Typhoid fever: treatment failure and multiple relapses with trimethoprim-sulfamethoxazole and chloramphenicol therapy.
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Adult↗
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Results for “Treatment Failure”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
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[Failures in periodontal treatments].
Failures in periodontal therapy may be caused by a faulty choice of patients, insufficient diagnosis, prognosis and planning, faulty choice of therapy, treatment and follow-up treatment. Particularly important is the motivation of the patient, his collaboration in periodontal therapy is decisive for success or failure of the treatment. Lasting success may only be expected if patients are regularly recalled, their brushing and cleaning habits may be checked and further treatments be dispensed in time.
Attitude to Health↗
A comparative study of epicillin and chloramphenicol in the treatment of enteric fever.
One hundred patients with acute enteric fever were randomly assigned to treatment with either chloramphenicol 50 mg/kg body-weight or epicillin 1 g six hourly. Eighty-one patients had a positive blood culture for typhoid or paratyphoid bacilli and nineteen had a positive stool culture with a significant Widal titre. All fifty patients in the group treated with chloramphenicol responded, however there was one relapse with bacteraemia. In the group treated with epicillin, six from the total of fifty patients were considred treatment failures. Treatment was considred as a failure if the patient was febrile after ten days treatment or if there was a deterioration despite antibiotic therapy.
Acute Disease↗
Tinidazole and metronidazole in the treatment of intestinal amoebiasis.
Sixty adult patients with symptomatic intestinal amoebiasis and with Entamoeba histolytica present in stools were allocated at random to treatment with tinidazole or metronidazole, both administered in a dose of 2 g once daily for 3 consecutive days. The treatment period was extended in patients with stools positive for Entamoeba histolytica on the day following the last treatment day. Fifty-six patients, 29 on tinidazole and 27 on metronidazole, completed the trial as per the protocol. Twenty-eight patients (96.5%) on tinidazole and 15 (55.5%) on metronidazole were cured. Parasitological cure with partial relief of symptoms was obtained in 1 (3.5%) and 5 (18.5%) patients on tinidazole and metronidazole, respectively. Seven patients (26%) on metronidazole were treatment failures. Treatment had to be extended beyond 3 day in 53% of patients (8/15) on metronidazole as opposed to 11% (3/28) on tinidazole (p less than 0.01). The total number of side-effects, their severity, and the types were more in the metronidazole group. No toxic effects due to either drug were recorded. Tinidazole provided significantly higher cure rates than metronidazole in the treatment of symptomatic intestinal amoebiasis (p less than 0.01), and was better tolerated than metronidazole.
Adult↗
Gonorrhea. Center for Disease Control recommended treatment schedules, 1979.
These recommendations specify appropriate treatment, including dosage of antibiotics for uncomplicated gonococcal infections in adults, infections with penicillinase-producing Neisseria gonorrhoeae, acute salpingitis, acute epididymitis, disseminated gonococcal infections, and gonococcal infections in pediatric patients (including neonatal infections). Special attention is given to important diagnostic considerations, relation of gonococcal infections to concomitant venereal infections, treatment of sexual partners, follow-up, treatment failures, treatments not recommended, allergic problems in treatment, needs for hospitalization, and prevention of gonococcal ophthalmia. Attention is called to the importance of using no less than the recommended dosages of antibiotics.
Amoxicillin↗
Afterload reduction in the treatment of cardiac failure.
The vasodilators produce disparate modifications of cardiac function depending on the differing alterations of preload versus impedance: nitrates principally cause venodilation; nitroprusside, phentolamine and prazosin produce balanced arterial and venous dilation; while hydralazine predominantly effects arterial dilation. Combined nitroprusside and dopamine or dobutamine synergistically enhance low cardiac output and decrease raised left ventricular end-diastolic pressure. Ambulatory oral vasodilator therapy is provided by long-acting nitrates, hydralazine and prazosin alone, combined nitrate-hydralazine and combined prazosin-hydralazine. It is truly remarkable how quickly systemic vasodilators have become established as an important new medical advance in acute and chronic congestive heart failure treatment. In the future, as more experience is gained with the vasodilators and as newer such agents become available, the systemic vasodilators likely will be utilized as often as digitalis in the standard treatment of congestive heart failure.
Blood Pressure↗
[Clinical implication of serum insulin determination. Diagnosis and prognosis in patients with apparent secondary failure of treatment with sulfonylureas (author's transl)].
