associated with penile pain, anatomical deformities in the erect penis, and difficulty with intromission. As the definitive pathophysiology of PD has not been completely elucidated, further basic research is required to make progress in the understanding of this enigmatic condition. Similarly, research on effective therapies is limited. Currently, nonsurgical treatments are used for those men who are in the acute stage of PD, whereas surgical options are reserved for men with established PD who cannot successfully penetrate. Intralesional treatments are growing in clinical popularity as a minimally invasive approach in the initial treatment of PD. A surgical approach should be considered when men with PD do not respond to conservative, medical, or minimally invasive therapies for approximately 1 year and cannot have satisfactory sexual intercourse. As scientific breakthroughs in the understanding of the mechanisms of this disease process evolve, novel treatments for the many men suffering with PD are anticipated.

  16. An Update on Medical Treatment Options for Hidradenitis Suppurativa.

    PubMed

    Deckers, I E; Prens, E P

    2016-02-01

    Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by recurrent inflammatory nodules mostly located in the armpits and groin. Over the years multiple treatments for HS have been proposed; however, to date a cure is still lacking. In this update we provide an overview of most drug treatments reported on for HS, where possible with their mode of action and side effects. In mild cases, clindamycin lotion or resorcinol cream have proven effective. Tetracyclines are a first-line systemic option in more widespread or severe cases, followed by the combination of clindamycin and rifampicin. However, the recurrence rate is high after discontinuation of clindamycin plus rifampicin combination therapy. Long-term treatment with retinoids, especially acitretin is feasible, although teratogenicity has to be taken into account in females of reproductive age. Multiple anti-inflammatory drugs have been suggested for HS, such as dapsone, fumarates or cyclosporine. However, their effectiveness in HS is based on small case series with varying results. If most common treatments have failed, biologics (e.g., infliximab or adalimumab) are the next step. Although not addressed in this review, surgical interventions are often needed to achieve remission. PMID:26659474

  17. Emerging treatment options for myelofibrosis: focus on pacritinib

    PubMed Central

    Chow, Vivian; Weissman, Ashley; O’Connell, Casey Lee; Mehrvar, Azim; Akhtari, Mojtaba

    2016-01-01

    Myelofibrosis (MF) is a myeloid malignancy associated with a heavy symptomatic burden that decreases quality of life and presents a risk for leukemic transformation. While there are limited curative treatments, the recent discovery of the Janus kinase/signal transducer and activator of transcription (JAK/STAT) pathway dysregulation has led to many clinical investigations for new treatment approaches. This review provides practical knowledge on the disease state, an overview of treatment options, and specifically focuses on the efficacy and safety of pacritinib in the management of MF. Pacritinib is a novel selective inhibitor of JAK2 and FMS-related tyrosine kinase 3 (FLT3) currently in Phase III trials for the treatment of MF. Thus far, studies have demonstrated clinical efficacy in reducing splenomegaly and constitutional symptoms. Common adverse events were gastrointestinal in nature, while hematologic toxicity was limited. However, it was announced that all ongoing clinical trials on pacritinib have been placed on hold by the US Food and Drug Administration in February 2016, due to concerns for increased intracranial hemorrhage and cardiac events. With comprehensive risk-benefit analysis of clinical trial data, the utility of pacritinib in the management of MF may be more clearly defined. PMID:27226728

  18. An Update on Medical Treatment Options for Hidradenitis Suppurativa.

    PubMed

    Deckers, I E; Prens, E P

    2016-02-01

    Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by recurrent inflammatory nodules mostly located in the armpits and groin. Over the years multiple treatments for HS have been proposed; however, to date a cure is still lacking. In this update we provide an overview of most drug treatments reported on for HS, where possible with their mode of action and side effects. In mild cases, clindamycin lotion or resorcinol cream have proven effective. Tetracyclines are a first-line systemic option in more widespread or severe cases, followed by the combination of clindamycin and rifampicin. However, the recurrence rate is high after discontinuation of clindamycin plus rifampicin combination therapy. Long-term treatment with retinoids, especially acitretin is feasible, although teratogenicity has to be taken into account in females of reproductive age. Multiple anti-inflammatory drugs have been suggested for HS, such as dapsone, fumarates or cyclosporine. However, their effectiveness in HS is based on small case series with varying results. If most common treatments have failed, biologics (e.g., infliximab or adalimumab) are the next step. Although not addressed in this review, surgical interventions are often needed to achieve remission.

  19. Myelodysplastic Syndromes in the Elderly: Treatment Options and Personalized Management.

    PubMed

    Burgstaller, Sonja; Wiesinger, Petra; Stauder, Reinhard

    2015-11-01

    Myelodysplastic syndromes (MDS) are typical diseases of the elderly, with a median age of 68-75 years at initial diagnosis. Demographic changes producing an increased proportion of elderly in our societies mean the incidence of MDS will rise dramatically. Considering the increasing number of treatment options, ranging from best supportive care to hematopoietic stem cell transplantation (HSCT), decision making is rather complex in this cohort of patients. Moreover, aspects of the aging process also have to be considered in therapy planning. Treatment of elderly MDS patients is dependent on the patient's individual risk and prognosis. Comorbidities play an essential role as predictors of survival and therapy tolerance. Age-adjusted models and the use of geriatric assessment scores are described as a basis for individualized treatment algorithms. Specific treatment recommendations for the different groups of patients are given. Currently available therapeutic agents, including supportive care, erythropoiesis-stimulating agents (ESAs), immune-modulating agents, hypomethylating agents, and HSCT are described in detail and discussed with a special focus on elderly MDS patients. The inclusion of elderly patients in clinical trials is of utmost importance to obtain data on efficacy and safety in this particular group of patients. Endpoints relevant for the elderly should be integrated, including maintenance of quality of life and functional activities as well as evaluation of use of healthcare resources.

  20. Intracoronary thrombolytic therapy: a treatment option for failed mechanical thrombectomy.

    PubMed

    Gallagher, Sean; Jain, Ajay K; Archbold, R Andrew

    2012-11-01

    The benefit of the routine application of aspiration thrombectomy in primary percutaneous coronary intervention (PPCI) is now well established. The optimal management of patients who have "failed" thrombectomy characterized by a large residual thrombus burden after repeated mechanical thrombectomy, however, is not known. We report a case of failed aspiration thrombectomy in a 66-year-old woman who was admitted to our institution with chest pain associated with inferior ST segment elevation. Coronary angiography showed a thrombotic occlusion of the right coronary artery. Aspiration thrombectomy did little to reduce thrombus load and so the patient was treated with intracoronary tenecteplase. Repeat coronary angiography 18 hr later revealed marked thrombus resolution with thrombolysis in myocardial infarction (TIMI) grade 3 anterograde flow and patency of the infarct-related artery was maintained at 2-month follow up. This case demonstrates the potential for intracoronary thrombolytic therapy as a treatment option for the management of patients following failed thrombectomy in PPCI.

  1. Hepatic sarcoidosis: pathogenesis, clinical context, and treatment options.

    PubMed

    Syed, Umer; Alkhawam, Hassan; Bakhit, Mena; Companioni, Rafael A Ching; Walfish, Aron

    2016-09-01

    Sarcoidosis is typically characterized as a non-caseating granulomatous disease that has the ability to affect multiple different organ systems. Although extra-thoracic sarcoidosis can occur in the presence and also without lung involvement, isolated extra-pulmonary disease is rare. The liver is the third most commonly affected organ system after the lungs and lymph nodes. When discussing hepatic sarcoidosis it is important to keep in mind that many patients in this population may not present as one would typically expect since most of the patients are asymptomatic or have mild presentations. Therefore, the diagnosis can be difficult at times since no single laboratory or imaging study can definitively diagnose this systemic disease. In the rare case of some patients where there is difficulty in discerning between different pathologies, the use of image-guided tissue biopsy may be necessary to establish a diagnosis. At the current time, there are no clear guidelines for the management of hepatic sarcoidosis and are mostly dependent on a patient's clinical status at time of presentation. The current body of research in regard to treatment suggests steroids to be the mainstay of therapy. However, there is a role for additional immunosuppressive therapy in cases where the initial treatment is refractory to steroids. In this manuscript, we discussed the pathogenesis of liver sarcoidosis and context of its presentation. In addition, the differential diagnosis and imaging evaluation in this population is discussed. Finally, treatment options are reviewed in setting of previous studies for liver sarcoidosis. PMID:27175775

  2. The Acceptability of Treatments for Depression to a Community Sample of Adolescent Girls

    ERIC Educational Resources Information Center

    Caporino, Nicole E.; Karver, Marc S.

    2012-01-01

    An efficacious treatment is diminished in value if consumers do not seek it out and adhere to it, making treatment acceptability an important predictor of the effectiveness of treatment. This study examined the acceptability of treatments for depression to 67 female high school students. All participants read a vignette describing a depressed…

  3. Diagnostic methods and treatment options for focal cortical dysplasia.

    PubMed

    Guerrini, Renzo; Duchowny, Michael; Jayakar, Prasanna; Krsek, Pavel; Kahane, Philippe; Tassi, Laura; Melani, Federico; Polster, Tilman; Andre, Véronique M; Cepeda, Carlos; Krueger, Darcy A; Cross, J Helen; Spreafico, Roberto; Cosottini, Mirco; Gotman, Jean; Chassoux, Francine; Ryvlin, Philippe; Bartolomei, Fabrice; Bernasconi, Andrea; Stefan, Hermann; Miller, Ian; Devaux, Bertrand; Najm, Imad; Giordano, Flavio; Vonck, Kristl; Barba, Carmen; Blumcke, Ingmar

    2015-11-01

    Our inability to adequately treat many patients with refractory epilepsy caused by focal cortical dysplasia (FCD), surgical inaccessibility and failures are significant clinical drawbacks. The targeting of physiologic features of epileptogenesis in FCD and colocalizing functionality has enhanced completeness of surgical resection, the main determinant of outcome. Electroencephalography (EEG)-functional magnetic resonance imaging (fMRI) and magnetoencephalography are helpful in guiding electrode implantation and surgical treatment, and high-frequency oscillations help defining the extent of the epileptogenic dysplasia. Ultra high-field MRI has a role in understanding the laminar organization of the cortex, and fluorodeoxyglucose-positron emission tomography (FDG-PET) is highly sensitive for detecting FCD in MRI-negative cases. Multimodal imaging is clinically valuable, either by improving the rate of postoperative seizure freedom or by reducing postoperative deficits. However, there is no level 1 evidence that it improves outcomes. Proof for a specific effect of antiepileptic drugs (AEDs) in FCD is lacking. Pathogenic mutations recently described in mammalian target of rapamycin (mTOR) genes in FCD have yielded important insights into novel treatment options with mTOR inhibitors, which might represent an example of personalized treatment of epilepsy based on the known mechanisms of disease. The ketogenic diet (KD) has been demonstrated to be particularly effective in children with epilepsy caused by structural abnormalities, especially FCD. It attenuates epigenetic chromatin modifications, a master regulator for gene expression and functional adaptation of the cell, thereby modifying disease progression. This could imply lasting benefit of dietary manipulation. Neurostimulation techniques have produced variable clinical outcomes in FCD. In widespread dysplasias, vagus nerve stimulation (VNS) has achieved responder rates >50%; however, the efficacy of noninvasive

  4. Review article: current treatment options and management of functional dyspepsia

    PubMed Central

    Lacy, B. E.; Talley, N. J.; Locke, G. R.; Bouras, E. P.; DiBaise, J. K.; El-Serag, H. B.; Abraham, B. P.; Howden, C. W.; Moayyedi, P.; Prather, C.

    2014-01-01

    SUMMARY Background Functional dyspepsia (FD), a common functional gastrointestinal disorder, is defined by the Rome III criteria as symptoms of epigastric pain or discomfort (prevalence in FD of 89–90%), postprandial fullness (75–88%), and early satiety (50–82%) within the last 3 months with symptom onset at least 6 months earlier. Patients cannot have any evidence of structural disease to explain symptoms and predominant symptoms of gastroesophageal reflux are exclusionary. Symptoms of FD are non-specific and the pathophysiology is diverse, which explains in part why a universally effective treatment for FD remains elusive. Aim To present current management options for the treatment of FD (therapeutic gain/response rate noted when available). Results The utility of Helicobacter pylori eradication for the treatment of FD is modest (6–14% therapeutic gain), while the therapeutic efficacy of proton pump inhibitors (PPI) (7–10% therapeutic gain), histamine-type-2-receptor antagonists (8–35% therapeutic gain), prokinetic agents (18–45%), tricyclic antidepressants (TCA) (response rates of 64–70%), serotonin reuptake inhibitors (no better than placebo) is limited and hampered by inadequate data. This review discusses dietary interventions and analyses studies involving complementary and alternative medications, and psychological therapies. Conclusions A reasonable treatment approach based on current evidence is to initiate therapy with a daily PPI in H. pylori-negative FD patients. If symptoms persist, a therapeutic trial with a tricyclic antidepressant may be initiated. If symptoms continue, the clinician can possibly initiate therapy with an antinociceptive agent, a prokinetic agent, or some form of complementary and alternative medications, although evidence from prospective studies to support this approach is limited. PMID:22591037

  5. Diagnostic methods and treatment options for focal cortical dysplasia.

    PubMed

    Guerrini, Renzo; Duchowny, Michael; Jayakar, Prasanna; Krsek, Pavel; Kahane, Philippe; Tassi, Laura; Melani, Federico; Polster, Tilman; Andre, Véronique M; Cepeda, Carlos; Krueger, Darcy A; Cross, J Helen; Spreafico, Roberto; Cosottini, Mirco; Gotman, Jean; Chassoux, Francine; Ryvlin, Philippe; Bartolomei, Fabrice; Bernasconi, Andrea; Stefan, Hermann; Miller, Ian; Devaux, Bertrand; Najm, Imad; Giordano, Flavio; Vonck, Kristl; Barba, Carmen; Blumcke, Ingmar

    2015-11-01

    Our inability to adequately treat many patients with refractory epilepsy caused by focal cortical dysplasia (FCD), surgical inaccessibility and failures are significant clinical drawbacks. The targeting of physiologic features of epileptogenesis in FCD and colocalizing functionality has enhanced completeness of surgical resection, the main determinant of outcome. Electroencephalography (EEG)-functional magnetic resonance imaging (fMRI) and magnetoencephalography are helpful in guiding electrode implantation and surgical treatment, and high-frequency oscillations help defining the extent of the epileptogenic dysplasia. Ultra high-field MRI has a role in understanding the laminar organization of the cortex, and fluorodeoxyglucose-positron emission tomography (FDG-PET) is highly sensitive for detecting FCD in MRI-negative cases. Multimodal imaging is clinically valuable, either by improving the rate of postoperative seizure freedom or by reducing postoperative deficits. However, there is no level 1 evidence that it improves outcomes. Proof for a specific effect of antiepileptic drugs (AEDs) in FCD is lacking. Pathogenic mutations recently described in mammalian target of rapamycin (mTOR) genes in FCD have yielded important insights into novel treatment options with mTOR inhibitors, which might represent an example of personalized treatment of epilepsy based on the known mechanisms of disease. The ketogenic diet (KD) has been demonstrated to be particularly effective in children with epilepsy caused by structural abnormalities, especially FCD. It attenuates epigenetic chromatin modifications, a master regulator for gene expression and functional adaptation of the cell, thereby modifying disease progression. This could imply lasting benefit of dietary manipulation. Neurostimulation techniques have produced variable clinical outcomes in FCD. In widespread dysplasias, vagus nerve stimulation (VNS) has achieved responder rates >50%; however, the efficacy of noninvasive

  6. Laparoscopic Cerclage as a Treatment Option for Cervical Insufficiency

    PubMed Central

    Bolla, D.; Raio, L.; Imboden, S.; Mueller, M. D.

    2015-01-01

    Background: The traditional surgical treatment for cervical insufficiency is vaginal placement of a cervical cerclage. However, in a small number of cases a vaginal approach is not possible. A transabdominal approach can become an option for these patients. Laparoscopic cervical cerclage is associated with good pregnancy outcomes but comes at the cost of a higher risk of serious surgical complications. The aim of the present study was to evaluate intraoperative and long-term pregnancy outcomes after laparoscopic cervical cerclage, performed either as an interval procedure or during early pregnancy, using a new device with a blunt grasper and a flexible tip. Methods: All women who underwent laparoscopic cervical cerclage for cervical insufficiency in our institution using the Goldfinger® device (Ethicon Endo Surgery, Somerville, NJ, USA) between January 2008 and March 2014 were included in the study. Data were collected from the patientsʼ medical records and included complications during and after the above-described procedure. Results: Eighteen women were included in the study. Of these, six were pregnant at the time of laparoscopic cervical cerclage. Mean duration of surgery was 55 ± 10 minutes. No serious intraoperative or postoperative complications occurred. All patients were discharged at 2.6 ± 0.9 days after surgery. One pregnancy ended in a miscarriage at 12 weeks of gestation. All other pregnancies ended at term (> 37 weeks of gestation) with good perinatal and maternal outcomes. Summary: Performing a laparoscopic cervical cerclage using a blunt grasper device with a flexible tip does not increase intraoperative complications, particularly in early pregnancy. We believe that use of this device, which is characterized by increased maneuverability, could be an important option to avoid intraoperative complications if surgical access is limited due to the anatomical situation. However, because of the small sample size, further studies are needed

  7. Interspinous Process Decompression: Expanding Treatment Options for Lumbar Spinal Stenosis

    PubMed Central

    Nunley, Pierce D.; Shamie, A. Nick; Blumenthal, Scott L.; Orndorff, Douglas; Geisler, Fred H.

    2016-01-01

    Interspinous process decompression is a minimally invasive implantation procedure employing a stand-alone interspinous spacer that functions as an extension blocker to prevent compression of neural elements without direct surgical removal of tissue adjacent to the nerves. The Superion® spacer is the only FDA approved stand-alone device available in the US. It is also the only spacer approved by the CMS to be implanted in an ambulatory surgery center. We computed the within-group effect sizes from the Superion IDE trial and compared them to results extrapolated from two randomized trials of decompressive laminectomy. For the ODI, effect sizes were all very large (>1.0) for Superion and laminectomy at 2, 3, and 4 years. For ZCQ, the 2-year Superion symptom severity (1.26) and physical function (1.29) domains were very large; laminectomy effect sizes were very large (1.07) for symptom severity and large for physical function (0.80). Current projections indicate a marked increase in the number of patients with spinal stenosis. Consequently, there remains a keen interest in minimally invasive treatment options that delay or obviate the need for invasive surgical procedures, such as decompressive laminectomy or fusion. Stand-alone interspinous spacers may fill a currently unmet treatment gap in the continuum of care and help to reduce the burden of this chronic degenerative condition on the health care system.

  8. Breast cancer in elderly women: presentation, survival, and treatment options.

    PubMed

    Law, T M; Hesketh, P J; Porter, K A; Lawn-Tsao, L; McAnaw, R; Lopez, M J

    1996-04-01

    Recent data suggest that breast cancer in elderly women does not present as more advanced disease, nor is survival significantly inferior to that in younger women. Unfortunately, until recently, older women have been excluded from clinical trials that have determined survival benefit in both screening and treatment modalities. Unless co-morbid conditions adversely affect one's life expectancy or tolerance to therapy, older women should be treated with standard surgical procedures (including breast conservation, if so desired) for early-stage disease, as outcome is comparable to that in younger patients. Adjuvant tamoxifen therapy has proven survival benefit in women over 70 years of age with estrogen receptor-positive tumors and should be considered in all women with tumors greater than 1 cm in size. Older women may experience more chemotherapy-related toxicities. However, for those with a significant risk of recurrence due to tumor size or lymph node status, chemotherapy can be safely administered when factors such as age-related decline in creatinine clearance and co-morbid conditions are considered. Hormonal therapy (tamoxifen) is usually the first-line treatment option over chemotherapy for metastatic disease in the elderly unless the patient has an estrogen receptor-negative tumor, visceral-dominant disease, or significant disease-related symptoms. In the latter settings, chemotherapy can provide improved or more rapid response proportions but does not affect long-term survival.

  9. Cachexia and pancreatic cancer: Are there treatment options?

    PubMed Central

    Mueller, Tara C; Burmeister, Marc A; Bachmann, Jeannine; Martignoni, Marc E

    2014-01-01

    Cachexia is frequently described in patients with pancreatic ductal adenocarcinoma (PDAC) and is associated with reduced survival and quality of life. Unfortunately, the therapeutic options of this multi-factorial and complex syndrome are limited. This is due to the fact that, despite extensive preclinical and clinical research, the underlying pathological mechanisms leading to PDAC-associated cachexia are still not fully understood. Furthermore, there is still a lack of consensus on the definition of cachexia, which complicates the standardization of diagnosis and treatment as well as the analysis of the current literature. In order to provide an efficient therapy for cachexia, an early and reliable diagnosis and consistent monitoring is required, which can be challenging especially in obese patients. Although many substances have been tested in clinical and preclinical settings, so far none of them have been proven to have a long-term effect in ameliorating cancer-associated cachexia. However, recent studies have demonstrated that multidimensional therapeutic modalities are able to alleviate pancreatic cancer-associated cachexia and ultimately improve patients’ outcome. In this current review, we propose a stepwise and pragmatic approach to facilitate and standardize the treatment of cachexia in pancreatic cancer patients. This strategy consists of nutritional, dietary, pharmacological, physical and psychological methods. PMID:25071331

  10. New and Emerging Treatment Options for Irritable Bowel Syndrome.

    PubMed

    Lacy, Brian E; Chey, William D; Lembo, Anthony J

    2015-04-01

    Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder associated with abdominal pain, diarrhea, constipation, or a mix of symptoms. The pathophysiology of IBS is not completely understood but appears to involve genetics, the gut microbiome, immune activation, altered intestinal permeability, and brain-gut interactions. There is no gold standard for diagnosis. Several sets of symptom-based guidelines exist. Treatment strategies for IBS may include both nonpharmacologic and pharmacologic approaches. Lifestyle modifications that aim to improve exercise, sleep, diet, and stress may be warranted. Recent data suggest that a gluten-free diet and a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) may benefit some patients. For patients with diarrhea-predominant IBS, treatment options include the synthetic peripheral μ-opioid receptor agonist loperamide, antispasmodic agents, antidepressants, serotonin 5-HT3 antagonists, and the gut-specific antibiotic rifaximin. Ongoing research is evaluating the use of probiotics. For patients with constipation-predominant IBS, therapeutic strategies may include dietary fiber, laxatives, and the prosecretory agents lubiprostone and linaclotide. Research is continuing to optimize the use of available agents and evaluating new approaches to further improve the care of patients with IBS. PMID:26491416

  11. New and Emerging Treatment Options for Irritable Bowel Syndrome

    PubMed Central

    Lacy, Brian E.; Chey, William D.; Lembo, Anthony J.

    2015-01-01

    Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder associated with abdominal pain, diarrhea, constipation, or a mix of symptoms. The pathophysiology of IBS is not completely understood but appears to involve genetics, the gut microbiome, immune activation, altered intestinal permeability, and brain-gut interactions. There is no gold standard for diagnosis. Several sets of symptom-based guidelines exist. Treatment strategies for IBS may include both nonpharmacologic and pharmacologic approaches. Lifestyle modifications that aim to improve exercise, sleep, diet, and stress may be warranted. Recent data suggest that a gluten-free diet and a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) may benefit some patients. For patients with diarrhea-predominant IBS, treatment options include the synthetic peripheral μ-opioid receptor agonist loperamide, antispasmodic agents, antidepressants, serotonin 5-HT3 antagonists, and the gut-specific antibiotic rifaximin. Ongoing research is evaluating the use of probiotics. For patients with constipation-predominant IBS, therapeutic strategies may include dietary fiber, laxatives, and the prosecretory agents lubiprostone and linaclotide. Research is continuing to optimize the use of available agents and evaluating new approaches to further improve the care of patients with IBS. PMID:26491416

  12. Clinical Characteristics and Treatment Options of Infantile Vascular Anomalies

    PubMed Central

    Yang, Bin; Li, Li; Zhang, Li-xin; Sun, Yu-juan; Ma, Lin

    2015-01-01

    Abstract To analyze the clinical characteristics and treatment outcomes of vascular anomalies, and determine which therapy is safe and effective. The data of vascular anomalies pediatric patients who arrived at Beijing children's Hospital from January 2001 to December 2014 were analyzed retrospectively, including the influence of gender, age, clinical manifestation, diagnosis, treatment options, and outcomes. As to infantile hemangiomas, the outcomes of different treatments and their adverse reactions were compared. As to spider angioma and cutaneous capillary malformation, the treatment effect of 595 nm pulsed dye laser (PDL) is analyzed. A total number of 6459 cases of vascular anomalies were reclassified according to the 2014 ISSVA classification system. Among them, the gender ratio is 1:1.69, head-and-neck involved is 53.3%, the onset age within the first month is 72.4%, the age of initial encounter that younger than 6 months is 60.1%. The most common anomalies were infantile hemangiomas (42.6%), congenital hemangiomas (14.1%), and capillary malformations (29.9%). In treating infantile hemangiomas, laser shows the lowest adverse reactions rate significantly. Propranolol shows a higher improvement rate than laser, glucocorticoids, glucocorticoids plus laser, and shows no significant difference with propranolol plus laser both in improvement rate and adverse reactions rate. The total improvement rate of 595 nm PDL is 89.8% in treating spider angioma and 46.7% in treating cutaneous capillary malformation. The improvement rate and excellent rate of laser in treating cutaneous capillary malformation are growing synchronously by increasing the treatment times, and shows no significant difference among different parts of lesion that located in a body. Vascular anomalies possess a female predominance, and are mostly occurred in faces. Definite diagnosis is very important before treatment. In treating infantile hemangioma, propranolol is recommended as the first

  13. Geothermal Produced Fluids: Characteristics, Treatment Technologies, and Management Options

    SciTech Connect

    Finster, Molly; Clark, Corrie; Schroeder, Jenna; Martino, Louis

    2015-10-01

    options for produced fluids that require additional treatment for these constituents are also discussed, including surface disposal, reuse and recycle, agricultural industrial and domestic uses, mineral extraction and recovery, and solid waste handling.

  14. Immunotoxin – a new treatment option in patients with relapsed and refractory Hodgkin lymphoma

    PubMed Central

    Novakovic, Barbara Jezersek

    2015-01-01

    Background Even though Hodgkin lymphoma is a highly curable disease, some of the patients have either a refractory disease or experience a relapse following a successful primary therapy. Durable responses and remissions in patients with relapsed or refractory disease may be achieved in approximately one-half with salvage chemotherapy followed by high dose chemotherapy (HDT) and autologous hematopoietic cell rescue (SCT). On the other hand, patients who relapse after HDT and autologous SCT or those who have failed at least two prior multi-agent chemotherapy regimens and are not candidates for HDT have limited treatment options. Conclusions A new treatment option in this population is an immunotoxin Brentuximab vedotin composed of a CD30 directed antibody linked to the antitubulin agent monomethyl auristatin E. It has demonstrated a substantial effectiveness and an acceptable toxicity. In the pivotal study, the overall response rate was 75% with 34% of complete remissions. The median durations of response were 20.5 and 6.7 months for those with complete remission and all responding patients, respectively. The median overall survival was 40.5 months (3-years overall survival 54%) and the median progression-free survival 9.3 months. The most common non-hematologic toxicities were peripheral sensory neuropathy, nausea, and fatigue while the most common severe side effects were neutropenia, thrombocytopenia, anemia, and peripheral sensory neuropathy. PMID:26834516

  15. Breast cancer and sexuality: multi-modal treatment options.

    PubMed

    Krychman, Michael L; Katz, Anne

    2012-01-01

    The sexual consequences of breast cancer and its treatments are well known and previously reviewed. Alterations in body image, with or without breast reconstruction, changes in sexual self-esteem and self-efficacy, vulvovaginal atrophy as a result of chemotherapy and/or adjuvant hormone therapy, and loss of libido secondary to dyspareunia and body image issues are common in survivors of breast cancer. Medications that are prescribed for long-term use including those in the class of aromatase inhibitors can have far-reaching implications on quality of life by contributing to vulvar and vaginal atrophic changes. While this is an important issue, there are few widely accepted treatments that have been evaluated for efficacy and safety for these sexual challenges in the breast cancer population. However, progress is being made in finding new and innovative solutions for many of the sexual problems faced by breast cancer survivors and their partners. Many institutions are now compelled to address survivorship concerns and addressing sexuality and intimacy are paramount issues in survivorship care. In this article, we present the evidence for the multimodal approach to the management of sexuality concerns in the breast cancer survivor. Pharmacologic, nonpharmacologic, and psychosocial interventions will be reviewed. PMID:22151953

  16. Acceptability of aversive procedures and medication as treatment alternatives for deviant child behavior.

    PubMed

    Kazdin, A E

    1984-06-01

    The present investigation evaluated the acceptability of alternative treatments for deviant child behavior. Clinical cases of children who displayed severe behavioral problems at home and a school were described along with three different treatments. The treatments, time-out from reinforcement, locked seclusion, and medication, were rated by psychiatric inpatient children and parents in a 3 X 3 replicated Latin-square design. The investigation also evaluated whether acceptability ratings were influenced by the clinical effectiveness of treatment in altering behavior. Although children and parents did not differ overall in acceptability ratings, they differed in their ranking of different treatments. Children viewed medication as the most acceptable treatment, whereas parents viewed time-out as the most acceptable treatment. For both children and parents, treatments described as producing marked effects were rated as more acceptable than treatments producing weaker effects. The results indicated that disturbed children and their parents can readily distinguish the acceptability of alternative treatments. The implications of treatment acceptability for clinical applications of treatment are discussed.

  17. Nonalcoholic steatohepatitis: emerging targeted therapies to optimize treatment options

    PubMed Central

    Milic, Sandra; Mikolasevic, Ivana; Krznaric-Zrnic, Irena; Stanic, Marija; Poropat, Goran; Stimac, Davor; Vlahovic-Palcevski, Vera; Orlic, Lidija

    2015-01-01

    Diet and lifestyle changes have led to worldwide increases in the prevalences of obesity and metabolic syndrome, resulting in substantially greater incidence of nonalcoholic fatty liver disease (NAFLD). NAFLD is considered a hepatic manifestation of metabolic syndrome and is related to diabetes, insulin resistance, central obesity, hyperlipidemia, and hypertension. Nonalcoholic steatohepatitis (NASH) is an entity that describes liver inflammation due to NAFLD. Growing evidence suggests that NAFLD is a multisystem disease with a clinical burden that is not only confined to liver-related morbidity and mortality, but that also affects several extra-hepatic organs and regulatory pathways. Thus, NAFLD is considered an important public health issue, but there is currently no effective therapy for all NAFLD patients in the general population. Studies seeking optimal therapy for NAFLD and NASH have not yet led to development of a universal protocol for treating this growing problem. Several pharmacological agents have been studied in an effort to improve insulin resistance and the proinflammatory mediators that may be responsible for NASH progression. Cardiovascular risk factors are highly prevalent among NASH patients, and the backbone of treatment regimens for these patients still comprises general lifestyle interventions, including dietary changes and increased physical activity. Vitamin E and thiazolidinedione derivatives are currently the most evidence-based therapeutic options, but only limited clinical evidence is available regarding their long-term efficacy and safety. Vitamin D and renin–angiotensin–aldosterone system blockers are promising drugs that are currently being intensively investigated for use in NAFLD/NASH patients. PMID:26316717

  18. Arsenic contaminated groundwater and its treatment options in Bangladesh.

    PubMed

    Jiang, Jia-Qian; Ashekuzzaman, S M; Jiang, Anlun; Sharifuzzaman, S M; Chowdhury, Sayedur Rahman

    2012-12-20

    Arsenic (As) causes health concerns due to its significant toxicity and worldwide presence in drinking water and groundwater. The major sources of As pollution may be natural process such as dissolution of As-containing minerals and anthropogenic activities such as percolation of water from mines, etc. The maximum contaminant level for total As in potable water has been established as 10 µg/L. Among the countries facing As contamination problems, Bangladesh is the most affected. Up to 77 million people in Bangladesh have been exposed to toxic levels of arsenic from drinking water. Therefore, it has become an urgent need to provide As-free drinking water in rural households throughout Bangladesh. This paper provides a comprehensive overview on the recent data on arsenic contamination status, its sources and reasons of mobilization and the exposure pathways in Bangladesh. Very little literature has focused on the removal of As from groundwaters in developing countries and thus this paper aims to review the As removal technologies and be a useful resource for researchers or policy makers to help identify and investigate useful treatment options. While a number of technological developments in arsenic removal have taken place, we must consider variations in sources and quality characteristics of As polluted water and differences in the socio-economic and literacy conditions of people, and then aim at improving effectiveness in arsenic removal, reducing the cost of the system, making the technology user friendly, overcoming maintenance problems and resolving sludge management issues.

  19. Familial hypercholesterolemia: etiology, diagnosis and new treatment options.

    PubMed

    Gouni-Berthold, Ioanna; Berthold, Heiner K

    2014-01-01

    Familial hypercholesterolemia (FH) is a common genetic disorder that presents with robust increases in low-density lipoprotein cholesterol (LDL-C) and can lead to premature cardiovascular disease. There are heterozygous and homozygous forms. The diagnosis is usually made based on blood cholesterol levels, clinical signs and family history. Genetic testing can be used to confirm the diagnosis. Effective lowering of LDL-C in FH can prevent cardiovascular morbidity and mortality, however, the disease remains greatly underdiagnosed. The mainstay of pharmacologic therapy in FH patients is high-dose statins, which are often combined with other lipid-lowering agents. The homozygous form is mainly treated with lipid apheresis. Guideline-recommended target levels of LDL-C are often not reached, making new treatment options desirable. Four classes of newer lipid-lowering drugs offer promising advances in treating FH, namely the apolipoprotein-B synthesis inhibitors (mipomersen), the microsomal transfer protein inhibitors (lomitapide), the cholesterol ester transfer protein inhibitors (anacetrapib, evacetrapib) and the proprotein convertase subtilisin/kexin type 9 inhibitors (evolocumab, alirocumab). In this review, the available evidence regarding the use of these drugs in patients with FH is discussed, with particular focus on their efficacy and safety.

  20. Familial hypercholesterolemia: etiology, diagnosis and new treatment options.

    PubMed

    Gouni-Berthold, Ioanna; Berthold, Heiner K

    2014-01-01

    Familial hypercholesterolemia (FH) is a common genetic disorder that presents with robust increases in low-density lipoprotein cholesterol (LDL-C) and can lead to premature cardiovascular disease. There are heterozygous and homozygous forms. The diagnosis is usually made based on blood cholesterol levels, clinical signs and family history. Genetic testing can be used to confirm the diagnosis. Effective lowering of LDL-C in FH can prevent cardiovascular morbidity and mortality, however, the disease remains greatly underdiagnosed. The mainstay of pharmacologic therapy in FH patients is high-dose statins, which are often combined with other lipid-lowering agents. The homozygous form is mainly treated with lipid apheresis. Guideline-recommended target levels of LDL-C are often not reached, making new treatment options desirable. Four classes of newer lipid-lowering drugs offer promising advances in treating FH, namely the apolipoprotein-B synthesis inhibitors (mipomersen), the microsomal transfer protein inhibitors (lomitapide), the cholesterol ester transfer protein inhibitors (anacetrapib, evacetrapib) and the proprotein convertase subtilisin/kexin type 9 inhibitors (evolocumab, alirocumab). In this review, the available evidence regarding the use of these drugs in patients with FH is discussed, with particular focus on their efficacy and safety. PMID:24953396

  1. SARS: clinical presentation, transmission, pathogenesis and treatment options.

    PubMed

    Chan, Paul K S; Tang, Julian W; Hui, David S C

    2006-02-01

    SARS (severe acute respiratory syndrome) appeared as the first emerging infectious disease of this century. It is fortunate that the culprit virus can be grown without much difficulty from a commonly used cell line, allowing an unlimited supply of isolates for further molecular studies and leading to the development of sensitive diagnostic assays. How the virus has successfully jumped the species barrier is still a mystery. The superspreading events that occurred within hospital, hotel and high-density housing estate opens a new chapter in the mechanisms and routes of virus transmission. The old practice of quarantine proved to be still useful in controlling the global outbreak. Despite all the available sophisticated tests, alertness with early recognition by healthcare workers and prompt isolation of suspected cases is still the most important step for containing the spread of the infection. Although the rapidly evolving outbreak did not allow the conducting of systematic clinical trails to evaluate treatment options, the accumulated experience on managing SARS patients will improve the clinical outcome should SARS return. Although SARS led to more than 700 deaths worldwide, the lessons learnt have prepared healthcare systems worldwide to face future emerging and re-emerging infections. PMID:16411895

  2. Keratosis lichenoides chronica: Case-based review of treatment options.

    PubMed

    Pistoni, Federica; Peroni, Anna; Colato, Chiara; Schena, Donatella; Girolomoni, Giampiero

    2016-08-01

    Keratosis lichenoides chronica (KLC) is a rare dermatological condition characterized by keratotic papules arranged in a parallel linear or reticular pattern and facial lesions resembling seborrheic dermatitis or rosacea. The clinical, histological and therapeutic information on 71 patients with KLC retrieved through a PubMed search plus one our new case were analyzed. KLC affects patients of all ages, with a modest male predominance. Pediatric cases represent about one quarter of patients. Diagnosis is usually delayed and histologically confirmed. All patients have thick, rough and scaly papules and plaques arranged in a linear or reticular pattern, on limbs (>80%) and trunk (about 60%). Face involvement is described in two-thirds of patients. Lesions are usually asymptomatic or mildly pruritic. Other manifestations, such as palmoplantar keratoderma, mucosal involvement, ocular manifestations, nail dystrophy, are reported in 20-30% of patients. Children present more frequently alopecia. No controlled trials are available. Results from small case series or single case reports show that the best treatment options are phototherapy and systemic retinoids, alone or in combination, with nearly half of patients reaching complete remission. Systemic corticosteroids as well as antibiotics and antimalarials are not effective. PMID:26652284

  3. Clean option: Berkeley Pit water treatment and resource recovery strategy

    SciTech Connect

    Gerber, M.A.; Orth, R.J.; Elmore, M.R.; Monzyk, B.F.

