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Düsseldorf, Germany

Objective: To test the hypothesis that Curly horses possess hypoallergenic properties making them suitable for horse-allergic riders. Methods: The feasibility of a standard horse prick test, compared with the Curly horse scratch test, was first studied on 4 prestudy phase patients. Subsequently, ten horse-allergic riders, who had previously stopped riding because of horse allergy with resulting bronchial asthma and/or allergic rhinoconjunctivitis, underwent basic lung function diagnostics: allergy testing (standard horse, Curly horses) and spirometry (or body plethysmography). Independently of the allergy test result, an escalated Curly horse contact program was conducted beginning with riding and later on brushing Curly horses while measuring lung function during and after horse contact. Results: The prestudy phase data show comparable results between the standard horse prick test and the scratch test using material of a German riding pony and a defined Curly horse mare (ABC 2563). In the main test phase, the skin test with Curly horses resulted in mostly reduced reactions compared to the standard horse prick test. The ten horse-allergic riders did not react significantly to exposure to the horses or reacted very slightly. Nine of 10 patients were found not to react significantly after brushing Curly horses. Conclusion: We conclude that Curly horses seem to be suitable for horse-allergic riders who want or need to continue riding. Source

Immunodeficiency-associated lymphoproliferative disorders (LPD) in rheumatoid arthritis are a rare, aggressive, and life-threatening clinical entity. We describe a 60-year-old man who had rheumatoid arthritis that was treated with methotrexate. Eight months after the treatment, the case was diagnosed as Epstein-Barr virus-negative LPD (diffuse large B-cell lymphoma) with abdominal bulky mass and clinical stage IVB at high risk in the international prognostic index. Immediate withdrawal of methotrexate led the patient to achieve complete remission, and 8 subsequent courses of rituximab treatment for the prevention of relapse kept the patient disease-free for 29 months. Our case suggests that these treatments may be an effective, safe, and feasible strategy for immunodeficiency-associated LPD in rheumatoid arthritis. Source

Fitzgerald S.P.,Internal Medicine | Bean N.G.,University of Adelaide
Journal of the American Medical Directors Association | Year: 2010

Background: With aging there is an increase in frailty and chronic disease leading to a potential increase in medication use. Most clinical trials have excluded old, frail individuals and have failed to take into account the effects of outcome interaction. Methods and Results: In this article we provide a mathematical model demonstrating that comorbidities, including old age, interact with therapies, reducing their effectiveness. Conclusion: These findings question the validity of single disease guidelines in old persons or in persons with multiple chronic diseases. © 2010 American Medical Directors Association. Source

Swami U.,Internal Medicine
Current drug targets | Year: 2013

CPT-11 (irinotecan), a DNA topoisomerase I inhibitor is one of the main treatments for colorectal cancer. The main dose limiting toxicities are neutropenia and late onset diarrhea. Though neutropenia is manageable, CPT-11 induced diarrhea is frequently severe, resulting in hospitalizations, dose reductions or omissions leading to ineffective treatment administration. Many potential agents have been tested in preclinical and clinical studies to prevent or ameliorate CPT-11 induced late onset diarrhea. It is predicted that prophylaxis of CPT-11 induced diarrhea will reduce sub-therapeutic dosing as well as hospitalizations and will eventually lead to dose escalations resulting in better response rates. This article reviews various experimental agents and strategies employed to prevent this debilitating toxicity. Covered topics include schedule/dose modification, intestinal alkalization, structural/chemical modification, genetic testing, anti-diarrheal therapies, transporter (ABCB1, ABCC2, BCRP2) inhibitors, enzyme (β-glucuronidase, UGT1A1, CYP3A4, carboxylesterase, COX-2) inducers and inhibitors, probiotics, antibiotics, adsorbing agents, cytokine and growth factor activators and inhibitors and other miscellaneous agents. Source

Gulati S.,Internal Medicine | Mulshine J.L.,Rush University
Translational Lung Cancer Research | Year: 2014

Lung cancer accounts for almost one-third of all cancer related deaths. Lung cancer risk persists even after smoking cessation and so many lung cancers now are diagnosed in former smokers. Five-year survival of lung cancer has marginally improved over decades and significantly lags behind that of colon, breast and prostate cancer. Over the past one decade, lung cancer screening trials have shown promising results. Results from National Lung Cancer Screening Trial (NLST), have shown a significant 20% reduction in mortality with annual low dose computed tomography (LDCT) screening. Based on these results, annual LDCT testing has been recommended for lung cancer screening in high risk population. However, development and acceptance of lung cancer screening as a public health policy is still in the nascent stages. Major concerns relate to risk of radiation, overdiagnosis bias, proportion of false positives and cost benefit analysis. This article reviews the literature pertaining to lung cancer screening guidelines and above mentioned concerns. © Translational lung cancer research. All rights reserved. Source

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