Effect Of Multidrug Therapy Research Articles

Effect of multidrug therapy on the prognosis of Mycobacterium avium complex pulmonary disease

Multidrug therapy for Mycobacterium avium complex pulmonary disease (MAC-PD) results in negative sputum cultures. However, the prognostic value of this treatment approach remains unclear. This study aimed to clarify whether multidrug therapy reduces the incidence of events related to MAC-PD and improves the mortality rate. Patients who met the diagnostic criteria for MAC-PD at our hospital between 2003 and 2019 were retrospectively evaluated using medical records. Events related to MAC-PD were defined as hospitalisation for haemoptysis or respiratory infection and the development of chronic respiratory failure. There were 90 and 108 patients in the multidrug and observation groups, respectively. The median observation period was 86 months. Intergroup differences in body mass index, proportion of patients with cavities, and erythrocyte sedimentation rate were not significant. However, the observation group was older with a higher mean age (multidrug group: 62 years, observation group: 69 years; P < 0.001) and had a higher proportion of male patients (multidrug group: 13/90 [14.4%], observation group: 35/108 [32.4%]; P < 0.01). Furthermore, intergroup differences in the incidence of events related to MAC-PD (multidrug group: 26.69/1000 person-years, observation group: 25.49/1000 person-years), MAC-PD-associated mortality rate (multidrug group: 12.13/1000 person-years, observation group: 12.74/1000 person-years), and total mortality (multidrug group: 24.26/1000 person-years, observation group: 29.50/1000 person-years) were not significant. Many patients relapse even after multidrug therapy, and our findings suggest that multidrug therapy has no effect in preventing the onset of respiratory events or prolonging life expectancy.

Analysis of SGOT, SGPT, and IgM anti PGL-1 in Multibacillary Leprosy Patient after Multi Drug Therapy

INTRODUCTION: Leprosy is a fairly dreaded disease, but it is curable. However, liver failure is one of the side effect of the treatment that challenging to manage.OBJECTIVES: Assessing the effects of Multi Drug Therapy (MDT) on the liver function (SGOT, SGPT) and Mycobacterium Leprae Particle Agglutination (MLPA) test (IgM anti PGL-1) before and after treatment in patients with multibacillary (MB) leprosy.METHOD: Twenty-eight patients who met the inclusion criteria were enrolled in this study which categorized as new MB leprosy patients in Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia. In order to test the liver function, blood serum was taken to measure the SGOT and SGPT level with Bochringer Mannheim automatic analysis, while MLPA test measurement was performed with qualitative method. Blood serum was collected three times with the following period; before the treatment, 3 months, and 6 months after treatment. The data was analyzed using Friedman and Wilcoxon Signed Rank test with significant level p&amp;lt;0.001.RESULT: There were significant increases in SGOT and SGPT levels (p&amp;lt;0.001) before and after MDT treatment between 3 to 6 months. Meanwhile, for IgM anti PGL-1, it was not significant (p&amp;gt;0.01) before treatment and after 3 months treatment, but significant different (p&amp;lt;0.001) on 6 months treatment.CONCLUSION: MDT treatment on MB leprosy patient increase the SGOT and SGPT level but decrease the IgM anti PGL-1 after the 6 months of treatment.

Challenges in immunodiagnostic tests for leprosy

Despite the effectiveness of multidrug therapy, leprosy still represents a significant global health problem: transmission of Mycobacterium leprae (M. leprae) is not sufficiently reduced as witnessed by unwavering new case rates in leprosy-endemic countries. Early detection of M. leprae infection (before clinical manifestations occur) is vital to reduction of transmission. Current diagnosis relies on detection of clinical signs since there are no tests available to detect asymptomatic M. leprae infection or predict progression to leprosy. Identification of risk factors (immunological or genetic biomarkers) for disease development and/or onset of leprosy reactions is imperative for efficient diagnosis. Tests simultaneously detecting biomarkers specific for cellular and humoral immunity are well suited for diagnosis of different clinical outcomes of leprosy. This review describes the challenges of discovery of biomarkers for M. leprae infection and their implementation in field-friendly tests. In view of the complicated nature of M. leprae infections, it is essential to invest in longitudinal studies allowing intra-individual comparison of immune and genetic biomarkers in various leprosy-endemic areas. Furthermore, the effect of co-infections on biomarker profiles should also be taken into account. Diagnostic tests based on such biomarkers can contribute significantly to early detection of leprosy (reactions) thus helping reduce nerve damage.