    1995-09-01

    The US Department of Energy (DOE), Office of Technology Development, established the Resource Recovery Project (RRP) in 1992 as a five-year effort to evaluate and demonstrate multiple technologies for recovering water, metals, and other industrial resources from contaminated surface and groundwater. Natural water resources located throughout the DOE complex and the and western states have been rendered unusable because of contamination from heavy metals. The Berkeley Pit, a large, inactive, open pit copper mine located in Butte, Montana, along with its associated groundwater system, has been selected by the RRP for use as a feedstock for a test bed facility located there. The test bed facility provides the infrastructure needed to evaluate promising technologies at the pilot plant scale. Data obtained from testing these technologies was used to assess their applicability for similar mine drainage water applications throughout the western states and at DOE. The objective of the Clean Option project is to develop strategies that provides a comprehensive and integrated approach to resource recovery using the Berkeley Pit water as a feedstock. The strategies not only consider the immediate problem of resource recovery from the contaminated water, but also manage the subsequent treatment of all resulting process streams. The strategies also employ the philosophy of waste minimization to optimize reduction of the waste volume requiring disposal, and the recovery and reuse of processing materials.

  4. Arsenic Contaminated Groundwater and Its Treatment Options in Bangladesh

    PubMed Central

    Jiang, Jia-Qian; Ashekuzzaman, S. M.; Jiang, Anlun; Sharifuzzaman, S. M.; Chowdhury, Sayedur Rahman

    2012-01-01

    Arsenic (As) causes health concerns due to its significant toxicity and worldwide presence in drinking water and groundwater. The major sources of As pollution may be natural process such as dissolution of As-containing minerals and anthropogenic activities such as percolation of water from mines, etc. The maximum contaminant level for total As in potable water has been established as 10 µg/L. Among the countries facing As contamination problems, Bangladesh is the most affected. Up to 77 million people in Bangladesh have been exposed to toxic levels of arsenic from drinking water. Therefore, it has become an urgent need to provide As-free drinking water in rural households throughout Bangladesh. This paper provides a comprehensive overview on the recent data on arsenic contamination status, its sources and reasons of mobilization and the exposure pathways in Bangladesh. Very little literature has focused on the removal of As from groundwaters in developing countries and thus this paper aims to review the As removal technologies and be a useful resource for researchers or policy makers to help identify and investigate useful treatment options. While a number of technological developments in arsenic removal have taken place, we must consider variations in sources and quality characteristics of As polluted water and differences in the socio-economic and literacy conditions of people, and then aim at improving effectiveness in arsenic removal, reducing the cost of the system, making the technology user friendly, overcoming maintenance problems and resolving sludge management issues. PMID:23343979

  5. Antimicrobial Treatment Options for Granulomatous Mastitis Caused by Corynebacterium Species

    PubMed Central

    Dobinson, Hazel C.; Anderson, Trevor P.; Chambers, Stephen T.; Doogue, Matthew P.; Seaward, Lois

    2015-01-01

    Corynebacterium species are increasingly recognized as important pathogens in granulomatous mastitis. Currently, there are no published treatment protocols for Corynebacterium breast infections. This study describes antimicrobial treatment options in the context of other management strategies used for granulomatous mastitis. Corynebacterium spp. isolated from breast tissue and aspirate samples stored from 2002 to 2013 were identified and determined to the species level using matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS), 16S RNA sequencing, and rpoB gene targets. The MICs for 12 antimicrobials were performed using Etest for each isolate. Correlations of these with antimicrobial characteristics, choice of antimicrobial, and disease outcome were evaluated. Corynebacterium spp. from breast tissue and aspirate samples were confirmed in 17 isolates from 16 patients. Based on EUCAST breakpoints, Corynebacterium kroppenstedtii isolates (n = 11) were susceptible to seven antibiotic classes but resistant to β-lactam antibiotics. Corynebacterium tuberculostearicum isolates (n = 4) were multidrug resistant. Two nonlipophilic species were isolated, Corynebacterium glucuronolyticum and Corynebacterium freneyi, both of which have various susceptibilities to antimicrobial agents. Short-course antimicrobial therapy was common (median, 6 courses per subject; range, 1 to 9 courses). Patients with C. kroppenstedtii presented with a hot painful breast mass and underwent multiple surgical procedures (median, 4 procedures; range, 2 to 6 procedures). The management of Corynebacterium breast infections requires a multidisciplinary approach and includes culture and appropriate sensitivity testing to guide antimicrobial therapy. Established infections have a poor outcome, possibly because adequate concentrations of some drugs will be difficult to achieve in lipophilic granulomata. Lipophilic antimicrobial therapy may offer a therapeutic

  6. Antimicrobial Treatment Options for Granulomatous Mastitis Caused by Corynebacterium Species.

    PubMed

    Dobinson, Hazel C; Anderson, Trevor P; Chambers, Stephen T; Doogue, Matthew P; Seaward, Lois; Werno, Anja M

    2015-09-01

    Corynebacterium species are increasingly recognized as important pathogens in granulomatous mastitis. Currently, there are no published treatment protocols for Corynebacterium breast infections. This study describes antimicrobial treatment options in the context of other management strategies used for granulomatous mastitis. Corynebacterium spp. isolated from breast tissue and aspirate samples stored from 2002 to 2013 were identified and determined to the species level using matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS), 16S RNA sequencing, and rpoB gene targets. The MICs for 12 antimicrobials were performed using Etest for each isolate. Correlations of these with antimicrobial characteristics, choice of antimicrobial, and disease outcome were evaluated. Corynebacterium spp. from breast tissue and aspirate samples were confirmed in 17 isolates from 16 patients. Based on EUCAST breakpoints, Corynebacterium kroppenstedtii isolates (n = 11) were susceptible to seven antibiotic classes but resistant to β-lactam antibiotics. Corynebacterium tuberculostearicum isolates (n = 4) were multidrug resistant. Two nonlipophilic species were isolated, Corynebacterium glucuronolyticum and Corynebacterium freneyi, both of which have various susceptibilities to antimicrobial agents. Short-course antimicrobial therapy was common (median, 6 courses per subject; range, 1 to 9 courses). Patients with C. kroppenstedtii presented with a hot painful breast mass and underwent multiple surgical procedures (median, 4 procedures; range, 2 to 6 procedures). The management of Corynebacterium breast infections requires a multidisciplinary approach and includes culture and appropriate sensitivity testing to guide antimicrobial therapy. Established infections have a poor outcome, possibly because adequate concentrations of some drugs will be difficult to achieve in lipophilic granulomata. Lipophilic antimicrobial therapy may offer a therapeutic

  7. Acceptance and Commitment Therapy for Anxiety Disorders: Three Case Studies Exemplifying a Unified Treatment Protocol

    ERIC Educational Resources Information Center

    Eifert, Georg H.; Forsyth, John P.; Arch, Joanna; Espejo, Emmanuel; Keller, Melody; Langer, David

    2009-01-01

    Acceptance and Commitment Therapy (ACT) is an innovative acceptance-based behavior therapy that has been applied broadly and successfully to treat a variety of clinical problems, including the anxiety disorders. Throughout treatment ACT balances acceptance and mindfulness processes with commitment and behavior change processes. As applied to…

  8. Excited delirium syndrome (ExDS): treatment options and considerations.

    PubMed

    Vilke, Gary M; Bozeman, William P; Dawes, Donald M; Demers, Gerard; Wilson, Michael P

    2012-04-01

    and initiate appropriate stabilizing treatment. ExDS patients will generally require transfer to an emergency department (ED) for further management, evaluation, and definitive care. In this paper, we present a typical ExDS case and then review existing literature for current treatment options.

  9. Polycystic ovary syndrome in adolescents: current and future treatment options.

    PubMed

    Mastorakos, George; Lambrinoudaki, Irene; Creatsas, George

    2006-01-01

    Polycystic ovary syndrome (PCOS) is a very common disorder affecting 5-10% of women of reproductive age. The pivotal endocrine abnormalities of this syndrome are insulin resistance and ovarian and, to a lesser degree, adrenal hypersensitivity to hormonal stimulation. PCOS may manifest itself as early as the first decade of life by premature pubarche or menarche. Oligoamenorrhea in the first postpubarchal years, although very common, may be an early symptom of PCOS, especially in overweight girls with hirsutism or acne. Girls with low birth weight as well as a family history of diabetes mellitus or premature cardiovascular disease are at high risk for developing PCOS. Circulating bioavailable testosterone levels are usually elevated, while total testosterone may be normal due to low levels of sex hormone-binding globulin. The typical sonographic appearance of PCOS ovaries consists of high ovarian volume (>10 mL) and the presence of 12 or more follicles in each ovary measuring 2-9 mm in diameter. However, this finding is not specific, since it may occur in >20% of healthy girls. The therapeutic goals in adolescents with PCOS is first to restore bodyweight and menses and to reduce the signs of hyperandrogenism. The reduction of bodyweight in this young age group may require the collaboration of the pediatrician, dietitian, and psychotherapist. The adolescent should be urged to adopt a healthy lifestyle with the aim to maintain a normal body mass index throughout adolescence and adult life. The choice of medical therapy depends on the clinical presentation. Oral contraceptives are a good option when acne and hirsutism are the principal complaints. Adolescents with isolated cycle irregularity may be placed on a cyclical progestin regimen to induce withdrawal bleeding. Metformin, by decreasing insulin resistance, alleviates many of the hormonal disturbances and restores menses in a considerable proportion of patients. It may be used alone or in combination with oral

  10. Stochastic water quality: Timing and option value of treatment

    NASA Astrophysics Data System (ADS)

    Conrad, Jon M.; López, Andrés

    2002-05-01

    An option-pricing model is developed to rank investments that might improve water quality. The model presumes that two investment options exist that have the potential to alter the stochastic drift of a pollutant. The investments have capital and operating costs and are irreversible once constructed. A stochastically evolving pollutant induces damage. The model provides a criterion for determining when it is optimal to adopt the investment with the highest option value. Option value, in this model, measures the expected present value of reduced damage, relative to doing nothing. If the investments are mutually exclusive, it is possible to obtain closed-form solutions for the barriers which would trigger investment. If the investments can be sequentially adopted, a methodology is developed to calculate option values for all possible combinations of adoption dates. To illustrate the option-pricing approach, a stylized analysis of investments to protect New York City's water supply is presented. Watershed management dominates filtration and, in the case of mutually exclusive investments, is initiated when the concentration of phosphorus reaches 22.80 μg/L.

  11. Treatment Options for Metastatic Squamous Neck Cancer with Occult Primary

    MedlinePlus

    ... Patient Hypopharyngeal Cancer Treatment Laryngeal Cancer Treatment Lip & Oral Cavity Treatment Metastatic Squamous Neck Cancer with Occult Primary ... Nasal Cavity Cancer Treatment Salivary Gland Cancer Treatment Oral Cavity and Oropharyngeal Cancer Prevention Oral Cavity and Oropharyngeal ...

  12. Treatment Option Overview (Metastatic Squamous Neck Cancer with Occult Primary)

    MedlinePlus

    ... Patient Hypopharyngeal Cancer Treatment Laryngeal Cancer Treatment Lip & Oral Cavity Treatment Metastatic Squamous Neck Cancer with Occult Primary ... Nasal Cavity Cancer Treatment Salivary Gland Cancer Treatment Oral Cavity and Oropharyngeal Cancer Prevention Oral Cavity and Oropharyngeal ...

  13. 78 FR 8060 - Treatment of Grantor of an Option on a Partnership Interest

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-05

    ... (noncompensatory partnership option regulations) were published in the Federal Register (68 FR 2930). Final... Internal Revenue Service 26 CFR Part 1 RIN 1545-BH89 Treatment of Grantor of an Option on a Partnership...: This document contains proposed regulations relating to the tax treatment of noncompensatory...

  14. Acceptability of Treatment for a Student Sleeping in the College Classroom

    ERIC Educational Resources Information Center

    Carter, Stacy L.; Punyanunt-Carter, Narissra Maria

    2006-01-01

    This study focused on various treatments for addressing the classroom misbehavior of sleeping during class. The findings revealed that students found some methods of addressing this problem behavior by the instructor more acceptable than other methods of treating the behavior. College students rated the most acceptable instructor treatment for…

  15. A Review of Recommendations and Treatment Options Regarding the Management of HIV Infection

    PubMed Central

    Boyd, Sarita D.

    2011-01-01

    Purpose This review focuses on the recommendations for when to initiate antiretroviral therapy and what regimen to use in treatment-naïve patients based on the January 2011 antiretroviral guidelines released by the Department of Health and Human Services (DHHS). The evolution of recommendations over the past decade, key data supporting recent changes, and information related to management of antiretroviral therapy are discussed. Summary Treatment guidelines are updated frequently because of ongoing emergence of data demonstrating the risks and benefits of antiretroviral therapy. The DHHS guidelines strongly recommend initiating therapy in patients with certain conditions regardless of CD4 cell count and in patients with CD4 cell counts <350 cells/mm3. Although supporting data are less definitive, treatment is also recommended for patients with CD4 cell counts between 350–500 cells/mm3. Treatment for patients with CD4 cell counts >500 cells/mm3 is controversial. Although cumulative observational data and biological evidence support treatment at higher CD4 cell counts, randomized controlled trial data are not available, and the risk of antiretroviral toxicities, resistance, nonadherence, and cost should be considered in individual patients. The preferred regimens have been consolidated to four options, including a dual-nucleoside reverse transcriptase inhibitor backbone (tenofovir/emtricitabine) with a non-nucleoside reverse transcriptase inhibitor (efavirenz), a ritonavir-boosted protease inhibitor (atazanavir + ritonavir or darunavir + ritonavir), or an integrase strand transfer inhibitor (raltegravir). Regimens are classified as alternative or acceptable when they have potential safety or efficacy concerns, consist of higher pill burdens, or require more frequent dosing compared to preferred regimens. Conclusion The DHHS guidelines advocate earlier treatment initiation than recommended in recent years, yet recognize the limitations of the data supporting

  16. Treatment Options by Stage (Mycosis Fungoides and the Sezary Syndrome)

    MedlinePlus

    ... following PDQ summaries: Adult Non-Hodgkin Lymphoma Treatment Skin Cancer Treatment Melanoma Treatment Kaposi Sarcoma Treatment A sign of ... or laser that directs UVB radiation at the skin. Chemotherapy Chemotherapy is a cancer treatment that uses drugs to stop the growth of ...

  17. Treatment Option Overview (Mycosis Fungoides and the Sezary Syndrome)

    MedlinePlus

    ... following PDQ summaries: Adult Non-Hodgkin Lymphoma Treatment Skin Cancer Treatment Melanoma Treatment Kaposi Sarcoma Treatment A sign of ... or laser that directs UVB radiation at the skin. Chemotherapy Chemotherapy is a cancer treatment that uses drugs to stop the growth of ...

  18. Treatment Options for Recurrent Mycosis Fungoides and the Sezary Syndrome

    MedlinePlus

    ... following PDQ summaries: Adult Non-Hodgkin Lymphoma Treatment Skin Cancer Treatment Melanoma Treatment Kaposi Sarcoma Treatment A sign of ... or laser that directs UVB radiation at the skin. Chemotherapy Chemotherapy is a cancer treatment that uses drugs to stop the growth of ...

  19. Treatment for Abused Children: When Is a Partial Solution Acceptable?

    ERIC Educational Resources Information Center

    Graziano, Anthony M.; Mills, Joseph R.

    1992-01-01

    This paper argues that insufficient attention has been paid to the psychological needs of physically maltreated children, who often require direct treatment for such problems as aggressive behavior, low self-esteem, and cognitive limitations. (DB)

  20. Recent and currently emerging medical treatment options for the treatment of alcoholic hepatitis

    PubMed Central

    Reep, Gabriel L; Soloway, Roger D

    2011-01-01

    Patients with severe alcoholic hepatitis (AH) need to be treated with specific treatment for better outcome. Currently available specific treatment modalities are use of corticosteroids or pentoxifylline. However, the response rate to these drugs is only about 50%-60%. Hence, there is an urgent need for better and more effective treatment options. Tumor necrosis factor plays an important role in the pathogenesis of AH. However, agents blocking the action of tumor necrosis factor have not been found to be effective. Rather the randomized studies evaluating these agents showed an adverse effect and more infections in treated patients. Critical role of tumor necrosis factor in hepatic regeneration explaining this contrast is discussed. Oxidative stress and inflammation derived from gut bacteria ate two main components in the pathogenesis of AH laying foundation for the role of antioxidants, probiotics, and antibiotics in the management of AH. This article reviews the current data and status of these newer agents for the treatment of AH. Of the various options available, Vitamin E and N-acetylcysteine (NAC) have shown great promise for clinical use as adjunct to corticosteroids. With these encouraging data, future well designed studies are suggested to assess Vitamin E and NAC before their routine use in clinical practice in the management of AH. PMID:21954409

  1. Prevention, diagnosis, and treatment of influenza: current and future options.

    PubMed

    Poehling, K A; Edwards, K M

    2001-02-01

    Because influenza significantly affects the health of children, this review describes the current and future options for preventing, diagnosing, and treating influenza infections. Currently, the inactivated influenza vaccine is recommended for prevention of influenza; however, the live, attenuated, intranasal influenza vaccine is a potential future option. For diagnosis, viral culture is the gold standard, although four rapid diagnostic tests are available for more immediate results. The impetus for rapid results is the availability of effective antiviral agents indicated for early influenza infection. The four currently approved antiviral agents are amantadine, rimantadine, zanamivir [Relenza, Glaxo Wellcome, Inc., Research Triangle Park, NC] and oseltamivir [Tamiflu, Roche Pharmaceuticals, Nutley, NJ]. The indications, benefits, side effects and ages for which each drug is approved are reviewed. PMID:11176246

  2. A new optional recycled water pre-treatment system prior to use in the household laundry.

    PubMed

    Chen, Zhuo; Ngo, Huu Hao; Guo, Wenshan; Pham, Thi Thu Nga; Lim, Richard; Wang, Xiaochang C; Miechel, Clayton; Halloran, Kelly O'; Listowski, Andrzej; Corby, Nigel

    2014-04-01

    With a constantly growing population, water scarcity becomes the limiting factor for further social and economic growth. To achieve a partial reduction in current freshwater demands and lessen the environmental loadings, an increasing trend in the water market tends to adopt recycled water for household laundries as a new recycled water application. The installation of a small pre-treatment unit for water purification can not only further improve the recycled water quality, but also be viable to enhance the public confidence and acceptance level on recycled water consumption. Specifically, this paper describes column experiments conducted using a 550 mm length bed of zeolite media as a one-dimensional flow reactor. The results show that the zeolite filter system could be a simple low-cost pre-treatment option which is able to significantly reduce the total hardness level of recycled water via effective ion exchange. Additionally, depending on the quality of recycled water required by end users, a new by-pass controller using a three-level operation switching mechanism is introduced. This approach provides householders sufficient flexibility to respond to different levels of desired recycled water quality and increase the reliability of long-term system operation. These findings could be beneficial to the smooth implementation of new end uses and expansion of the potential recycled water market. The information could also offer sound suggestions for future research on sustainable water management and governance.

  3. Acceptance and commitment therapy as a novel treatment for eating disorders: an initial test of efficacy and mediation.

    PubMed

    Juarascio, Adrienne; Shaw, Jena; Forman, Evan; Timko, C Alix; Herbert, James; Butryn, Meghan; Bunnell, Douglas; Matteucci, Alyssa; Lowe, Michael

    2013-07-01

    Eating disorders are among the most challenging disorders to treat, with even state-of-the-art cognitive-behavioral treatments achieving only modest success. One possible reason for the high rate of treatment failure for eating disorders is that existing treatments do not attend sufficiently to critical aspects of the disorder such as high experiential avoidance, poor experiential awareness, and lack of motivation. These variables are explicit targets of Acceptance and Commitment Therapy (ACT). The current study examined the efficacy of an ACT-based group treatment for eating disorders by examining whether the addition of ACT groups to treatment-as-usual (TAU) at a residential treatment facility for eating disorders would improve treatment outcomes. TAU patients received an intensive residential treatment, while ACT patients received these services but additionally attended, depending on diagnosis, either ACT for anorexia nervosa groups or ACT for bulimia nervosa groups. Although individuals in both treatment conditions demonstrated large decreases in eating pathology, there were trends toward larger decreases among those receiving ACT. ACT patients also showed lower rates of rehospitalization during the 6 months after discharge. Overall, results suggest that ACT is a viable treatment option for individuals with eating pathology and further outcome research is warranted.

  4. Approved and Off-Label Uses of Obesity Medications, and Potential New Pharmacologic Treatment Options

    PubMed Central

    Isidro, Maria Luisa; Cordido, Fernando

    2010-01-01

    Available anti-obesity pharmacotherapy options remain very limited and development of more effective drugs has become a priority. The potential strategies to achieve weight loss are to reduce energy intake by stimulating anorexigenic signals or by blocking orexigenic signals, and to increase energy expenditure. This review will focus on approved obesity medications, as well as potential new pharmacologic treatment options.

  5. Piggery wastewater treatment in a tropical climate: biological and chemical treatment options.

    PubMed

    Shipin, O V; Lee, S H; Chiemchaisri, C; Wiwattanakom, W; Ghosh, G C; Anceno, A J; Stevens, W F

    2007-03-01

    A novel biological treatment system was developed for the treatment of piggery wastewater under tropical conditions. It consisted of three consecutive sponge-based floating biofilters. The Upflow Anaerobic/Anoxic/Aerobic Floating Filter (UA3FF) system was shown to be effective with carbonaceous and, particularly, nitrogenous matter. The rationale for the processes occurring in anoxic-aerobic reactors was based on the concept of nitritation-denitritation rather than nitrification-denitrification. The N-related microbial communities manipulated by changing DO concentration and hydraulic retention time were able to effect a considerable increase in the total and specific N-removal (70% and 0.6 kg N m(-3) filter media per day, respectively) as compared to data reported elsewhere. Fluorescence In Situ Hybridization and Polymerase Chain Reaction amplification of ammonia monooxygenase (amoA) gene were used to study interrelationships between N-related microbial groups in the system. Microbiological data was interpreted in terms of operational behavior and performance of the reactors. The N-removal efficiency of the biological UA3FF system was compared with a combined biological/physicochemical system based on (a) biological anaerobic pretreatment followed by (b) a chemical precipitation (CP) and (c) an air stripping. Both systems were scrutinized as to operational advantages and costs. The treatment options could produce effluent of a high quality (202 mg COD l(-1), 126 total-N l(-1) and 89 mg COD l(-1) 48 total-N l(-1) in the biological and combined biological/physico-chemical treatment options, respectively) amenable for the subsequent treatment at the municipal facilities. However, the UA3FF biological treatment system was superior to the combined system by a factor of 20 as far as costs are concerned.

  6. Pharmacologic options for the treatment and management of food allergy.

    PubMed

    Kobernick, Aaron K; Chambliss, Jeffrey; Burks, A Wesley

    2015-01-01

    Food allergy affects approximately 5% of adults and 8% of children in developed countries, and there is currently no cure. Current pharmacologic management is limited to using intramuscular epinephrine or oral antihistamines in response to food allergen exposure. Recent trials have examined the efficacy and safety of subcutaneous, oral, sublingual, and epicutaneous immunotherapy, with varying levels of efficacy and safety demonstrated. Bacterial adjuvants, use of anti-IgE monoclonal antibodies, and Chinese herbal formulations represent exciting potential for development of future pharmacotherapeutic agents. Ultimately, immunotherapy may be a viable option for patients with food allergy, although efficacy and safety are likely to be less than ideal. PMID:26289224

  7. Treatment Options for Plasma Cell Neoplasms (Including Multiple Myeloma)

    MedlinePlus

    ... Neoplasms for more information. High-dose chemotherapy with stem cell transplant This treatment is a way of giving ... blood -forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood ...

  8. Treatment Option Overview (Plasma Cell Neoplasms Including Multiple Myeloma)

    MedlinePlus

    ... Neoplasms for more information. High-dose chemotherapy with stem cell transplant This treatment is a way of giving ... blood -forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood ...

  9. Onshore ballast water treatment: a viable option for major ports.

    PubMed

    Pereira, Newton Narciso; Brinati, Hernani Luiz

    2012-11-01

    Ballast water treatment consists of the elimination of exotic species. Currently, the development of alternative methods for this process is directed toward treatment onboard ships. However, we present onshore treatment as a viable alternative for ballast water treatment. We investigated onshore treatment in two iron ore ports with movement capacities of 25 and 90 million tons annually (Mta) that receive 7.5 and 25 million cubic meters annually (Mm(3)) of ballast water, respectively. Discrete event simulation was used as the method of analysis, considering the processes of arrival, berthing, ship loading and capture and treatment of ballast water. We analyzed data from 71 ships operating in these ports to validate our simulation model. We were able to demonstrate that onshore treatment does not impact the cargo capacity, occupation rate or average queuing time of ships at these ports. We concluded that implementation of onshore ballast water treatment may be practicable in ports that receive high volumes of ballast water.

  10. An Open Trial of Acceptance-based Separated Family Treatment (ASFT) for Adolescents with Anorexia Nervosa

    PubMed Central

    Timko, C. Alix; Zucker, Nancy L.; Herbert, James D.; Rodriguez, Daniel; Merwin, Rhonda M.

    2016-01-01

    Family based-treatments have the most empirical support in the treatment of adolescent anorexia nervosa; yet, a significant percentage of adolescents and their families do not respond to manualized family based treatment (FBT). The aim of this open trial was to conduct a preliminary evaluation of an innovative family-based approach to the treatment of anorexia: Acceptance-based Separated Family Treatment (ASFT). Treatment was grounded in Acceptance and Commitment Therapy (ACT), delivered in a separated format, and included an ACT-informed skills program. Adolescents (ages 12–18) with anorexia or sub-threshold anorexia and their families received 20 treatment sessions over 24 weeks. Outcome indices included eating disorder symptomatology reported by the parent and adolescent, percentage of expected body weight achieved, and changes in psychological acceptance/avoidance. Half of the adolescents (48.0%) met criteria for full remission at the end of treatment, 29.8% met criteria for partial remission, and 21.3% did not improve. Overall, adolescents had a significant reduction in eating disorder symptoms and reached expected body weight. Treatment resulted in changes in psychological acceptance in the expected direction for both parents and adolescents. This open trial provides preliminary evidence for the feasibility, acceptability, and efficacy of ASFT for adolescents with anorexia. Directions for future research are discussed. PMID:25898341

  11. 40 CFR 141.715 - Microbial toolbox options for meeting Cryptosporidium treatment requirements.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... criteria are in § 141.716(b). Pre Filtration Toolbox Options (3) Presedimentation basin with coagulation 0... separate granular media filtration stage if treatment train includes coagulation prior to first...

  12. 40 CFR 141.715 - Microbial toolbox options for meeting Cryptosporidium treatment requirements.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... criteria are in § 141.716(b). Pre Filtration Toolbox Options (3) Presedimentation basin with coagulation 0... separate granular media filtration stage if treatment train includes coagulation prior to first...

  13. 40 CFR 141.715 - Microbial toolbox options for meeting Cryptosporidium treatment requirements.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... criteria are in § 141.716(b). Pre Filtration Toolbox Options (3) Presedimentation basin with coagulation 0... separate granular media filtration stage if treatment train includes coagulation prior to first...

  14. 40 CFR 141.715 - Microbial toolbox options for meeting Cryptosporidium treatment requirements.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... criteria are in § 141.716(b). Pre Filtration Toolbox Options (3) Presedimentation basin with coagulation 0... separate granular media filtration stage if treatment train includes coagulation prior to first...

  15. 40 CFR 141.715 - Microbial toolbox options for meeting Cryptosporidium treatment requirements.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... criteria are in § 141.716(b). Pre Filtration Toolbox Options (3) Presedimentation basin with coagulation 0... separate granular media filtration stage if treatment train includes coagulation prior to first...

  16. New Treatment Option for Young Women with Hormone-Sensitive Breast Cancer

    MedlinePlus

    ... treatment option for young women with hormone-sensitive breast cancer Posted: June 1, 2014 Contact: NCI Press Office 301-496-6641 A drug used for treating breast cancer, known as exemestane, is more effective than a ...

  17. Caries infiltration with resins: a novel treatment option for interproximal caries.

    PubMed

    Phark, Jin-Ho; Duarte, Sillas; Meyer-Lueckel, Hendrik; Paris, Sebastian

    2009-10-01

    Noninvasive (preventive) measures involving fluoridation, dietary control, and oral hygiene instruction, as well as invasive restorative methods, are the standard treatment options for interproximal caries. Intermediate treatment options, similar to pit-and-fissure sealing on occlusal surfaces that has been shown to be effective in preventing and inhibiting caries, have not yet been established on interproximal surfaces. Recently, the application of resins on interproximal caries lesions has been studied and improved, leading to the development of new materials, which infiltrate and seal the carious lesion, improving the inhibition of caries progression. Clinical data show this new technique complements existing treatment options for interproximal caries by delaying the time point for a restoration and consequently closing the gap between noninvasive and invasive treatment options.

  18. Taking Control: Non-Surgical Treatment Options for Urinary Incontinence in Women

    MedlinePlus

    ... UI? Taking Control: Non-surgical Treatment Options for Urinary Incontinence in Women What is UI? “Taking Control” (5- ... own home. Page 0 Page 2 What is urinary incontinence (UI)? Taking Control (5-minute video) Click on ...

  19. Current treatment options for non-small-cell lung cancer.

    PubMed

    Waxman, Elizabeth S

    2012-08-01

    Non-small-cell lung cancer (NSCLC) remains a difficult-to-treat malignancy, and durable long-term survival is elusive for patients with advanced-stage disease. Chemotherapy, especially with platinum-based combinations, is the mainstay of treatment, yet these regimens yield only modest response and survival rates. Outcomes of recent clinical trials have shown that histology, mutation analyses, and biomarkers have an impact on the selection and combination of chemotherapeutic agents. Oral tyrosine kinase inhibitors and monoclonal antibodies are now part of the treatment schema. Other changes to the treatment paradigm include the duration of treatment and the use of maintenance therapy. Additionally, chemotherapy is now employed in earlier-stage disease in neoadjuvant, adjuvant, and combined-modality treatments. The aim of this article is to review the current systemic treatments for NSCLC.

  20. [Coccygectomy can be a treatment option in chronic coccygodynia].

    PubMed

    Aarby, Nanett Skjellerup; Trollegaard, Anton Mitchell; Hellberg, Steen

    2011-02-14

    Coccygodynia is pain in the region of the coccyx. Treatment is primarily conservative, but some patients have persistent pain and may require surgical treatment. This study was performed to investigate if patients benefit from coccygectomy where conservative treatment has failed. Via a search on MedLine, we found 24 studies including a total of 702 patients who had undergone coccygectomy. Overall, 83% had an excellent or good result. We recommend coccygectomy for selected patients with intractable coccygodynia.

  1. Acceptance and commitment therapy group-treatment for non-responsive patients with personality disorders: An exploratory study.

    PubMed

    Chakhssi, Farid; Janssen, Wim; Pol, Silvia M; van Dreumel, Malinda; Westerhof, Gerben J

    2015-11-01

    Patients with personality disorders who did not respond to previous outpatient treatment are among the most challenging patients to treat and are often referred to specialized settings. Acceptance and commitment therapy (ACT) is an innovative therapy that has shown effectiveness in treatment-resistant cases with chronic or recurrent depression with or without co-morbid personality disorders. The central role that ACT accords to positive values and experiential avoidance may enhance treatment responsivity in patients with personality disorders that did not respond to previous treatments. The current nonrandomized study explored the effectiveness of a 26-week ACT-based group treatment (n = 60) for personality disorders compared to treatment-as-usual (n = 21) based on cognitive behaviour therapy (CBT-TAU) at a specialized setting for patients with personality disorders. Individuals in both treatment conditions demonstrated small to moderate decreases in general psychological functioning and personality pathology. There was no main effect of therapy condition. Overall, results suggest that ACT is a possible treatment option for individuals with difficult-to-treat personality pathology and further outcome research is warranted.

  2. Bacterial meningitis: an update of new treatment options.

    PubMed

    Nau, Roland; Djukic, Marija; Spreer, Annette; Ribes, Sandra; Eiffert, Helmut

    2015-01-01

    The outcome of bacterial meningitis critically depends on the rapid initiation of bactericidal antibiotic therapy and adequate management of septic shock. In community-acquired meningitis, the choice of an optimum initial empirical antibiotic regimen depends on the regional resistance patterns. Pathogens resistant to antibacterials prevail in nosocomial bacterial meningitis. Dexamethasone is recommended as adjunctive therapy for community-acquired meningitis in developed countries. In comatose patients, aggressive measures to lower intracranial pressure <20 mmHg (in particular, external ventriculostomy, osmotherapy and temporary hyperventilation) were effective in a case-control study. Although many experimental approaches were protective in animal models, none of them has been proven effective in patients. Antibiotics, which are bactericidal but do not lyse bacteria, and inhibitors of matrix metalloproteinases or complement factor C5 appear the most promising therapeutic options. At present, vaccination is the most efficient method to reduce disease burden. Palmitoylethanolamide appears promising to enhance the resistance of the brain to infections. PMID:26293166

  3. EXTRA-ABDOMINAL DESMOID TUMOR: LOCAL RECURRENCE AND TREATMENT OPTIONS

    PubMed Central

    TEIXEIRA, LUIZ EDUARDO MOREIRA; ARANTES, EUGÊNIO COSTA; VILLELA, RAFAEL FREITAS; SOARES, CLAUDIO BELING GONÇALVES; COSTA, ROBERTO BITARÃES DE CARVALHO; ANDRADE, MARCO ANTÔNIO PERCOPE DE

    2016-01-01

    ABSTRACT Objective: To evaluate the rate of local recurrence of extra-abdominal desmoid tumor and compare the outcomes of surgical treatment and conservative treatment. Methods: Twenty one patients (14 women and seven men), mean age 33.0±8.7 years old, with a diagnosis of desmoid tumor were evaluated. The mean follow-up period was 58.5±29.0 months. Fourteen cases involved the lower limbs, four cases involved the upper limbs, and three cases involved the trunk. The average tumor size was 12.7±7.5 cm. Of the 21 patients, 14 did not undergo previous treatment and seven patients relapsed before the initial evaluation. Surgical treatment was performed in 16 patients and conservative treatment was performed in five patients. Results: Recurrence occurred in seven patients (33%) and six of them relapsed within the first 18 months. No significant difference was observed between conservative and surgical treatment. However, a significant difference was observed among patients undergoing wide resection and who experienced improved local control. Conclusion: The recurrence rate of desmoid tumor was 33.3%. There was no difference in recurrence between conservative and surgical treatment. In surgical treatment, wide margins showed better results for recurrence control. Level of Evidence III. Retrospective Observational Study. PMID:27217816

  4. Treatment options for patients with triple-negative breast cancer

    PubMed Central

    2010-01-01

    Breast cancer is a heterogeneous disease composed of different subtypes, characterized by their different clinicopathological characteristics, prognoses and responses to treatment. In the past decade, significant advances have been made in the treatment of breast cancer sensitive to hormonal treatments, as well as in patients whose malignant cells overexpress or amplify HER2. In contrast, mainly due to the lack of molecular targets, little progress has been made in the treatment of patients with triple-negative breast cancer. Recent improved understanding of the natural history, pathophysiology, and molecular features of triple-negative breast cancers have provided new insights into management and therapeutic strategies for women affected with this entity. Ongoing and planned translational clinical trials are likely to optimize and improve treatment of women with this disease. PMID:20979652

  5. Advanced Vulvar Cancers: What are the Best Options for Treatment?

    PubMed

    Soderini, Alejandro; Aragona, Alejandro; Reed, Nicholas

    2016-10-01

    The treatment of patients with vulvar cancer remains challenging for gynecologic oncologists. Up to 30 % of the cases are diagnosed in a clinical condition of irresectability, and some kind of strategy has to be taken into account beyond surgery. In this regard, a common and standard definition is critical to maximize oncological results and minimize complications after treatments. Each patient treatment must be tailored individually according to their clinical and biological features and to the setting in which they are dealing with. PMID:27586378

  6. Options for the treatment of psoriasis: a multifactorial approach.

    PubMed

    van de Kerkhof, Peter C M

    2008-01-01

    The expression of psoriasis is highly variable and may even differ within a single patient. This comprises not only extent of lesions, severity in terms of erythema induration, and scaling or visibility of the lesions, but particularly the responsiveness to antipsoriatic treatments in the past. Therefore, the management of psoriasis has to reconcile the variability of treatment responses, which, to some extent, may be genetically determined but also are the result of nongenetic factors, including triggering factors and adaptation (habituation) to treatments. In this article, we will provide a patient-based approach on the management of psoriasis, which reconciles the heterogeneity of psoriasis in individual patients.

