European journal of medical research
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Despite of changes in the use of antiviral or chemotherapy regimens, the median survival of patients with AIDS-related lymphoma has not significantly changed until recently. However, partly due to prolonged survival with the introduction of highly active antiretroviral therapy (HAART) prognosis in AIDS patients with lymphoma seems to improve. ⋯ It is hoped that novel strategies will lead to a survival benefit in these patients. In this review, we discuss the current strategies for the treatment of AIDS-related lymphoma.
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HIV-infected patients fail viral load suppression, because resistance against antiretroviral drugs arises or for other reasons. HIV-resistance analyses can aid to achieve effective HAART regimen. Furthermore, clinical benefits from genotyping in study settings are significantly higher for treating physicians, who can include external advice from HIV-experts into HAART switch. ⋯ Radata is a novel database concept with features to generate expert advice for implementation into HAART switch of HIV-infected subjects. A test period has shown, that the concept is technically approved to fit all requirements with regard to data collection, evaluation and to generate expert advice for therapy switch in daily clinical practice.
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Fungal infections have been recognized as major cause of morbidity and mortality in neutropenic and non-neutropenic surgical intensive care patients. The incidence of Candida has increased: it is now the fourth most often isolated pathogen in bloodstream infections. The incidence of Aspergillus infection in transplant patients is highest in heart and lung transplants: 19-26%. ⋯ This has lead to treatment failures in severe Candida and Aspergillus infections. The prognosis for invasive Aspergillus infections remains poor despite amphotericin B treatment. Newer azoles, e.g. voriconazole, demonstrated stable activity against most of these strains and may offer an option in the treatment of refractory fungal infections.
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The past two decades have witnessed an increase in serious fungal infections, without corresponding growth in available antifungal agents. Voriconazole (VRC) is a novel triazole antifungal, recently approved in Europe for treatment of serious infections caused by Aspergillus, Fusarium, Scedosporium, and resistant Candida species. Voriconazole has in vitro activity against yeasts and yeast-like fungi similar, or superior to, fluconazole (FLC), itraconazole (ITC) and amphotericin B (AMB). ⋯ Most importantly, well-designed human clinical trials have confirmed the efficacy of VRC in the treatment of candidal esophagitis, IA, and febrile neutropenia. Smaller studies and case reports have shown VRC is useful for salvage therapy of IA, cerebral aspergillosis, Scedosporium, and other fungal infections. Clinical testing has shown VRC is safe and well tolerated; the most common side effect is benign, self-limited visual disturbance.
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Multicenter Study Clinical Trial
Initial treatment of symptomatic mild to moderate bronchial asthma with the salmeterol/fluticasone propionate (50/250 microg) combination product (SAS 40023).
Chronic controller therapy, particularly with inhaled corticosteroids, is required in patients with persistent bronchial asthma. Long-acting beta agonists provide prolonged bronchodilatation, improve symptoms and reduce exacerbations. A powder inhaler containing both fluticasone propionate and salmeterol xinafoate combines anti-inflammatory treatment and bronchodilatation in a single user-friendly device (Diskus). ⋯ The combined inhalation of salmeterol and fluticasone from a single dry powder inhaler (DiskuS) was an effective initial treatment for patients with mild to moderate asthma. Improvements of symptoms and lung function were documented by the first week of treatment. This combination provides rapid and effective asthma control that is highly acceptable to both the patient and physician.