Modelling the immunopathogenesis of HIV-1 infection and the effect of multidrug therapy: The role of fusion inhibitors in HAART

There is currently tremendous effort being directed at developing potent, highly active antiretroviral therapies that can effectively control HIV- 1 infection without the need for continuous, lifelong use of these drugs. In the ongoing search for powerful antiretroviral agents that can affect sustained control for HIV infection, mathematical models can help in assessing both the correlates of protective immunity and the clinical role of a given drug regimen as well as in understanding the efficacy of drug therapies administered at different stages of the disease. In this study, we develop a new mathematical model of the immuno-pathogenesis of HIV-1 infection, which we use to assess virological responses to both intracellular and extracellular antiretroviral drugs. We first develop a basic mathematical model of the immuno-pathogenesis of HIV-1 infection that incorporates three distinct stages in the infection cycle of HIV-1: entry of HIV-1 into the cytoplasm of CD4+ T cells, transcription of HIV-1 RNA to DNA within CD4+ T cells, and production of HIV-1 viral particles within CD4+ T cells. Then we extend the basic model to incorporate the effect of three major categories of anti-HIV-1 drugs: fusion/entry inhibitors (FIs), reverse transcriptase inhibitors (RTIs), and protease inhibitors (PIs). Model analysis establishes that the actual drug efficacy of FIs, gamma and of PIs, kappa is the same as their effective efficacies while the effective drug efficacy for the RTIs, gamma (upsilon ) , is dependent on the rate of transcription of the HIV-1 RNA to DNA, and the lifespan of infected CD4+ T cells where virions have only entered the cytoplasm and that this effective efficacy is less than the actual efficacy, upsilon. Our studies suggest that, of the three anti-HIV drug categories (FIs, RTIs, and PIs), any drug combination of two drugs that includes RTIs is the weakest in the control of HIV-1 infection.

Carville and Curupaiti: experiences of confinement and community.

Although Hansen's disease (leprosy) is still a significant problem in many parts of the world, the effectiveness of multidrug therapy has allowed people affected by this disease to be treated on an outpatient basis. However, throughout much of the twentieth century, people diagnosed with Hansen's disease were isolated from their families in facilities known as "leprosaria". This article presents a brief history of isolation policies and the development of community structures at two such facilities, Carville and Curupaiti, in the United States and Brazil, respectively. The modern dilemmas faced by the administration, staff, and residents of these institutions will also be discussed.

Immunohistological localization of mycobacterial antigens within the peripheral nerves of treated leprosy patients and their significance to nerve damage in leprosy.

The presence and distribution of Mycobacterium leprae-specific and cross-reacting antigens within the peripheral nerves of multidrug-treated patients with leprosy was investigated to gain a better understanding of the mechanism of nerve damage and the effect of multidrug therapy (MDT) on it. There was no specific qualitative difference in the type of antigens in the leprosy spectrum. However, our results indicate that there may be differential handling of antigens by the macrophages as compared to Schwann cells. This could play a key role in the pathogenesis of the disease. Multidrug treatment is effective in arresting the progression of the disease process as well as in reducing the viable bacterial load, both in borderline lepromatous and lepromatous (MB) and borderline tuberculoid and tuberculoid (PB) cases. However, the presence of M. leprae antigens in all the multidrug-treated MB nerve lesions and 87% of PB nerve lesions suggest that the antigens persist for a prolonged period. Hence, the risk of immunological reaction and antigen-associated silent nerve damage may continue even after majority of M. leprae were killed. The findings give further support to the view that most of the nerve damage is due to bacterial antigens.

Bacillaemia in leprosy and effect of multidrug therapy

Twenty-five patients of bacilliferous leprosy (17 LL, 8 BL) were studied by the modified haemolysis method for occurrence of bacillaemia and its clearance after two multidrug therapy regimens. Acid-fast bacilli were found in 76% of all patients and in 88.2% LL and 50% BL patients. Bacillaemia occurred with significantly reduced frequency in patients with type II reaction. Acid-fast bacilli were demonstrable in peripheral blood after 1 month in one patient on MDT of an Indian Working Group and 3 lepromatous patients on WHO multidrug therapy. However, bacillaemia could not be demonstrated in any patients after 2 and 3 months of treatment with both regimens.

The treatment of stage III nonseminomatous testicular tumors. Roswell Park Memorial Institute results (1970–1979)

A review of 92 patients with Stage III nonseminomatous tumors treated at Roswell Park Memorial Institute between 1970-1979 was undertaken to verify changes in concepts as related to multiple agent chemotherapy and cytoreductive surgery. Each patient had a minimal follow-up of 18 months. Fifty-three patients were seen before 1975. Eighteen had metastasis to the lungs only. These were treated with a variety of single chemotherapeutic agents and cytoreductive surgery. The survival of this group was 38%. Among 35 patients with lung and visceral involvement seen at the same time, only one patient is alive. Thirty-nine patients were seen after 1975 and treated with multi-drug chemotherapy and cytoreductive surgery. The current survival rate of 23 patients with lung metastasis only is 69%. Among 16 patients with lung and visceral involvement, the present survival rate is 31%. This report confirms the effectiveness of multi-drug therapy in conjunction with cytoreductive surgery in the treatment of disseminated testicular tumors.