  7. Intermittent Screening and Treatment versus Intermittent Preventive Treatment of Malaria in Pregnancy: Provider Knowledge and Acceptability

    PubMed Central

    Smith Paintain, Lucy; Antwi, Gifty D.; Jones, Caroline; Amoako, Esther; Adjei, Rose O.; Afrah, Nana A.; Greenwood, Brian; Chandramohan, Daniel; Tagbor, Harry; Webster, Jayne

    2011-01-01

    Malaria in pregnancy (MiP) is associated with increased risks of maternal and foetal complications. The WHO recommends a package of interventions including intermittent preventive treatment (IPT) with sulphadoxine-pyrimethamine (SP), insecticide-treated nets and effective case management. However, with increasing SP resistance, the effectiveness of SP-IPT has been questioned. Intermittent screening and treatment (IST) has recently been shown in Ghana to be as efficacious as SP-IPT. This study investigates two important requirements for effective delivery of IST and SP-IPT: antenatal care (ANC) provider knowledge, and acceptance of the different strategies. Structured interviews with 134 ANC providers at 67 public health facilities in Ashanti Region, Ghana collected information on knowledge of the risks and preventative and curative interventions against MiP. Composite indicators of knowledge of SP-IPT, and case management of MiP were developed. Log binomial regression of predictors of provider knowledge was explored. Qualitative data were collected through in-depth interviews with fourteen ANC providers with some knowledge of IST to gain an indication of the factors influencing acceptance of the IST approach. 88.1% of providers knew all elements of the SP-IPT policy, compared to 20.1% and 41.8% who knew the treatment policy for malaria in the first or second/third trimesters, respectively. Workshop attendance was a univariate predictor of each knowledge indicator. Qualitative findings suggest preference for prevention over cure, and increased workload may be barriers to IST implementation. However, a change in strategy in the face of SP resistance is likely to be supported; health of pregnant women is a strong motivation for ANC provider practice. If IST was to be introduced as part of routine ANC activities, attention would need to be given to improving the knowledge and practices of ANC staff in relation to appropriate treatment of MiP. Health worker support for

  8. Pancreatic cancer from bench to bedside: molecular pathways and treatment options

    PubMed Central

    Kosmidis, Christoforos; Sapalidis, Konstantinos; Kotidis, Efstathios; Mixalopoulos, Nikolaos; Tsavlis, Drosos; Baka, Sofia; Man, Yan-Gao; Kanellos, John

    2016-01-01

    In the last forty years the pancreatic cancer treatment has made advances, however; still novel drugs are needed. It is known that the five year survival rate remains around 5%. The best treatment option still remains surgery, if patients are diagnosed early. In the last decade the biology of pancreatic cancer has been vastly explored and novel agents such as; tyrosine kinase agents, or vaccines have been added as a treatment perspective. The big challenge is now to translate this knowledge in better outcomes for patients. In this current review we will present information from pancreatic cancer diagnosis to molecular pathways and treatment options; current and future. PMID:27275478

  9. Treatment Options for Childhood Non-Hodgkin Lymphoma

    MedlinePlus

    ... Past treatment for cancer and having a weakened immune system affect the risk of having childhood non-Hodgkin ... or human immunodeficiency virus (HIV). Having a weakened immune system after a transplant or from medicines given after ...

  10. Treatment Option Overview (Childhood Non-Hodgkin Lymphoma)

    MedlinePlus

    ... Past treatment for cancer and having a weakened immune system affect the risk of having childhood non-Hodgkin ... or human immunodeficiency virus (HIV). Having a weakened immune system after a transplant or from medicines given after ...

  11. Parkinson Disease Treatment Options - Medications (Beyond the Basics)

    MedlinePlus

    ... treatments depends upon the person's signs and symptoms, age, stage and severity of disease, and their level of physical activity. The information that follows can help patients and family members ...

  12. Treatment Options by Stage (Small Cell Lung Cancer)

    MedlinePlus

    ... Cancer Prevention Lung Cancer Screening Research Small Cell Lung Cancer Treatment (PDQ®)–Patient Version General Information About Small Cell Lung Cancer Go to Health Professional Version Key Points ...

  13. Advanced pancreatic cancer - how to choose an adequate treatment option

    PubMed Central

    Korkeila, Eija A

    2015-01-01

    The prognosis of pancreatic adenocarcinoma is poor, making it one of the leading causes of cancer-related death. The 5-year overall survival rate remains below 5% and little progress is made during the past decade. Only about 10%-20% of patients are eligible for curative-intent surgery and the majority end up having recurring disease even after radical surgery and postoperative adjuvant chemotherapy. Chemotherapy in metastatic disease is palliative at best, aiming at disease and symptom control and prolongation of life. Treatment always causes side effects, the degree of which varies from patient to patient, depending on the patient’s general condition, concomitant morbidities as well as on the chosen treatment modality. Why is pancreatic cancer so resistant to treatment? How to best help the patient to reach the set treatment goals? PMID:26478662

  14. Treatment Options for Recurrent Lip and Oral Cavity Cancer

    MedlinePlus

    ... Cavity and Oropharyngeal Cancer Screening Research Lip and Oral Cavity Cancer Treatment (PDQ®)–Patient Version General Information About Lip and Oral Cavity Cancer Go to Health Professional Version Key Points ...

  15. Treatment Options by Stage (Lip and Oral Cavity Cancer)

    MedlinePlus

    ... Cavity and Oropharyngeal Cancer Screening Research Lip and Oral Cavity Cancer Treatment (PDQ®)–Patient Version General Information About Lip and Oral Cavity Cancer Go to Health Professional Version Key Points ...

  16. Treatment Option Overview (Lip and Oral Cavity Cancer)

    MedlinePlus

    ... Cavity and Oropharyngeal Cancer Screening Research Lip and Oral Cavity Cancer Treatment (PDQ®)–Patient Version General Information About Lip and Oral Cavity Cancer Go to Health Professional Version Key Points ...

  17. Treatment Options by Type of Adult Brain Tumor

    MedlinePlus

    ... on their chemical make-up. SPECT scan (single photon emission computed tomography scan) : A procedure that uses ... has come back after treatment: SPECT scan (single photon emission computed tomography scan) : A procedure that uses ...

  18. Current and emerging options for the drug treatment of narcolepsy.

    PubMed

    De la Herrán-Arita, Alberto K; García-García, Fabio

    2013-11-01

    Narcolepsy/hypocretin deficiency (now called type 1 narcolepsy) is a lifelong neurologic disorder with well-established diagnostic criteria and etiology. Narcolepsy is a chronic sleep disorder characterized by excessive daytime sleepiness (EDS) and symptoms of dissociated rapid eye movement sleep such as cataplexy (sudden loss of muscle tone), hypnagogic hallucinations (sensory events that occur at the transition from wakefulness to sleep), sleep paralysis (inability to perform movements upon wakening or sleep onset), and nocturnal sleep disruption. As these symptoms are often disabling, most patients need life-long treatment. The treatment of narcolepsy is well defined, and, traditionally, amphetamine-like stimulants (i.e., dopaminergic release enhancers) have been used for clinical management to improve EDS and sleep attacks, whereas tricyclic antidepressants have been used as anticataplectics. However, treatments have evolved to better-tolerated compounds such as modafinil or armodafinil (for EDS) and adrenergic/serotonergic selective reuptake inhibitors (as anticataplectics). In addition, night-time administration of a short-acting sedative, c-hydroxybutyrate (sodium oxybate), has been used for the treatment for EDS and cataplexy. These therapies are almost always needed in combination with non-pharmacologic treatments (i.e., behavioral modification). A series of new drugs is currently being tested in animal models and in humans. These include a wide variety of hypocretin agonists, melanin- concentrating hormone receptor antagonists, antigenspecific immunopharmacology, and histamine H3 receptor antagonists/inverse agonists (e.g., pitolisant), which have been proposed for specific therapeutic applications, including the treatment of Alzheimer's disease, attention-deficit hyperactivity disorder, epilepsy, and more recently, narcolepsy. Even though current treatment is strictly symptomatic, based on the present state of knowledge of the pathophysiology of

  19. Current and emerging options for the drug treatment of narcolepsy.

    PubMed

    De la Herrán-Arita, Alberto K; García-García, Fabio

    2013-11-01

    Narcolepsy/hypocretin deficiency (now called type 1 narcolepsy) is a lifelong neurologic disorder with well-established diagnostic criteria and etiology. Narcolepsy is a chronic sleep disorder characterized by excessive daytime sleepiness (EDS) and symptoms of dissociated rapid eye movement sleep such as cataplexy (sudden loss of muscle tone), hypnagogic hallucinations (sensory events that occur at the transition from wakefulness to sleep), sleep paralysis (inability to perform movements upon wakening or sleep onset), and nocturnal sleep disruption. As these symptoms are often disabling, most patients need life-long treatment. The treatment of narcolepsy is well defined, and, traditionally, amphetamine-like stimulants (i.e., dopaminergic release enhancers) have been used for clinical management to improve EDS and sleep attacks, whereas tricyclic antidepressants have been used as anticataplectics. However, treatments have evolved to better-tolerated compounds such as modafinil or armodafinil (for EDS) and adrenergic/serotonergic selective reuptake inhibitors (as anticataplectics). In addition, night-time administration of a short-acting sedative, c-hydroxybutyrate (sodium oxybate), has been used for the treatment for EDS and cataplexy. These therapies are almost always needed in combination with non-pharmacologic treatments (i.e., behavioral modification). A series of new drugs is currently being tested in animal models and in humans. These include a wide variety of hypocretin agonists, melanin- concentrating hormone receptor antagonists, antigenspecific immunopharmacology, and histamine H3 receptor antagonists/inverse agonists (e.g., pitolisant), which have been proposed for specific therapeutic applications, including the treatment of Alzheimer's disease, attention-deficit hyperactivity disorder, epilepsy, and more recently, narcolepsy. Even though current treatment is strictly symptomatic, based on the present state of knowledge of the pathophysiology of

  20. [Community acquired pneumonia - treatment options according to the international recommendations].

    PubMed

    Lewandowska, Katarzyna; Kuś, Jan

    2016-01-01

    Pneumonia remains one of the main reasons of heath care system utilization. Quick diagnosis and prompt treatment initiation determine favorable outcome. Empirical antibiotic treatment allows to achieve treatment success in most patients. Treatment recommendations are based on big epidemiological trials. Nevertheless, it is sometimes necessary to know the definite etiologic factor of pneumonia. In these cases microbiological diagnostics is useful, i.e. sputum microscopy and culture, blood culture, bronchial lavage culture, bacterial antigen tests in urine, molecular tests. Serological tests do not help much in everyday clinical practice. The most common microorganisms causing community acquired pneumonia (CAP) are: Streptococcus pneumoniae, atypical bacteria (Mycoplasma pneumoniae, Chlamydophila pneumoniae, Legionella pneumophila), Haemophilus influenzae, influenza virus. Staphylococcus aureus and Pseudomonas aeruginosa rarely are etiologic factors of CAP. First line antibiotics in pneumonia treatment are beta - lactams. In case of allergy or intolerance of beta - lactams, new fluorochinolones should be used. Macrolides are useful if the atypical etiology is suspected. Duration of treatment in most cases should not exceed 7 days, sometimes it may be even shorter. PMID:27421128

  1. Consumers' Valuation of Primary Care-Based Treatment Options for Mental and Substance Use Disorders.

    PubMed

    Epstein, Andrew J; Barry, Colleen L; Fiellin, David A; Busch, Susan H

    2015-08-01

    Most individuals with substance use disorders and with mental disorders do not receive treatment. If treatment options were more attractive, treatment rates might increase. The advantages of novel approaches, including primary care-based treatment and collaborative care in a primary care setting, have been documented. However, less is known about consumers' valuation of these options. The authors assessed monetary valuation of these treatment types compared with usual care in a specialty treatment setting. Contingent valuation methods were used in a Web-based randomized vignette experiment that involved 2,146 individuals who screened positive for a drug or alcohol use disorder or a mental disorder. Participants valued a primary care-based treatment visit over usual care in a specialty treatment setting by $9.00 and a collaborative care visit over usual care in a specialty treatment setting by $5.85.

  2. Stigma and the Acceptability of Depression Treatments Among African Americans and Whites

    PubMed Central

    Katz, Ira R.; Bellamy, Scarlett; Holmes, William C.

    2007-01-01

    BACKGROUND Stigma is associated with depression treatment, however, whether stigma differs between depression treatment modalities is not known, nor have racial differences in depression treatment stigma been fully explored. OBJECTIVE To measure stigma for four depression treatments and estimate its association with treatment acceptability for African Americans and whites. DESIGN Cross-sectional, anonymous mailed survey. PARTICIPANTS Four hundred and ninety African-American and white primary care patients. MEASUREMENTS The acceptability of four depression treatments (prescription medication, mental health counseling, herbal remedy, and spiritual counseling) was assessed using a vignette. Treatment-specific stigma was evaluated by asking whether participants would: (1) feel ashamed; (2) feel comfortable telling friends and family; (3) feel okay if people in their community knew; and (4) not want people at work to know about each depression treatment. Sociodemographics, depression history, and current depressive symptoms were measured. RESULTS Treatment-specific stigma was lower for herbal remedy than prescription medication or mental health counseling (p < .01). Whites had higher stigma than African Americans for all treatment modalities. In adjusted analyses, stigma relating to self [AOR 0.43 (0.20–0.95)] and friends and family [AOR 0.42 (0.21–0.88)] was associated with lower acceptability of mental health counseling. Stigma did not account for the lower acceptability of prescription medication among African Americans. CONCLUSIONS Treatment associated stigma significantly affects the acceptability of mental health counseling but not prescription medication. Efforts to improve depression treatment utilization might benefit from addressing concerns about stigma of mental health counseling. PMID:17610120

  3. Progressive multifocal leukoencephalopathy: current treatment options and future perspectives

    PubMed Central

    Pavlovic, Dejan; Patera, Andriani C.; Nyberg, Fredrik; Gerber, Marianne; Liu, Maggie

    2015-01-01

    Progressive multifocal leukoencephalopathy (PML) is a rare but debilitating and frequently fatal viral disease of the central nervous system, primarily affecting individuals with chronically and severely suppressed immune systems. The disease was relatively obscure until the outbreak of HIV/AIDS, when it presented as one of the more frequent opportunistic infections in this immune deficiency syndrome. It attracted additional attention from the medical and scientific community following the discovery of significant PML risk associated with natalizumab, a monoclonal antibody used for treatment of relapsing–remitting multiple sclerosis. This was followed by association of PML with other immunosuppressive or immunomodulating drugs. PML is currently untreatable disease with poor outcomes, so it is a significant concern when developing new immunotherapies. Current prophylaxis and treatment of PML are focused on immune reconstitution, restoration of immune responses to JC virus infection, and eventual suppression of immune reconstitution inflammatory syndrome. This approach was successful in reducing the incidence of PML and improved survival of PML patients with HIV infection. However, the outcome for the majority of PML patients, regardless of their medical history, is still relatively poor. There is a high unmet need for both prophylaxis and treatment of PML. The aim of this review is to discuss potential drug candidates for prophylaxis and treatment of PML with a critical review of previously conducted and completed PML treatment studies as well as to provide perspectives for future therapies. PMID:26600871

  4. Acceptable Care? Illness Constructions, Healthworlds, and Accessible Chronic Treatment in South Africa

    PubMed Central

    Harris, Bronwyn; Eyles, John; Moshabela, Mosa

    2015-01-01

    Achieving equitable access to health care is an important policy goal, with access influenced by affordability, availability, and acceptability of specific services. We explore patient narratives from a 5-year program of research on health care access to examine relationships between social constructions of illness and the acceptability of health services in the context of tuberculosis treatment and antiretroviral therapy in South Africa. Acceptability of services seems particularly important to the meanings patients attach to illness and care, whereas—conversely—these constructions appear to influence what constitutes acceptability and hence affect access to care. We highlight the underestimated role of individually, socially, and politically constructed healthworlds; traditional and biomedical beliefs; and social support networks. Suggested policy implications for improving acceptability and hence overall health care access include abandoning patronizing approaches to care and refocusing from treating “disease” to responding to “illness” by acknowledging and incorporating patients’ healthworlds in patient–provider interactions. PMID:25829509

  5. Treatment options for second-stage gambiense human African trypanosomiasis.

    PubMed

    Eperon, Gilles; Balasegaram, Manica; Potet, Julien; Mowbray, Charles; Valverde, Olaf; Chappuis, François

    2014-11-01

    Treatment of second-stage gambiense human African trypanosomiasis relied on toxic arsenic-based derivatives for over 50 years. The availability and subsequent use of eflornithine, initially in monotherapy and more recently in combination with nifurtimox (NECT), has drastically improved the prognosis of treated patients. However, NECT logistic and nursing requirements remain obstacles to its deployment and use in peripheral health structures in rural sub-Saharan Africa. Two oral compounds, fexinidazole and SCYX-7158, are currently in clinical development. The main scope of this article is to discuss the potential impact of new oral therapies to improve diagnosis-treatment algorithms and patients' access to treatment, and to contribute to reach the objectives of the recently launched gambiense human African trypanosomiasis elimination program.

  6. Faropenem medoxomil: a treatment option in acute bacterial rhinosinusitis.

    PubMed

    Hadley, James A; Tillotson, Glenn S; Tosiello, Robert; Echols, Roger M

    2006-12-01

    Faropenem medoxomil is the first oral penem in a new class of beta-lactam antibiotics. Faropenem medoxomil has excellent in vitro activity against Streptococcus pneumoniae, Haemophilus influenzae and other key pathogens implicated in acute bacterial rhinosinusitis. Clinical studies have demonstrated that, in the treatment of acute bacterial rhinosinusitis in adults, 7 days of treatment with faropenem medoxomil is as clinically and bacteriologically effective as 10 days of treatment with cefuroxime axetil. One study showed faropenem medoxomil to be superior to cefuroxime axetil. Overall, the safety profile of faropenem medoxomil is similar to that of most comparators. Specifically, the minimal impact of faropenem medoxomil on the gastrointestinal flora leads to less diarrhea and other adverse events than coamoxicillin-clavulanate. Faropenem medoxomil has almost no drug-drug interactions and little requirement for dosage adjustments in the typical acute rhinosinusitis population. PMID:17181408

  7. Fused teeth: a review of the treatment options.

    PubMed

    Tuna, E Bahar; Yildirim, Mine; Seymen, Figen; Gencay, Koray; Ozgen, Mehmet

    2009-01-01

    Fused/geminated teeth may cause esthetic, spacing, periodontal, eruption and caries problems. The present study describes two clinical cases of similar dental fusion and compromises different and individualized treatment methods based on the proper treatment needs of a patient. In the first case the fused tooth was separated and the supernumerary tooth was extracted intraorally. In the second case, due to the union structure of a fused tooth up to the apex, extraction and extraoral separation was considered a better alternative than the separation of the fused tooth intraorally. Clinical and radiographic controls of the two cases revealed that the teeth were symptom-free and all clinical and radiographic findings were within normal limits after the long term follow-up periods. Following careful clinical and radiographic examination and diagnosis, extraoral hemi-section and immediate replantation may be considered as an alternative treatment in appropriate cases where a permanent tooth is fused with a supernumerary one.

  8. Treatment of autoimmune liver disease: current and future therapeutic options

    PubMed Central

    Trivedi, Palak J.

    2013-01-01

    Autoimmune liver disease spans three predominant processes, from the interface hepatitis of autoimmune hepatitis to the lymphocytic cholangitis of primary biliary cirrhosis, and finally the obstructive fibrosing sclerotic cholangiopathy of primary sclerosing cholangitis. Although all autoimmune in origin, they differ in their epidemiology, presentation and response to immunosuppressive therapy and bile acid based treatments. With an ongoing better appreciation of disease aetiology and pathogenesis, treatment is set ultimately to become more rational. We provide an overview of current and future therapies for patients with autoimmune liver disease, with an emphasis placed on some of the evidence that drives current practice. PMID:23634279

  9. Medical Treatments of Hidradenitis Suppurativa: More Options, Less Evidence.

    PubMed

    van der Zee, Hessel H; Gulliver, Wayne P

    2016-01-01

    Hidradenitis suppurativa is a common debilitating skin disease that has been neglected by science. The disease is getting more and more attention, reflected by the rising number of scientific publications. There is a clear need for effective treatment. We are still at the beginning of improving care for these patients as demonstrated by the low levels of evidence for the medical treatments. Many of these therapies showed promising results, but are still waiting to be validated in randomized, controlled trials. Much more research is needed to strengthen the Level of Evidence for these therapies and thus improve patient care.

  10. Predictability of uncontrollable multifocal seizures – towards new treatment options

    PubMed Central

    Lehnertz, Klaus; Dickten, Henning; Porz, Stephan; Helmstaedter, Christoph; Elger, Christian E.

    2016-01-01

    Drug-resistant, multifocal, non-resectable epilepsies are among the most difficult epileptic disorders to manage. An approach to control previously uncontrollable seizures in epilepsy patients would consist of identifying seizure precursors in critical brain areas combined with delivering a counteracting influence to prevent seizure generation. Predictability of seizures with acceptable levels of sensitivity and specificity, even in an ambulatory setting, has been repeatedly shown, however, in patients with a single seizure focus only. We did a study to assess feasibility of state-of-the-art, electroencephalogram-based seizure-prediction techniques in patients with uncontrollable multifocal seizures. We obtained significant predictive information about upcoming seizures in more than two thirds of patients. Unexpectedly, the emergence of seizure precursors was confined to non-affected brain areas. Our findings clearly indicate that epileptic networks, spanning lobes and hemispheres, underlie generation of seizures. Our proof-of-concept study is an important milestone towards new therapeutic strategies based on seizure-prediction techniques for clinical practice. PMID:27091239

  11. Acceptance and Commitment Therapy modules: Differential impact on treatment processes and outcomes.

    PubMed

    Villatte, Jennifer L; Vilardaga, Roger; Villatte, Matthieu; Plumb Vilardaga, Jennifer C; Atkins, David C; Hayes, Steven C

    2016-02-01

    A modular, transdiagnostic approach to treatment design and implementation may increase the public health impact of evidence-based psychosocial interventions. Such an approach relies on algorithms for selecting and implementing treatment components intended to have a specific therapeutic effect, yet there is little evidence for how components function independent of their treatment packages when employed in clinical service settings. This study aimed to demonstrate the specificity of treatment effects for two components of Acceptance and Commitment Therapy (ACT), a promising candidate for modularization. A randomized, nonconcurrent, multiple-baseline across participants design was used to examine component effects on treatment processes and outcomes in 15 adults seeking mental health treatment. The ACT OPEN module targeted acceptance and cognitive defusion; the ACT ENGAGED module targeted values-based activation and persistence. According to Tau-U analyses, both modules produced significant improvements in psychiatric symptoms, quality of life, and targeted therapeutic processes. ACT ENGAGED demonstrated greater improvements in quality of life and values-based activation. ACT OPEN showed greater improvements in symptom severity, acceptance, and defusion. Both modules improved awareness and non-reactivity, which were mutually targeted, though using distinct intervention procedures. Both interventions demonstrated high treatment acceptability, completion, and patient satisfaction. Treatment effects were maintained at 3-month follow up. ACT components should be considered for inclusion in a modular approach to implementing evidence-based psychosocial interventions for adults. PMID:26716932

  12. Acceptance and Commitment Therapy modules: Differential impact on treatment processes and outcomes.

    PubMed

    Villatte, Jennifer L; Vilardaga, Roger; Villatte, Matthieu; Plumb Vilardaga, Jennifer C; Atkins, David C; Hayes, Steven C

    2016-02-01

    A modular, transdiagnostic approach to treatment design and implementation may increase the public health impact of evidence-based psychosocial interventions. Such an approach relies on algorithms for selecting and implementing treatment components intended to have a specific therapeutic effect, yet there is little evidence for how components function independent of their treatment packages when employed in clinical service settings. This study aimed to demonstrate the specificity of treatment effects for two components of Acceptance and Commitment Therapy (ACT), a promising candidate for modularization. A randomized, nonconcurrent, multiple-baseline across participants design was used to examine component effects on treatment processes and outcomes in 15 adults seeking mental health treatment. The ACT OPEN module targeted acceptance and cognitive defusion; the ACT ENGAGED module targeted values-based activation and persistence. According to Tau-U analyses, both modules produced significant improvements in psychiatric symptoms, quality of life, and targeted therapeutic processes. ACT ENGAGED demonstrated greater improvements in quality of life and values-based activation. ACT OPEN showed greater improvements in symptom severity, acceptance, and defusion. Both modules improved awareness and non-reactivity, which were mutually targeted, though using distinct intervention procedures. Both interventions demonstrated high treatment acceptability, completion, and patient satisfaction. Treatment effects were maintained at 3-month follow up. ACT components should be considered for inclusion in a modular approach to implementing evidence-based psychosocial interventions for adults.

  13. Treatment Options for Low Back Pain in Athletes

    PubMed Central

    Petering, Ryan C.; Webb, Charles

    2011-01-01

    Context: Low back pain is one of the most common medical presentations in the general population. It is a common source of pain in athletes, leading to significant time missed and disability. The general categories of treatment for low back pain are medications and therapies. Evidence acquisition: Relevant studies were identified through a literature search of MEDLINE and the Cochrane Database from 1990 to 2010. A manual review of reference lists of identified sources was also performed. Results: It is not clear whether athletes experience low back pain more often than the general public. Because of a aucity of trials with athlete-specific populations, recommendations on treatments must be made from reviews of treatments for the general population. Several large systemic reviews and Cochrane reviews have compiled evidence on different modalities for low back pain. Superficial heat, spinal manipulation, nonsteroidal anti-inflammatory medications, and skeletal muscle relaxants have the strongest evidence of benefit. Conclusions: Despite the high prevalence of low back pain and the significant burden to the athletes, there are few clearly superior treatment modalities. Superficial heat and spinal manipulation therapy are the most strongly supported evidence-based therapies. Nonsteroidal anti-inflammatory medications and skeletal muscle relaxants have benefit in the initial management of low back pain; however, both have considerable side effects that must be considered. Athletes can return to play once they have recovered full range of motion and have the strength to prevent further injury. PMID:23016058

  14. [PCSK9 inhibitors : New treatment option in clinical practice].

    PubMed

    Müller-Wieland, D; Marx, N

    2016-06-01

    Proprotein convertase subtilisin/kexin type 9 (PCSK9) binds to low-density lipoprotein (LDL) receptors leading to their degradation in the liver. Inhibition of PCSK9 leads to an increase in LDL receptors and as a result to a reduction of LDL cholesterol in blood. Currently, two antibodies against PCSK9 are available for clinical treatment in Germany, evolocumab (Repatha®) and alirocumab (Praluent®). Clinical studies have shown that treatment with these antibodies, which must be subcutaneously injected by patients every 2 or 4 weeks, in addition to an already existing lipid therapy can lower the LDL cholesterol level in blood by an average of 50-60 %. Data from previous study programs show that this treatment is safe although long-term data are still lacking. The results of currently running cardiovascular endpoint studies are not yet available, whereby a beneficial effect is to be expected after the preliminary analyses. These novel effective therapy approaches open up new perspectives for the treatment of patients whose LDL cholesterol values are still in excess of the corresponding target values despite previous maximum lipid-reducing therapy and suffer from a preexisting cardiovascular disease, statin intolerance, genetic forms of familiar hypercholesterolemia and patients on LDL apheresis. PMID:27215418

  15. Central Retinal Vein Occlusion: A Review of Current Evidence-based Treatment Options

    PubMed Central

    Patel, Amy; Nguyen, Christine; Lu, Stephanie

    2016-01-01

    A central retinal vein occlusion (CRVO) can induce an ischemic and hypoxic state with resulting sequelae of macular edema and neovascularization. Many treatment options have been studied. Our review aims to investigate the safety and efficacy of the multiple treatment options of CRVO. A PubMed and Cochrane literature search was performed. Well-controlled randomized clinical trials that demonstrated strong level 1 evidence-based on the rating scale developed by the British Centre for Evidence-Based Medicine were included. Seven clinical trials met inclusion criteria to be included in this review. These included studies that investigated the safety and efficacy of retinal photocoagulation (1 study), intravitreal steroid treatment (2 studies), and antivascular endothelial growth factor treatment (4 studies) for the treatment of CRVO. In addition, studies evaluating surgical treatment options for CRVO were also included. Many treatment modalities have been demonstrated to be safe and efficacious in the treatment of CRVO. These treatment options offer therapeutic benefits for patients and clinically superior visual acuity and perhaps the quality of life after suffering from a CRVO. PMID:26957838

  16. The antimicrobial armamentarium: evaluating current and future treatment options.

    PubMed

    Bosso, John A

    2005-10-01

    The development and introduction of new antibiotics has, unfortunately, not kept pace with the development of bacterial resistance, and the need for new agents is becoming acute. Although some currently marketed agents remain valuable tools in the treatment of infectious diseases, few new drugs have reached the market in the last decade. In recent years, antibiotics with activity against certain problematic resistant bacteria such as methicillin-resistant Staphylococcus aureus, including linezolid and daptomycin, have been approved for clinical practice. Recently, tigecycline, a minocycline derivative, received approval by the United States Food and Drug Administration for treatment of complicated skin and skin structure and intraabdominal infections; the agent is also active against a variety of multidrug-resistant bacteria. Of the other agents in phase III development, ceftobiprole--a cephalosporin, and faropenem and doripenem--both carbapenems, have wide antibacterial spectra. Antimicrobial agents in the pipeline with marked gram-positive activity include dalbavancin, telavancin, and oritavancin. PMID:16178676

  17. Multidisciplinary Treatment Options of Tooth Avulsion Considering Different Therapy Concepts

    PubMed Central

    Kostka, Eckehard; Meissner, Simon; Finke, Christian H; Mandirola, Manlio; Preissner, Saskia

    2014-01-01

    Background: Avulsion of permanent front teeth is a rare accident, mostly affecting children between seven and nine years of age. Replanted and splinted, these teeth often develop inflammation, severe resorption or ankylosis affecting alveolar bone development and have to be extracted sooner or later. Objectives: The purpose of this study was to evaluate different therapy concepts to create a structured concept for the treatment of avulsions. Results: Based on existing therapy concepts, a concept for different initial conditions (dry time, age, growth, tooth, hard and soft tissues) was developed and is presented here. Conclusion: A great deal of research has been performed during recent years and guidelines for the management of avulsions have been published. With the help of this literature it is possible to identify the best treatment procedure for each tooth. Clinical Relevance: The prognosis of avulsed teeth can be improved by considering evidence-based therapy concepts. Resorption, ankylosis and tooth loss could be minimized. PMID:25352922

  18. [New options in the treatment of painful shoulder syndrome].

    PubMed

    Esparza Miñana, J M; Londoño Parra, M; Villanueva Pérez, V L; De Andrés Ibáñez, J

    2012-01-01

    Shoulder pain is a common complaint in clinical practice in Primary Care and affects 20% of the general population. The usual form of treatment is based on NSAIDs, rest, rehabilitation and, as an alternative, a local injection into the joint. There are also radiofrequency techniques on the suprascapular nerve in the cases of refractory pain to these therapies. Radiofrequency can be used in two ways: Conventional Radiofrequency, using high temperatures to the target tissue with the aim of producing a thermal neurolysis and Pulsed Radiofrequency where the temperatures are lower and produces a temporary non-destructive blockage; the latter being the most common technique in the management of shoulder pain. Although the analgesic mechanism of action of Radiofrequency is unknown, recent studies have shown that it is safe, effective and Lasting. Radiofrequency of the suprascapular nerve is a valid, effective and with few complications in the treatment of shoulder pain refractory to other therapies.

  19. Baropacing as a new option for treatment of resistant hypertension.

    PubMed

    Alnima, Teba; de Leeuw, Peter W; Kroon, Abraham A

    2015-09-15

    Electrical carotid baroreflex activation therapy is an emerging device-based treatment for patients with resistant hypertension. Its blood pressure lowering effect has been demonstrated in several animal and human studies, with prolonged effect over the long-term. The main mechanism of the blood pressure reduction during this therapy is by inhibition of the sympathetic outflow. Yet the question arises whether the inhibition of central sympathetic activity is sufficient to be the sole mechanism behind the sustained reduction in blood pressure. The major focus of this review is to elucidate the mechanisms of action that account for the effects of continuous carotid baroreflex activation on blood pressure in humans. Recent results of baroreflex activation therapy as a treatment for heart failure will also be discussed.

  20. Testosterone treatment comes of age: new options for hypogonadal men.

    PubMed

    Nieschlag, Eberhard

    2006-09-01

    Male hypogonadism is one of the most frequent, but also most underdiagnosed, endocrinopathies. However, the required testosterone treatment is simple and very effective if properly administered. Although testosterone has been available for clinical use for seven decades, until quite recently the treatment modalities were far from ideal. Subdermal testosterone pellets require minor surgery for insertion and often cause local problems. The injectable testosterone enanthate, for a long period the most frequently used mode of administration, lasts for two to four weeks, but produces supraphysiological levels initially and low levels before the next injection. The oral testosterone undecanoate has to be taken three times daily, has an uncertain absorption pattern and results in peaks and valleys of serum testosterone levels throughout the day. With the advent of transdermal testosterone preparations, the desired physiological serum levels could be achieved for the first time. Scrotal testosterone patches were the first to fulfil this requirement. These were followed by nonscrotal skin patches, which, however, cause considerable skin reactions including erythema and blisters. Recently introduced, invisible transdermal testosterone gels increased the intervals of application and are now slowly replacing other modalities. A mucoadhesive buccal testosterone tablet with sustained release is also a recent competing modality. Finally, injectable testosterone undecanoate in castor oil was made into a real depot preparation requiring only four injections per year for replacement therapy. These new preparations with a desired pharmacokinetic testosterone profile give the patient a real choice and make treatment easier. Based on pharmacogenetic considerations taking the androgen receptor polymorphism into account, treatment may be individualized for each patient in the future. PMID:16918944

  1. Treatment options for tank farms long-length contaminated equipment

    SciTech Connect

    Josephson, W.S.

    1995-10-16

    This study evaluated a variety of treatment and disposal technologies for mixed waste (MW) meeting the following criteria: 1. Single-Shell and Double-Shell Tank System (tank farms) equipment and other debris; 2. length greater than 12 feet; and contaminated with listed MW from the tank farms. This waste stream, commonly referred to as tank farms long-length contaminated equipment (LLCE), poses a unique and costly set of challenges during all phases of the waste management lifecycle.

