Prophylactic Treatment Strategies Research Articles

Recurrence and relapse in geriatric depression: a review of risk factors and prophylactic treatment strategies.

An emerging body of epidemiologic data has substantiated that in younger and middle-aged populations, major depression may be characterized by early relapse, recurrence, and chronicity. Information regarding the prognosis of geriatric depression is less extensive. This article reviews the literature on the longitudinal outcome of major depression in older adults, with particular emphasis on the limited data on strategies for the pharmacologic and electroconvulsive prophylaxis of recurrent unipolar geriatric depression. Possible biological markers for relapse risk, derived from sleep electroencephalography, neuroendocrine tests, and neuroradiographic findings, are also discussed. Recommendations for the treatment and long-term follow-up of geriatric depression are presented.

FUNGAL INFECTIONS IN SOLID ORGAN TRANSPLANT RECIPIENTS

Invasive fungal infections occur in 5% to 45% of solid organ transplant recipients, and are a major cause of morbidity and mortality in the immunocompromised population. The net depression of host defenses and environmental factors, such as preoperative exposures to endemic mycoses or nosocomial and specific surgery-associated exposures, affect the development of invasive infection. Most fungal infections in solid organ transplant recipients occur within the first 2 months after transplantation. The most common pathogens in the majority of solid organ transplant recipients are Candida spp, followed by Aspergillus sp. Diagnosis is best made by a high index of suspicion and aggressive acquisition of specimens for culture; serologic tests are useful for infections due to Cryptococcus neoformans and Histoplasma capsulatum. Amphotericin B is the drug of choice for life-threatening infections. The triazoles, fluconazole and itraconazole, may be effective alternatives for less serious infections due to susceptible organisms. Prophylactic and preemptive treatment strategies require further study.

Chlorpromazine prophylaxis of steroid-induced psychosis

We report a case of successful prophylactic treatment for psychiatric side effects of megadose glucocorticoid therapy by the administration of chlorpromazine. We review currently used prophylactic treatment strategies and discuss the rationale for adding neuroleptic treatment as an alternative to these strategies.

Sheep and goat scab in Basutoland

Ovine psoroptic mange (sheep scab) is a debilitating and damaging condition caused by a hypersensitivity reaction to the faecal material of the parasitic mite Psoroptes ovis. Farmers incur costs from the use of prophylactic acaricides and, if their sheep become infected, they incur the costs of therapeutic treatment plus the economic loss from reduced stock growth, lower reproductive rate, wool loss and hide damage. The unwillingness of farmers to use routine prophylactic treatment has been cited as a primary cause of the growing incidence of sheep scab in the United Kingdom (UK) since the disease was deregulated in 1992. However, if farmers behave rationally from an economic perspective, the optimum strategy that they should adopt will depend on the risk of infection and the relative costs of prophylactic versus therapeutic treatment, plus potential losses. This calculation is also complicated by the fact that the risk of infection is increased if neighbours have scab and reduced if neighbours treat prophylactically. Hence, for any farmer, the risk of infection and optimum approach to treatment is also contingent on the behaviour of neighbours, particularly when common grazing is used. Here, the relative economic costs of different prophylactic treatment strategies are calculated for upland and lowland farmers and a game theory model is used to evaluate the relative costs for a farmer and his/her neighbour under different risk scenarios. The analysis shows that prophylaxis with organophosphate (OP) dipping is a cost effective strategy, but only for upland farmers where the risk of infection is high. In all other circumstances prophylaxis is not cost effective relative to reliance on reactive (therapeutic) treatment. Hence, farmers adopting a reactive treatment policy only, are behaving in an economically rational manner. Prophylaxis and cooperation only become economically rational if the risk of scab infection is considerably higher than the current national average, or the cost of treatment is lower. Should policy makers wish to reduce the national prevalence of scab, economic incentives such as subsidising the cost of acaricides or rigorously applied financial penalties, would be required to make prophylactic treatment economically appealing to individual farmers. However, such options incur their own infrastructure and implementation costs for central government.