Serum insulin was measured after maximal stimulation in 213 patients with apparent secondary failure of treatment with sulfonylureas. The maximal increase of serum insulin was 327% of baseline in patients treated with oral drugs alone and 175% in patients switched to insulin. The control of diabetes in the patients treated with oral drugs alone was investigated 2 to 3 years later by a questionnaire and correlated to the insulin values measured earlier. Following conclusions were drawn: Sulfonylurea treatment is indicated if the increase of serum insulin is more than 300%. If the increase of serum insulin is below 200%, insulin treatment is necessary now or in the near future. The determination of serum insulin after maximal stimulation in patients with apparent secondary failure of sulfonylurea treatment has a diagnostic as well as a prognostic value.
Blood Glucose↗
Treatment monitoring in syphilis using the autoanalyser.
Treatment monitoring in syphilis using the automated Reiter protein complement fixation test and the automated reagin test was investigated over a two-year period. Clearly defined response patterns were demonstrated in primary and secondary syphilis and, to a lesser extent, in latent syphilis, thus facilitating the assessment of treatment and the identification of treatment failures and reinfection. No obvious treatment failures were detected in those patients receiving penicillin, but two failures were noted in a group of patients with secondary syphilis treated with doxycyline. The combination of two automated tests overcame some of the disadvantages inherent in the use of a single reagin test.
Antibodies↗
Formaldehyde induced anti-N: a possible cause of renal graft failure.
Treatment of human red cells with low concentrations of formaldehyde induces an antigenic change which makes them react very strongly with the anti-N sera found in certain patients treated by haemodialysis. This supports the idea that formaldehyde sterilisation of reusable home dialysers leads to the development of anti-N in these patients' sera. The clinical problems produced by this antibody are discussed together with ways of overcoming them.
Antibody Formation↗
Ovarian carcinoma: improved survival following abdominopelvic irradiation in patients with a completed pelvic operation.
A prospective, stratified, randomized study of 190 postoperative ovarian patients with Stages IB, II, and III (asymptomatic) presentations is reported. The median time of follow-up was 52 months. Patients in whom bilateral salpingo-oophorectomy and hysterectomy (BSOH) could not be completed because of extensive pelvic tumor had a poor prognosis which did not differ for any of the therapied tested. When BSOH was completed, pelvic plus abdominopelvic irradiation (P + AB) with no diaphragmatic shielding significnatly improved patient survival rate and long-term control of occult upper abdominal disease in approximately 25% more patients than pelvic irradiation alone or followed by adjuvant daily chlorambucil therapy. The effectiveness of P + AB in BSOH-completed patients was independent of stage or tumor grade and was most clearly appreciated in patients with all gross tumor removed. Chlorambucil added to pelvic irradiation delayed the time to treatment failure without reducing the number of treatment failures.
Abdomen↗
Machine learning detection of heteroresistance in Escherichia coli.
BACKGROUND: Heteroresistance (HR) is a significant type of antibiotic resistance observed for several bacterial species and antibiotic classes where a susceptible main population contains small subpopulations of resistant cells. Mathematical models, animal experiments and clinical studies associate HR with treatment failure. Currently used susceptibility tests do not detect heteroresistance reliably, which can result in misclassification of heteroresistant isolates as susceptible which might lead to treatment failure. Here we examined if whole genome sequence (WGS) data and machine learning (ML) can be used to detect bacterial HR. METHODS: We classified 467 Escherichia coli clinical isolates as HR or non-HR to the often used β-lactam/inhibitor combination piperacillin-tazobactam using pre-screening and Population Analysis Profiling tests. We sequenced the isolates, assembled the whole genomes and created a set of predictors based on current knowledge of HR mechanisms. Then we trained several machine learning models on 80% of this data set aiming to detect HR isolates. We compared performance of the best ML models on the remaining 20% of the data set with a baseline model based solely on the presence of β-lactamase genes. Furthermore, we sequenced the resistant sub-populations in order to analyse the genetic mechanisms underlying HR. FINDINGS: The best ML model achieved 100% sensitivity and 84.6% specificity, outperforming the baseline model. The strongest predictors of HR were the total number of β-lactamase genes, β-lactamase gene variants and presence of IS elements flanking them. Genetic analysis of HR strains confirmed that HR is caused by an increased copy number of resistance genes via gene amplification or plasmid copy number increase. This aligns with the ML model's findings, reinforcing the hypothesis that this mechanism underlies HR in Gram-negative bacteria. INTERPRETATION: We demonstrate that a combination of WGS and ML can identify HR in bacteria with perfect sensitivity and high specificity. This improved detection would allow for better-informed treatment decisions and potentially reduce the occurrence of treatment failures associated with HR. FUNDING: Funding provided to DIA from the Swedish Research Council (2021-02091) and NIH (1U19AI158080-01).