  2. Fecal incontinence: A review of current treatment options.

    PubMed

    Fejka, Michael David

    2016-09-01

    Fecal incontinence affects patients of all sexes, races, and ethnicities; however, those affected often are afraid or too embarrassed to ask for help. Attention to risk factors and directed physical examinations can help healthcare providers diagnose and formulate treatment plans. Numerous diagnostic tests are available. Diligent follow-up is needed to direct patients to second-line therapies such as sacral nerve stimulation or surgical procedures. PMID:27580000

  3. Current and emerging treatment options in the management of lupus.

    PubMed

    Jordan, Natasha; D'Cruz, David

    2016-01-01

    Systemic lupus erythematosus (SLE) is a complex autoimmune disease with variable clinical manifestations. While the clearest guidelines for the treatment of SLE exist in the context of lupus nephritis, patients with other lupus manifestations such as neuropsychiatric, hematologic, musculoskeletal, and severe cutaneous lupus frequently require immunosuppression and/or biologic therapy. Conventional immunosuppressive agents such as mycophenolate mofetil, azathioprine, and cyclophosphamide are widely used in the management of SLE with current more rationalized treatment regimens optimizing the use of these agents while minimizing potential toxicity. The advent of biologic therapies has advanced the treatment of SLE particularly in patients with refractory disease. The CD20 monoclonal antibody rituximab and the anti-BLyS agent belimumab are now widely in use in clinical practice. Several other biologic agents are in ongoing clinical trials. While immunosuppressive and biologic agents are the foundation of inflammatory disease control in SLE, the importance of managing comorbidities such as cardiovascular risk factors, bone health, and minimizing susceptibility to infection should not be neglected. PMID:27529058

  4. Current and emerging treatment options in the management of lupus

    PubMed Central

    Jordan, Natasha; D’Cruz, David

    2016-01-01

    Systemic lupus erythematosus (SLE) is a complex autoimmune disease with variable clinical manifestations. While the clearest guidelines for the treatment of SLE exist in the context of lupus nephritis, patients with other lupus manifestations such as neuropsychiatric, hematologic, musculoskeletal, and severe cutaneous lupus frequently require immunosuppression and/or biologic therapy. Conventional immunosuppressive agents such as mycophenolate mofetil, azathioprine, and cyclophosphamide are widely used in the management of SLE with current more rationalized treatment regimens optimizing the use of these agents while minimizing potential toxicity. The advent of biologic therapies has advanced the treatment of SLE particularly in patients with refractory disease. The CD20 monoclonal antibody rituximab and the anti-BLyS agent belimumab are now widely in use in clinical practice. Several other biologic agents are in ongoing clinical trials. While immunosuppressive and biologic agents are the foundation of inflammatory disease control in SLE, the importance of managing comorbidities such as cardiovascular risk factors, bone health, and minimizing susceptibility to infection should not be neglected. PMID:27529058

  5. Geothermal injection treatment: process chemistry, field experiences, and design options

    SciTech Connect

    Kindle, C.H.; Mercer, B.W.; Elmore, R.P.; Blair, S.C.; Myers, D.A.

    1984-09-01

    The successful development of geothermal reservoirs to generate electric power will require the injection disposal of approximately 700,000 gal/h (2.6 x 10/sup 6/ 1/h) of heat-depleted brine for every 50,000 kW of generating capacity. To maintain injectability, the spent brine must be compatible with the receiving formation. The factors that influence this brine/formation compatibility and tests to quantify them are discussed in this report. Some form of treatment will be necessary prior to injection for most situations; the process chemistry involved to avoid and/or accelerate the formation of precipitate particles is also discussed. The treatment processes, either avoidance or controlled precipitation approaches, are described in terms of their principles and demonstrated applications in the geothermal field and, when such experience is limited, in other industrial use. Monitoring techniques for tracking particulate growth, the effect of process parameters on corrosion and well injectability are presented. Examples of brine injection, preinjection treatment, and recovery from injectivity loss are examined and related to the aspects listed above.

  6. Emerging pharmacologic treatment options for fragile X syndrome

    PubMed Central

    Schaefer, Tori L; Davenport, Matthew H; Erickson, Craig A

    2015-01-01

    Fragile X syndrome (FXS) is the most common single gene cause of intellectual disability and autism spectrum disorder. Caused by a silenced fragile X mental retardation 1 gene and the subsequent deficiency in fragile X mental retardation protein, patients with FXS experience a range of physical, behavioral, and intellectual debilitations. The FXS field, as a whole, has recently met with some challenges, as several targeted clinical trials with high expectations of success have failed to elucidate significant improvements in a variety of symptom domains. As new clinical trials in FXS are planned, there has been much discussion about the use of the commonly used clinical outcome measures, as well as study design considerations, patient stratification, and optimal age range for treatment. The evidence that modification of these drug targets and use of these failed compounds would prove to be efficacious in human clinical study were rooted in years of basic and translational research. There are questions arising as to the use of the mouse models for studying FXS treatment development. This issue is twofold: many of the symptom domains and molecular and biochemical changes assessed and indicative of efficacy in mouse model study are not easily amenable to clinical trials in people with FXS because of the intolerability of the testing paradigm or a lack of noninvasive techniques (prepulse inhibition, sensory hypersensitivity, startle reactivity, or electrophysiologic, biochemical, or structural changes in the brain); and capturing subtle yet meaningful changes in symptom domains such as sociability, anxiety, and hyperactivity in human FXS clinical trials is challenging with the currently used measures (typically parent/caregiver rating scales). Clinicians, researchers, and the pharmaceutical industry have all had to take a step back and critically evaluate the way we think about how to best optimize future investigations into pharmacologic FXS treatments. As new clinical

  7. Current and future treatment options for cystic fibrosis lung disease: latest evidence and clinical implications.

    PubMed

    Edmondson, Claire; Davies, Jane C

    2016-05-01

    Treatment for cystic fibrosis (CF) has conventionally targeted downstream consequences of the defect such as mucus plugging and infection. More recently, significant advances have been made in treating the root cause of the disease, namely a defective CF transmembrane conductance regulator (CFTR) gene. This review summarizes current pulmonary treatment options and highlights advances in research and development of new therapies. PMID:27347364

  8. Current and future treatment options for cystic fibrosis lung disease: latest evidence and clinical implications

    PubMed Central

    Edmondson, Claire; Davies, Jane C.

    2016-01-01

    Treatment for cystic fibrosis (CF) has conventionally targeted downstream consequences of the defect such as mucus plugging and infection. More recently, significant advances have been made in treating the root cause of the disease, namely a defective CF transmembrane conductance regulator (CFTR) gene. This review summarizes current pulmonary treatment options and highlights advances in research and development of new therapies. PMID:27347364

  9. Insomnia treatment acceptability and preferences of male Iraq and Afghanistan combat veterans and their healthcare providers.

    PubMed

    Epstein, Dana R; Babcock-Parziale, Judith L; Haynes, Patricia L; Herb, Christine A

    2012-01-01

    Sleep difficulty is a prevalent problem among returning Veterans. Although there is strong evidence for the efficacy and durability of cognitive-behavioral treatment for insomnia (CBT-I) in the general population, the interventions require motivation, attention, and adherence from patients to achieve successful outcomes. Given the unique characteristics of Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) Veterans who have experienced blast-related injuries and other trauma, CBT-I for these patients may require modification, including alternative delivery methods, to ensure effective implementation and positive outcomes. We interviewed 18 OIF/OEF Veterans who screened positive for mild traumatic brain injury and 19 healthcare providers to determine the acceptability of insomnia treatments and preferences for the interventions and treatment delivery. Veterans and providers had distinct preferences for insomnia treatment and its delivery. The treatments the Veterans found most acceptable were also the ones they preferred: relaxation treatment and pharmacotherapy. The providers identified relaxation therapy as the most acceptable treatment. Veterans preferred the individual treatment format as well as electronic methods of treatment delivery. Despite some differences between patients and providers, a compromise through modification of empirically supported behavioral treatments is feasible, and implications for preference-based insomnia intervention development and testing are discussed.

  10. Pretubulysin: a new option for the treatment of metastatic cancer.

    PubMed

    Braig, S; Wiedmann, R M; Liebl, J; Singer, M; Kubisch, R; Schreiner, L; Abhari, B A; Wagner, E; Kazmaier, U; Fulda, S; Vollmar, A M

    2014-01-01

    Tubulin-binding agents such as taxol, vincristine or vinblastine are well-established drugs in clinical treatment of metastatic cancer. However, because of their highly complex chemical structures, the synthesis and hence the supply issues are still quite challenging. Here we set on stage pretubulysin, a chemically accessible precursor of tubulysin that was identified as a potent microtubule-binding agent produced by myxobacteria. Although much simpler in chemical structure, pretubulysin abrogates proliferation and long-term survival as well as anchorage-independent growth, and also induces anoikis and apoptosis in invasive tumor cells equally potent to tubulysin. Moreover, pretubulysin posseses in vivo efficacy shown in a chicken chorioallantoic membrane (CAM) model with T24 bladder tumor cells, in a mouse xenograft model using MDA-MB-231 mammary cancer cells and finally in a model of lung metastasis induced by 4T1 mouse breast cancer cells. Pretubulysin induces cell death via the intrinsic apoptosis pathway by abrogating the expression of pivotal antiapoptotic proteins, namely Mcl-1 and Bcl-xL, and shows distinct chemosensitizing properties in combination with TRAIL in two- and three-dimensional cell culture models. Unraveling the underlying signaling pathways provides novel information: pretubulysin induces proteasomal degradation of Mcl-1 by activation of mitogen-activated protein kinase (especially JNK (c-Jun N-terminal kinase)) and phosphorylation of Mcl-1, which is then targeted by the SCF(Fbw7) E3 ubiquitin ligase complex for ubiquitination and degradation. In sum, we designate the microtubule-destabilizing compound pretubulysin as a highly promising novel agent for mono treatment and combinatory treatment of invasive cancer. PMID:24434509

  11. Metabolic bone disease in children : etiology and treatment options.

    PubMed

    Skowrońska-Jóźwiak, Elzbieta; Lorenc, Roman S

    2006-01-01

    Metabolic bone disease in children includes many hereditary and acquired conditions of diverse etiology that lead to disturbed metabolism of the bone tissue. Some of these processes primarily affect bone; others are secondary to nutritional deficiencies, a variety of chronic disorders, and/or treatment with some drugs. Some of these disorders are rare, but some present public health concerns (for instance, rickets) that have been well known for many years but still persist. The most important clinical consequences of bone metabolic diseases in the pediatric population include reduced linear growth, bone deformations, and non-traumatic fractures leading to bone pain, deterioration of motor development and disability. In this article, we analyze primary and secondary osteoporosis, rickets, osteomalacia (nutritional and hereditary vitamin D-dependent, hypophosphatemic and that due to renal tubular abnormalities), renal osteodystrophy, sclerosing bony disorders, and some genetic bone diseases (hypophosphatasia, fibrous dysplasia, skeletal dysplasia, juvenile Paget disease, familial expansile osteolysis, and osteoporosis pseudoglioma syndrome). Early identification and treatment of potential risk factors is essential for skeletal health in adulthood. In most conditions it is necessary to ensure an appropriate diet, with calcium and vitamin D, and an adequate amount of physical activity as a means of prevention. In secondary bone diseases, treatment of the primary disorder is crucial. Most genetic disorders await prospective gene therapies, while bone marrow transplantation has been attempted in other disorders. At present, affected patients are treated symptomatically, frequently by interdisciplinary teams. The role of exercise and pharmacologic therapy with calcium, vitamin D, phosphate, bisphosphonates, calcitonin, sex hormones, growth hormone, and thiazides is discussed. The perspectives on future therapy with insulin-like growth factor-1, new analogs of vitamin D

  12. Acquired hemophilia a: diagnosis, aetiology, clinical spectrum and treatment options.

    PubMed

    Shetty, Shrimati; Bhave, Manali; Ghosh, Kanjaksha

    2011-04-01

    Acquired hemophilia A (AHA) is a rare disorder with an incidence of approximately 1 per million/year with a high mortality rate of more than 20%. The disease occurs due to autoantibodies against coagulation factor VIII (FVIII) which neutralize its procoagulant function and result in severe, often life-threatening bleeding. The antibodies arise in individuals with no prior history of hemophilia A. AHA may be associated with pregnancy, autoimmune diseases, malignancy, infections or medication and occurs most commonly in the elderly. Approximately 50% of the patients remain idiopathic with no known underlying pathological condition. Clinical manifestations include spontaneous hemorrhages into the skin, muscles or soft tissues or excessive bleeding during surgery. Hemarthrosis which is the hallmark of congenital severe hemophilia A seldom occurs in AHA. The diagnosis of AHA is based on the isolated prolongation of activated partial thromboplastin time (APTT) which does not normalize after the addition of normal plasma along with reduced FVIII levels. The treatment involves two aspects-eradication of antibodies and maintaining effective hemostasis during a bleeding episode. The protocols for eradication of antibodies include immunoadsorption, immunosuppression or immune tolerance induction (ITI). The treatment of acute bleeding episodes involves use of different bypassing agents like recombinant activated factor VIIa (rFVIIa, NovoSeven®) and activated prothrombin complex concentrate (aPCC, (FEIBA®) in case of patients with high titer inhibitors or with antifibrinolytics,1-deamino-8-D-arginine vasopressin (DDAVP) or FVIII concentrates in low titer inhibitor patients. The anti CD20 monoclonal antibody, rituximab, has shown very good results either singly or in combination with immunosuppressive regimens in patients who do not respond to standard immunosuppressors. The present review summarizes the diagnostic, aetiological, clinical and treatment aspects of AHA focusing

  13. Pretubulysin: a new option for the treatment of metastatic cancer

    PubMed Central

    Braig, S; Wiedmann, R M; Liebl, J; Singer, M; Kubisch, R; Schreiner, L; Abhari, B A; Wagner, E; Kazmaier, U; Fulda, S; Vollmar, A M

    2014-01-01

    Tubulin-binding agents such as taxol, vincristine or vinblastine are well-established drugs in clinical treatment of metastatic cancer. However, because of their highly complex chemical structures, the synthesis and hence the supply issues are still quite challenging. Here we set on stage pretubulysin, a chemically accessible precursor of tubulysin that was identified as a potent microtubule-binding agent produced by myxobacteria. Although much simpler in chemical structure, pretubulysin abrogates proliferation and long-term survival as well as anchorage-independent growth, and also induces anoikis and apoptosis in invasive tumor cells equally potent to tubulysin. Moreover, pretubulysin posseses in vivo efficacy shown in a chicken chorioallantoic membrane (CAM) model with T24 bladder tumor cells, in a mouse xenograft model using MDA-MB-231 mammary cancer cells and finally in a model of lung metastasis induced by 4T1 mouse breast cancer cells. Pretubulysin induces cell death via the intrinsic apoptosis pathway by abrogating the expression of pivotal antiapoptotic proteins, namely Mcl-1 and Bcl-xL, and shows distinct chemosensitizing properties in combination with TRAIL in two- and three-dimensional cell culture models. Unraveling the underlying signaling pathways provides novel information: pretubulysin induces proteasomal degradation of Mcl-1 by activation of mitogen-activated protein kinase (especially JNK (c-Jun N-terminal kinase)) and phosphorylation of Mcl-1, which is then targeted by the SCFFbw7 E3 ubiquitin ligase complex for ubiquitination and degradation. In sum, we designate the microtubule-destabilizing compound pretubulysin as a highly promising novel agent for mono treatment and combinatory treatment of invasive cancer. PMID:24434509

  14. Urinary tract infections: epidemiology, mechanisms of infection and treatment options

    PubMed Central

    Flores-Mireles, Ana L.; Walker, Jennifer N.; Caparon, Michael; Hultgren, Scott J.

    2015-01-01

    Urinary tract infections (UTIs) are a severe public health problem and are caused by a range of pathogens, but most commonly by Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Enterococcus faecalis and Staphylococcus saprophyticus. High recurrence rates and increasing antimicrobial resistance among uropathogens threaten to greatly increase the economic burden of these infections. In this Review, we discuss how basic science studies are elucidating the molecular details of the crosstalk that occurs at the host–pathogen interface, as well as the consequences of these interactions for the pathophysiology of UTIs. We also describe current efforts to translate this knowledge into new clinical treatments for UTIs. PMID:25853778

  15. Review of current and emerging treatment options in acromegaly.

    PubMed

    Muhammad, A; van der Lely, A J; Neggers, S J C M M

    2015-10-01

    In almost every patient, acromegaly is caused by a growth hormone secreting pituitary adenoma. Clinical features are the result of excessive growth hormone secretion and the consecutive excess in insulin-like growth factor I levels. This results in somatic overgrowth and metabolic disturbances with a higher morbidity and mortality than in the general population. With optimal disease management, mortality can be reduced to that seen in the general population. The current treatment of acromegaly is based on a combination of surgery, radiotherapy and medical therapy. This review provides an overview of the current and upcoming therapies with a focus on medical therapy.

  16. Review of current and emerging treatment options in acromegaly.

    PubMed

    Muhammad, A; van der Lely, A J; Neggers, S J C M M

    2015-10-01

    In almost every patient, acromegaly is caused by a growth hormone secreting pituitary adenoma. Clinical features are the result of excessive growth hormone secretion and the consecutive excess in insulin-like growth factor I levels. This results in somatic overgrowth and metabolic disturbances with a higher morbidity and mortality than in the general population. With optimal disease management, mortality can be reduced to that seen in the general population. The current treatment of acromegaly is based on a combination of surgery, radiotherapy and medical therapy. This review provides an overview of the current and upcoming therapies with a focus on medical therapy. PMID:26478545

  17. Urinary tract infections: epidemiology, mechanisms of infection and treatment options.

    PubMed

    Flores-Mireles, Ana L; Walker, Jennifer N; Caparon, Michael; Hultgren, Scott J

    2015-05-01

    Urinary tract infections (UTIs) are a severe public health problem and are caused by a range of pathogens, but most commonly by Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Enterococcus faecalis and Staphylococcus saprophyticus. High recurrence rates and increasing antimicrobial resistance among uropathogens threaten to greatly increase the economic burden of these infections. In this Review, we discuss how basic science studies are elucidating the molecular details of the crosstalk that occurs at the host-pathogen interface, as well as the consequences of these interactions for the pathophysiology of UTIs. We also describe current efforts to translate this knowledge into new clinical treatments for UTIs. PMID:25853778

  18. Pharmacologic treatments for opioid dependence: detoxification and maintenance options

    PubMed Central

    Kleber, Herbert D.

    2007-01-01

    While opioid dependence has more treatment agents available than other abused drugs, none are curative. They can, however, markedly diminish withdrawal symptoms and craving, and block opioid effects due to lapses. The most effective withdrawal method is substituting and tapering methadone or buprenorphine, α-2 Adrenergic agents can ameliorate untreated symptoms or substitute for agonists if not available. Shortening withdrawal by precipitating it with narcotic antagonists has been studied, but the methods are plagued by safety issues or persisting symptoms. Neither the withdrawal agents nor the methods are associated with better long-term outcome, which appears mostly related to post-detoxification treatment. Excluding those with short-term habits, the best outcome occurs with long-term maintenance on methadone or buprenorphine accompanied by appropriate psychosocial interventions. Those with strong external motivation may do well on the antagonist naltrexone. Currently, optimum duration of maintenance on either is unclear. Better agents are needed to impact the brain changes related to addiction. PMID:18286804

  19. Lung abscess-etiology, diagnostic and treatment options.

    PubMed

    Kuhajda, Ivan; Zarogoulidis, Konstantinos; Tsirgogianni, Katerina; Tsavlis, Drosos; Kioumis, Ioannis; Kosmidis, Christoforos; Tsakiridis, Kosmas; Mpakas, Andrew; Zarogoulidis, Paul; Zissimopoulos, Athanasios; Baloukas, Dimitris; Kuhajda, Danijela

    2015-08-01

    Lung abscess is a type of liquefactive necrosis of the lung tissue and formation of cavities (more than 2 cm) containing necrotic debris or fluid caused by microbial infection. It can be caused by aspiration, which may occur during altered consciousness and it usually causes a pus-filled cavity. Moreover, alcoholism is the most common condition predisposing to lung abscesses. Lung abscess is considered primary (60%) when it results from existing lung parenchymal process and is termed secondary when it complicates another process, e.g., vascular emboli or follows rupture of extrapulmonary abscess into lung. There are several imaging techniques which can identify the material inside the thorax such as computerized tomography (CT) scan of the thorax and ultrasound of the thorax. Broad spectrum antibiotic to cover mixed flora is the mainstay of treatment. Pulmonary physiotherapy and postural drainage are also important. Surgical procedures are required in selective patients for drainage or pulmonary resection. In the current review we will present all current information from diagnosis to treatment.

  20. Dosimetric Study of Current Treatment Options for Radiotherapy in Retinoblastoma

    SciTech Connect

    Eldebawy, Eman; Parker, William; Abdel Rahman, Wamied; Freeman, Carolyn R.

    2012-03-01

    Purpose: To determine the best treatment technique for patients with retinoblastoma requiring radiotherapy to the whole eye. Methods and Materials: Treatment plans for 3 patients with retinoblastoma were developed using 10 radiotherapy techniques including electron beams, photon beam wedge pair (WP), photon beam three-dimensional conformal radiotherapy (3D-CRT), fixed gantry intensity-modulated radiotherapy (IMRT), photon volumetric arc therapy (VMAT), fractionated stereotactic radiotherapy, and helical tomotherapy (HT). Dose-volume analyses were carried out for each technique. Results: All techniques provided similar target coverage; conformity was highest for VMAT, nine-field (9F) IMRT, and HT (conformity index [CI] = 1.3) and lowest for the WP and two electron techniques (CI = 1.8). The electron techniques had the highest planning target volume dose gradient (131% of maximum dose received [D{sub max}]), and the CRT techniques had the lowest (103% D{sub max}) gradient. The volume receiving at least 20 Gy (V{sub 20Gy}) for the ipsilateral bony orbit was lowest for the VMAT and HT techniques (56%) and highest for the CRT techniques (90%). Generally, the electron beam techniques were superior in terms of brain sparing and delivered approximately one-third of the integral dose of the photon techniques. Conclusions: Inverse planned image-guided radiotherapy delivered using HT or VMAT gives better conformity index, improved orbital bone and brain sparing, and a lower integral dose than other techniques.

  1. Understanding the mechanisms and treatment options in cancer cachexia.

    PubMed

    Fearon, Kenneth; Arends, Jann; Baracos, Vickie

    2013-02-01

    Cancer cachexia is a metabolic syndrome that can be present even in the absence of weight loss ('precachexia'). Cachexia is often compounded by pre-existing muscle loss, and is exacerbated by cancer therapy. Furthermore, cachexia is frequently obscured by obesity, leading to under-diagnosis and excess mortality. Muscle wasting (the signal event in cachexia) is associated not only with reduced quality of life, but also markedly increased toxicity from chemotherapy. Many of the primary events driving cachexia are likely mediated via the central nervous system and include inflammation-related anorexia and hypoanabolism or hypercatabolism. Treatment of cachexia should be initiated early. In addition to active management of secondary causes of anorexia (such as pain and nausea), therapy should target reduced food intake (nutritional support), inflammation-related metabolic change (anti-inflammatory drugs or nutrients) and reduced physical activity (resistance exercise). Advances in the understanding of the molecular biology of the brain, immune system and skeletal muscle have provided novel targets for the treatment of cachexia. The combination of therapies into a standard multimodal package coupled with the development of novel therapeutics promises a new era in supportive oncology whereby quality of life and tolerance to cancer therapy could be improved considerably.

  2. Acceptance and Commitment Therapy for a Heterogeneous Group of Treatment-Resistant Clients: A Treatment Development Study

    ERIC Educational Resources Information Center

    Clarke, Sue; Kingston, Jessica; Wilson, Kelly G.; Bolderston, Helen; Remington, Bob

    2012-01-01

    Acceptance and commitment therapy (ACT) has been shown to have broad applicability to different diagnostic groups, and there are theoretical reasons to consider its use with clients with chronic mental health problems. We report an innovative treatment development evaluation of ACT for a heterogeneous group of "treatment-resistant clients" (N =…

  3. A review of treatment options for Graves' disease: why total thyroidectomy is a viable option in selected patients.

    PubMed

    Mohan, Vinuta; Lind, Robert

    2016-01-01

    Graves' disease is the most common cause of hyperthyroidism. If left untreated, patients may have multiple systemic complications such as cardiac, reproductive, and skeletal disease. Thionamides, such as methimazole and propylthiouracil, and I(131) iodine ablation are the most commonly prescribed treatment for Graves' disease. Total thyroidectomy is often overlooked for treatment and is usually only offered if the other options have failed. In our case, we discuss a patient who was admitted to our medical center with symptomatic hyperthyroidism secondary to long-standing Graves' disease. She had a history of non-compliance with medications and medical clinic follow-up. The risks and benefits of total thyroidectomy were explained and she consented to surgery. A few months after the procedure, she was biochemically and clinically euthyroid on levothyroxine. She had no further emergency room visits or admissions for uncontrolled thyroid disease. Here we review the advantages and disadvantages of the more typically prescribed treatments, thionamides and I(131)iodine ablation. We also review the importance of shared decision making and the benefits of total thyroidectomy for the management of Graves' disease. Given the improvement in surgical techniques over the past decade and a significant reduction of complications, we suggest total thyroidectomy be recommended more often for patients with Graves' disease.

  4. A review of treatment options for Graves' disease: why total thyroidectomy is a viable option in selected patients.

    PubMed

    Mohan, Vinuta; Lind, Robert

    2016-01-01

    Graves' disease is the most common cause of hyperthyroidism. If left untreated, patients may have multiple systemic complications such as cardiac, reproductive, and skeletal disease. Thionamides, such as methimazole and propylthiouracil, and I(131) iodine ablation are the most commonly prescribed treatment for Graves' disease. Total thyroidectomy is often overlooked for treatment and is usually only offered if the other options have failed. In our case, we discuss a patient who was admitted to our medical center with symptomatic hyperthyroidism secondary to long-standing Graves' disease. She had a history of non-compliance with medications and medical clinic follow-up. The risks and benefits of total thyroidectomy were explained and she consented to surgery. A few months after the procedure, she was biochemically and clinically euthyroid on levothyroxine. She had no further emergency room visits or admissions for uncontrolled thyroid disease. Here we review the advantages and disadvantages of the more typically prescribed treatments, thionamides and I(131)iodine ablation. We also review the importance of shared decision making and the benefits of total thyroidectomy for the management of Graves' disease. Given the improvement in surgical techniques over the past decade and a significant reduction of complications, we suggest total thyroidectomy be recommended more often for patients with Graves' disease. PMID:27609732

  5. A review of treatment options for Graves’ disease: why total thyroidectomy is a viable option in selected patients

    PubMed Central

    Mohan, Vinuta; Lind, Robert

    2016-01-01

    Graves’ disease is the most common cause of hyperthyroidism. If left untreated, patients may have multiple systemic complications such as cardiac, reproductive, and skeletal disease. Thionamides, such as methimazole and propylthiouracil, and I131 iodine ablation are the most commonly prescribed treatment for Graves’ disease. Total thyroidectomy is often overlooked for treatment and is usually only offered if the other options have failed. In our case, we discuss a patient who was admitted to our medical center with symptomatic hyperthyroidism secondary to long-standing Graves’ disease. She had a history of non-compliance with medications and medical clinic follow-up. The risks and benefits of total thyroidectomy were explained and she consented to surgery. A few months after the procedure, she was biochemically and clinically euthyroid on levothyroxine. She had no further emergency room visits or admissions for uncontrolled thyroid disease. Here we review the advantages and disadvantages of the more typically prescribed treatments, thionamides and I131iodine ablation. We also review the importance of shared decision making and the benefits of total thyroidectomy for the management of Graves' disease. Given the improvement in surgical techniques over the past decade and a significant reduction of complications, we suggest total thyroidectomy be recommended more often for patients with Graves’ disease. PMID:27609732

  6. Treatment Options: Biological Basis of Regenerative Endodontic Procedures

    PubMed Central

    Hargreaves, Kenneth M.; Diogenes, Anibal; Teixeira, Fabricio B.

    2013-01-01

    Dental trauma occurs frequently in children and often can lead to pulpal necrosis. The occurrence of pulpal necrosis in the permanent but immature tooth represents a challenging clinical situation since the thin and often short roots increase the risk of subsequent fracture. Current approaches for treating the traumatized immature tooth with pulpal necrosis do not reliably achieve the desired clinical outcomes, consisting of healing of apical periodontitis, promotion of continued root development and restoration of the functional competence of pulpal tissue. An optimal approach for treating the immature permanent tooth with a necrotic pulp would be to regenerate functional pulpal tissue. This review summarizes the current literature supporting a biological rationale for considering regenerative endodontic treatment procedures in treating the immature permanent tooth with pulp necrosis. PMID:23439043

  7. Stem cell therapy: a novel treatment option for cerebral malaria?

    PubMed

    Wang, Wei; Qian, Hui; Cao, Jun

    2015-01-01

    Cerebral malaria, a severe form of the disease, is one of the most severe complications of infection with Plasmodium parasites and a leading cause of malaria mortality. Currently available antimalarial therapy has proven insufficient to prevent neurological complications and death in all cases of cerebral malaria. Souza and colleagues observed that transplantation of bone marrow-derived mesenchymal stromal cells (BM-MSCs) increased survival, reduced parasitemia, decreased malaria pigment accumulation in the spleen, liver and kidney, elevated Kupffer cell count in liver, alleviated renal injury and lung inflammation, and improved lung mechanics in an experimental mouse model of cerebral malaria. Although plenty of challenges lie ahead, their findings show the promise of BM-MSC therapy for the treatment of cerebral malaria. PMID:26253514

  8. Aggression in autism spectrum disorder: presentation and treatment options

    PubMed Central

    Fitzpatrick, Sarah E; Srivorakiat, Laura; Wink, Logan K; Pedapati, Ernest V; Erickson, Craig A

    2016-01-01

    Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by persistent difficulties in social communication and social interaction, coupled with restricted, repetitive patterns of behavior or interest. Research indicates that aggression rates may be higher in individuals with ASD compared to those with other developmental disabilities. Aggression is associated with negative outcomes for children with ASD and their caregivers, including decreased quality of life, increased stress levels, and reduced availability of educational and social support. Therapeutic strategies including functional behavioral assessment, reinforcement strategies, and functional communication training may have a significant impact in reducing the frequency and intensity of aggressive behavior in individuals with ASD. Pharmacologic treatments, particularly the use of second-generation antipsychotics, may also be of some benefit in reducing aggression in individuals with ASD. With the ever-increasing rate of ASD diagnosis, development of effective therapeutic and pharmacologic methods for preventing and treating aggression are essential to improving outcomes in this disorder. PMID:27382295

  9. Aggression in autism spectrum disorder: presentation and treatment options.

    PubMed

    Fitzpatrick, Sarah E; Srivorakiat, Laura; Wink, Logan K; Pedapati, Ernest V; Erickson, Craig A

    2016-01-01

    Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by persistent difficulties in social communication and social interaction, coupled with restricted, repetitive patterns of behavior or interest. Research indicates that aggression rates may be higher in individuals with ASD compared to those with other developmental disabilities. Aggression is associated with negative outcomes for children with ASD and their caregivers, including decreased quality of life, increased stress levels, and reduced availability of educational and social support. Therapeutic strategies including functional behavioral assessment, reinforcement strategies, and functional communication training may have a significant impact in reducing the frequency and intensity of aggressive behavior in individuals with ASD. Pharmacologic treatments, particularly the use of second-generation antipsychotics, may also be of some benefit in reducing aggression in individuals with ASD. With the ever-increasing rate of ASD diagnosis, development of effective therapeutic and pharmacologic methods for preventing and treating aggression are essential to improving outcomes in this disorder. PMID:27382295

  10. The androgen-deficient aging male: current treatment options.

    PubMed

    Tenover, J Lisa

    2003-01-01

    All delivery forms of testosterone should be equally efficacious in treating the androgen-deficient aging male if adequate serum testosterone levels are obtained. The testosterone preparations available in North America include the oral undecanoate, injectable testosterone esters, the scrotal patch, the nonscrotal transdermal patch, and the transdermal gels. Selection of a specific testosterone preparation for replacement therapy depends on many factors, including the magnitude and pattern of serum testosterone levels produced, side effects of the particular formulation, reversibility if an adverse event should occur, convenience of use, cosmetic issues related to the preparation, and cost. In addition, potential adverse effects of testosterone therapy applicable to all forms of testosterone delivery, such as fluid retention, gynecomastia, polycythemia, worsening of sleep apnea, change in cardiovascular-disease risk, or alterations in prostate health, need to be considered both prior to therapy and during treatment monitoring. PMID:16985939

  11. Systemic therapy for endometrial stromal sarcomas: current treatment options.

    PubMed

    Serkies, Krystyna; Pawłowska, Ewa; Jassem, Jacek

    2016-01-01

    Uterine endometrial stromal sarcomas including true low-grade endometrial stromal sarcoma (LG-ESS) and high-grade (HG-ESS) or undifferentiated endometrial sarcoma (UES) constitute a group of rare, aggressive malignancies. Most LG-ESSs express steroid receptors. Surgery is the principal primary therapy for endometrial stromal sarcomas and should be considered in all cases. These malignancies are relatively radio- and chemoresistant. Chemotherapy is used in recurrent and advanced HG-ESS and UES. Currently, the combination of gemcitabine and docetaxel is considered the most effective regimen, but at the expense of substantial toxicity. In steroid receptor positive advanced LG-ESS hormonal therapy, mainly with progestins, allows in some patients for a long-term survival. Aromatase inhibitors seem to be equally effective as first- and subsequent-line of treatment, and are well tolerated. The role of molecular-targeted therapies in endometrial stromal sarcomas remains to be established. PMID:27629136

  12. Laser and light-based treatment options for hidradenitis suppurativa.

    PubMed

    Hamzavi, Iltefat H; Griffith, James L; Riyaz, Farhaad; Hessam, Schapoor; Bechara, Falk G

    2015-11-01

    Hidradenitis suppurativa (HS) is a chronic inflammatory disease that commonly develops painful, deep dermal abscesses and chronic, draining sinus tracts. Classically, pharmacologic and surgical therapies have been effective for reducing lesion activity and inflammation, but provide only modest success in the prevention of future recurrences and disease progression. Adjunctive therapies, such as laser and light-based therapies, have become more commonly used in the management of HS. These therapies work to reduce the occurrence of painful HS flare-ups by decreasing the number of hair follicles, sebaceous glands, and bacteria in affected areas, and by ablatively debulking chronic lesions. The best results are seen when treatment is individualized, taking disease severity into consideration when selecting specific energy-based approaches. This article will discuss various light-based therapies and the evidence supporting their use in the management of HS.

  13. Contemporary treatment options for relapsing-remitting multiple sclerosis.

    PubMed

    Salhofer-Polanyi, S; Leutmezer, F

    2014-05-01

    Multiple sclerosis (MS) is an autoimmune disease of the central nervous system, encompassing both neuroinflammatory as well as prominent neurodegenerative aspects. A significant proportion of MS patients will develop neurological disability over time and up until recently licensed drugs could not satisfactorily halt this process. However, in the last years MS treatment has raised a stage of rapid progress. Several new drugs with significantly improved efficacy have entered the therapeutic field and several others are currently undergoing phase III clinical trials. In this review, we will summarize efficacy data as well as safety and tolerability issues of currently licensed drugs for relapsing-remitting MS and will give a short update on new drugs currently undergoing late-stage clinical trials. PMID:24918837

  14. [Low Back Pain in Pregnancy: Diagnosis, Treatment Options and Outcomes].

    PubMed

    Mühlemann, Daniel; Mühlemann, Malin B

    2015-05-20

    Low back pain in pregnancy is a common occurrence and is mainly caused by hormonal and biomechanical changes. Patients with pregnancy-induced low back pain (PILBP) frequently complain of moderate to severe and disabling pain often restricting their daily activities. In these cases, a “watch and wait” approach cannot be the best solution. On the basis of anamnesis and examination PILBP can be divided into three subgroups: pregnancy-related low back pain (PLBP), pelvic girdle pain (PGP) and the combination of PLBP and PGP. The three entities ask for different diagnostic workups and therapeutic modalities. There are many possible treatments for PLBP, however, only a few are based on sound evidence. Information and advice, exercise and training programs, acupuncture, stabilizing belts and analgesic medication can have a positive impact on pain and disability. PGP und PLBP respond well to chiropractic interventions.

  15. Diagnostic approach and current treatment options in childhood vasculitis

    PubMed Central

    Barut, Kenan; Şahin, Sezgin; Adroviç, Amra; Kasapçopur, Özgür

    2015-01-01

    All inflammatory changes in the vessel wall are defined as vasculitis. Pediatric vasculitis may present with different clinical findings. Although Henoch-Schönlein purpura which is the most common pediatric vasculitis generally recovers spontaneously, it should be monitorized closely because of the risk of renal failure. Although Kawasaki disease is easy to diagnose with its classical findings, the diagnosis may be delayed in case of incomplete Kawasaki disease. Kawasaki disease should be considered especially in infants in case of prolonged fever even if the criteria are not fully met and intravenous immunoglobulin treatment should be administered without delay in order to prevent development of coronary artery aneurism. Reaction at the site of administration of Bacillus Calmette-Guerin (BCG) vaccine may be observed as commonly as cervical lymphadenopathy in Kawasaki disease and may be used as a valuable finding in suspicious cases. Although anti-neutrophil cytoplasmic antibody-associated vasculitides are rare in children, renal involvement is more common and progression is more severe compared to adults. Hence, efficient and aggressive treatment is required. Takayasu’s arteritis is observed commonly in young adult women and rarely in adolescent girls. Therefore, a careful physical examination and blood pressure measurement should be performed in addition to a detailed history in daily practice. In children with unexplained neurological findings, cerebral vasculitis should be considered in the absence of other systemic vasculitides and necessary radiological investigations should be performed in this regard. This review will provide an insight into the understanding of pediatric vasculitis, current diagnostic approaches and prognosis by the aid of new studies. PMID:26884688

  16. Fiber-reinforced Composite Resin Bridge: A Treatment Option in Children

    PubMed Central

    Yelluri, Rama Krishna; Munshi, AK

    2015-01-01

    ABSTRACT A number of treatment options, ranging from Maryland bridges to implants, are available for the replacement of congenitally or traumatically missing permanent anterior teeth. But, there are several limitations of these therapeutic options when they have to be used before the completion of the growth, particularly in children. Reinforcement of composite resins with polyethylene fibers significantly improves their mechanical properties. Fiber-reinforced composite (FRC) bridge can offer a good alternative to conventional treatment options in replacing a missing permanent anterior tooth until a more definitive prosthesis can be provided at the end of the growth period. The purpose of this article is to present a clinical case of a single tooth replacement utilizing noninvasive and metal free fixed FRC bridge in a 13 years old child as an interim treatment option. How to cite this article: Gupta A, Yelluri RK, Munshi AK. Fiber-reinforced Composite Resin Bridge: A Treatment Option in Children. Int J Clin Pediatr Dent 2015;8(1):62-65. PMID:26124584

  17. Bowen’s disease – a review of newer treatment options

    PubMed Central

    Neubert, Thorsten; Lehmann, Percy

    2008-01-01

    Bowen’s disease (squamous cell carcinoma in situ) has a 3%–5% risk to develop into invasive squamous cell carcinoma. Non-melanoma skin cancer is the most common cancer among Caucasians and its incidence has increased during the last decades dramatically. Multiple treatment options for Bowen’s disease have been described and are established with advantages and disadvantages. Bowen’s disease occurs more often in elderly patients (with a higher risk of comorbidities) and is frequently located on body sites with poor wound healing. Therefore there is need for non-invasive/non-destructive but effective treatment options. We would like to give an overview of established therapies and more detailed information about the newer treatment options for Bowen’s disease with topical diclofenac, topical imiquimod and photodynamic therapy. PMID:19209288

  18. Treatment options for low-level radiologically contaminated ORNL filtercake

    SciTech Connect

    Lee, Hom-Ti; Bostick, W.D.

