Chemical antagonists as adjunctive therapy in alcoholism treatment.
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Alcoholism↗
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A trial of sulfasalazine as adjunctive therapy in Crohn's disease.
The effect of the combination of sulfasalazine and prednisone has been compared with that of prednisone and placebo in 89 actively symptomatic patients with Crohn's disease in a double-blind, randomized, multicenter controlled trial. The combination was less effective than prednisone alone in treatment of active symptomatic disease. The probability of obtaining this result, if sulfasalazine truly has a clinically useful effect equal to or greater than that specified in the calculation, is less than 1%. Patients who were in remission at the end of 8 wk were rerandomized to receive either the two drugs together or prednisone plus placebo while repeated systematic attempts to withdraw prednisone were made over the next 6 mo. Sulfasalazine showed no prednisone-sparing effect as judged either by outcome ranking or total dose of prednisone consmed by the two treatment groups. However, in this comparison the probability is greater than 5% that, given the results observed, a clinically useful effect of sulfasalazine of specified minimum degree truly exists. It was possible to withdraw prednisone from 25% of patients at the first attempt and ultimately in 37%.
Adult↗
Periodontal therapy in humans. I. Microbiological and clinical effects of a single course of periodontal scaling and root planing, and of adjunctive tetracycline therapy.
The present results showed that maarked and long-lasting changes in the subgingival microflora associated with periodontal disease could be achieved by a single course of periodontal treatment. Immediately following therapy, the total number of subgingival organisms decreased 10- to 100-fold and the proportions of cultivable Gram negative organisms and anaerobic organisms generally decreased 3- to 4-fold or more. After treatment, most periodontal pockets were populated by a scant microflora predominated by facultative Actinomyces and Streptococcus species. The kinetics of the subgingival bacterial recolonization revealed that the total cell counts and the proportions of spirochetes and Capnocytophaga species did not reach their pretreatment levels even after 6 months. Other Gram negative anaerobic species returned to pretreatment proportions after 3 to 6 months. Several Gram positive species exhibited higher posttreatment than pretreatment proportions throughout the 6 months study. The microbiological shifts paralleled significant changes in the clinical status of the periodontal tissues. Following therapy, the periodontal pocket depths decreased generally 1 to 4 mm, the gingival inflammatory index, the gingival fluid flow, and the suppurative index were generally lower, and nine of 33 test pockets examined showed apposition of alveolar bone. The microbiological and clinical changes described were exhibited by two patients treated with periodontal scaling and root planing alone and by two patients treated with the adjunctive use of systemic tetracycline therapy. In two other patients, mechanical periodontal therapy only slightly reduced the total number of subgingival organisms and the proportions of spirochetes and other Gram negative anaerobic rods. A shift in the subgingival microbial composition was achieved in these two patients after tetracycline therapy. The following model for treatment of periodontal disease is proposed: (1) Conventional therapy including thorough periodontal scaling and root planing; (2) Monitoring the subgingival flora and the clinical course; and (3) Use of antimicrobial therapy in refractory cases. Further studies are needed to develop means for rapid identification of refractory patients, and to determine the optimal antimicrobial agent, the optimal route of administration, and the optimal dosage regime.
Actinomyces↗
Controlled study of PUVA and adjunctive topical therapy in the management of psoriasis.
In a random study of 116 patients with psoriasis vulgaris, oral psoralen photochemotherapy (PUVA) used alone was compared to PUVA plus adjunctive topical therapy with tar, dithranol, or topical corticosteroids. PUVA plus topical corticosteroids produced more rapid clearing of psoriasis but despite maintenance therapy, the frequency of recurrences of the disease during the early phase of follow-up was significantly higher with that treatment, as compared to all other treatments. Dithranol plus PUVA also cleared psoriasis quicker than PUVA alone but patient acceptability for that regimen was low. The addition of tar to PUVA therapy appeared to have little influence on results.