Machine Learning↗
Failure of treatment in chronic dermatophyte infections.
A proportion of dermatophyte infections fail to respond to normally adequate courses of griseofulvin and topical antifungal therapy. The organism Trichophyton rubrum was isolated from 96% of 50 patients studied, but no instances of in vitro resistance were seen. Of these patients, 57% had an underlying condition, commonly hay fever/asthma, atopic eczema, collagen disease or ichthyosis. Defective delayed type hypersensitivity responses and leucocyte migration inhibition to the specific antigen, trichophytin, were demonstrated. Immediate type hypersensitivity was seen in 58% and this was partially suppressible with chlorpheniramine and cimetidine. The relationship between these abnormalities and failure of treatment is discussed.
Adolescent↗
Pathologic identification of poor prognosis stage I (T1N0M0) cancer of the breast.
Twenty to 40% of Stage I(T1N0M0) cancers of the breast recur in ten years. This is an attempt to identify those patients in whom the disease is likely to recur. On the basis of a study of the histologic changes in the tumor and treatment failures poor prognosis was associated with several histological characteristics: poor cytologic differentiation; lymphatic permeation; blood vessel invasion and invasion of the tumor into the surrounding soft tissue. This classification was then applied to 363 cancers of the breast seen over a five year period and followed three to eight years. There were 203 Stage I (T1N0M0) tumors in the group. Ninety-four of the 203 Stage I tumors had one to four of the above histologic characteristics; 109 had none. Among the 109 patients characterized as good risks there were two treatment failures (2%). In the group of 94 with any high risk histologic features there were 47 treatment failures (50%) which were statistically significant (p = 0.001). The histologic changes had a cumulative effect on the degree of malignancy of the tumor. Pathologic changes in the tumor identified those patients whose Stage I (T1N0M0) tumors were likely to recur.
Adenocarcinoma↗
Artemether-lumefantrine for the treatment of Plasmodium falciparum malaria in Laos: a therapeutic efficacy study coupled with genomic and in vitro phenotypic analyses.
BACKGROUND: Artemisinin-based combination therapies (ACTs) have played a crucial role in decreasing the impact of malaria worldwide. Since 2005, artemether-lumefantrine (AL) has been the main first-line treatment for uncomplicated Plasmodium falciparum malaria in Laos. Herein, we aimed to study the efficacy of AL in the context of malaria elimination in Laos. METHODS: Between Aug 1, 2019, and June 11, 2023, AL efficacy was evaluated in four provinces of southern Laos: Attapeu, Champassack, Salavan, and Savannakhet. Adults and children (aged 1-60 years) with microscopically confirmed P falciparum malaria received oral AL twice a day for 3 days, with follow-up on days 7, 14, 21, and 28. The primary outcome was PCR-adjusted adequate clinical and parasitological response (ACPR) by day 28. Resistance to dihydroartemisinin (DHA) and lumefantrine (LM) was assessed by an in vitro phenotypic analysis, and mutations in P falciparum kelch13 (pfkelch13), P falciparum multidrug resistance 1 (pfmdr1), P falciparum plasmepsin 2 (pfpm2), and P falciparum chloroquine resistant transporter (pfcrt) were characterised in parasites collected from enrolled patients. Safety outcomes included the frequency and nature of adverse events and serious adverse events. FINDINGS: A total of 198 patients (median age 16 years [IQR 10-28]; 124 [63%] male and 74 [37%] female) were initially enrolled, of whom three were lost to follow-up, resulting in 195 patients who received the 3-day AL regimen. At day 28, the PCR-adjusted ACPR was 96% (95% CI 92-98), with a treatment failure rate of 2% (1-5) and a reinfection rate of 2% (1-5). Among the four PCR-confirmed recrudescent isolates, one showed markedly reduced LM susceptibility (LM 50% inhibitory concentration [IC50] 59·9 nM, 2·5 times higher than the median IC50 of other isolates) and high artemisinin resistance in vitro (ring-stage survival survival rate 35·8%), which was associated with the pfkelch13 R539T mutation and day-3 microscopy-positive parasitaemia. Among 190 isolates with successfully determined pfkelch13 sequencing, nine (5%) carried the pfkelch13 mutation R539T and 43 (23%) carried the C580Y mutation, and both were associated with day-3 microscopy-positive parasitaemia (p=0·044). No amplification of pfmdr1 or pfpm2, nor any mutations in pfmdr1 and pfcrt, were associated with treatment failure. INTERPRETATION: Our findings indicate the potential emergence of LM resistance in Laos. Although AL remains efficacious, vigilance for decreasing efficacy and close monitoring of LM efficacy should be considered to support the country's goal of eliminating malaria by 2030. Importantly, none of the known pfmdr1 or pfcrt haplotypes were uniquely associated with treatment failure, including the isolate with the highest LM IC50, underscoring the need to identify reliable molecular markers for LM resistance. FUNDING: Bill and Melinda Gates Foundation and The Global Fund.