    1996-04-01

    Water softening sludge (>4000 stored low level contaminated drums; 600 drums per year) generated by the ORNL Process Waste Treatment Plant must be treated, stabilized, and placed in safe storage/disposal. The sludge is primarily CaCO{sub 3} and is contaminated by low levels of {sup 90}Sr and {sup 137}Cs. In this study, microwave sintering and calcination were evaluated for treating the sludge. The microwave melting experiments showed promise: volume reductions were significant (3-5X), and the waste form was durable with glass additives (LiOH, fly ash). A commercial vendor using surrogate has demonstrated a melt mineralization process that yields a dense monolithic waste form with a volume reduction factor (VR) of 7.7. Calcination of the sludge at 850-900 C yielded a VR of 2.5. Compaction at 4500 psi increased the VR to 4.2, but the compressed form is not dimensionally stable. Addition of paraffin helped consolidate fines and yielded a VR of 3.5. In conclusion, microwave melting or another form of vitrification is likely to be the best method; however for immediate implementation, the calculation/compaction/waxing process is viable.

  19. Velaglucerase alfa: a new option for Gaucher disease treatment.

    PubMed

    Zimran, A

    2011-07-01

    Type 1 Gaucher disease (GD) results from inherited β-glucocerebrosidase gene mutations, leading to anemia, thrombocytopenia, splenomegaly, hepatomegaly and skeletal disease. Velaglucerase alfa is a β-glucocerebrosidase produced by gene activation in a human cell line, and indicated for type 1 GD. A phase I/II clinical trial (TKT025; N = 12), its ongoing extension (TKT025EXT) and three phase III trials (total N = 82), showed that velaglucerase alfa is generally well tolerated in adult and pediatric patients. Many disease-related parameters improved significantly in two phase III trials in treatment-naïve patients, and were successfully maintained in imiglucerase-experienced patients in a phase II/III switch study. Ten adults in TKT025EXT sustained improvements through 5 years, including bone mineral density. Comparison with imiglucerase shows that velaglucerase alfa is an effective, generally well-tolerated alternative enzyme replacement therapy. In vitro data suggest velaglucerase alfa may be internalized into cells more efficiently and have a lower rate of seroconversion. However, these results do not necessarily correlate with clinical efficacy. PMID:22013559

  20. Stem cells: An eventual treatment option for heart diseases.

    PubMed

    Bilgimol, Joseph C; Ragupathi, Subbareddy; Vengadassalapathy, Lakshmanan; Senthil, Nathan S; Selvakumar, Kalimuthu; Ganesan, M; Manjunath, Sadananda Rao

    2015-09-26

    Stem cells are of global excitement for various diseases including heart diseases. It is worth to understand the mechanism or role of stem cells in the treatment of heart failure. Bone marrow derived stem cells are commonly practiced with an aim to improve the function of the heart. The majority of studies have been conducted with acute myocardial infarction and a few has been investigated with the use of stem cells for treating chronic or dilated cardiomyopathy. Heterogeneity in the treated group using stem cells has greatly emerged. Ever increasing demand for any alternative made is of at most priority for cardiomyopathy. Stem cells are of top priority with the current impact that has generated among physicians. However, meticulous selection of proper source is required since redundancy is clearly evident with the present survey. This review focuses on the methods adopted using stem cells for heart diseases and outcomes that are generated so far with an idea to determine the best therapeutic possibility in order to fulfill the present demand.

  1. Treatment Options for Medulloblastoma and CNS Primitive Neuroectodermal Tumor (PNET)

    PubMed Central

    Packer, Roger J.

    2016-01-01

    The amount of residual disease after surgery better correlates with survival for medulloblastomas than for CNS PNETs. Maximal surgical resection of tumor should be done, only if additional permanent, neurologic deficits can be spared. Patients should have a staging work-up to assess the extent of disease. This includes postoperative magnetic resonance imaging (MRI) of the brain, MRI of the entire spine and lumbar cerebrospinal fluid (CSF) sampling for cytological examination, if deemed safe. Radiation therapy to the entire CNS axis is required, with a greater dose (boost) given to the region of the primary site or any bulky residual disease for older children. Adjuvant chemotherapy must be given even if no evidence of disease after radiation therapy exists, as the risk of relapse is substantial after radiation alone. Subsets of younger children with medulloblastoma, arbitrarily defined as those younger than 3 years of age in some studies and 4 or even 5 years in other studies, can be effectively treated with chemotherapy alone. Recent genomic studies have revealed further subtypes of disease than previously recognized. Clinical trials to exploit these biologic differences are required to assess potential efficacy of targeted agents. The treatment of medulloblastoma and CNS PNET can cause significant impairment in neurologic function. Evaluations by physical therapy, occupational therapy, speech therapy and neurocognitive assessments should be obtained, as needed. After therapy is completed, survivors need follow-up of endocrine function, surveillance scans and psychosocial support. PMID:23979905

  2. Tear trough deformity: different types of anatomy and treatment options

    PubMed Central

    Jiang, Jindou; Wang, Xuekun; Chen, Rongrong; Xia, Xueying; Sun, Sai

    2016-01-01

    Aim To explore the efficacy of tear trough deformity treatment with the use of hyaluronic acid gel or autologous fat for soft tissue augmentation and fat repositioning via arcus marginalis release. Material and methods Seventy-eight patients with the tear trough were divided into three groups. Class I has tear trough without bulging orbital fat or excess of the lower eyelid skin. Class II is associated with mild to moderate orbital fat bulging, without excess of the lower eyelid skin. Class III is associated with severe orbital fat bulging and excess of the lower eyelid skin. Class I or II was treated using hyaluronic acid gel or autologous fat injections. Class III was treated with fat repositioning via arcus marginalis release. The patients with a deep nasojugal groove of class III were treated with injecting autologous fat into the tear trough during fat repositioning lower blepharoplasty as a way of supplementing the volume added by the repositioned fat. Results Seventy-eight patients with tear trough deformity were confirmed from photographs taken before and after surgery. There were some complications, but all had complete resolution. Conclusions Patients with mild to moderate peri-orbital volume loss without severe orbital fat bulging may be good candidates for hyaluronic acid filler or fat grafting alone. However, patients with more pronounced deformities, severe orbital fat bulging and excess of the lower eyelid skin are often better served by fat repositioning via arcus marginalis release and fat grafting.

  3. Post-treatment management options for patients with lung cancer.

    PubMed Central

    Virgo, K S; McKirgan, L W; Caputo, M C; Mahurin, D M; Chao, L C; Caputo, N A; Naunheim, K S; Flye, M W; Gillespie, K N; Johnson, F E

    1995-01-01

    OBJECTIVES: The first objective was to identify variations in patient management practice patterns after potentially curative lung cancer surgery. Patient management practice patterns were expected to range from intensive follow-up to no active surveillance. The second objective was to measure whether intensity of follow-up was related to patient outcomes. METHODS: An 18-month retrospective analysis was conducted of 182 patients with low TNM stage (< or = IIIA) lung cancer who were surgically treated with curative intent over the 11-year period from 1982 through 1992 at the St. Louis Department of Veterans Affairs Medical Center. RESULTS: Patients were followed for a mean of 3.3 years, until death or the end of the study. Analyses of diagnostic test and outpatient visit frequency distributions and cluster analyses facilitated the identification of 62 nonintensively followed patients and 120 intensively followed patients. Both groups were comparable at baseline, and there were no significant differences in patient outcomes attributable to intensity of follow-up. Intensively followed patients did, however, live an average of 192 days longer than nonintensively followed patients. CONCLUSIONS: Significant variations in follow-up practice patterns can exist within a single health care facility. In this analysis, variations in test and visit frequency did not result in statistically significant differences in patient outcomes, though the survival difference between groups suggests that some benefit might exist. Only well-designed prospective trials are likely to answer the question of what constitutes optimal follow-up after potentially curative lung cancer treatment. PMID:8526576

  4. Acinetobacter baumannii: Evolution of Antimicrobial Resistance—Treatment Options

    PubMed Central

    Doi, Yohei; Murray, Gerald L.; Peleg, Anton Y.

    2015-01-01

    The first decade of the 20th century witnessed a surge in the incidence of infections due to several highly antimicrobial-resistant bacteria in hospitals worldwide. Acinetobacter baumannii is one such organism that turned from an occasional respiratory pathogen into a major nosocomial pathogen. An increasing number of A. baumannii genome sequences have broadened our understanding of the genetic makeup of these bacteria and highlighted the extent of horizontal transfer of DNA. Animal models of disease combined with bacterial mutagenesis have provided some valuable insights into mechanisms of A. baumannii pathogenesis. Bacterial factors known to be important for disease include outer membrane porins, surface structures including capsule and lipopolysaccharide, enzymes such as phospholipase D, iron acquisition systems, and regulatory proteins. A. baumannii has a propensity to accumulate resistance to various groups of antimicrobial agents. In particular, carbapenem resistance has become commonplace, accounting for the majority of A. baumannii strains in many hospitals today. Carbapenem-resistant strains are often resistant to all other routinely tested agents. Treatment of carbapenem-resistant A. baumannii infection therefore involves the use of combinations of last resort agents such as colistin and tigecycline, but the efficacy and safety of these approaches are yet to be defined. Antimicrobial-resistant A. baumannii has high potential to spread among ill patients in intensive care units. Early recognition and timely implementation of appropriate infection control measures is crucial in preventing outbreaks. PMID:25643273

  5. The Impact of Neoadjuvant Treatment on Surgical Options and Outcomes.

    PubMed

    Ataseven, Beyhan; von Minckwitz, Gunter

    2016-10-01

    Neoadjuvant systemic therapy (NST) has become a well-established treatment method for patients with breast cancer, not only for those with large tumors, but also for patients with early high-risk cancers. In earlier times, the clinical advantage of NST was seen in improvement of tumor shrinkage for better operability, conversion of mastectomy candidates to breast conservation, and optimization of cosmetic results. Over the decades, therapy regimens were optimized, resulting in significantly higher response rates. Rates for breast conservation and for conversion from mastectomy to breast conservation, especially for patients with advanced breast cancers, rose significantly for patients undergoing NST. A multidisciplinary approach with close and accurate diagnostic assessment of the breast, axillary tumor, or both during NST and individual-response-guided surgery is mandatory. To reduce unnecessary surgery and prevent mastectomies, more conclusive prediction models and minimally invasive methods for selection of patients with pathologic complete remission after NST are needed. Furthermore, prospective studies demonstrate that sentinel node biopsy for patients with initial clinically node-positive axillary nodes converting to clinically node-negative axillary nodes is oncologically safe and offers less morbidity, avoiding complete axillary node dissection. Initial concerns regarding surgical complications and morbidity due to potential immune frailty of patients with NST were not observed. PMID:27364505

  6. Severe alcoholic hepatitis-current concepts, diagnosis and treatment options

    PubMed Central

    Kim, Won; Kim, Dong Joon

    2014-01-01

    Alcoholic hepatitis (AH) is an acute hepatic manifestation occurring from heavy alcohol ingestion. Alcoholic steatohepatitis (ASH) is histologically characterized by steatosis, inflammation, and fibrosis in the liver. Despite the wide range of severity at presentation, those with severe ASH (Maddrey’s discriminant function ≥ 32) typically present with fever, jaundice, and abdominal tenderness. Alcohol abstinence is the cornerstone of therapy for AH and, in the milder forms, is sufficient for clinical recovery. Severe ASH may progress to multi-organ failure including acute kidney injury and infection. Thus, infection and renal failure have a major impact on survival and should be closely monitored in patients with severe ASH. Patients with severe ASH have a reported short-term mortality of up to 40%-50%. Severe ASH at risk of early death should be identified by one of the available prognostic scoring systems before considering specific therapies. Corticosteroids are the mainstay of treatment for severe ASH. When corticosteroids are contraindicated, pentoxifylline may be alternatively used. Responsiveness to steroids should be assessed at day 7 and stopping rules based on Lille score should come into action. Strategically, future studies for patients with severe ASH should focus on suppressing inflammation based on cytokine profiles, balancing hepatocellular death and regeneration, limiting activation of the innate immune response, and maintaining gut mucosal integrity. PMID:25349640

  7. Mitochondrial myopathies: diagnosis, exercise intolerance, and treatment options.

    PubMed

    Tarnopolsky, Mark A; Raha, Sandeep

    2005-12-01

    Mitochondrial myopathies are caused by genetic mutations that directly influence the functioning of the electron transport chain (ETC). It is estimated that 1 of 8,000 people have pathology inducing mutations affecting mitochondrial function. Diagnosis often requires a multifaceted approach with measurements of serum lactate and pyruvate, urine organic acids, magnetic resonance spectroscopy (MRS), muscle histology and ultrastructure, enzymology, genetic analysis, and exercise testing. The ubiquitous distribution of the mitochondria in the human body explains the multiple organ involvement. Exercise intolerance is a common but often an overlooked hallmark of mitochondrial myopathies. The muscle consequences of ETC dysfunction include increased reliance on anaerobic metabolism (lactate generation, phosphocreatine degradation), enhanced free radical production, reduced oxygen extraction and electron flux through ETC, and mitochondrial proliferation or biogenesis (see article by Hood in current issue). Treatments have included antioxidants (vitamin E, alpha lipoic acid), electron donors and acceptors (coenzyme Q10, riboflavin), alternative energy sources (creatine monohydrate), lactate reduction strategies (dichloroacetate) and exercise training. Exercise is a particularly important modality in diagnosis as well as therapy (see article by Taivassalo in current issue). Increased awareness of these disorders by exercise physiologists and sports medicine practitioners should lead to more accurate and more rapid diagnosis and the opportunity for therapy and genetic counseling. PMID:16331134

  8. Tear trough deformity: different types of anatomy and treatment options

    PubMed Central

    Jiang, Jindou; Wang, Xuekun; Chen, Rongrong; Xia, Xueying; Sun, Sai

    2016-01-01

    Aim To explore the efficacy of tear trough deformity treatment with the use of hyaluronic acid gel or autologous fat for soft tissue augmentation and fat repositioning via arcus marginalis release. Material and methods Seventy-eight patients with the tear trough were divided into three groups. Class I has tear trough without bulging orbital fat or excess of the lower eyelid skin. Class II is associated with mild to moderate orbital fat bulging, without excess of the lower eyelid skin. Class III is associated with severe orbital fat bulging and excess of the lower eyelid skin. Class I or II was treated using hyaluronic acid gel or autologous fat injections. Class III was treated with fat repositioning via arcus marginalis release. The patients with a deep nasojugal groove of class III were treated with injecting autologous fat into the tear trough during fat repositioning lower blepharoplasty as a way of supplementing the volume added by the repositioned fat. Results Seventy-eight patients with tear trough deformity were confirmed from photographs taken before and after surgery. There were some complications, but all had complete resolution. Conclusions Patients with mild to moderate peri-orbital volume loss without severe orbital fat bulging may be good candidates for hyaluronic acid filler or fat grafting alone. However, patients with more pronounced deformities, severe orbital fat bulging and excess of the lower eyelid skin are often better served by fat repositioning via arcus marginalis release and fat grafting. PMID:27605904

  9. Hand dermatitis--differential diagnoses, diagnostics, and treatment options.

    PubMed

    Mahler, Vera

    2016-01-01

    The pathogenesis of hand dermatitis is multifactorial, and includes factors such as genetic predisposition and exposure. A high incidence rate is associated with female gender, contact allergy, atopic dermatitis, and wet work. The most important risk factors for the persistence of hand dermatitis include its extent, contact allergic or atopic etiology, childhood dermatitis, and early onset (before the age of 20). The cost of illness of hand dermatitis corresponds to this seen in moderate to severe psoriasis. The diagnostic workup of hand dermatitis and its differential diagnoses requires a detailed assessment of occupational and recreational exposure. In case of possible work-related triggers, early notification of the accident insurer should be sought (via the dermatologist's report). Exposure to a contact allergen is a contributing factor in one-half of all cases of hand dermatitis. It is therefore imperative that all patients with hand dermatitis persisting for more than three months undergo patch testing. Successful and sustainable treatment of hand dermatitis starts with the proper identification and elimination of individual triggers, including the substitution of identified contact allergens and irritants, as well as optimizing preventive measures. Graded therapy taking the clinical severity into account is essential. Validated instruments may be used to monitor therapeutic efficacy.

  10. Acinetobacter baumannii: evolution of antimicrobial resistance-treatment options.

    PubMed

    Doi, Yohei; Murray, Gerald L; Peleg, Anton Y

    2015-02-01

    The first decade of the 20th century witnessed a surge in the incidence of infections due to several highly antimicrobial-resistant bacteria in hospitals worldwide. Acinetobacter baumannii is one such organism that turned from an occasional respiratory pathogen into a major nosocomial pathogen. An increasing number of A. baumannii genome sequences have broadened our understanding of the genetic makeup of these bacteria and highlighted the extent of horizontal transfer of DNA. Animal models of disease combined with bacterial mutagenesis have provided some valuable insights into mechanisms of A. baumannii pathogenesis. Bacterial factors known to be important for disease include outer membrane porins, surface structures including capsule and lipopolysaccharide, enzymes such as phospholipase D, iron acquisition systems, and regulatory proteins. A. baumannii has a propensity to accumulate resistance to various groups of antimicrobial agents. In particular, carbapenem resistance has become commonplace, accounting for the majority of A. baumannii strains in many hospitals today. Carbapenem-resistant strains are often resistant to all other routinely tested agents. Treatment of carbapenem-resistant A. baumannii infection therefore involves the use of combinations of last resort agents such as colistin and tigecycline, but the efficacy and safety of these approaches are yet to be defined. Antimicrobial-resistant A. baumannii has high potential to spread among ill patients in intensive care units. Early recognition and timely implementation of appropriate infection control measures is crucial in preventing outbreaks. PMID:25643273

  11. Pharmacotherapy Treatment Options for Insomnia: A Primer for Clinicians

    PubMed Central

    Asnis, Gregory M.; Thomas, Manju; Henderson, Margaret A.

    2015-01-01

    Insomnia is a prevalent disorder with deleterious effects such as decreased quality of life, and a predisposition to a number of psychiatric disorders. Fortunately, numerous approved hypnotic treatments are available. This report reviews the state of the art of pharmacotherapy with a reference to cognitive behavioral therapy for insomnia (CBT-I) as well. It provides the clinician with a guide to all the Food and Drug Administration (FDA) approved hypnotics (benzodiazepines, nonbenzodiazepines, ramelteon, low dose sinequan, and suvorexant) including potential side effects. Frequently, chronic insomnia lasts longer than 2 years. Cognizant of this and as a result of longer-term studies, the FDA has approved all hypnotics since 2005 without restricting the duration of use. Our manuscript also reviews off-label hypnotics (sedating antidepressants, atypical antipsychotics, anticonvulsants and antihistamines) which in reality, are more often prescribed than approved hypnotics. The choice of which hypnotic to choose is discussed partially being based on which segment of sleep is disturbed and whether co-morbid illnesses exist. Lastly, we discuss recent label changes required by the FDA inserting a warning about “sleep-related complex behaviors”, e.g., sleep-driving for all hypnotics. In addition, we discuss FDA mandated dose reductions for most zolpidem preparations in women due to high zolpidem levels in the morning hours potentially causing daytime carry-over effects. PMID:26729104

  12. Various treatment options for benign prostatic hyperplasia: A current update

    PubMed Central

    Shrivastava, Alankar; Gupta, Vipin B.

    2012-01-01

    In benign prostatic hyperplasia (BPH) there will be a sudden impact on overall quality of life of patient. This disease occurs normally at the age of 40 or above and also is associated with sexual dysfunction. Thus, there is a need of update on current medications of this disease. The presented review provides information on medications available for BPH. Phytotherapies with some improvements in BPH are also included. Relevant articles were identified through a search of the English-language literature indexed on MEDLINE, PUBMED, Sciencedirect and the proceedings of scientific meetings. The search terms were BPH, medications for BPH, drugs for BPH, combination therapies for BPH, Phytotherapies for BPH, Ayurveda and BPH, BPH treatments in Ayurveda. Medications including watchful waitings, Alpha one adrenoreceptor blockers, 5-alpha reductase inhibitors, combination therapies including tamsulosin-dutasteride, doxazosin-finasteride, terazosin-finasteride, tolterodine-tamsulosin and rofecoxib-finasteride were found. Herbal remedies such as Cernilton, Saxifraga stolonifera, Zi-Shen Pill (ZSP), Orbignya speciosa, Phellodendron amurense, Ganoderma lucidum, Serenoa Repens, pumpkin extract and Lepidium meyenii (Red Maca) have some improvements on BPH are included. Other than these discussions on Ayurvedic medications, TURP and minimally invasive therapies (MITs) are also included. Recent advancements in terms of newly synthesized molecules are also discussed. Specific alpha one adrenoreceptor blockers such as tamsulosin and alfuzosin will remain preferred choice of urologists for symptom relief. Medications with combination therapies are still needs more investigation to establish as preference in initial stage for fast symptom relief reduced prostate growth and obviously reduce need for BPH-related surgery. Due to lack of proper evidence Phytotherapies are not gaining much advantage. MITs and TURP are expensive and are rarely supported by healthcare systems. PMID:22923974

  13. Various treatment options for benign prostatic hyperplasia: A current update.

    PubMed

    Shrivastava, Alankar; Gupta, Vipin B

    2012-01-01

    In benign prostatic hyperplasia (BPH) there will be a sudden impact on overall quality of life of patient. This disease occurs normally at the age of 40 or above and also is associated with sexual dysfunction. Thus, there is a need of update on current medications of this disease. The presented review provides information on medications available for BPH. Phytotherapies with some improvements in BPH are also included. Relevant articles were identified through a search of the English-language literature indexed on MEDLINE, PUBMED, Sciencedirect and the proceedings of scientific meetings. The search terms were BPH, medications for BPH, drugs for BPH, combination therapies for BPH, Phytotherapies for BPH, Ayurveda and BPH, BPH treatments in Ayurveda. Medications including watchful waitings, Alpha one adrenoreceptor blockers, 5-alpha reductase inhibitors, combination therapies including tamsulosin-dutasteride, doxazosin-finasteride, terazosin-finasteride, tolterodine-tamsulosin and rofecoxib-finasteride were found. Herbal remedies such as Cernilton, Saxifraga stolonifera, Zi-Shen Pill (ZSP), Orbignya speciosa, Phellodendron amurense, Ganoderma lucidum, Serenoa Repens, pumpkin extract and Lepidium meyenii (Red Maca) have some improvements on BPH are included. Other than these discussions on Ayurvedic medications, TURP and minimally invasive therapies (MITs) are also included. Recent advancements in terms of newly synthesized molecules are also discussed. Specific alpha one adrenoreceptor blockers such as tamsulosin and alfuzosin will remain preferred choice of urologists for symptom relief. Medications with combination therapies are still needs more investigation to establish as preference in initial stage for fast symptom relief reduced prostate growth and obviously reduce need for BPH-related surgery. Due to lack of proper evidence Phytotherapies are not gaining much advantage. MITs and TURP are expensive and are rarely supported by healthcare systems. PMID:22923974

  14. Therapeutical options for the treatment of Cheyne-Stokes respiration.

    PubMed

    Randerath, Winfried J

    2009-03-01

    The awareness of Cheyne-Stokes respiration (CSR) and of the co-existence of the obstructive sleep apnoea syndrome and central breathing disturbances has rapidly grown in recent years. CSR is defined by a waxing and waning pattern of the breathing amplitude. Sleep related breathing disorders in patients with heart failure are associated with impaired clinical outcome and survival. While continuous positive airway pressure treatment (CPAP) is widely used to treat CSR, it has failed to improve overall survival of heart failure patients. Nevertheless, it has been shown that CPAP reduces mortality if breathing disturbances were sufficiently eliminated. Therefore, optimal suppression of CSR is critical. While CPAP reduces CSR by 50% on average, adaptive servoventilation (ASV) normalises CSR in most patients. ASV devices apply different levels of pressure support: during periods of hypoventilation the inspiratory pressure is increased while it is reduced to the lowest possible level during hyperventilation. The devices deliver an expiratory pressure to overcome upper airways obstruction. Pressure support is defined by the difference between expiratory and inspiratory pressure. Thus, while pressure support is fixed in bilevel devices, it varies under ASV. However, the hypothesis that ASV might improve survival in CSR patients has to be proved in prospective studies in CPAP nonresponders. There is a lack of evidence on the use of bilevel devices in CSR. However, ASV has proven both to effectively treat CSR and to be superior to CPAP in respiratory and sleep parameters in short term and medium term studies. Nevertheless, data on the long term use and the influence on cardiac parameters are necessary.

  15. Unmet needs of patients with narcolepsy: perspectives on emerging treatment options

    PubMed Central

    Wozniak, Dariusz R; Quinnell, Timothy G

    2015-01-01

    The treatment options currently available for narcolepsy are often unsatisfactory due to suboptimal efficacy, troublesome side effects, development of drug tolerance, and inconvenience. Our understanding of the neurobiology of narcolepsy has greatly improved over the last decade. This knowledge has not yet translated into additional therapeutic options for patients, but progress is being made. Some compounds, such as histaminergic H3 receptor antagonists, may prove useful in symptom control of narcolepsy. The prospect of finding a cure still seems distant, but hypocretin replacement therapy offers some promise. In this narrative review, we describe these developments and others which may yield more effective narcolepsy treatments in the future. PMID:26045680

  16. Culturally-Competent Treatments for Asian Americans: The Relevance of Mindfulness and Acceptance-Based Psychotherapies

    PubMed Central

    Nagayama Hall, Gordon C.; Hong, Janie J.; Zane, Nolan W. S.; Meyer, Oanh L.

    2011-01-01

    The development of effective treatments for Asian Americans is important because treatment disparities continue to exist for this population. Because of their theoretical grounding in East Asian philosophies, mindfulness and acceptance-based psychotherapies appear to constitute promising ways to provide culturally responsive mental health care to Asian Americans. However, in practice these approaches often reflect conceptions of mental health that are more consistent with Western world views. We review points of intersection and divergence between Western-based mindfulness and acceptance psychotherapies and Asian American cultural values. We then propose a culturally syntonic approach that accentuates certain components of mindfulness and acceptance psychotherapies and adapts other components of these approaches to be more consistent with Asian American cultural values. PMID:22065893

  17. A Preliminary Investigation of Acceptance and Commitment Therapy as a Treatment for Marijuana Dependence in Adults

    ERIC Educational Resources Information Center

    Twohig, Michael P.; Shoenberger, Deacon; Hayes, Steven C.

    2007-01-01

    In this investigation, 3 adults who met criteria for marijuana dependence were treated using an abbreviated version of acceptance and commitment therapy (ACT). The treatment was delivered in eight weekly 90-min individual sessions. The effects of the intervention were assessed using a nonconcurrent multiple baseline across participants design.…

  18. Acceptance and Values-Based Action in Chronic Pain: A Study of Treatment Effectiveness and Process

    ERIC Educational Resources Information Center

    Vowles, Kevin E.; McCracken, Lance M.

    2008-01-01

    Developing approaches within cognitive behavioral therapy are increasingly process-oriented and based on a functional and contextual framework that differs from the focus of earlier work. The present study investigated the effectiveness of acceptance and commitment therapy (S. C. Hayes, K. Strosahl, & K. G. Wilson, 1999) in the treatment of…

  19. Using Acceptance and Commitment Therapy during Methadone Dose Reduction: Rationale, Treatment Description, and a Case Report

    ERIC Educational Resources Information Center

    Stotts, Angela L.; Masuda, Akihiko; Wilson, Kelly

    2009-01-01

    Many clients who undergo methadone maintenance (MM) treatment for heroin and other opiate dependence prefer abstinence from methadone. Attempts at methadone detoxification are often unsuccessful, however, due to distressing physical as well as psychological symptoms. Outcomes from an MM client who voluntarily participated in an Acceptance and…

  20. Children with Developmental Disabilities and Sleep Problems: Parental Beliefs and Treatment Acceptability

    ERIC Educational Resources Information Center

    Keenan, Ruth A.; Wild, Matt R.; McArthur, Irene; Espie, Colin A.

    2007-01-01

    Background: This exploratory study investigated the relationships between illness beliefs and treatment acceptability among parents of children with a developmental disability living at home who had sleep onset or maintenance problems. Materials and Methods: A within-subject correlational design was employed. The parents of 58 children each…

  1. Assessing Treatment Integrity in Acceptance and Commitment Therapy: Strategies and Suggestions

    ERIC Educational Resources Information Center

    Plumb, Jennifer C.; Vilardaga, Roger

    2010-01-01

    In this paper, we briefly review the current literature on treatment integrity and discuss the relevance of this procedure for detecting, measuring and ensuring that the proposed mechanisms of change in cognitive behavior therapy, in this case of acceptance and commitment therapy (ACT; S.C. Hayes, Strosahl, & Wilson, 1999), take place. We discuss…

  2. Acceptance and Commitment Therapy in the Treatment of Posttraumatic Stress Disorder

    ERIC Educational Resources Information Center

    Orsillo, Susan M.; Batten, Sonja V.

    2005-01-01

    The current article describes the application of a behavioral psychotherapy, acceptance and commitment therapy (ACT), to the treatment of post-traumatic stress disorder (PTSD). It is argued that PTSD can be conceptualized as a disorder that is developed and maintained in traumatized individuals as a result of excessive, ineffective attempts to…

  3. Efficacy and environmental acceptability of two ballast water treatment chemicals and an alkylamine based-biocide.

    PubMed

    La Carbona, Stéphanie; Viitasalo-Frösen, Satu; Masson, Daniel; Sassi, Jukka; Pineau, Samuel; Lehtiniemi, Maiju; Corroler, David

    2010-12-15

    Ship's ballast waters transport large numbers of organisms which may become invasive in coastal regions. One option to address this problem is the use of biocides as ballast water treatment (BWT). Efficacy and environmental acceptability of three commercial active substances (the BWT biocides Peraclean(®) Ocean and Seakleen(®), and alkylamine-based biocide Mexel(®) 432/336) were tested against three bacteria species, two vegetative microalgae and one zooplanktonic larva, in 10 and 30 Practical Salinity Unit (PSU) waters. In both salinities, PeraClean(®) Ocean was the most effective biocide against bacteria causing >90% mortality at 20mg/l, compared with 50mg/l for Mexel(®) 432/336 and >500 mg/l for Seakleen(®). Regarding zooplankton, Seakleen(®) was the most effective chemical causing 90% mortality in 24h at concentrations <6 mg/l (LC90(24h)) in both salinities, compared with 23 and 26 mg/l for Mexel(®) 432/336 and 370 and 480 mg/l for PeraClean(®) Ocean in 10 and 30 PSU, respectively. Similar pattern of efficacy was obtained for microalgae in 30 PSU: effective concentrations inducing 50% growth inhibition in 4 days were ≤ 1.6 mg/l for Seakleen(®), ≤ 10.1mg/l for Mexel(®) 432/336 and ≤ 30.9 mg/l for PeraClean(®) Ocean. Our work highlighted that treated waters displayed residual toxicity after 24h still inducing mortality depending on the organism and biocide. However Mexel(®) 432/336 is the only biocide which had no impact on oyster larvae development at effective concentration. Altogether our data showed that Mexel(®) 432/336 was the only biocide displaying a broad spectrum efficacy in concentrations <50mg/l and not toxic for oyster larvae development at this concentration. However residual toxicity of treated waters for any organism should be taken into account in BWT systems utilising biocides. PMID:21056457

  4. Benign prostatic hyperplasia and new treatment options – a critical appraisal of the UroLift system

    PubMed Central

    McNicholas, Thomas Anthony

    2016-01-01

    The prostatic urethral lift procedure, more commonly known as UroLift, has been designed to improve male lower urinary tract symptoms while avoiding the complications and disadvantages of existing drug and surgical therapies. In particular, UroLift does not damage ejaculatory function or affect orgasmic sensation. It appears an option for men who wish to avoid long-term drug therapy, the side effects of drugs or surgery and who do not need or will not accept traditional surgical treatments. UroLift was introduced following a series of planned studies that led to US Food and Drug Administration approval in September 2013. UroLift has recently been approved by the UK National Institute for Clinical and Health Excellence (September 2015) as effective and safe and cost-effective for use in the UK health system. This review describes the device and the procedure and the evidence base that has led to those approvals. PMID:27274321

  5. Treatment Options for the Cardinal Symptoms of Disruptive Mood Dysregulation Disorder

    PubMed Central

    Tourian, Leon; LeBoeuf, Amélie; Breton, Jean-Jacques; Cohen, David; Gignac, Martin; Labelle, Réal; Guile, Jean-Marc; Renaud, Johanne

    2015-01-01

    Objective: DSM-5 has added a new developmentally appropriate child and adolescent mood disorder subtype called disruptive mood dysregulation disorder (DMDD). The core features of DMDD are temper outbursts (manifested by either verbal rages and/or physical aggression) and unrelenting irritability or anger. Currently, the literature is lacking a thorough review of the possible treatment options for the cardinal symptoms constituting DMDD. The objective of this article is to provide a thorough review of peer-reviewed studies on the subject of pharmacological treatment options for children and adolescents with the cardinal symptoms of DMDD. Methods: Relevant articles for this study were obtained through Pubmed, Medline, PsychINFO and PsychINDEXplus using the key words: “adolescents,” “children,” “paediatric,” “youth,” “irritability,” “temper outbursts,” “aggression,” “rage,” “disruptive behaviour,” “treatment,” “dysphoria,” “autism,” “mental retardation/intellectual disability,” “impulsivity,” “ADHD,” “oppositional defiant disorder,” and “conduct disorder.” A total of 823 studies were generated; only English studies focusing on pharmacological treatment were retained. Results: Currently there are no established guidelines or thorough reviews summarizing the treatment of DMDD. Pharmacotherapeutic treatment options of both aggression and chronic irritability include: antidepressants/selective norepinephrine reuptake inhibitors, mood stabilizers, psychostimulants, antipsychotics, and alpha-2 agonists. Conclusion: Treatment options of severe, persistent irritability in youth are numerous, and a consensual treatment algorithm has not yet emerged from the literature. Further studies and clinical trials are warranted to determine efficacious and safe treatment modalities. PMID:26336379

  6. Parkinson's Disease and Its Management: Part 3: Nondopaminergic and Nonpharmacological Treatment Options.

    PubMed

    DeMaagd, George; Philip, Ashok

    2015-10-01

    This installment of a five-part series reviews the role of nondopaminergic pharmacotherapies and adjunctive options-such as monoamine oxidase type B inhibitors, catechol-O-methyltransferase inhibitors, and anticholinergic agents-in managing Parkinson's disease. Nonpharmacological treatments are also explored. PMID:26535023

  7. The assessment of and treatment options for the buried maxillary canine.

    PubMed

    McSherry, P F

    1996-01-01

    Impaction of the upper permanent canine is almost as common as impaction of the third molar. The likelihood of being able to align one of these teeth with the rest of the dentition depends on a number of factors, and several treatment options are available. PMID:8948215

  8. Peripheral Nerve Regeneration – an Appraisal of the Current Treatment Options

    PubMed Central

    CINTEZA, Dragos; PERSINARU, Iulia; MACIUCEANU ZARNESCU, Bogdan Mircea; IONESCU, Dan; LASCAR, Ioan

    2015-01-01

    During the last decades significant progress was made in the understanding of the physiopathology of the peripheral nerve regeneration. Although the evolution of therapy is not as spectacular, a series of new treatment solutions were developed. The gold standard in therapy remains the use of autografts. We present the current concepts and therapeutic options available. PMID:26225155

  9. The assessment of and treatment options for the buried maxillary canine.

    PubMed

    McSherry, P F

    1996-01-01

    Impaction of the upper permanent canine is almost as common as impaction of the third molar. The likelihood of being able to align one of these teeth with the rest of the dentition depends on a number of factors, and several treatment options are available.

