Therapy Guidelines For Patients Research Articles

New Radiation Therapy Guidelines for Patients With Brain Metastases

New Radiation Therapy Guidelines for Patients With Brain Metastases

Guidelines for therapy of patients with chronic myeloproliferative neoplasms during the novel coronavirus SARS-CoV2 pandemic.

The novel coronavirus has swept across the world in 2020 and ushered a new era. In the current scenario, it is not clear how patients with myeloproliferative neoplasms (including chronic myelogenous leukemia) should be managed, considering the risk of therapy, the need for social distancing and the risk of untimely therapy discontinuation of delay. This guideline aims to give providers a sense of direction in order to better take care of patients and prioritize care.

Correlating Interictal Spikes with Sigma and Delta Dynamics during Non-Rapid-Eye-Movement-Sleep.

Interictal spikes (IS) are one of the major hallmarks of epilepsy. Understanding the factors promoting or suppressing IS would increase our comprehension of epilepsy and possibly open new avenues for therapy. Sleep strongly influences epileptic activity, and the modulatory effects of the different sleep stages on IS have been studied for decades. However, several aspects are still disputed, in particular the role of sleep spindles and slow waves in the activation of IS during Non-REM sleep. Here, we correlate the rate of IS with quantitative measures derived from stereo-EEG during one Non-REM cycle in 10 patients suffering from drug-resistant epilepsy due to type 2 focal cortical dysplasia. We show that the IS rate (ISR) is positively correlated with sigma power (a surrogate for sleep-spindle density) but negatively correlated with delta power (surrogate for slow wave activity). In addition, we present two new indices for quantifying the spatial and temporal instability of sleep. We found that both instability indices are correlated with a high ISR. The main contribution of this study is to confirm the suppressive effect of stable deep sleep on IS. This result might influence future guidelines for therapy of patients suffering from epilepsy and sleep disorders.

Transplant Outcomes in Mucopolysaccharidoses

The mucopolysaccharidoses (MPSs) are inherited metabolic disorders (IMDs) caused by single-gene defects leading to progressive cellular accumulation of glycosaminoglycans (GAGs) and damage to multiple organs, including the central nervous, musculoskeletal, cardiorespiratory, and other systems. Hurler syndrome (MPS IH), the most severe form, is the prototypical model. Enzyme replacement therapy (ERT), available for MPS I, II, and VI, is beneficial in some patients. However, ERT does not improve neurocognitive function because of its inability to cross the blood-brain barrier. In contrast, allogeneic hematopoietic stem cell transplantation (HSCT) allows donor-derived, enzyme-producing cells to migrate to the brain and other organs to provide permanent enzyme therapy and thus help somatic organs, improve neurocognitive function and quality of life, and prolong survival, particularly when performed early in the course of the disease. Bone marrow has been the graft source in the past. However, in the last 5 years many patients have been treated with unrelated donor (URD) umbilical cord blood transplant (UCBT), allowing rapid and increased access to transplantation with favorable outcomes. This review describes published and our institutional clinical experiences, discusses the current status of the field, and provides therapy guidelines for patients with MPS.

Nifedipine gastrointestinal therapeutic system: an overview of its antiatherosclerotic effects

Atherosclerosis is the main underlying pathology of cardiovascular disease. Experimental studies in animal models provided early evidence of the antiatherosclerotic effects of nifedipine in reducing and reversing plaque formation and improving endothelial function. Over the past decade, clinical trials, including ‘Intervention as a Goal in Hypertension Treatment’, ‘Prospective Randomized Enalapril Study Evaluating Regression of Ventricular Enlargement’, ‘Evaluation of Nifedipine and Cerivastatin on Recovery of Coronary Endothelial Function’ and ‘A Coronary Disease Trial Investigating Outcome with Nifedipine Gastrointestinal System’, have further demonstrated that nifedipine gastrointestinal therapeutic system can slow the progression of various markers of atherosclerosis, restore endothelial function, and reduce the incidence of coronary events and the need for coronary interventions. These results are reviewed here, along with the impact they have had on therapy guidelines for patients with hypertension and symptomatic stable angina.

Guidelines for community-acquired pneumonia in the US and Canada: a practical approach to antibiotic selection.

Several US and Canadian national organizations have published guidelines for antibiotic therapy of patients with community-acquired pneumonia (CAP). This review paper will present the clinician with a practical approach to antibiotic selection based on current guidelines.

Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. National Diabetes Data Group.

A classification of diabetes and other categories of glucose intolerance, based on contemporary knowledge of this heterogeneous syndrome, was developed by an international workgroup sponsored by the National Diabetes Data Group of the NIH. This classification, and revised criteria for the diagnosis of diabetes, were reviewed by the professional members of the American Diabetes Association, and similar versions were circulated by the British Diabetic Association, the Australian Diabetes Society, and the European Association for the Study of Diabetes. The ADA has endorsed the proposals of the international workgroup, and the Expert Committee on Diabetes of the World Health Organization has accepted its substantive recommendations. It is proposed that this classification be used as a uniform framework in which to conduct clinical and epidemiologie research so that more meaningful and comparative data will be obtained on the scope and impact of the various forms of diabetes and other classes of glucose intolerance. Medical treatment of diabetes is not considered in this paper, and the classification is not an attempt to define guidelines for therapy of patients. The salient changes proposed in the classification are that 1. The insulin-dependent, ketosis-prone type of diabetes, which is associated with increased or decreased frequency of certain histocompatibility antigens (HLA) on chromosome 6 and with islet cell antibodies, be considered a distinct subclass of diabetes [insulin-dependent diabetes mellitus (IDDM)]. This type of diabetes has been inappropriately termed juvenile diabetes. Since it can occur at any age, it is recommended that diagnosis based on age of onset be eliminated. 2. The noninsulin-dependent, nonketosis-prone types of diabetes, which are not secondary to other diseases or conditions, be considered a second distinct subclass of diabetes [noninsulin-dependent diabetes mellitus (NIDDM)]. This subclass has been divided-according to whether or not obesity is present (obese NIDDM and nonobese NIDDM, respectively), and patients in this subclass can be further characterized by the type of treatment they receive (insulin, oral hypoglycemie agents, diet) or by other characteristics of interest to the researcher. It is believed that heterogeneity within this subclass, and also within IDDM, will be demonstrated by further research. 3. The types of diabetes caused by other conditions or found in increased frequency with other conditions (implying an etiologie relationship) be considered a third subclass of diabetes mellitus—diabetes associated with certain conditions and syndromes. This subclass has been divided according to the known or suspected etiologie relationships. 4. The class gestational diabetes be restricted to women in whom glucose intolerance develops or is discovered during pregnancy. 5. Individuals with plasma glucose (PG) levels intermediate between those considered normal and those considered diabetic [see (8)] be termed to have impaired glucose tolerance. It is proposed that the terms chemical, latent, borderline, subclinical, and asymptomatic diabetes, which have been applied to persons in this class, be abandoned, since use of the term diabetes invokes social, psychologic, and economic sanctions that are unjustified in light of the lack of severity of their glucose intolerance.