PubMed Health⌕ Search

Biomedical subjects

Michael L Tapper

Publications and source records attributed to Michael L Tapper.

7 recordsLinked to original sources
PubMed2006

Clinical perspectives of emerging pathogens in bleeding disorders.

As a result of immunological and nucleic-acid screening of plasma donations for transfusion-transmissible viruses, and the incorporation of viral reduction processes during plasma fractionation, coagulation-factor concentrates (CFC) are now judged safe in terms of many known infectious agents, including hepatitis B and C viruses, HIV, and human T-cell lymphotropic virus. However, emerging pathogens could pose future threats, particularly those with blood-borne stages that are resistant to viral-inactivation steps in the manufacturing process, such as non-lipid-coated viruses. As outlined in this Review, better understanding of infectious diseases allows challenges from newly described agents of potential concern in the future to be anticipated, but the processes of zoonotic transmission and genetic selection or modification ensure that plasma-derived products will continue to be subject to infectious concerns. Manufacturers of plasma-derived CFC have addressed the issue of emerging infectious agents by developing recombinant products that limit the need for human plasma during production. Such recombinant products have extended the safety profile of their predecessors by ensuring that all reagents used for cell culture, purification steps, and stabilisation and storage buffers are completely independent of human plasma.

Animals↗
PubMed2005

Strategies for initiating combination antiretroviral therapy.

Numerous potent antiretroviral regimens have proven successful as initial therapy in treatment-naive HIV-infected patients. As the development of new agents makes possible new treatment regimens, providers are faced with increasingly complex questions of when to initiate treatment and which regimen to select for individual patients. Clinical trial data provide a foundation for choosing an initial regimen and play a key role in the formation of treatment guidelines issued by the United States Public Health Service and other organizations. This paper reviews the results of recent clinical trials focusing on initial therapy and addresses important considerations when beginning antiretroviral therapy (ART) in treatment-naive individuals.

Antiretroviral Therapy, Highly Active↗
PubMed2004

Simplifying antiretroviral therapy.

The substantial benefits conferred by HAART require strict patient adherence. Many of the initial HAART regimens consisted of a number of large pills that needed to be taken several times daily, sometimes with meal restrictions. The development of once-daily antiretroviral agents has eased some of the burden associated with the intense, difficult schedules of early HAART regimens.. The majority of regimens currently used in treatment-naive HIV-positive patients contain a mixture of agents that are taken on a once- and twice-daily basis. Although this is an improvement over past regimens, the asynchronous administration of pills throughout the day still presents a scheduling challenge for most patients. The newest advance in simplifying antiretroviral therapy is the use of regimens in which all pills are taken at the same time once a day. Choosing drugs for a fully once-daily regimen requires awareness of a number of factors, including pharmacokinetics, potency, durability of response, resistance and safety. At this time, there are a limited number of combinations that can be used as a fully once-daily regimen and few clinical trials evaluating such combinations. Results from initial clinical trials using simplified, once-daily regimens in treatment-naive patients have been promising. Additional studies should add to this experience and provide guidance on the role and timing of such regimens in the management of patients with HIV disease.

Anti-HIV Agents↗
PubMed2002

Fatal inhalational anthrax with unknown source of exposure in a 61-year-old woman in New York City.

A 61-year-old woman who was a New York City hospital employee developed fatal inhalational anthrax, but with an unknown source of anthrax exposure. The patient presented with shortness of breath, malaise, and cough that had developed 3 days prior to admission. Within hours of presentation, she developed respiratory failure and septic shock and required mechanical ventilation and vasopressor therapy. Spiral contrast-enhanced computed tomography of the chest demonstrated large bilateral pleural effusions and hemorrhagic mediastinitis. Blood cultures, as well as DNA amplification by polymerase chain reaction of the blood, bronchial washings, and pleural fluid specimens, were positive for Bacillus anthracis. The clinical course was complicated by liver failure, renal failure, severe metabolic acidosis, disseminated intravascular coagulopathy, and cardiac tamponade, and the patient died on the fourth hospital day. The cause of death was inhalational anthrax. Despite epidemiologic investigation, including environmental samples from the patient's residence and workplace, no mechanism for anthrax exposure has been identified.

Aortic Dissection↗