  10. Experiential acceptance, motivation for recovery, and treatment outcome in eating disorders

    PubMed Central

    Espel, Hallie M.; Goldstein, Stephanie P.; Manasse, Stephanie M.; Juarascio, Adrienne S.

    2016-01-01

    Purpose This study sought to test whether the relationship between experiential acceptance (EA) and treatment outcome among eating disorder (ED) patients was mediated by motivation. Methods Upon admission to a residential ED treatment facility, female patients completed measures of EA, motivation, and baseline ED symptom severity (covariate); symptom severity was reassessed at discharge. Results Higher levels of baseline EA predicted significantly greater symptom reduction during treatment. Moreover, results from bootstrapped mediation analyses indicated that the relationship between EA and treatment outcome was partially mediated by motivation: increased EA was associated with greater motivation to give up ED behaviors at the beginning of treatment, and this led to greater symptom reduction from admission to discharge. Conclusions Motivation appears to be one mechanism by which EA facilitates improved treatment outcomes in EDs. Further development of interventions that promote EA as a means for improving motivation and subsequent ED treatment response may be warranted. PMID:26511501

  11. Update on neuropathic pain treatment for trigeminal neuralgia. The pharmacological and surgical options.

    PubMed

    Al-Quliti, Khalid W

    2015-04-01

    Trigeminal neuralgia is a syndrome of unilateral, paroxysmal, stabbing facial pain, originating from the trigeminal nerve. Careful history of typical symptoms is crucial for diagnosis. Most cases are caused by vascular compression of the trigeminal root adjacent to the pons leading to focal demyelination and ephaptic axonal transmission. Brain imaging is required to exclude secondary causes. Many medical and surgical treatments are available. Most patients respond well to pharmacotherapy; carbamazepine and oxcarbazepine are first line therapy, while lamotrigine and baclofen are considered second line treatments. Other drugs such as topiramate, levetiracetam, gabapentin, pregabalin, and botulinum toxin-A are alternative treatments. Surgical options are available if medications are no longer effective or tolerated. Microvascular decompression, gamma knife radiosurgery, and percutaneous rhizotomies are most promising surgical alternatives. This paper reviews the medical and surgical therapeutic options for the treatment of trigeminal neuralgia, based on available evidence and guidelines.

  12. Bilateral and recurrent myositis ossificans in an athlete: a case report and review of treatment options.

    PubMed

    Miller, Alan E; Davis, Brian A; Beckley, Olawunmi A

    2006-02-01

    An unusual case of recurrent myositis ossificans (MO) bilaterally in the hamstring muscles of a 47-year-old athlete secondary to trauma is presented with a review of the literature of current treatment options. MO is a common condition that occurs among athletes in association with muscle and/or tendon strain or contusion. After an extensive literature review, we believe this to be the first case reported of recurrent and bilateral MO in a nonsurgical setting from recurrent hamstring strains. Plain radiographs and physical examination revealed the appearance and chronology of this pathology. Treatment options to improve flexibility and decrease morbidity are discussed along with prophylaxis for future injury. Treatment of mobility and flexibility, rehabilitation goals and treatment with nonsteroidal anti-inflammatory drugs, bisphosphonates, and magnesium are discussed along with prophylaxis.

  13. Current management of fecal incontinence: Choosing amongst treatment options to optimize outcomes

    PubMed Central

    Van Koughnett, Julie Ann M; Wexner, Steven D

    2013-01-01

    The severity of fecal incontinence widely varies and can have dramatic devastating impacts on a person’s life. Fecal incontinence is common, though it is often under-reported by patients. In addition to standard treatment options, new treatments have been developed during the past decade to attempt to effectively treat fecal incontinence with minimal morbidity. Non-operative treatments include dietary modifications, medications, and biofeedback therapy. Currently used surgical treatments include repair (sphincteroplasty), stimulation (sacral nerve stimulation or posterior tibial nerve stimulation), replacement (artificial bowel sphincter or muscle transposition) and diversion (stoma formation). Newer augmentation treatments such as radiofrequency energy delivery and injectable materials, are minimally invasive tools that may be good options before proceeding to surgery in some patients with mild fecal incontinence. In general, more invasive surgical treatments are now reserved for moderate to severe fecal incontinence. Functional and quality of life related outcomes, as well as potential complications of the treatment must be considered and the treatment of fecal incontinence must be individualized to the patient. General indications, techniques, and outcomes profiles for the various treatments of fecal incontinence are discussed in detail. Choosing the most effective treatment for the individual patient is essential to achieve optimal outcomes in the treatment of fecal incontinence. PMID:24409050

  14. Decision-Making in Prostate Cancer: Active Surveillance Over Other Treatment Options.

    PubMed

    Bayliss, David; Duff, Jed; Stricker, Phil; Walker, Kim

    2016-01-01

    A qualitative-descriptive study of four patients with prostate cancer used the Cognitive-Social Health Information Processing framework to understand how and why men diagnosed with prostate cancer choose active surveillance over other treatment options. In accordance with the literature, it was found that the surgeon or general practitioner's recommendation was the most influential factor when patients are making a treatment decision. PMID:27501595

  15. The efficacy and tolerability of pharmacologic treatment options for Lennox-Gastaut syndrome.

    PubMed

    Montouris, Georgia D; Wheless, James W; Glauser, Tracy A

    2014-09-01

    Lennox-Gastaut syndrome (LGS) is a severe epileptic encephalopathy that appears in childhood. LGS is characterized by a slow spike-wave pattern on electroencephalogram (EEG), cognitive impairment, and multiple seizure types. This mixture of seizure types, along with the need to use more than one type of medication, makes LGS one of the most complicated epilepsies to treat successfully. Recent developments in approved therapies for the treatment of LGS offer physicians more options, but also make developing a treatment strategy that minimizes adverse events more challenging. There are currently 5 treatment options for LGS: felbamate, lamotrigine, topiramate, rufinamide, and clobazam, and several others that are used off-label, each of which has benefits and limitations. There are several factors that must be considered when determining which medication to use when treating patients with LGS, including efficacy, which is assessed by seizure frequency, tolerability, and the anticipated duration of treatment. In this article, data supporting current treatment options are discussed, and important considerations about the treatment of LGS are reviewed. PMID:25284033

  16. The efficacy and tolerability of pharmacologic treatment options for Lennox-Gastaut syndrome.

    PubMed

    Montouris, Georgia D; Wheless, James W; Glauser, Tracy A

    2014-09-01

    Lennox-Gastaut syndrome (LGS) is a severe epileptic encephalopathy that appears in childhood. LGS is characterized by a slow spike-wave pattern on electroencephalogram (EEG), cognitive impairment, and multiple seizure types. This mixture of seizure types, along with the need to use more than one type of medication, makes LGS one of the most complicated epilepsies to treat successfully. Recent developments in approved therapies for the treatment of LGS offer physicians more options, but also make developing a treatment strategy that minimizes adverse events more challenging. There are currently 5 treatment options for LGS: felbamate, lamotrigine, topiramate, rufinamide, and clobazam, and several others that are used off-label, each of which has benefits and limitations. There are several factors that must be considered when determining which medication to use when treating patients with LGS, including efficacy, which is assessed by seizure frequency, tolerability, and the anticipated duration of treatment. In this article, data supporting current treatment options are discussed, and important considerations about the treatment of LGS are reviewed.

  17. State of the art psychopharmacological treatment options in seasonal affective disorder.

    PubMed

    Yildiz, Mesut; Batmaz, Sedat; Songur, Emrah; Oral, Esat Timuçin

    2016-03-01

    Seasonal affective disorder (SAD) is defined as a subtype of mood disorders in DSM 5, and it is characterized by a seasonal onset. SAD is proposed to be related to the seasonal changes in naturally occurring light, and the use of bright light therapy for depressive symptoms has been shown to reduce them in placebo controlled trials. Cognitive behavioral therapy has also been demonstrated to be effective in SAD. This review article aims to focus on the psychopharmacological treatment options for SAD. According to clinical trial results, first line treatment options seem to be sertraline and fluoxetine, and are well tolerated by the patients. There is some evidence that other antidepressants (e.g. bupropion) might be effective as well. Although clinical trials have shown that some of these antidepressants may be of benefit, a recent review has concluded that there is not enough evidence to support the use of any of these agents for the treatment of SAD yet. Moreover, more studies are still needed to evaluate the effectiveness of other treatment options, e.g., propranolol, melatonin, hypericum, etc. In addition to the above proposed treatments, patients with seasonal depressive symptoms should thoroughly be evaluated for any cues of bipolarity, and their treatment should be planned accordingly.

  18. Non-pharmacological treatment options for refractory epilepsy: an overview of human treatment modalities and their potential utility in dogs.

    PubMed

    Martlé, Valentine; Van Ham, Luc; Raedt, Robrecht; Vonck, Kristl; Boon, Paul; Bhatti, Sofie

    2014-03-01

    Refractory epilepsy is a common disorder both in humans and dogs and treatment protocols are difficult to optimise. In humans, different non-pharmacological treatment modalities currently available include surgery, the ketogenic diet and neurostimulation. Surgery leads to freedom from seizures in 50-75% of patients, but requires strict patient selection. The ketogenic diet is indicated in severe childhood epilepsies, but efficacy is limited and long-term compliance can be problematic. In the past decade, various types of neurostimulation have emerged as promising treatment modalities for humans with refractory epilepsy. Currently, none of these treatment options are used in routine daily clinical practice to treat dogs with the condition. Since many dogs with poorly controlled seizures do not survive, the search for alternative treatment options for canine refractory epilepsy should be prioritised. This review provides an overview of non-pharmacological treatment options for human refractory epilepsy. The current knowledge and limitations of these treatments in canine refractory epilepsy is also discussed.

  19. Acceptability and feasibility of a mobile phone-based case management intervention to retain mothers and infants from an Option B+ program in postpartum HIV care

    PubMed Central

    SCHWARTZ, Sheree R; CLOUSE, Kate; YENDE, Nompumelelo; VAN RIE, Annelies; BASSETT, Jean; RATSHEFOLA, Mamothe; PETTIFOR, Audrey

    2016-01-01

    Objective To assess the acceptability and feasibility of a cell-phone based case manager intervention targeting HIV-infected pregnant women on highly-active antiretroviral therapy (HAART). Methods Pregnant women ≥36 weeks gestation attending antenatal care and receiving HAART through the Option B+ program at a primary care clinic in South Africa were enrolled into a prospective pilot intervention to receive text messages and telephone calls from a case manager through six weeks postpartum. Acceptability and feasibility of the intervention were assessed along with infant HIV testing rates and 10-week and 12-month postpartum maternal retention in care. Retention outcomes were compared to women of similar eligibility receiving care prior to the intervention. Results Fifty women were enrolled into the pilot from May-July 2013. Most (70%) were HAART-naive at time of conception and started HAART during antenatal care. During the intervention, the case manager sent 482 text messages and completed 202 telephone calls, for a median of 10 text messages and 4 calls/woman. Ninety-six percent completed the postpartum interview and 47/48 (98%) endorsed the utility of the intervention. Engagement in 10-week postpartum maternal HIV care was >90% in the pre-intervention (n=50) and intervention (n=50) periods; by 12-months retention fell to 72% and was the same across periods. More infants received HIV-testing by 10-weeks in the intervention period as compared to pre-intervention (90.0% vs. 63.3%, p<0.01). Conclusions Maternal support through a cell-phone based case manager approach was highly acceptable among South African HIV infected women on HAART and feasible, warranting further assessment of effectiveness. PMID:25656728

  20. Efficacy, acceptability and cost effectiveness of four therapeutic agents for treatment of scabies.

    PubMed

    Abdel-Raheem, Talal A; Méabed, Eman M H; Nasef, Ghada A; Abdel Wahed, Wafaa Y; Rohaim, Rania M A

    2016-10-01

    The aim of this study is to evaluate four drug regimens for treatment of scabies as regard their efficacy, acceptability and cost effectiveness. Two hundred cases with ordinary scabies were randomized into four groups. First group received ivermectin 200 μg/kg body weight single oral dose, repeated after one week. The second received benzyl benzoate 20% cream. The third received permethrin 2.5%-5% lotion, whereas the fourth group received 5-10% sulfur ointment. Topical treatments were applied for five consecutive nights. Patients were followed up for two weeks for cure rate and adverse effects. At the end of the study, permethrin provided a significant efficacy of 88% and acceptability in 100% of cases, but had higher cost to treat one case (20.25 LE). Ivermectin provided efficacy and acceptability rates of 84% and 96%, respectively, and had a cheaper cost (9.5 LE). Benzyl benzoate provided 80% for both rates and was the cheapest drug. Sulfur ointment provided the least rates, and it was the most expensive. Treatment choice will depend on the age, the general condition of cases, patient compliance to topical treatment and his ability to stick to its roles, and the economic condition of the patient.

  1. Efficacy, acceptability and cost effectiveness of four therapeutic agents for treatment of scabies.

    PubMed

    Abdel-Raheem, Talal A; Méabed, Eman M H; Nasef, Ghada A; Abdel Wahed, Wafaa Y; Rohaim, Rania M A

    2016-10-01

    The aim of this study is to evaluate four drug regimens for treatment of scabies as regard their efficacy, acceptability and cost effectiveness. Two hundred cases with ordinary scabies were randomized into four groups. First group received ivermectin 200 μg/kg body weight single oral dose, repeated after one week. The second received benzyl benzoate 20% cream. The third received permethrin 2.5%-5% lotion, whereas the fourth group received 5-10% sulfur ointment. Topical treatments were applied for five consecutive nights. Patients were followed up for two weeks for cure rate and adverse effects. At the end of the study, permethrin provided a significant efficacy of 88% and acceptability in 100% of cases, but had higher cost to treat one case (20.25 LE). Ivermectin provided efficacy and acceptability rates of 84% and 96%, respectively, and had a cheaper cost (9.5 LE). Benzyl benzoate provided 80% for both rates and was the cheapest drug. Sulfur ointment provided the least rates, and it was the most expensive. Treatment choice will depend on the age, the general condition of cases, patient compliance to topical treatment and his ability to stick to its roles, and the economic condition of the patient. PMID:27027929

  2. New treatment option for an incomplete vertical root fracture--a preliminary case report.

    PubMed

    Hadrossek, Paul Henryk; Dammaschke, Till

    2014-01-01

    Instead of extraction this case report presents an alternative treatment option for a maxillary incisor with a vertical root fracture (VRF) causing pain in a 78-year-old patient. After retreatment of the existing root canal filling the tooth was stabilized with a dentine adhesive and a composite restoration. Then the tooth was extracted, the VRF gap enlarged with a small diamond bur and the existing retrograde root canal filling removed. The enlarged fracture line and the retrograde preparation were filled with a calcium-silicate-cement (Biodentine). Afterwards the tooth was replanted and a titanium trauma splint was applied for 12d. A 24 months clinical and radiological follow-up showed an asymptomatic tooth, reduction of the periodontal probing depths from 7 mm prior to treatment to 3 mm and gingival reattachment in the area of the fracture with no sign of ankylosis. Hence, the treatment of VRF with Biodentine seems to be a possible and promising option.

  3. New treatment option for an incomplete vertical root fracture--a preliminary case report.

    PubMed

    Hadrossek, Paul Henryk; Dammaschke, Till

    2014-01-01

    Instead of extraction this case report presents an alternative treatment option for a maxillary incisor with a vertical root fracture (VRF) causing pain in a 78-year-old patient. After retreatment of the existing root canal filling the tooth was stabilized with a dentine adhesive and a composite restoration. Then the tooth was extracted, the VRF gap enlarged with a small diamond bur and the existing retrograde root canal filling removed. The enlarged fracture line and the retrograde preparation were filled with a calcium-silicate-cement (Biodentine). Afterwards the tooth was replanted and a titanium trauma splint was applied for 12d. A 24 months clinical and radiological follow-up showed an asymptomatic tooth, reduction of the periodontal probing depths from 7 mm prior to treatment to 3 mm and gingival reattachment in the area of the fracture with no sign of ankylosis. Hence, the treatment of VRF with Biodentine seems to be a possible and promising option. PMID:24670232

  4. [Subglottic stenosis in the first year of life. Characteristics and treatment options].

    PubMed

    Sittel, C

    2012-07-01

    Subglottic stenosis of congenital origin or acquired within the first 12 months of life are challenging in many aspects. Surgical reconstruction is difficult due to the small anatomic dimensions. Tracheostomy is an additional risk factor attributing to mortality and should be avoided, if possible. In this paper, the most important types of subglottic stenosis in the first year of life are discussed. Conservative, endoscopic, and open surgical treatment options are presented and evaluated. Laryngotracheal reconstruction with autologous thyroid cartilage is the treatment of choice for the majority of significant subglottic stenosis cases in this age group. This technique is comparatively less invasive, versatile, and allows all options for open reconstruction using other techniques in case of recurrent stenosis. Subglottic stenosis in early infancy requires expertise and experience in diagnosis and treatment. Considering the limited incidence, these cases should be managed in a referral center.

  5. Acceptability and feasibility of mHealth and community-based directly observed antiretroviral therapy to prevent mother-to-child HIV transmission in South African pregnant women under Option B+: an exploratory study

    PubMed Central

    Nachega, Jean B; Skinner, Donald; Jennings, Larissa; Magidson, Jessica F; Altice, Frederick L; Burke, Jessica G; Lester, Richard T; Uthman, Olalekan A; Knowlton, Amy R; Cotton, Mark F; Anderson, Jean R; Theron, Gerhard B

    2016-01-01

    Objective To examine the acceptability and feasibility of mobile health (mHealth)/short message service (SMS) and community-based directly observed antiretroviral therapy (cDOT) as interventions to improve antiretroviral therapy (ART) adherence for preventing mother-to-child human immunodeficiency virus (HIV) transmission (PMTCT). Design and methods A mixed-method approach was used. Two qualitative focus group discussions with HIV-infected pregnant women (n=20) examined the acceptability and feasibility of two ART adherence interventions for PMTCT: 1) SMS text messaging and 2) patient-nominated cDOT supporters. Additionally, 109 HIV-infected, pregnant South African women (18–30 years old) receiving PMTCT services under single-tablet antiretroviral therapy regimen during pregnancy and breastfeeding and continuing for life (“Option B+”) were interviewed about mobile phone access, SMS use, and potential treatment supporters. Setting A community primary care clinic in Cape Town, South Africa. Participants HIV-infected pregnant women. Main outcomes Acceptability and feasibility of mHealth and cDOT interventions. Results Among the 109 women interviewed, individual mobile phone access and SMS use were high (>90%), and 88.1% of women were interested in receiving SMS ART adherence support messages such as reminders, motivation, and medication updates. Nearly all women (95%) identified at least one person close to them to whom they had disclosed their HIV status and would nominate as a cDOT supporter. Focus group discussions revealed that cDOT supporters and adherence text messages were valued, but some concerns regarding supporter time availability and risk of unintended HIV status disclosure were expressed. Conclusion mHealth and/or cDOT supporter as interventions to improve ART adherence are feasible in this setting. However, safe HIV status disclosure to treatment supporters and confidentiality of text messaging content about HIV and ART were deemed crucial. PMID

  6. Assessing Treatment Options Based on Expected Long-Term Results: Case Report Demonstrates 6-Year Outcomes.

    PubMed

    McMaster, Douglas E

    2015-05-01

    A patient whose chief concern was the esthetics of her anterior teeth presented for a second opinion after it had been recommended that crowns be placed throughout her mouth. Examination revealed numerous defective and some fractured restorations with recurring caries. With treatment goals including creating and maintaining a healthy periodontal environment, leveling the occlusal plane, and decreasing biomechanical risk, the treatment plan incorporated an interdisciplinary approach that utilized orthodontics, a Kois deprogrammer, and implant therapy. Demonstrating 6-year outcomes, this report discusses use of a method to assess treatment options based on expected long-term results.

  7. Treatment for infections with carbapenem-resistant Enterobacteriaceae: what options do we still have?

    PubMed Central

    2014-01-01

    The global spread of carbapenem-resistant Enterobacteriaceae (CRE) is increasingly becoming a major challenge in clinical and public health settings. To date, the treatment for serious CRE infections remains difficult. The intelligent use of antimicrobials and effective infection control strategies is crucial to prevent further CRE spread. Early consultation with experts in the treatment of infections with multidrug-resistant organisms is valuable in patient management. This brief review will focus on the current, yet limited, treatment options for CRE infections. PMID:25041592

  8. [Quadriceps tendon insufficiency and rupture : Treatment options in total knee arthroplasty].

    PubMed

    Thiele, K; von Roth, P; Pfitzner, T; Preininger, B; Perka, C

    2016-05-01

    Quadriceps tendon injuries and insufficiencies in total knee arthroplasty are rare, but are followed by a devastating complication that left untreated leads to a complete loss of function of the knee. This review article summarizes the functional anatomy, risk factors, and the prevalence and diagnosis of quadriceps tendon injuries, in addition to the possible management options for partial and complete ruptures. The treatment options are adapted according to the extent of the loss of function (partial, complete) and the duration of the injury (acute vs chronic). Furthermore, the choice of treatment should take into account the quality and availability of primary tissue, the patient's general health, along with their likely functional requirements. Conservative treatment is often justified in partial ruptures with good results. Complete ruptures require surgical intervention and multiple operative techniques are described. Treatment options for acute ruptures include direct primary repair with autogenous or synthetic tissue augmentation. In the case of chronic insufficiency and a lack of soft-tissue surroundings, reconstruction with the aid of a muscle flap or allograft tissue can be considered. All surgical intervention techniques used so far have been fraught with complications and rarely lead to satisfactory results. A new surgical approach to the reconstruction and augmentation of the extensor mechanism consists of the use of a synthetic mesh. The technique is described here in detail.

  9. Operative and nonoperative treatment options for ACL tears in the adult patient: a conceptual review.

    PubMed

    Bogunovic, Ljiljana; Matava, Matthew J

    2013-11-01

    Injury to the anterior cruciate ligament (ACL) is common among athletic individuals. Both nonoperative and operative treatment options exist. The optimal treatment of an adult with an ACL tear depends on several patient-specific factors, including age, occupation, and desired activity level. In less active patients with sedentary jobs, nonoperative management, consisting of physical therapy, bracing, and activity modification can yield successful results. In active patients who want to resume participation in jumping, cutting, or pivoting sports, patients who have physically demanding occupations, or patients who fail a trial of nonoperative management, ACL reconstruction is recommended. Reconstruction utilizing autograft tissue is preferred over allograft, especially in the younger athlete, but allograft tissue is a reasonable option in the older (aged > 40 years) and less active adult, as well. Successful results have been achieved with both patellar tendon and hamstring grafts. The optimal treatment in adult patients with ACL tears should be based on careful consideration of the patient's goals for return to activity, knee-specific comorbidities, such as coexistent meniscal pathology or osteoarthritis, and his or her willingness to follow a detailed rehabilitation regimen. Our article provides an overview of current nonoperative and operative treatment options for adults with ACL tears, considers the outcomes of both nonoperative and operative strategies, and provides general recommendations as to the ideal management for a given patient. PMID:24231595

  10. Acceptability of solar disinfection of drinking water treatment in Kathmandu Valley, Nepal.

    PubMed

    Rainey, Rochelle C; Harding, Anna K

    2005-10-01

    This research examines the acceptability of solar disinfection of drinking water (SODIS) in a village in Kathmandu Valley, Nepal, using constructs from the Health Belief Model as a framework to identify local understandings of water, sanitation and health issues. There has been no published research on the acceptability of SODIS in household testing in Nepal. Understanding the context of water and water purity in Nepalese villages is essential to identify culturally appropriate interventions to improve the quality of drinking water and health. Forty households from the village census list were randomly selected and the senior woman in each household was asked to participate. Baseline data on water sources and behaviors were collected in March 2002, followed by training in SODIS. Follow-up data were collected in June and July 2002. Only 9% of households routinely adopted SODIS. Participants mentioned the benefit of treating water to reduce stomach ailments, but this did not outweigh the perceived barriers of heavy domestic and agricultural workloads, other cultural barriers, uncertainty about the necessity of treating the water, and lack of knowledge that untreated drinking water causes diarrhea. Strategies for developing safe water systems must include public health education about waterborne diseases, source water protection, and a motivational component to achieve implementation and sustained use. In addition, other options for disinfecting water should be provided, given the women's work constraints and low level of formal education.

  11. Treatment Acceptability of Behavioral Interventions for Children: An Assessment by Mothers of Children with Disruptive Behavior Disorders.

    ERIC Educational Resources Information Center

    Jones, Melanie L.; Eyberg, Sheila M.; Adams, Christina D.; Boggs, Stephen R.

    1998-01-01

    Study assesses the acceptability of six child-management interventions as rated by mothers (N=20) of children referred for treatment for a disruptive-behavior disorder. Positive reinforcement was rated as a more acceptable treatment than response time, time-out, differential attention, overcorrection, and spanking. Results validate findings of…

  12. The feasibility and acceptability of virtual environments in the treatment of childhood social anxiety disorder

    PubMed Central

    Wong, Nina; Beidel, Deborah C.; Spitalnick, Josh

    2013-01-01

    Objective Two significant challenges for the dissemination of social skills training programs are the need to assure generalizability and provide sufficient practice opportunities. In the case of social anxiety disorder, virtual environments may provide one strategy to address these issues. This study evaluated the utility of an interactive virtual school environment for the treatment of social anxiety disorder in preadolescent children. Method Eleven children with a primary diagnosis of social anxiety disorder between 8 to 12 years old participated in this initial feasibility trial. All children were treated with Social Effectiveness Therapy for Children, an empirically supported treatment for children with social anxiety disorder. However, the in vivo peer generalization sessions and standard parent-assisted homework assignments were substituted by practice in a virtual environment. Results Overall, the virtual environment programs were acceptable, feasible, and credible treatment components. Both children and clinicians were satisfied with using the virtual environment technology, and children believed it was a high quality program overall. Additionally, parents were satisfied with the virtual environment augmented treatment and indicated that they would recommend the program to family and friends. Conclusion Virtual environments are viewed as acceptable and credible by potential recipients. Furthermore, they are easy to implement by even novice users and appear to be useful adjunctive elements for the treatment of childhood social anxiety disorder. PMID:24144182

  13. Fully-customized lingual appliances: how lingual orthodontics became a viable treatment option.

    PubMed

    George, Richard D; Hirani, Sunil

    2013-09-01

    Despite being available for over 30 years, it is perhaps only over the past decade or so that lingual therapy has entered into the mainstream and become a viable treatment option. This paper outlines the problems encountered with traditional lingual techniques and describes how fully-customized lingual appliances have been designed to overcome many of the issues that had risked confining lingual orthodontics to the margins of clinical practice.

  14. Acceptance and Commitment Therapy and Behavioral Activation for the Treatment of Depression: Description and Comparison

    PubMed Central

    Kanter, Jonathan W; Baruch, David E; Gaynor, Scott T

    2006-01-01

    The field of clinical behavior analysis is growing rapidly and has the potential to affect and transform mainstream cognitive behavior therapy. To have such an impact, the field must provide a formulation of and intervention strategies for clinical depression, the “common cold” of outpatient populations. Two treatments for depression have emerged: acceptance and commitment therapy (ACT) and behavioral activation (BA). At times ACT and BA may suggest largely redundant intervention strategies. However, at other times the two treatments differ dramatically and may present opposing conceptualizations. This paper will compare and contrast these two important treatment approaches. Then, the relevant data will be presented and discussed. We will end with some thoughts on how and when ACT or BA should be employed clinically in the treatment of depression. PMID:22478462

  15. Arthroscopic treatment options for irreparable rotator cuff tears of the shoulder

    PubMed Central

    Anley, Cameron M; Chan, Samuel KL; Snow, Martyn

    2014-01-01

    The management of patients with irreparable rotator cuff tears remains a challenge for orthopaedic surgeons with the final treatment option in many algorithms being either a reverse shoulder arthroplasty or a tendon transfer. The long term results of these procedures are however still widely debated, especially in younger patients. A variety of arthroscopic treatment options have been proposed for patients with an irreparable rotator cuff tear without the presence of arthritis of the glenohumeral joint. These include a simple debridement with or without a biceps tenotomy, partial rotator cuff repair with or without an interval slide, tuberplasty, graft interposition of the rotator cuff, suprascapular nerve ablation, superior capsule reconstruction and insertion of a biodegradable spacer (Inspace) to depress the humeral head. These options should be considered as part of the treatment algorithm in patients with an irreparable rotator cuff and could be used as either as an interim procedure, delaying the need for more invasive surgery in the physiologically young and active, or as potential definitive procedures in the medically unfit. The aim of this review is to highlight and summarise arthroscopic procedures and the results thereof currently utilised in the management of these challenging patients. PMID:25405083

  16. The genetics of age-related macular degeneration (AMD)--Novel targets for designing treatment options?

    PubMed

    Grassmann, Felix; Fauser, Sascha; Weber, Bernhard H F

    2015-09-01

    Age-related macular degeneration (AMD) is a progressive disease of the central retina and the main cause of legal blindness in industrialized countries. Risk to develop the disease is conferred by both individual as well as genetic factors with the latter being increasingly deciphered over the last decade. Therapeutically, striking advances have been made for the treatment of the neovascular form of late stage AMD while for the late stage atrophic form of the disease, which accounts for almost half of the visually impaired, there is currently no effective therapy on the market. This review highlights our current knowledge on the genetic architecture of early and late stage AMD and explores its potential for the discovery of novel, target-guided treatment options. We reflect on current clinical and experimental therapies for all forms of AMD and specifically note a persisting lack of efficacy for treatment in atrophic AMD. We further explore the current insight in AMD-associated genes and pathways and critically question whether this knowledge is suited to design novel treatment options. Specifically, we point out that known genetic factors associated with AMD govern the risk to develop disease and thus may not play a role in its severity or progression. Treatments based on such knowledge appear appropriate rather for prevention than treatment of manifest disease. As a consequence, future research in AMD needs to be greatly focused on approaches relevant to the patients and their medical needs.

  17. Complementary and Alternative Medicine Treatment Options for Otitis Media: A Systematic Review.

    PubMed

    Marom, Tal; Marchisio, Paola; Tamir, Sharon Ovnat; Torretta, Sara; Gavriel, Haim; Esposito, Susanna

    2016-02-01

    Otitis media (OM) has numerous presentations in children. Together with conventional medical therapies aimed to prevent and/or treat OM, a rising number of complementary and alternative medicine (CAM) treatment options can be offered. Since OM is common in children, parents may ask healthcare professionals about possible CAM therapies. Many physicians feel that their knowledge is limited regarding these therapies, and that they desire some information. Therefore, we conducted a literature review of CAM therapies for OM, taking into account that many of these treatments, their validity and efficacy and have not been scientifically demonstrated.We performed a search in MEDLINE (accessed via PubMed) using the following terms: "CAM" in conjunction with "OM" and "children. Retrieved publications regarding treatment of OM in children which included these terms included randomized controlled trials, prospective/retrospective studies, and case studies.The following CAM options for OM treatment in children were considered: acupuncture, homeopathy, herbal medicine/phytotherapy, osteopathy, chiropractic, xylitol, ear candling, vitamin D supplement, and systemic and topical probiotics. We reviewed each treatment and described the level of scientific evidence of the relevant publications.The therapeutic approaches commonly associated with CAM are usually conservative, and do not include drugs or surgery. Currently, CAM is not considered by physicians a potential treatment of OM, as there is limited supporting evidence. Further studies are warranted in order to evaluate the potential value of CAM therapies for OM.

  18. Complementary and Alternative Medicine Treatment Options for Otitis Media: A Systematic Review.

    PubMed

    Marom, Tal; Marchisio, Paola; Tamir, Sharon Ovnat; Torretta, Sara; Gavriel, Haim; Esposito, Susanna

    2016-02-01

    Otitis media (OM) has numerous presentations in children. Together with conventional medical therapies aimed to prevent and/or treat OM, a rising number of complementary and alternative medicine (CAM) treatment options can be offered. Since OM is common in children, parents may ask healthcare professionals about possible CAM therapies. Many physicians feel that their knowledge is limited regarding these therapies, and that they desire some information. Therefore, we conducted a literature review of CAM therapies for OM, taking into account that many of these treatments, their validity and efficacy and have not been scientifically demonstrated.We performed a search in MEDLINE (accessed via PubMed) using the following terms: "CAM" in conjunction with "OM" and "children. Retrieved publications regarding treatment of OM in children which included these terms included randomized controlled trials, prospective/retrospective studies, and case studies.The following CAM options for OM treatment in children were considered: acupuncture, homeopathy, herbal medicine/phytotherapy, osteopathy, chiropractic, xylitol, ear candling, vitamin D supplement, and systemic and topical probiotics. We reviewed each treatment and described the level of scientific evidence of the relevant publications.The therapeutic approaches commonly associated with CAM are usually conservative, and do not include drugs or surgery. Currently, CAM is not considered by physicians a potential treatment of OM, as there is limited supporting evidence. Further studies are warranted in order to evaluate the potential value of CAM therapies for OM. PMID:26871802

  19. Parent's Acceptance of Behavioral Interventions for Children with Behavior and Communication Problems

    ERIC Educational Resources Information Center

    Boothe, Jennifer L.; Borrego, Joaquin

    2004-01-01

    The purpose of the study was to examine what parents find as acceptable treatment options for children with behavior problems in a communication disorders population. Parents' acceptability of seven treatment options, including positive reinforcement, time-out, response cost, spanking, overcorrection, differential attention, and medication were…

  20. Radium-223 chloride: a new treatment option for metastatic castration-resistant prostate carcinoma.

    PubMed

    Pinto, Alvaro; Cruz, Patricia

    2012-12-01

    In the last few years, the treatment of castration-resistant prostate carcinoma (CRPC) has changed completely. The approval of docetaxel and subsequent investigation in this field have led to development of new agents that have demonstrated an improvement in overall survival in the post-docetaxel setting, such as cabazitaxel and abiraterone. Radium-223 chloride is a radioisotope that has recently shown efficacy after docetaxel and in patients unfit for docetaxel, with improvements in overall survival and the time to the first skeletal-related event, compared with placebo, without increasing toxicity. These findings have made this agent a new option for treatment of these patients in the near future.