Humans↗
Clinical correlations and significance of orceinpositivity in chronic active hepatitis and primary biliary cirrhosis.
Clinical, biochemical and immunological variables were analyzed in 30 patients with orcein-negative (ON) chronic active hepatitis (CAH), 4 patients with ON primary biliary cirrhosis (PBC), 8 patients with orcein-positive (OP; intracellular copper-binding protein seen histologically in liver biopsy specimens) CAH and 15 patients with OP-PBC. A marked elevation of serum bile acids, alkaline phosphatase, leusine aminopeptidase, gammaglutamyl transpeptidase and cholesterol concentrations, and highly pathological BSP Tm values were characteristic for OP-cases. In addition the faecal fat level was increased and bile acids decreased in OP-cases. Serum levels of IgG or IgM and the occurrence of smooth muscle, mitochondrial or glomerular antibodies were identical in ON- and OP-CAH as well as also in ON- and OP-PBC. 49 patients were treated with a combination of prednisone and azathioprine from 4 to 72 months (mean 22). 26 patients with ON-CAH responded biochemically and morphologically to the treatment. No treatment failures were found in ON-CAH. In contrast treatment failure was confirmed in every treated OP-PBC or OP-CAH. The results suggest that orcein-positivity indicates a poor response to prednisone-azathioprine treatment of CAH.
Adult↗
Limb salvage using preoperative intraarterial adriamycin and radiation therapy for extremity soft tissue sarcomas.
Surgical therapy has been the accepted method for management of most soft tissue sarcomas of the extremities, although it has been associated frequently with local treatment failure. Even when local control was achieved, over 50% of the patients with soft tissue sarcomas eventually developed and succumbed to distant metastases of their disease. Therefore, single modality therapy for soft tissue sarcomas by operation alone results in an unacceptably high incidence of treatment failure. Fortunately, new adjuvant treatment techniques have been developed that seem to have activity against these neoplasms. It is the purpose of this article to discuss our experience with a number of these techniques.
Doxorubicin↗
Ethics of psychopharmacological research.
1. Psychiatry is in dire need of research in all areas--from psychopharmacology to psychotherapy. 2. It is unethical not to undertake research as long as hundreds of thousands of patients suffer from incapacitating mental disorders. 3. It is unethical not to apply proper research principles to obtain maximal information from the observations of patients treated by different drugs or techniques. 4. The Tokyo (Helsinki II) declaration takes cognizance of the special problems in psychiatric (and certain other areas of) research, and should help to heighten the standard of all clinical research. 5. Psychopharmacology is based on the principles of the biological sciences. In the behavioral aspects of clinical psychopharmacological research non-objective observations cannot solely be based on these principles, but we should always be able to aim at: a. Description of spontaneous history. b. Description of diagnostic and therapeutic techniques and processes. c. Description of goals. d. Description of results (with as detailed information on treatment failures as on treatment successes). e. Prospective studies instead of retrospective ones. 6. Psychopharmacology is probably the area within psychiatry where the ethical issues have been most protected against the uncritical introduction of unproven therapeutic principles.
Ethics, Medical↗
Diffuse histiocytic lymphoma involving the gastrointestinal tract.
The results of staging and treatment of 18 patients with diffuse histiocytic lymphoma involving the gastrointestinal tract are summarized. Widespread disease (Stage IV) was found in the majority (72%) of patients after rigorous staging, indicating the relative rarity of localized gastrointestinal lymphoma and the resulting need for systemic therapy in most of these patients. Chemotherapy combined with surgical resection and/or radiation therapy produced complete remissions in only 5 of 18 patients (28%). Patients failed to achieve complete remission due to 1) tumor resistance to drug therapy (46% of treatment failures), and 2) massive intestinal hemorrhage or bowel perforation secondary to tumor necrosis (38% of treatment failures). These findings indicate the need for more active chemotherapeutic regimens and for measures aimed at preventing complications such as bowel perforation or hemorrhage, possibly by combining surgical resection of bowel lesions with systemic chemotherapy.
Adult↗