  1. Current and emerging therapeutic options for the treatment of chronic chagasic cardiomyopathy

    PubMed Central

    Muratore, Claudio A; Baranchuk, Adrian

    2010-01-01

    Chagas’ disease is an endemic disease in Latin America caused by a unicellular parasite (Trypanosoma cruzi) that affects almost 18 million people. This condition involves the heart, causing heart failure, arrhythmias, heart block, thromboembolism, stroke, and sudden death. In this article, we review the current and emerging treatment of Chagas’ cardiomyopathy focusing mostly on management of heart failure and arrhythmias. Heart failure therapeutical options including drugs, stem cells and heart transplantation are revised. Antiarrhythmic drugs, catheter ablation, and intracardiac devices are discussed as well. Finally, the evidence for a potential role of specific antiparasitic treatment for the prevention of cardiovascular disease is reviewed. PMID:20730015

  2. Current challenges in treatment options for visceral leishmaniasis in India: a public health perspective.

    PubMed

    Singh, Om Prakash; Singh, Bhawana; Chakravarty, Jaya; Sundar, Shyam

    2016-01-01

    Visceral leishmaniasis (VL) is a serious parasitic disease causing considerable mortality and major disability in the Indian subcontinent. It is most neglected tropical disease, particularly in terms of new drug development for the lack of financial returns. An elimination campaign has been running in India since 2005 that aim to reduce the incidence of VL to below 1 per 10,000 people at sub-district level. One of the major components in this endeavor is reducing transmission through early case detection followed by complete treatment. Substantial progress has been made during the recent years in the area of VL treatment, and the VL elimination initiatives have already saved many lives by deploying them effectively in the endemic areas. However, many challenges remain to be overcome including availability of drugs, cost of treatment (drugs and hospitalization), efficacy, adverse effects, and growing parasite resistance. Therefore, better emphasis on implementation research is urgently needed to determine how best to deliver existing interventions with available anti-leishmanial drugs. It is essential that the new treatment options become truly accessible, not simply available in endemic areas so that they may promote healing and save lives. In this review, we highlight the recent advancement and challenges in current treatment options for VL in disease endemic area, and discuss the possible strategies to improve the therapeutic outcome. PMID:26951132

  3. Integrating first-line treatment options into clinical practice: what's new in advanced melanoma?

    PubMed

    Dummer, Reinhard; Schadendorf, Dirk; Ascierto, Paolo A; Larkin, James; Lebbé, Celeste; Hauschild, Axel

    2015-12-01

    Melanoma remains a serious form of skin cancer in Europe and worldwide. Localized, early-stage melanomas can usually be treated with surgical excision. However, the prognosis is poorer for patients with advanced disease. Before 2011, treatment for advanced melanoma included palliative surgery and/or radiotherapy, and chemotherapy with or without immunotherapy, such as interleukin-2. As none of these treatments had shown survival benefits in patients with advanced melanoma, European guidelines had recommended that patients be entered into clinical trials. The lack of approved first-line options and varying access to clinical trials meant that European clinicians relied on experimental regimens and chemotherapy-based treatments when no other options were available. Since 2011, ipilimumab, an immuno-oncology therapy, and vemurafenib and dabrafenib, targeted agents that inhibit mutant BRAF, have been approved by the European Medicines Agency for the treatment of advanced melanoma. More recently, the MEK inhibitor, trametinib, received European marketing authorization for use in patients with BRAF mutation-positive advanced melanoma. In 2014, the anti-PD-1 antibody nivolumab was approved as a first-line therapy in Japan. Whereas nivolumab and another anti-PD-1 antibody, pembrolizumab, were approved as second-line therapies in the USA, their recent approval in Europe are for first-line use based on new clinical trial data in this setting. Together these agents are changing clinical practice and making therapeutic decisions more complex. Here, we discuss current and emerging therapeutic options for the first-line treatment of advanced melanoma, and how these therapies can be optimized to provide the best possible outcomes for patients. PMID:26426764

  4. Integrated care for chronic migraine patients: epidemiology, burden, diagnosis and treatment options.

    PubMed

    Diener, Hans-Christoph; Solbach, Kasja; Holle, Dagny; Gaul, Charly

    2015-08-01

    Migraine is a common neurological disorder, characterised by severe headaches. Epidemiological studies in the USA and Europe have identified a subgroup of migraine patients with chronic migraine. Chronic migraine is defined as ≥15 headache days per month for ≥3 months, in which ≥8 days of the month meet criteria for migraine with or without aura, or respond to treatment specifically for migraine. Chronic migraine is associated with a higher burden of disease, more severe psychiatric comorbidity, greater use of healthcare resources, and higher overall costs than episodic migraine (<15 headache days per month). There is a strong need to improve diagnosis and therapeutic treatment of chronic migraine. Primary care physicians, as well as hospital-based physicians, are integral to the identification and treatment of these patients. The latest epidemiological data, as well as treatment options for chronic migraine patients, are reviewed here.

  5. Treatment Options for Individuals with PTSD and Concurrent TBI: A Literature Review and Case Presentation.

    PubMed

    Watson, Hans R; Ghani, Musammar; Correll, Terry

    2016-07-01

    Posttraumatic stress disorder (PTSD) is a well-studied mental health condition with existing guidelines and algorithms for treatment of PTSD. Those guidelines, while acknowledging an increased complexity, fail to provide clear PTSD treatment guidelines when an individual has a concurrent traumatic brain injury (TBI) diagnosis. Therefore, a literature review along with an accompanying case presentation is presented to demonstrate the minimum necessary considerations for approaching treatment of this complex population. Treatment approaches must be lead by providers that have the expertise and training necessary to consider all facets of the patient and their potential options. The provider must consider the pathophysiology of PTSD and TBI and be capable of leading a team to identify the patient's source(s) of dysfunction, current cognitive abilities, and potential indications for psychotropic medications and/or other types of therapeutic intervention. PMID:27222137

  6. How acceptable are antiretrovirals for the prevention of sexually transmitted HIV?: A review of research on the acceptability of oral pre-exposure prophylaxis and treatment as prevention.

    PubMed

    Young, Ingrid; McDaid, Lisa

    2014-02-01

    Recent research has demonstrated how antiretrovirals (ARVs) could be effective in the prevention of sexually transmitted HIV. We review research on the acceptability of oral pre-exposure prophylaxis (PrEP) and treatment as prevention (TasP) for HIV prevention amongst potential users. We consider with whom, where and in what context this research has been conducted, how acceptability has been approached, and what research gaps remain. Findings from 33 studies show a lack of TasP research, PrEP studies which have focused largely on men who have sex with men (MSM) in a US context, and varied measures of acceptability. In order to identify when, where and for whom PrEP and TasP would be most appropriate and effective, research is needed in five areas: acceptability of TasP to people living with HIV; motivation for PrEP use and adherence; current perceptions and management of risk; the impact of broader social and structural factors; and consistent definition and operationalisation of acceptability which moves beyond adherence. PMID:23897125

  7. Subtotal gastrectomy with limited lymph node dissection is a feasible treatment option for patients with early gastric stump cancer.

    PubMed

    Irino, Tomoyuki; Hiki, Naoki; Nunobe, Souya; Ohashi, Manabu; Tanimura, Shinya; Sano, Takeshi; Yamaguchi, Toshiharu

    2014-08-01

    The de facto standard treatment for early gastric stump cancer (GSC) has been total gastrectomy combined with radical lymph node dissection. However, some patients could benefit if partial resection of the gastric stump is feasible. We investigated the feasibility of subtotal gastrectomy for early GSC as less invasive surgery. Subtotal gastrectomy was defined as a segmental resection of the gastric remnant including the anastomosis with limited lymph node dissection. A total of 66 patients with early GSC were enrolled and 24 patients (36.4 %) underwent subtotal gastrectomy (SG group). Clinicopathological characteristics were analyzed along with those of the other 42 patients (63.6 %) who underwent total gastrectomy (TG group). There were no significant differences between the two groups in the number of lymph nodes harvested (p = 0.880). Lymph node involvement was detected in 2 patients (8.3 %) in SG group and 5 patients (11.9 %) in TG group (p = 1.000). The previous disease (benign or malignant) and surgery (Billroth I or II) did not affect the rate of nodal involvement. The 5-year overall survival rate of SG group (94.7 %) was acceptable. Subtotal gastrectomy of the gastric remnant could be a feasible treatment option for patients with early gastric stump cancer when indicated.

  8. Placebo use in pain management: The role of medical context, treatment efficacy, and deception in determining placebo acceptability.

    PubMed

    Kisaalita, Nkaku; Staud, Roland; Hurley, Robert; Robinson, Michael

    2014-12-01

    Placebo effects can act as powerful pain relievers. Although the ethics of therapeutic placebo use are highly controversial, recent evidence suggests that medical providers frequently utilize placebo treatments and patients may be open to these interventions in certain contexts. This investigation used a patient-centered approach to answer essential questions about placebo treatment acceptability. People with chronic musculoskeletal pain completed a placebo survey in which they rated their knowledge of placebo and its efficacy for alleviating pain, evaluated the acceptability of placebo analgesic interventions across several unique medical contexts, and responded to 6 different patient-physician treatment scenarios to assess the role of deception and placebo effectiveness on mood and provider trust. Results showed that participants had limited knowledge of placebo and its efficacy for alleviating pain. Placebo acceptability was highly dependent on the context of the intervention, as placebo treatments were considered acceptable when used as complementary/adjunct treatments and when no other established treatments were available. Also, an analgesic placebo response mitigated the negative consequences of deception by improving provider trust and decreasing negative mood. These findings suggest that, contrary to popular belief, patients may be rather pragmatic in their appraisals of placebo treatment acceptability, and may consider a variety of treatments/contexts as ethically permissible for managing their pain. This is the first study of its kind to quantify perceptions of placebo analgesia knowledge and efficacy among individuals with chronic pain, and to assess the role of different medical contexts in treatment acceptability.

  9. LANL Waste acceptance criteria, Chapter 3, radioactive liquid waste treatment facility

    SciTech Connect

    McClenahan, Robert L.

    2006-08-01

    The Radioactive Liquid Waste Treatment Facility (RLWTF) receives and treats aqueous radioactive wastewater generated at Los Alamos National Laboratory (LANL) to meet he discharge criteria specified in a National Pollution Discharge Elimination System (NPDES) permit. The majority of this wastewater is received at the RL WTF through a network of buried pipelines, known as the Radioactive Liquid Waste Collection System (RLWCS). Other wastewater is transported to the RL WTF by truck. The Waste Acceptance Criteria (WAC) outlined in this Chapter are applicable to all radioactive wastewaters which are conveyed to the Technical Area 50(T A-50), RL WTF by the RL WCS or by truck.

  10. Ustekinumab as an Alternative Treatment Option for Chronic Pityriasis Rubra Pilaris

    PubMed Central

    Chowdhary, Mudit; Davila, Ulysses; Cohen, David J.

    2015-01-01

    Pityriasis rubra pilaris (PRP) is an exceptionally rare, chronic inflammatory dermatosis of unknown etiology. Patients classically present with small, follicular keratosis and salmon-colored plaques that begin at the head and neck and slowly progress to widespread erythroderma including the palms and soles. It is difficult to distinguish PRP from other inflammatory dermatoses; however, features that help aid in the diagnosis include ‘islands’ of spared skin, orangish hue and typical findings on biopsy. There are no specific guidelines on therapy and treatment options include corticosteroids, vitamin D analogs, retinoids, methotrexate, cyclosporine, azathioprine and tumor necrosis factor alpha antagonists. Unfortunately options are limited for patients when these drugs do not work. We report a case of chronic PRP, refractory to conventional treatment, successfully treated with ustekinumab monotherapy. The patient was treated with 90 mg subcutaneous ustekinumab injections and began to show improvement within only 8 weeks. Long-term control of the disease has been attained without any significant side effects. We report this case to show that ustekinumab can be used as an alternative treatment method for patients with chronic, unremitting PRP. Treatment response is remarkably rapid and the infrequent dosing leads to patient compliance and a significantly improved quality of life. PMID:25969677

  11. Web-based Acceptance and Commitment Therapy Smoking Cessation Treatment for Smokers with Depressive Symptoms

    PubMed Central

    Jones, Helen A.; Heffner, Jaimee L.; Mercer, Laina; Wyszynski, Christopher M.; Vilardaga, Roger

    2014-01-01

    Objective Smokers with depressive symptoms have more difficulty quitting smoking than the general population of smokers. The present study examines a web-based treatment using Acceptance and Commitment Therapy (ACT) for smokers with depressive symptoms. The study aimed to determine participant receptivity to the intervention and its effects on smoking cessation, acceptance of internal cues, and depressive symptoms. Methods Smokers who screened positive for depressive symptoms at baseline (n = 94) were selected from a randomized controlled trial (N = 222) comparing web-based ACT for smoking cessation (Webquit.org) with Smokefree.gov. Forty-five participants (48%) completed the three-month follow-up. Results Compared to Smokefree.gov, WebQuit participants spent significantly more time on site (p = 0.001) and had higher acceptance of physical cravings (p = 0.033). While not significant, WebQuit participants were more engaged and satisfied with their program and were more accepting of internal cues overall. There was preliminary evidence that WebQuit participants had higher quit rates (20% vs. 12%) and lower depressive symptoms at follow-up (45% vs. 56%) than those in Smokefree.gov. Conclusions This was the first study of web-based ACT for smoking cessation among smokers with depressive symptoms, with promising evidence of receptivity, efficacy, impact on a theory-based change process, and possible secondary effects on depression. A fully powered trial of the ACT Webquit.org intervention specifically for depressed smokers is needed. This was part of a clinical trial registered as NCT#01166334, at www.clinicaltrials.gov. PMID:25671683

  12. Acceptance of Treatment of Sexually Transmitted Infections for Stable Sexual Partners by Female Sex Workers in Kampala, Uganda

    PubMed Central

    Mayanja, Yunia; Mukose, Aggrey David; Nakubulwa, Susan; Omosa-Manyonyi, Gloria

    2016-01-01

    Background The prevalence of sexually transmitted infections (STIs) among female sex workers (FSWs) in sub-Saharan Africa remains high. Providing treatment to the affected FSWs is a challenge, and more so to their stable sexual partners. There is scanty research information on acceptance of STI treatment for stable sexual partners by FSWs. We conducted a study to assess acceptance of STI treatment for stable sexual partners by FSWs, and to identify factors associated with acceptance. Methods We enrolled 241 FSWs in a cross sectional study; they were aged ≥ 18 years, had a stable sexual partner and a diagnosis of STI. Factors associated with acceptance of STI treatment for stable sexual partners were analysed in STATA (12) using Poisson regression. Mantel-Haenszel tests for interaction were performed. Results Acceptance of partner treatment was 50.6%. Majority (83.8%) of partners at the last sexual act were stable partners, and 32.4% of participants had asymptomatic STIs. Factors independently associated with acceptance were: earning ≤ $4 USD per sexual act (aPR 0.68; 95% CI: 0.49–0.94) and a clinical STI diagnosis (aPR 1.95; 95% CI: 1.30–2.92). The effect of low income on acceptance of partner treatment was seen in those with less education. Conclusion Acceptance of STI treatment for stable sexual partners was lower than that seen in other studies. Interventions to improve economic empowerment among FSWs may increase acceptance of partner treatment. PMID:27171270

  13. College Students' Perceptions of Treatment Acceptability of How College Professors Deal with Disruptive Talking in the Classroom

    ERIC Educational Resources Information Center

    Carter, Stacy L.; Punyanunt-Carter, Narissra Maria

    2009-01-01

    This study focused on various treatments for addressing the classroom misbehavior of disruptive talking during class lecture. The findings revealed that students found some methods of addressing this problem behavior by the instructor more acceptable than other methods of treating the behavior. College students rated the most acceptable instructor…

  14. New treatment options for infections caused by increasingly antimicrobial-resistant Neisseria gonorrhoeae.

    PubMed

    Lee, Hyukmin; Lee, Kyungwon; Chong, Yunsop

    2016-01-01

    The emergence of high-level resistance to ceftriaxone is giving rise to serious concern about absence of effective treatment options to cure gonococcal infections. Increasing the dosage regimen can be applied to ceftriaxone and azithromycin, but the emergence of high-level resistance has already been reported. Spectinomycin is another active drug but has low efficacy in the treatment of pharyngeal gonorrhoea. Conventional antibiotics could be introduced for gonococcal treatment, but they have some limitations, such as the absence of clinical trials and breakpoint. Combining antibiotics is another promising method to cure patients and to prevent the emergence of resistance. The most important strategy to maintain the efficacy of antibiotics is rapid detection and dissemination control of novel resistant isolate.

  15. New treatment options for infections caused by increasingly antimicrobial-resistant Neisseria gonorrhoeae.

    PubMed

    Lee, Hyukmin; Lee, Kyungwon; Chong, Yunsop

    2016-01-01

    The emergence of high-level resistance to ceftriaxone is giving rise to serious concern about absence of effective treatment options to cure gonococcal infections. Increasing the dosage regimen can be applied to ceftriaxone and azithromycin, but the emergence of high-level resistance has already been reported. Spectinomycin is another active drug but has low efficacy in the treatment of pharyngeal gonorrhoea. Conventional antibiotics could be introduced for gonococcal treatment, but they have some limitations, such as the absence of clinical trials and breakpoint. Combining antibiotics is another promising method to cure patients and to prevent the emergence of resistance. The most important strategy to maintain the efficacy of antibiotics is rapid detection and dissemination control of novel resistant isolate. PMID:26690658

  16. Eating Disorders and Disordered Eating in Type 1 Diabetes: Prevalence, Screening, and Treatment Options

    PubMed Central

    Hanlan, Margo E.; Griffith, Julie; Patel, Niral

    2013-01-01

    This review is focused on the prevalence of eating disorders and disordered eating behaviors in individuals with type 1 diabetes. Recent research indicates higher prevalence rates of eating disorders among people with type 1 diabetes, as compared to their peers without diabetes. Eating disorders and disordered eating behaviors – especially insulin omission – are associated with poorer glycemic control and serious risk for increased morbidity and mortality. Screening should begin in pre-adolescence and continue through early adulthood, as many disordered eating behaviors begin during the transition to adolescence and may persist for years. Available screening tools and treatment options are reviewed. Given the complexity of diabetes management in combination with eating disorder treatment, it is imperative to screen early and often, in order to identify those most vulnerable and begin appropriate treatment in a timely manner. PMID:24022608

  17. Are there treatments for atypical parkinsonism? An update on actual options.

    PubMed

    Moretti, Davide V

    2015-01-01

    Success in treating patients with atypical parkinsonism remains exceedingly low. It is particularly important for both neurologists and general practicians to have a guideline in the actual possible cure options. This study reviews the limited available literature reporting treatment trials about treatment in parkinsonism. Various therapeutical approaches have been tried with rasagiline, immunoglobulin, autologous mesenchymal stem cells, davunetide, lithium, and tideglusib. Recently, the transdermal rotigotine has been proposed for the treatment of atypical parkinsonism, as well as deep brain stimulation (DBS) of the peduncolopontine nucleus alone or combined with globus pallidus internus stimulation. The outcomes reviewed here highlight the need for the development of randomized, placebo-controlled trials to validate outcomes about rotigotine, DBS, and all other new therapies directed at altering the underlying biological mechanisms involved in the disease process.

  18. SU-E-T-178: Experimental Study of Acceptable Movement Conditions for SBRT Lung Treatments

    SciTech Connect

    Carrasco de Fez, P; Ruiz-Martinez, A; Jornet, N; Eudaldo, T; Latorre-Musoll, A; Ribas, Morales M

    2014-06-01

    Purpose: To experimentally study the acceptable movement conditions for SBRT lung treatments we quantified with film dosimetry the change in dose distributions due to periodic movements of 5 different amplitudes and 4 respiratory gating duty cycles on a SBRT treatment plan. Methods: We planned a SBRT treatment plan for the QUASAR™ (Modus Medical) phantom equipped with the respiratory motion device. We placed a 3 mm water-equivalent sphere simulating a tumour inside the lung-equivalent insert. This sphere is divided in two hemispheres that allow placing films in between. We used radiochromic EBT2™ (Ashland) films. We oriented the lung insert in such a way that sagittal dose distributions could be measured. We applied a sinusoidal movement with 3 s period for 5 different amplitudes of 0(static), 5, 7, 10, 15 and 20 mm without gating. For the 20 mm amplitude we studied the gating technique with 4 duty cycles of 20, 40, 60 and 80% of the respiratory cycle. Each situation was irradiated in a Clinac 2100 linac (Varian) equipped with the RPM™ system. FilmQA Pro™ (Ashland) software together with an Expression 10000XL scanner (EPSON) were used to analyze and compare the measured dose distributions with those planned by the Eclipse™ TPS v. 8.9 (Varian) by means of gamma analysis with 6 criteria: 5%/3mm, 5%/2mm, 5%/1mm, 3%/3mm, 3%/2mm and 2%/2mm (threshold of 10%). Results: Movements with amplitude of less than 7mm do not significantly modified the dosimetry. Gating duty cycles of less than 40% yielded also acceptable results for a 2 cm amplitude movement. Conclusion: To safely perform daily accurate SBRT treatments, movements have to be restricted to 7 mm amplitude (±3.5 mm). Otherwise, a gating strategy should be considered.

  19. Acceptance and commitment therapy as a treatment for problematic internet pornography viewing.

    PubMed

    Twohig, Michael P; Crosby, Jesse M

    2010-09-01

    Despite the prevalence of problematic Internet pornography viewing and the breadth of intervention approaches to potentially address it, no studies to address this problem have been reported to date. An emerging treatment approach, Acceptance and Commitment Therapy (ACT), holds promise as a treatment for Internet pornography viewing because of its focus on processes hypothesized to underlie this maladaptive behavior. In the first experiment on the treatment of problematic Internet pornography viewing, 6 adult males who reported that their Internet pornography viewing was affecting their quality of life were treated in eight 1.5-hour sessions of ACT for problematic pornography viewing. The effects of the intervention were assessed in a multiple-baseline-across-participants design with time viewing pornography as the dependent variable. Treatment resulted in an 85% reduction in viewing at posttreatment with results being maintained at 3-month follow-up (83% reduction). Increases were seen on measures of quality of life, and reductions were seen on measures of OCD and scrupulosity. Weekly measures of ACT-consistent processes showed reductions that corresponded with reductions in viewing. Large reductions were seen on a measure of psychological flexibility, and minor reductions were seen on measures of thought-action fusion and thought control. Overall, results suggest the promise of ACT as a treatment for problematic Internet pornography viewing and the value of future randomized trials of this approach. PMID:20569778

  20. New treatment option for an incomplete vertical root fracture–a preliminary case report

    PubMed Central

    2014-01-01

    Instead of extraction this case report presents an alternative treatment option for a maxillary incisor with a vertical root fracture (VRF) causing pain in a 78-year-old patient. After retreatment of the existing root canal filling the tooth was stabilized with a dentine adhesive and a composite restoration. Then the tooth was extracted, the VRF gap enlarged with a small diamond bur and the existing retrograde root canal filling removed. The enlarged fracture line and the retrograde preparation were filled with a calcium-silicate-cement (Biodentine). Afterwards the tooth was replanted and a titanium trauma splint was applied for 12d. A 24 months clinical and radiological follow-up showed an asymptomatic tooth, reduction of the periodontal probing depths from 7 mm prior to treatment to 3 mm and gingival reattachment in the area of the fracture with no sign of ankylosis. Hence, the treatment of VRF with Biodentine seems to be a possible and promising option. PMID:24670232

  1. Amino Acid PET - An Imaging Option to Identify Treatment Response, Posttherapeutic Effects, and Tumor Recurrence?

    PubMed

    Galldiks, Norbert; Langen, Karl-Josef

    2016-01-01

    Routine diagnostics and treatment monitoring in patients with primary and secondary brain tumors is usually based on contrast-enhanced standard MRI. However, the capacity of standard MRI to differentiate neoplastic tissue from non-specific posttreatment effects may be limited particularly after therapeutic interventions such as radio- and/or chemotherapy or newer treatment options, e.g., immune therapy. Metabolic imaging using PET may provide relevant additional information on tumor metabolism, which allows a more accurate diagnosis especially in clinically equivocal situations, particularly when radiolabeled amino acids are used. Amino acid PET allows a sensitive monitoring of a response to various treatment options, the early detection of tumor recurrence, and an improved differentiation of tumor recurrence from posttherapeutic effects. In the past, this method had only limited availability due to the use of PET tracers with a short half-life, e.g., C-11. In recent years, however, novel amino acid PET tracers labeled with positron emitters with a longer half-life (F-18) have been developed and clinically validated, which allow a more efficient and cost-effective application. These developments and the well-documented diagnostic performance of PET using radiolabeled amino acids suggest that its application continues to spread and that this technique may be available as a routine diagnostic tool for several indications in the field of neuro-oncology. PMID:27516754

  2. The best MSW treatment option by considering greenhouse gas emissions reduction: a case study in Georgia.

    PubMed

    Tayyeba, Omid; Olsson, Monika; Brandt, Nils

    2011-08-01

    The grave concern over climate change and new economic incentives such as the clean development mechanism (CDM) have given more weight to the potential of projects for reducing greenhouse gas (GHG) emissions. In the Adjara solid waste management project, even though the need for reductions in GHG emissions is acknowledged, it is not one of the key factors for selecting the most appropriate treatment method. This study addresses the benefit of various solid waste treatment methods that could be used in the Adjara project in terms of reducing GHG emissions. Seven different options for solid waste treatment are examined: open dumping as the baseline case, four options for landfill technology (no provision of landfill gas capture, landfill gas capture with open flare system, with enclosed flare system and with electricity generation), composting and anaerobic digestion with electricity production. CDM methodologies were used to quantify the amount of reductions for the scenarios. The study concludes sanitary landfill with capture and burning of landfill gas by an enclosed flare system could satisfy the requirements, including GHG reduction potential. The findings were tested for uncertainty and sensitivity by varying the data on composition and amount of waste and were found to be robust.

  3. New direct oral anticoagulants--current therapeutic options and treatment recommendations for bleeding complications.

    PubMed

    Miesbach, Wolfgang; Seifried, Erhard

    2012-10-01

    To date, clinical studies show that the incidence of spontaneous bleeding with new direct oral anticoagulants (DOAs) is comparable to that of established anticoagulants. However, unlike vitamin K antagonists, there are currently no clinically available antidotes or approved reversal agents for new DOAs. Restoring normal coagulation is important in many cases, such as emergency surgeries, serious bleedings, or anticoagulant overdosing. Attempts have been made to restore normal coagulation after treatment with new DOAs using compounds such as recombinant activated factor VII (rFVIIa), prothrombin complex concentrate (PCC), or FEIBA (factor eight inhibitor bypassing activity). Limited pre-clinical data and even less clinical evidence are available on the usefulness of these methods in restoring normal coagulation for the emergency management of critical bleeding episodes. Evaluating the utility of DOAs is further complicated by the fact that it is unknown how predictive established test systems are of the bleeding risks. Clinical practice requires further evaluation of the emergency management options for the new DOAs to define the agents and the doses that are most useful. Furthermore, patients receiving long-term treatment with a DOA are likely to undergo elective surgery at some point, and there is lack of evidence regarding perioperative treatment regimens under such conditions. This review summarises potential bleeding management options and available data on the new DOAs. PMID:22782297

  4. Evolution of the treatment options of ulnar collateral ligament injuries of the elbow.

    PubMed

    Langer, P; Fadale, P; Hulstyn, M

    2006-06-01

    Ulnar collateral ligament (UCL) insufficiency is potentially a career threatening, or even a career ending, injury, particularly in overhead throwing athletes. The evolution of treating modalities provides afflicted athletes with the opportunity to avoid premature retirement. There have been several clinical and basic science research efforts which have investigated the pathophysiology of UCL disruption, the biomechanics specific to overhead throwing, and the various types of treatment modalities. UCL reconstruction is currently the most commonly performed surgical treatment option. An in depth analysis of the present treatment options, both non-operative and operative, as well as their respective results and biomechanical evaluation, is lacking in the literature to date. This article provides a comprehensive current review and comparative analysis of these modalities. Over the last 30 years there has been an evolution of the original UCL reconstruction. Yet, despite the variability in modifications, such as the docking technique, interference screw fixation, and use of suture anchors, the unifying concepts of UCL reconstruction are that decreased dissection of the flexor-pronator mass and decreased handling of the ulnar nerve leads to improved outcomes.

  5. Hemisection: A Treatment Option for an Endodontically treated Molar with Vertical Root Fracture.

    PubMed

    Anitha, S; Rao, Deepika S C

    2015-02-01

    Vertical root fractures (VRF) in endodontically treated teeth have long been reported and pose diagnostic difficulties. A hemisection/root resection procedures removes the fractured fragments completely, and retains a portion of the compromized tooth offers a predictable treatment option. The key to this rests in ideal case selection involving balancing all indications and contraindications. The success of the treatment depends on careful case selection based on a firm set of guidelines. This article presents a case with VRF in an endodontic treated molar. This article describes the case of a 65-year-old man with a VRF on the mesial root and a healthy periodontium supporting the distal root making it ideal for retention as well as restoration and support of the final prosthesis. Also, the patient was motivated to try and save as much of the tooth as possible. Postoperatively no untoward complication was reported making it an alternative treatment option in patients with VRF in a molar, willing to retain the remaining tooth portion. With all other factors balanced, it allows for retaining the remaining intact portion of the tooth structure. PMID:25906809

  6. Amino Acid PET – An Imaging Option to Identify Treatment Response, Posttherapeutic Effects, and Tumor Recurrence?

    PubMed Central

    Galldiks, Norbert; Langen, Karl-Josef

    2016-01-01

    Routine diagnostics and treatment monitoring in patients with primary and secondary brain tumors is usually based on contrast-enhanced standard MRI. However, the capacity of standard MRI to differentiate neoplastic tissue from non-specific posttreatment effects may be limited particularly after therapeutic interventions such as radio- and/or chemotherapy or newer treatment options, e.g., immune therapy. Metabolic imaging using PET may provide relevant additional information on tumor metabolism, which allows a more accurate diagnosis especially in clinically equivocal situations, particularly when radiolabeled amino acids are used. Amino acid PET allows a sensitive monitoring of a response to various treatment options, the early detection of tumor recurrence, and an improved differentiation of tumor recurrence from posttherapeutic effects. In the past, this method had only limited availability due to the use of PET tracers with a short half-life, e.g., C-11. In recent years, however, novel amino acid PET tracers labeled with positron emitters with a longer half-life (F-18) have been developed and clinically validated, which allow a more efficient and cost-effective application. These developments and the well-documented diagnostic performance of PET using radiolabeled amino acids suggest that its application continues to spread and that this technique may be available as a routine diagnostic tool for several indications in the field of neuro-oncology. PMID:27516754

  7. Balloon Pulmonary Angioplasty: A Treatment Option for Inoperable Patients with Chronic Thromboembolic Pulmonary Hypertension

    PubMed Central

    Ogawa, Aiko; Matsubara, Hiromi

    2015-01-01

    In chronic thromboembolic pulmonary hypertension (CTEPH), stenoses or obstructions of the pulmonary arteries due to organized thrombi can cause an elevation in pulmonary artery resistance, which in turn can result in pulmonary hypertension. CTEPH can be cured surgically by pulmonary endarterectomy (PEA); however, patients deemed unsuitable for PEA due to lesion, advanced age, or comorbidities have a poor prognosis and limited treatment options. Recently, advances have been made in balloon pulmonary angioplasty for these patients, and this review highlights this recent progress. PMID:26664876

  8. All Roads Lead to Rome: Update on Rome III Criteria and New Treatment Options

    PubMed Central

    Shih, David Q.; Kwan, Lola Y.

    2010-01-01

    The recently published Rome III criteria reflect current understanding of functional gastrointestinal disorders. These criteria include definitions of these conditions and their pathophysiologic subtypes and offer guidelines for their management. At the 2006 Annual Scientific Meeting of the American College of Gastroenterology, a panel of experts discussed these criteria as they pertain to irritable bowel syndrome, functional dyspepsia, and chronic constipation. This article reviews the panel’s findings, highlights the differences between the Rome II and III criteria, and summarizes best treatment options currently available to practitioners and their patients. PMID:21544252

  9. Effectiveness of Acceptance-Commitment Therapy on Anxiety and Depression among Patients on Methadone Treatment: A Pilot Study

    PubMed Central

    Saedy, Mozhgan; Kooshki, Shirin; Jamali Firouzabadi, Mahmoud; Emamipour, Susan; Rezaei Ardani, Amir

    2015-01-01

    Background: Substance dependence disorder is a psychiatric disorders with different factors that influence its nature, severity, outcome, and treatment options. Objectives: This study evaluates the effectiveness of Acceptance-Commitment Therapy (ACT) to decrease anxiety and depression in patients with opioid dependencies who are undergoing methadone maintenance treatment (MMT). Materials and Methods: The present study was done in Mashhad from 2011-2012. Twenty-eight patients (18-50 yr) with opioid dependency who were on MMT were selected using purposive sampling and were divided equally between case and control groups. The case group received 8 sessions of individual psychotherapy with ACT. The level of depression and anxiety of these patients were measured using the Beck Depression Inventory-II and Beck Anxiety Inventory before the initiation of ACT as a pretest, 2 weeks after the termination of ACT as the posttest, and 3-months after the termination as a follow-up. The collected data was analyzed with SPSS (ver. 20) using χ2, paired t-test, ANOVA, and MANOVA. Results: The pretest-posttest-follow up of anxiety showed no significant differences between the two groups (P = 0.05); however, the case group had lower depression scores in the posttest and follow-up than the control group (P = 0.04). Evaluating the results of the case group revealed that depression significantly decreased in the posttest group when compared to the pretest (P = 0.01) and there were no significant decreases in the follow up compared to the pretest (P = 0.34). Conclusion: Short-term ACT for opioid dependent patients on MMT are not associated with a significant decrease in the level of anxiety; however, it is associated with a significant decrease in the level of depression. Nonetheless, this reduction was not maintained long term. PMID:26251660

  10. Questionnaire based assessment of patients' acceptability of leukocytapheresis for the treatment of inflammatory bowel disease.

    PubMed

    Nagase, Kazuko; Fukuanga, Ken; Yokoyama, Yoko; Kamikozuru, Koji; Miwa, Hiroto; Nakamura, Shiro

    2013-10-01

    The aim of the present study was to assess patients' acceptance of therapeutic leukocytapheresis known as cytapheresis (CAP) for the treatment of an active flare of inflammatory bowel disease (IBD). A questionnaire was sent to 155 IBD patients who had been treated with CAP for an active flare of IBD at the IBD center of Hyogo College of Medicine between January 2009 and July 2012. In the questionnaire, patients were asked to evaluate CAP including efficacy, safety, unfavorable features and their willingness to be retreated with CAP for a subsequent IBD flare-up. Seventy-eight percent (112 of 155 patients) including 86 with ulcerative colitis and 26 with Crohn's disease completed the questionnaire. The need for coming to hospital for CAP, needle pain during blood access, sparing time for CAP process were scored by 57%, 58%, and 58.9% of the patients, respectively as unfavorable. Patients highly favored the safety of CAP, the sum of very and relatively favorable was 89%, higher than for efficacy (68%). Seventy-two percent of patients favored retreatment with CAP. In binary logistic regression analysis, the levels of satisfaction for efficacy (P < 0.001), and inconvenience for CAP treatment time (P < 0.001) were highly significant factors for patients' willingness to be retreated. Bearing in mind that CAP is a non-pharmacologic treatment intervention, our analyses indicated that IBD patients favored high efficacy, as well as comfort of CAP or maintaining their normal social activity even during an active phase of the disease. Patient's acceptability for CAP appeared to be determined by the balance of these factors.

  11. The Engagement Interview Protocol (EIP): improving the acceptance of mental health treatment among Chinese immigrants

    PubMed Central

    Yeung, Albert; Trinh, Nhi-Ha T.; Chang, Trina E.; Fava, Maurizio

    2014-01-01

    Many depressed Chinese immigrants are unfamiliar with Western psychiatric terminology and have high levels of stigma toward psychiatric illnesses, making it difficult to engage them into psychiatric treatment. We have designed the Engagement Interview Protocol (EIP), a semi-standardized protocol that incorporates cultural components to a standard psychiatric evaluation. The EIP elicits patients’ narratives and uses anthropological questions to explore patients’ illness beliefs, which are integrated with patients’ information on medical and psychiatric history, psychosocial background and mental status examination so that treatment options can be negotiated in a culturally sensitive manner. In our field testing on depressed Chinese immigrants, the EIP model was found to be a practical tool that can be completed within the allotted one-hour time frame and was highly effective in facilitating the enrollment of patients in treatment for depression. The EIP is a concise, time-effective, user-friendly protocol that can be used both in research and real-world clinical settings with diverse patient populations. PMID:25076983

  12. Topotecan: An evolving option in the treatment of relapsed small cell lung cancer

    PubMed Central

    Garst, Jennifer

    2007-01-01

    The topoisomerase I inhibitor topotecan is the only single-agent therapy approved for the treatment of recurrent small cell lung cancer (SCLC). Many patients with recurrent SCLC may be predisposed to treatment-related adverse events because of the presence of comorbidities such as advanced age, renal impairment, or extensive prior therapy. In this setting, disease stabilization is considered a treatment benefit, and quality-of-life effects and toxicity profiles of treatments should be considered. The approved regimen of topotecan 1.5 mg/m2 on days 1 to 5 of a 21-day cycle is active and has generally mild nonhematologic toxicity and a well-established hematologic toxicity profile characterized by reversible, manageable, and noncumulative neutropenia. Alternative dosing and treatment schedules may lower the incidence of hematologic toxicities while maintaining antitumor efficacy in this patient population. Therefore, topotecan may provide physicians with an effective and versatile therapeutic option for the treatment of patients with relapsed SCLC. PMID:18516270

  13. Topotecan: An evolving option in the treatment of relapsed small cell lung cancer.

    PubMed

    Garst, Jennifer

    2007-12-01

    The topoisomerase I inhibitor topotecan is the only single-agent therapy approved for the treatment of recurrent small cell lung cancer (SCLC). Many patients with recurrent SCLC may be predisposed to treatment-related adverse events because of the presence of comorbidities such as advanced age, renal impairment, or extensive prior therapy. In this setting, disease stabilization is considered a treatment benefit, and quality-of-life effects and toxicity profiles of treatments should be considered. The approved regimen of topotecan 1.5 mg/m² on days 1 to 5 of a 21-day cycle is active and has generally mild nonhematologic toxicity and a well-established hematologic toxicity profile characterized by reversible, manageable, and noncumulative neutropenia. Alternative dosing and treatment schedules may lower the incidence of hematologic toxicities while maintaining antitumor efficacy in this patient population. Therefore, topotecan may provide physicians with an effective and versatile therapeutic option for the treatment of patients with relapsed SCLC. PMID:18516270

  14. Current treatment options of brain metastases and outcomes in patients with malignant melanoma.

    PubMed

    Nowak-Sadzikowska, Jadwiga; Walasek, Tomasz; Jakubowicz, Jerzy; Blecharz, Paweł; Reinfuss, Marian

    2016-01-01

    The prognosis for patients with melanoma who have brain metastases is poor, a median survival does not exceed 4-6 months. There are no uniform standards of treatment for patients with melanoma brain metastases (MBMs). The most preferred treatment approaches include local therapy - surgical resection and/or stereotactic radiosurgery (SRS). The role of whole brain radiotherapy (WBRT) as an adjuvant to local therapy is controversial. WBRT remains a palliative approach for those patients who have multiple MBMs with contraindications for surgery or SRS, or/and poor performance status, or/and very widespread extracranial metastases. Corticosteroids have been used in palliative treatment of MBMs as relief from symptoms related to intracranial pressure and edema. In recent years, the development of new systemic therapeutic strategies has been observed. Various modalities of systemic treatment include chemotherapy, immunotherapy and targeted therapy. Also, multimodality management in different combinations is a common strategy. Decisions regarding the use of specific treatment modalities are dependent on patient's performance status, and the extent of both intracranial and extracranial disease. This review summarizes current treatment options, indications and outcomes in patients with brain metastases from melanoma. PMID:27601961

  15. PTSD and comorbid AUD: a review of pharmacological and alternative treatment options

    PubMed Central

    Ralevski, Elizabeth; Olivera-Figueroa, Lening A; Petrakis, Ismene

    2014-01-01

    Background Although posttraumatic stress disorder (PTSD) and alcohol use disorders (AUD) frequently co-occur there are no specific treatments for individuals diagnosed with these comorbid conditions. The main objectives of this paper are to review the literature on pharmacological options for PTSD and comorbid AUD, and to summarize promising behavioral and alternative interventions for those with these dual diagnoses. Methods We conducted a comprehensive search on PsycINFO and MEDLINE/PubMed databases using Medical Subject Headings terms in various combinations to identify articles that used pharmacotherapy for individuals with dual diagnoses of PTSD and AUD. Similar strategies were used to identify articles on behavioral and alternative treatments for AUD and PTSD. We identified and reviewed six studies that tested pharmacological treatments for patients with PTSD and comorbid AUD. Results The literature on treatment with US Food and Drug Administration approved medications for patients with dual diagnosis of PTSD and AUD is very limited and inconclusive. Promising evidence indicates that topiramate and prazosin may be effective in reducing PTSD and AUD symptoms in individuals with comorbidity. Seeking safety has had mixed efficacy in clinical trials. The efficacy of other behavioral and alternative treatments (mindfulness-based, yoga, and acupuncture) is more difficult to evaluate since the evidence comes from small, single studies without comparison groups. Conclusion There is a clear need for more systematic and rigorous study of pharmacological, behavioral, and alternative treatments for patients with dual diagnoses of PTSD and AUD. PMID:24648794

  16. Preferences for different insomnia treatment options in people with schizophrenia and related psychoses: a qualitative study.

    PubMed

    Waters, Flavie; Chiu, Vivian W; Janca, Aleksandar; Atkinson, Amanda; Ree, Melissa

    2015-01-01

    Symptoms of psychosis such as hallucinations and delusions can be intrusive and unwanted and often remain treatment-resistant. Due to recent progress in basic and clinical sciences, novel approaches such as sleep-based interventions are increasingly becoming offered to address the physical and mental health issues of people with severe mental illness. While the primary outcome is to improve sleep, studies have demonstrated that interventions that target symptoms of insomnia can also produce improvements in the severity of psychotic symptoms, quality of life, and functional outcomes. This study presents qualitative data on the attitudes and preferences of people with schizophrenia and schizo-affective disorders to three different types of therapies for insomnia (standard pharmacological, melatonin-based, and cognitive and/or behavior therapy). Interviews included discussions regarding the perceived advantages and limitations of different therapies, enablers to taking up the preferred option, as well as personal strategies that have helped respondents with sleep problems in the past. Results showed that, when given the choice, these individuals prefer psychological and behavioral-type therapy to other sleep interventions because of its potential to support and empower them in taking responsibility for their own recovery. Pharmacological therapies, by contrast, are viewed as useful in managing acute sleep problems, but only as a short-term solution. Overall, the findings underscore the need for patients' active engagement when making decisions about treatment options. PMID:26236265

  17. A Study of Hair Follicular Transplantation as a Treatment Option for Vitiligo

    PubMed Central

    Thakur, Parul; Sacchidanand, S; Nataraj, HV; Savitha, AS

    2015-01-01

    Background: Repigmentation of vitiligo is closely related to hair follicles. Hence, replenishing melanocytes in vitiliginous patches utilizing undifferentiated stem cells of the hair follicles using follicular unit transplantation (FUT) is a possible treatment option. Objectives of the Study: To study the efficacy of FUT in cases of segmental/stabilized vitiligo as a treatment option for leukotrichia. Materials and Methods: Fifty patients with 63 lesions of stable vitiligo over nonglabrous areas were treated with follicular unit grafts. Reduction in the size of vitiligo patches as well as improvement in the associated leukotrichia were evaluated using subjective and objective assessments. Results: Of the 63 patches, good to excellent response was seen in 39 (61.9%), fair in 16 (25.4%), and poor in eight (12.7%) lesions. No repigmentation was seen in two (4.8%) lesions. The mean improvement seen was 61.17%. Excellent color match was observed in 44 lesions (69.8%). Repigmentation of the depigmented hairs occurred in 11 out of 46 patients with associated leukotrichia. Conclusion: FUT is a safe and effective method for treating localized and segmental vitiligo, especially on hairy parts of the skin. Though labor intensive, it was found to be associated with a quick patient recovery time, very low morbidity, and good color match. PMID:26865785

  18. Preferences for different insomnia treatment options in people with schizophrenia and related psychoses: a qualitative study

    PubMed Central

    Waters, Flavie; Chiu, Vivian W.; Janca, Aleksandar; Atkinson, Amanda; Ree, Melissa

    2015-01-01

    Symptoms of psychosis such as hallucinations and delusions can be intrusive and unwanted and often remain treatment-resistant. Due to recent progress in basic and clinical sciences, novel approaches such as sleep-based interventions are increasingly becoming offered to address the physical and mental health issues of people with severe mental illness. While the primary outcome is to improve sleep, studies have demonstrated that interventions that target symptoms of insomnia can also produce improvements in the severity of psychotic symptoms, quality of life, and functional outcomes. This study presents qualitative data on the attitudes and preferences of people with schizophrenia and schizo-affective disorders to three different types of therapies for insomnia (standard pharmacological, melatonin-based, and cognitive and/or behavior therapy). Interviews included discussions regarding the perceived advantages and limitations of different therapies, enablers to taking up the preferred option, as well as personal strategies that have helped respondents with sleep problems in the past. Results showed that, when given the choice, these individuals prefer psychological and behavioral-type therapy to other sleep interventions because of its potential to support and empower them in taking responsibility for their own recovery. Pharmacological therapies, by contrast, are viewed as useful in managing acute sleep problems, but only as a short-term solution. Overall, the findings underscore the need for patients’ active engagement when making decisions about treatment options. PMID:26236265

  19. Reluctance to Accept Alcohol Treatment by Alcoholic Liver Disease Transplant Patients: A Qualitative Study

    PubMed Central

    Heyes, Cathy M.; Schofield, Toni; Gribble, Robert; Day, Carolyn A.; Haber, Paul S.

    2016-01-01

    Background Liver transplantation (LT) is the optimum treatment for patients with end-stage alcoholic liver disease (ALD). However, despite a recognized risk of relapse to harmful drinking, ALD transplant patients are reluctant to use speciality alcohol treatment to support their abstinence, even when offered within the LT context. This study aimed to understand and identify factors contributing to alcohol treatment reluctance by ALD patients undergoing transplantation. Methods We conducted an in-depth qualitative study of ALD transplant patients. Minimally structured face-to-face interviews explored participants' alcohol-related experiences and their reasons for not using alcohol treatment during the course of their transplantation. Thematic analysis was used to analyze and interpret interview data to understand treatment reluctance based on participants' experiences. Results Five major themes were identified among 3 subgroups of patients (pretransplant and posttransplant abstainers and posttransplant relapsers): (i) the “contract” of mandatory abstinence, (ii) the “gap in the program” involving the lack of candour between patient and staff about alcohol-related matters and the lack of addiction services, (iii) a preference by participants to self-manage their alcohol use disorder, (iv) social support as a facilitator of abstinence and the risk of relapse when social support is diminished, and (v) the fear of stigmatization. Each of these factors were dynamically interrelated and differed slightly for each subgroup. Conclusions The LT services may benefit from the inclusion of integrated specialist addiction services in their model of care. Such an approach may enhance the acceptability of alcohol treatment and reduce the risk of relapse among ALD transplant participants, especially for those whose social supports have diminished. PMID:27795986

  20. Levosimendan as treatment option in severe verapamil intoxication: a case report and review of the literature.

    PubMed

    Osthoff, Mirjam; Bernsmeier, Christine; Marsch, Stephan C; Hunziker, Patrick R

    2010-01-01

    Cardiovascular shock due to verapamil intoxication is often refractory to standard resuscitation methods. Recommended therapy includes prevention of further absorption of the drug, inotropic therapy, calcium gluconate, and hyperinsulinemia/euglycemia therapy. Often further measures are needed such as ventricular pacing or mechanical circulatory support. Still, mortality remains high. Levosimendan, an inotropic agent, that enhances myofilament response to calcium, increases myocardial contraction and could therefore be beneficial in verapamil intoxication. Here, we report the case of a 60-year-old patient with clinically severe verapamil poisoning who presented with shock, bradycardia, and sopor. Standard therapy including high-dose inotropes failed to ameliorate the signs of intoxication. But additional therapy with levosimendan led to rapid improvement. Based on this observation, the literature is reviewed focusing on utilization of levosimendan in the treatment of calcium channel blocker overdose. We suggest to consider levosimendan as additional treatment option in patients with cardiovascular shock due to verapamil intoxication that are refractory to standard management.

  1. Treatment and prevention of cryptosporidiosis: what options are there for a country like Zambia?

    PubMed

    Kelly, Paul

    2011-10-01

    Cryptosporidiosis is a major infection of humans, leading to diarrhoea and growth failure in children, diarrhoea and malnutrition in immunocompromised adults, and is associated with increased mortality in all age groups. Using the country of Zambia as an example, I review the possible approaches to treatment and prevention in a tropical setting. The current optimal therapy for cryptosporidiosis is nitazoxanide which works well in HIV uninfected children, but treatment in patients with HIV infection remains remarkably difficult. No single drug has demonstrated efficacy in a randomised trial. No vaccine is available, so the best option for prevention for the moment is filtration and clean storage of drinking water. This would be expected to reduce cryptosporidiosis dramatically, but this needs to be demonstrated directly. Water filtration would have the added benefit of protection against many other pathogens, but the paucity of alternative approaches highlights the need for a better understanding of this important human pathogen.

  2. Semidirect Restorations in Multidisciplinary Treatment: Viable Option for Children and Teenagers.

    PubMed

    Tonetto, Mateus Rodrigues; Frizzera, Fausto; Silva, Monica Barros da; Bhandi, Shilpa H; Kuga, Milton Carlos; Pereira, Kamila Figueiredo; Pinzan-Vercelino, Célia Regina Maio; Bandéca, Matheus Coelho

    2015-04-01

    Due to the esthetic necessity required nowadays, the multidisciplinary treatment became a fundamental step in the restoration success. When the patient exhibits dental agenesis of one or more elements, he can show difficulty in social interactions. The age of the patient is a limiting factor to esthetic procedures, however, it should be evaluated as a real indicative with each case. The utilization of semi-direct restorations is a viable option due the cost, esthetic and improvement of physical and mechanical properties. The purpose of this paper is to present a case detailing the confection and cementation of anterior semi-direct restorations aimed at an anatomic reestablishment associated with integrated treatment with periodontics and orthodontics.

  3. Paediatric Stroke: Review of the Literature and Possible Treatment Options, including Endovascular Approach

    PubMed Central

    Ciceri, Elisa F.; Cuccarini, Valeria; Chiapparini, Luisa; Saletti, Veronica; Valvassori, Luca

    2011-01-01

    Stroke is among the top 10 causes of death in childhood. More than half of the surviving children have long-term neurological sequelae. Ischemic stroke (IS) includes arterial ischemic stroke and cerebral venous thrombosis with venous infarction. Haemorrhagic stroke (HS) includes intracerebral haematoma or subarachnoid haemorrhage. Risk factors for stroke are different in children and in adults. 10–30% of IS have no identified risk factors. However, multiple risk factors are recognizable in the majority of stroke in children; thus, a comprehensive diagnostic evaluation is crucial. Vascular abnormalities, such as arteriovenous malformations, aneurysms, vessel dissection, stenosis, and moyamoya disease, are frequently associated with both IS and HS and lead to high recurrence rates. Endovascular and surgical treatment options are sometimes indicated, performed on the basis of expert opinion, and extrapolated from the adult procedures. In the present paper, we review the recent literature and we discuss the treatment in five cases managed at our institutions. PMID:21789272

  4. Evaluation of nasal and oropharyngeal flora in patients with acne vulgaris according to treatment options.

    PubMed

    Ozuguz, Pınar; Callioglu, Elif E; Tulaci, Kamil G; Kacar, Seval D; Balta, Ilknur; Asik, Gulsah; Karatas, Serap; Karaca, Semsettin

    2014-11-01

    The aim of this study was to evaluate changes in nasal and oropharyngeal flora in patients with acne during treatments with tetracycline and isotretinoin. Swab specimens were taken from the right and left nasal cavities and oropharynx of 55 patients with acne and 20 healthy volunteers who were admitted to the dermatology department (Etlik Educational and Research Hospital, Ankara, Turkey) before the administration of treatment and in the third month of treatment. Study participants were divided into four groups as follows: patients with acne on topical treatment only, systemic isotretinoin, and systemic tetracycline, and the control group. Of 55 patients with acne, 18 were male and 37 were female. The mean age of the patients and the control group was 22.21 ± 4.22 and 21.95 ± 7.64, respectively. Staphylococcus aureus was isolated from the nasal flora of five patients, normal flora was suppressed in the oropharyngeal cultures of seven patients, and normal flora grew in the cultures of the other 20 patients who were on tetracycline treatment. On the other hand, normal flora grew in the nasal and oropharyngeal cultures of all the patients who were on isotretinoin treatment. Treatment options and follow-up procedures for acne vulgaris may lead to the development of bacterial resistance and damage to flora. In particular, systemic tetracycline treatment leads to changes in flora of the nose and throat in patients with acne with an increased carriage of S. aureus. Therefore, careful attention should be paid to the duration of tetracycline treatment in order to not increase the risk of disturbance of microbial flora.

  5. Methadone Maintenance for HIV Positive and HIV Negative Patients in Kyiv: Acceptability and Treatment Response

    PubMed Central

    Dvoriak, Sergii; Karachevsky, Andrey; Chhatre, Sumedha; Booth, Robert; Metzger, David; Schumacher, Joseph; Chychula, Nina; Pecoraro, Anna; Woody, George

    2014-01-01

    Background With up to 40% of opioid injectors infected with HIV, Ukraine has one of the most concentrated HIV epidemics in the world, mainly due to unsterile injection practices and a historical absence of effective prevention services. Harm reduction programs, including syringe exchange and a small buprenorphine treatment program, were introduced in 2004 and methadone maintenance was allowed in 2007. Despite an initial expansion, by 2009, only 3221 injectors were receiving methadone treatment. A growing body of research on methadone maintenance has found high retention rates with reduction in opioid use and HIV risk behaviors. We report on the acceptability and initial outcome of methadone treatment as a function of HIV status, an issue that has not yet been reported for injectors in Ukraine. Methods Longitudinal observational study of a 12-week course of methadone treatment in 25 HIV+ and 25 HIV− opioid addicted individuals recruited from a harm reduction program and the city AIDS Center. Drug use and HIV risk were assessed at baseline and weeks 4, 8, 12 and 20; all patients were offered continued methadone maintenance in the Kyiv city program at the end of 12 weeks. Results Fifty-four individuals were asked if they were interested in the study and 50, demographically similar to other samples of opioid addicted Ukrainians, agreed to participate. Two died of non-study related causes; the other 48 completed assessments at weeks 4, 8 and 12, and 47 completed followups at week 20. Significant reductions were seen in use of heroin (p<. 0001), other opiates/analgesics (p< 0.0001), and HIV risk behaviors (drug, sex, total; all p <0.0001). All 48 patients chose to continue methadone after the 12-weeks of study medication ended. Unlike most opioid treatment studies, sexual risk was somewhat higher than injecting risk at study intake. Conclusions Methadone maintenance was well accepted by HIV+ and HIV− opioid dependent individuals and has the potential for significant

  6. Primary focal hyperhidrosis: current treatment options and a step-by-step approach.

    PubMed

    Hoorens, I; Ongenae, K

    2012-01-01

    Primary focal hyperhidrosis is a common disorder for which treatment is often a therapeutic challenge. A systematic review of current literature on the various treatment modalities for primary focal hyperhidrosis was performed and a step-by-step approach for the different types of primary focal hyperhidrosis (axillary, palmar, plantar and craniofacial) was established. Non-surgical treatments (aluminium salts, local and systemic anticholinergics, botulinum toxin A (BTX-A) injections and iontophoresis) are adequately supported by the current literature. More invasive surgical procedures (suction curettage and sympathetic denervation) have also been extensively investigated, and can offer a more definitive solution for cases of hyperhidrosis that are unresponsive to non-surgical treatments. There is no consensus on specific techniques for sympathetic denervation, and this issue should be further examined by meta-analysis. There are numerous treatment options available to improve the quality of life (QOL) of the hyperhidrosis patient. In practice, however, the challenge for the dermatologist remains to evaluate the severity of hyperhidrosis to achieve the best therapeutic outcome, this can be done most effectively using the Hyperhidrosis Disease Severity Scale (HDSS). PMID:21749468

  7. Endermologie (with and without compression bandaging)--a new treatment option for secondary arm lymphedema.

    PubMed

    Moseley, A L; Esplin, M; Piller, N B; Douglass, J

    2007-09-01

    Two treatment protocols are presented using the LPG Endermologie system in combination with compression bandaging as a new treatment option for secondary arm lymphedema. Both protocols were applied 4 days a week for 4 weeks but differed in Trial II in time spent clearing the regions of the trunk adjacent to the swollen limb and the addition of a larger treatment head so that a greater area could be covered more quickly. The first protocol involved 24 women and the second involved 10 women. At the end of the treatment period, both protocols demonstrated overall reductions in limb volume (134mls; 18.3% p = 0.000 and 185mls; 28%, p = 0.002), limb fluid (182mls; 28%, p = 0.000 and 216mls; 33%. p = 0.014), truncal fluid (342mls; p = 0.002 and 290mls; p = 0.066), improvements in fibrotic induration in some lymphatic territories, and significant improvements in subject reporting of heaviness, tightness, tissue hardness and limb size. Trial II demonstrated additional benefits in terms of reduction in whole arm volume at 24 hours, improved fluid and arm volume reductions, and a significant improvement in subject reported arm range of movement. The additional time spent clearing the regions adjacent to the swollen limb in the second protocol appears to produce an increase in limb volume and limb fluid loss compared to the original treatment protocol.

  8. Clinical Efficacy of Blue Light Full Body Irradiation as Treatment Option for Severe Atopic Dermatitis

    PubMed Central

    Becker, Detlef; Seemann, Gunda; Fell, Isabel; Saloga, Joachim; Grabbe, Stephan; von Stebut, Esther

    2011-01-01

    Background Therapy of atopic dermatitis (AD) relies on immunosuppression and/or UV irradiation. Here, we assessed clinical efficacy and histopathological alterations induced by blue light-treatment of AD within an observational, non-interventional study. Methodology/Principal Findings 36 patients with severe, chronic AD resisting long term disease control with local corticosteroids were included. Treatment consisted of one cycle of 5 consecutive blue light-irradiations (28.9 J/cm2). Patients were instructed to ask for treatment upon disease exacerbation despite interval therapy with topical corticosteroids. The majority of patients noted first improvements after 2–3 cycles. The EASI score was improved by 41% and 54% after 3 and 6 months, respectively (p≤0.005, and p≤0.002). Significant improvement of pruritus, sleep and life quality was noted especially after 6 months. Also, frequency and intensity of disease exacerbations and the usage of topical corticosteroids was reduced. Finally, immunohistochemistry of skin biopsies obtained at baseline and after 5 and 15 days revealed that, unlike UV light, blue light-treatment did not induce Langerhans cell or T cell depletion from skin. Conclusions/Significance Blue light-irradiation may represent a suitable treatment option for AD providing long term control of disease. Future studies with larger patient cohorts within a randomized, placebo-controlled clinical trial are required to confirm this observation. PMID:21687679

  9. Primary focal hyperhidrosis: current treatment options and a step-by-step approach.

    PubMed

    Hoorens, I; Ongenae, K

    2012-01-01

    Primary focal hyperhidrosis is a common disorder for which treatment is often a therapeutic challenge. A systematic review of current literature on the various treatment modalities for primary focal hyperhidrosis was performed and a step-by-step approach for the different types of primary focal hyperhidrosis (axillary, palmar, plantar and craniofacial) was established. Non-surgical treatments (aluminium salts, local and systemic anticholinergics, botulinum toxin A (BTX-A) injections and iontophoresis) are adequately supported by the current literature. More invasive surgical procedures (suction curettage and sympathetic denervation) have also been extensively investigated, and can offer a more definitive solution for cases of hyperhidrosis that are unresponsive to non-surgical treatments. There is no consensus on specific techniques for sympathetic denervation, and this issue should be further examined by meta-analysis. There are numerous treatment options available to improve the quality of life (QOL) of the hyperhidrosis patient. In practice, however, the challenge for the dermatologist remains to evaluate the severity of hyperhidrosis to achieve the best therapeutic outcome, this can be done most effectively using the Hyperhidrosis Disease Severity Scale (HDSS).

  10. Treatment Options for Liquid Radioactive Waste. Factors Important for Selecting of Treatment Methods

    SciTech Connect

    Dziewinski, J.J.

    1998-09-28

    The cleanup of liquid streams contaminated with radionuclides is obtained by the selection or a combination of a number of physical and chemical separations, processes or unit operations. Among those are: Chemical treatment; Evaporation; Ion exchange and sorption; Physical separation; Electrodialysis; Osmosis; Electrocoagulation/electroflotation; Biotechnological processes; and Solvent extraction.

  11. Different options for metal recovery after sludge decontamination at the Montreal Urban Community wastewater treatment plant.

    PubMed

    Meunier, N; Blais, J F; Lounès, M; Tyagi, R D; Sasseville, J L

    2002-01-01

    The MUG (Montreal Urban Community) treatment plant produces approximately 270 tons of dry sludge daily (270 tds/day) during the physico-chemical treatment of wastewater. Recently, this treatment plant endowed a system of drying and granulation of sludge for valorization as an agricultural fertilizer having a capacity of 70 tds/day (25% of the daily sludge production). However, the metal content (mainly Cu and Cd) of the sludge surpasses the norms for biosolids valorization. In order to solve this problem, a demonstration project, from the lab scale to the industrial pilot plant, was carried out to test the Metix-AC technology for the removal of metals. A strongly metal-loaded filtrate was generated during the sludge decontamination. Tests concerned the study of the metal recovery by total precipitation and selective precipitation, as well as the use of alternative products for the metal precipitation. Other works consisted to simulate the acid filtrate recirculation from the decontaminated sludge (25% of the total volume) in the untreated sludge (75% of the total volume) intended for the incineration. The total precipitation with hydrated limeappearedeffectivefortherecoveryof metals (87% Cd, 96% Cr, 97% Cu, 98% Fe, 71% Ni, 100% Pb, 98% Zn). However, this option entails the production of an important quantity of metallic residue, which should be disposed of expensively as dangerous material. The selective iron precipitation does not appear to bean interesting option because the iron in solution within the leached sludge was principally present in the form of ferrous iron, which cannot be precipitated at pH lower than five. On the other hand, the use of commercial precipitating agents (TMT-15, CP-33Z, CP-NB and CPX) without pH adjustment of filtrate gave good results for the recovery of Cu and, to a lesser degree for the recovery of Pb. However, the efficiency for the other metals' (Cd, Cr, Fe, Ni and Zn) recovery was weaker (< 25%). Finally, the acid filtrate

  12. Different options for metal recovery after sludge decontamination at the Montreal Urban Community wastewater treatment plant.

    PubMed

    Meunier, N; Blais, J F; Lounès, M; Tyagi, R D; Sasseville, J L

    2002-01-01

    The MUG (Montreal Urban Community) treatment plant produces approximately 270 tons of dry sludge daily (270 tds/day) during the physico-chemical treatment of wastewater. Recently, this treatment plant endowed a system of drying and granulation of sludge for valorization as an agricultural fertilizer having a capacity of 70 tds/day (25% of the daily sludge production). However, the metal content (mainly Cu and Cd) of the sludge surpasses the norms for biosolids valorization. In order to solve this problem, a demonstration project, from the lab scale to the industrial pilot plant, was carried out to test the Metix-AC technology for the removal of metals. A strongly metal-loaded filtrate was generated during the sludge decontamination. Tests concerned the study of the metal recovery by total precipitation and selective precipitation, as well as the use of alternative products for the metal precipitation. Other works consisted to simulate the acid filtrate recirculation from the decontaminated sludge (25% of the total volume) in the untreated sludge (75% of the total volume) intended for the incineration. The total precipitation with hydrated limeappearedeffectivefortherecoveryof metals (87% Cd, 96% Cr, 97% Cu, 98% Fe, 71% Ni, 100% Pb, 98% Zn). However, this option entails the production of an important quantity of metallic residue, which should be disposed of expensively as dangerous material. The selective iron precipitation does not appear to bean interesting option because the iron in solution within the leached sludge was principally present in the form of ferrous iron, which cannot be precipitated at pH lower than five. On the other hand, the use of commercial precipitating agents (TMT-15, CP-33Z, CP-NB and CPX) without pH adjustment of filtrate gave good results for the recovery of Cu and, to a lesser degree for the recovery of Pb. However, the efficiency for the other metals' (Cd, Cr, Fe, Ni and Zn) recovery was weaker (< 25%). Finally, the acid filtrate

  13. Current classification, treatment options, and new perspectives in the management of adipocytic sarcomas

    PubMed Central

    De Vita, Alessandro; Mercatali, Laura; Recine, Federica; Pieri, Federica; Riva, Nada; Bongiovanni, Alberto; Liverani, Chiara; Spadazzi, Chiara; Miserocchi, Giacomo; Amadori, Dino; Ibrahim, Toni

    2016-01-01

    Sarcomas are a heterogeneous group of mesenchymal tumors arising from soft tissue or bone, with an uncertain etiology and difficult classification. Soft tissue sarcomas (STSs) account for around 1% of all adult cancers. Till date, more than 50 histologic subtypes have been identified. Adipocyte sarcoma or liposarcoma (LPS) is one of the most common STS subtypes, accounting for 15% of all sarcomas, with an incidence of 24% of all extremity STSs and 45% of all retroperitoneal STSs. The new World Health Organization classification system has divided LPS into four different subgroups: atypical lipomatous tumor/well-differentiated LPS, dedifferentiated LPS, myxoid LPS, and pleomorphic LPS. These lesions can develop at any location and exhibit different aggressive potentials reflecting their morphologic diversity and clinical behavior. Patients affected by LPS should be managed in specialized multidisciplinary cancer centers. Whereas surgical resection is the mainstay of treatment for localized disease, the benefits of adjuvant and neoadjuvant chemotherapy are still unclear. Systemic treatment, particularly chemotherapy, is still limited in metastatic disease. Despite the efforts toward a better understanding of the biology of LPS, the outcome of advanced and metastatic patients remains poor. The advent of targeted therapies may lead to an improvement of treatment options and clinical outcomes. A larger patient enrollment into translational and clinical studies will help increase the knowledge of the biological behavior of LPSs, test new drugs, and introduce new methodological studies, that is, on treatment response. PMID:27785071

  14. Conservative surgery for the treatment of osteonecrosis of the femoral head: current options

    PubMed Central

    Gasbarra, Elena; Perrone, Fabio Luigi; Baldi, Jacopo; Bilotta, Vincenzo; Moretti, Antimo; Tarantino, Umbertto

    2015-01-01

    Summary The prevention of femoral head collapse and the maintenance of hip function would represent a substantial achievement in the treatment of osteonecrosis of the femoral head; however it is difficult to identify appropriate treatment protocols to manage patients with pre-collapse avascular necrosis in order to obtain a successful outcome in joint preserving procedures. Conservative treatments, including pharmacological management and biophysical modalities, are not supported by any evidence and require further investigation. The appropriate therapeutic approach has not been identified. The choice of surgical procedures is based on patient clinical conditions and anatomopathological features; preservation of the femoral head by core decompression may be attempted in younger patients without head collapse. Biological factors, such as bone morphogenetic proteins and bone marrow stem cells, would improve the outcome of core decompression. Another surgical procedure proposed for the treatment of avascular necrosis consists of large vascularized cortical bone grafts, but its use is not yet common due to surgical technical issues. Use of other surgical technique, such as osteotomies, is controversial, since arthroplasty is considered as the first option in case of severe femoral head collapse without previous intervention. PMID:27134632

  15. An alternative treatment option for a bony defect from large odontoma using recycled demineralization at chairside.

    PubMed

    Lee, JuHyon; Lee, Eun-Young; Park, Eun-Jin; Kim, Eun-Suk

    2015-04-01

    Odontoma is the most common odontogenic benign tumor, and the treatment of choice is generally surgical removal. After excision, bone grafts may be necessary depending on the need for further treatment, or the size and location of the odontoma. Although the osteogenic capacity of a demineralized tooth was verified as early as 1967 by Urist and many other investigators, the cumbersome procedure, including a long demineralization time, may be less than comfortable for clinicians. A modified ultrasonic technology, with periodic negative pressure and temperature control, facilitated rapid and aseptic preparation of demineralized teeth for bone grafts. This approach reduces the demineralization time dramatically (≤80 minutes), so that the graft material can be prepared chairside on the same day as the extraction. The purpose of this article is to describe two cases of large compound odonotomas used as graft material prepared chairside for enucleation-induced bony defects. These two clinical cases showed favorable wound healing without complications, and good bony support for future dental implants or orthodontic treatment. Finally, this report will suggest the possibility of recycling the benign pathologic hard tissue as an alternative treatment option for conventional bone grafts in clinics.

  16. An alternative treatment option for a bony defect from large odontoma using recycled demineralization at chairside

    PubMed Central

    2015-01-01

    Odontoma is the most common odontogenic benign tumor, and the treatment of choice is generally surgical removal. After excision, bone grafts may be necessary depending on the need for further treatment, or the size and location of the odontoma. Although the osteogenic capacity of a demineralized tooth was verified as early as 1967 by Urist and many other investigators, the cumbersome procedure, including a long demineralization time, may be less than comfortable for clinicians. A modified ultrasonic technology, with periodic negative pressure and temperature control, facilitated rapid and aseptic preparation of demineralized teeth for bone grafts. This approach reduces the demineralization time dramatically (≤80 minutes), so that the graft material can be prepared chairside on the same day as the extraction. The purpose of this article is to describe two cases of large compound odonotomas used as graft material prepared chairside for enucleation-induced bony defects. These two clinical cases showed favorable wound healing without complications, and good bony support for future dental implants or orthodontic treatment. Finally, this report will suggest the possibility of recycling the benign pathologic hard tissue as an alternative treatment option for conventional bone grafts in clinics. PMID:25922824

  17. Treatment Options for Class III Malocclusion in Growing Patients with Emphasis on Maxillary Protraction

    PubMed Central

    Azamian, Zeinab; Shirban, Farinaz

    2016-01-01

    It is very difficult to diagnose and treat Class III malocclusion. This type of malocclusion involves a number of cranial base and maxillary and mandibular skeletal and dental compensation components. In Class III malocclusion originating from mandibular prognathism, orthodontic treatment in growing patients is not a good choice and in most cases orthognathic surgery is recommended after the end of growth. Approximately 30–40% of Class III patients exhibit some degree of maxillary deficiency; therefore, devices can be used for maxillary protraction for orthodontic treatment in early mixed dentition. In cases in which dental components are primarily responsible for Class III malocclusion, early therapeutic intervention is recommended. An electronic search was conducted using the Medline database (Entrez PubMed), the Cochrane Collaboration Oral Health Group Database of Clinical Trials, Science Direct, and Scopus. In this review article, we described the treatment options for Class III malocclusion in growing patient with an emphasis on maxillary protraction. It seems that the most important factor for treatment of Class III malocclusion in growing patient is case selection. PMID:27144056

  18. Managing Urinary Incontinence in Patients with Dementia: Pharmacological Treatment Options and Considerations.

    PubMed

    Orme, Susie; Morris, Vikky; Gibson, William; Wagg, Adrian

    2015-07-01

    Urinary incontinence and lower urinary tract symptoms are highly prevalent in late life and are strongly associated with dementia and frailty. Incontinence is extremely common among those living in long-term care and is most commonly due to urgency incontinence. Although national and international guidelines for continence care exist, they often fail to consider the complex comorbidity found in patients with dementia and are often not followed; continence practices in long-term care may promote rather than prevent incontinence. The majority of those with dementia living in the community can be managed successfully with standard treatments, both pharmacological and non-pharmacological; the expectations and aims of treatment of both the patient and their caregivers should be considered. A dementia diagnosis does not preclude management of incontinence, but treatment options may be more limited in those with advanced dementia who are unable to retain information and modify behaviors. High-quality data to guide the choice of pharmacological agent in those with dementia are lacking. Oxybutynin has been shown to have significant adverse cognitive effects, but data to support the use of trospium, solifenacin, darifenacin, and fesoterodine are limited. No data are available for mirabegron. Neither age, frailty, nor dementia should be considered a barrier to pharmacological management, but consideration should be given to the total anticholinergic load. Evidence to guide the treatment of incontinence in this vulnerable patient group is scarce, and available guidelines adapted for each individual's situation should be applied. PMID:26169438

  19. Managing Urinary Incontinence in Patients with Dementia: Pharmacological Treatment Options and Considerations.

    PubMed

    Orme, Susie; Morris, Vikky; Gibson, William; Wagg, Adrian

    2015-07-01

    Urinary incontinence and lower urinary tract symptoms are highly prevalent in late life and are strongly associated with dementia and frailty. Incontinence is extremely common among those living in long-term care and is most commonly due to urgency incontinence. Although national and international guidelines for continence care exist, they often fail to consider the complex comorbidity found in patients with dementia and are often not followed; continence practices in long-term care may promote rather than prevent incontinence. The majority of those with dementia living in the community can be managed successfully with standard treatments, both pharmacological and non-pharmacological; the expectations and aims of treatment of both the patient and their caregivers should be considered. A dementia diagnosis does not preclude management of incontinence, but treatment options may be more limited in those with advanced dementia who are unable to retain information and modify behaviors. High-quality data to guide the choice of pharmacological agent in those with dementia are lacking. Oxybutynin has been shown to have significant adverse cognitive effects, but data to support the use of trospium, solifenacin, darifenacin, and fesoterodine are limited. No data are available for mirabegron. Neither age, frailty, nor dementia should be considered a barrier to pharmacological management, but consideration should be given to the total anticholinergic load. Evidence to guide the treatment of incontinence in this vulnerable patient group is scarce, and available guidelines adapted for each individual's situation should be applied.

  20. Musculoskeletal conditions of the foot and ankle: assessments and treatment options.

    PubMed

    Rao, Smita; Riskowski, Jody L; Hannan, Marian T

    2012-06-01

    Musculoskeletal conditions of the foot and ankle are an important public health challenge due to their increasing incidence combined with their substantial negative impact on patients' quality of life. Non-pharmacological treatments serve as the first line of treatment and are frequently used for patients with musculoskeletal conditions of the foot and ankle. This review provides a summary of the assessments and non-invasive treatment options based upon available evidence. Recent studies show that individuals with foot and ankle pain have multiple co-existing impairments in alignment, motion, load distribution and muscle performance that may be evident in static and/or dynamic tasks. In addition, both clinical and epidemiological studies support the inter-dependence between the foot and proximal joints. For instance, aberrant foot structure has been linked to foot osteoarthritis (OA), as well as OA and pain at the knee and hip. Most recently, advances in motion capture technology and plantar load distribution measurement offer opportunities for precise dynamic assessments of the foot and ankle. In individuals with musculoskeletal conditions of the foot and ankle, the chief objectives of treatment are to afford pain relief, restore mechanics (alignment, motion and/or load distribution) and return the patient to their desired level of activity participation. Given that most patients present with multiple impairments, combinational therapies that target foot-specific as well as global impairments have shown promising results. In particular, in individuals with rheumatoid arthritis and other rheumatic diseases, comprehensive rehabilitation strategies including early detection, foot-based interventions (such as orthoses) and wellness-based approaches for physical activity and self-management have been successful. While significant improvements have been made in the last decade to the assessment and treatment of foot and ankle conditions, few randomised clinical trials