Adult↗
Insulin, Semaglutide and Dapagliflozin in Adults With Type 1 Diabetes: Design and Methods of Triple Therapy for Type 1 Diabetes (TTT1)-An International Phase 3 Clinical Trial.
AIMS: Attaining target glycaemia can be a challenge in Type 1 Diabetes (T1D) due to insulin-induced weight gain. Adjunct therapy with modern glucose-lowering agents developed for type 2 diabetes (T2D) has great potential but may be insufficiently efficacious and carries risks of hypoglycaemia and ketosis. We designed the first Phase 3 clinical trial to assess the efficacy and safety of adding a Glucagon-Like Peptide 1 receptor agonist (GLP-1RA) and a Sodium-Glucose Co-transporter (SGLT2) Inhibitor to insulin therapy in overweight and obese adults with T1D and glycaemia above target (HbA1c 7.5%-11.0% inclusive) (NCT03899402). MATERIALS AND METHODS: In Period 1, participants are randomized 2:1 (open label) for 26 weeks to semaglutide and insulin (uptitrated to 1.0 mg weekly) or standard insulin therapy. In Period 2, those randomized to semaglutide and insulin in Period 1 are further randomized (double-blind) for 26 weeks to dapagliflozin (10 mg daily) or placebo, in addition to semaglutide. The primary objective is to compare change in HbA1c on 'triple therapy' (dapagliflozin, semaglutide and insulin) with 'dual therapy' (placebo, semaglutide and insulin). Secondary objectives include comparisons of triple therapy with standard insulin therapy and dual therapy (semaglutide and insulin) with standard insulin therapy. Safety outcomes include hypoglycaemia and ketosis. A sample size recalculation during the trial based on analysis of masked data revised the original recruitment target from 114 to 82 participants. CONCLUSION: The TTT1 trial will provide clinically useful information on combination adjunct therapy in the treatment of T1D.
Humans↗
The role of adjunctive drug therapy for intermittent catheterization and self-catheterization in children with vesical dysfunction.
Thirty-nine children with vesical dysfunction were managed with clean intermittent catheterization. Most children achieved effective urinary continence, the majority with the help of adjunctive drug therapy to relax the detrusor, contract the bladder neck or both. Intermittent catheterization had a generally favourable effect on infection, reflux and hydronephrosis. Intermittent catheterization in childhood is a perferred alternative to urinary diversion in cases of neurogenic bladder dysfunction.
Adolescent↗
Partial plasma exchange, and adjunct in therapy to complex clinical problems.
The use of therapeutic partial plasma exchange (PPE) is reviewed as an adjunct in the treatment of certain complex clinical problems. The procedure is performed with a Model 30 Haemonetics Blood Cell Separator in which the patient's plasma is partially exchanged with fresh frozen plasma, fresh frozen plasma with cryoprecipitate removed or with plasma protein fraction. The present study describes the use of PPE on 12 patients within the last 15 months as a means of altering the plasma proteins to achieve certain therapeutic goals. The study consists of six procoagulant deficient patients (five congentital and one acquired) in which five of the six patients responded by reflecting a satisfactory rise in the plasma procoagulant level following the procedure, resulting in cessation of bleeding. The sixth patient was thought to have had a procoagulant inhibitor, thus the procoagulant level was changed only minimally. The remaining six patients (five with hyperviscosity syndrome and one with platelet antibody) responded only to the degree of the intensiveness of the PPE procedure. More aggressvie, repeated PPE and/or plasmapheresis are needed if the clinical objective is to decrease the plasma viscosity or to lower a humoral antibody within the patient's plasma.
Blood Coagulation Disorders↗
Beta-adrenergic blockade as adjunctive oral therapy in patients with chronic atrial fibrillation.
In many patients with chronic atrial fibrillation, it is difficult to prevent an excessive ventricular rate under stress, even with high levels of digoxin in the blood. The effect of adding beta-adrenergic blockade with practolol to digoxin on the heart rate at rest and during low-grade controlled exercise was investigated in 28 patients with chronic atrial fibrillation and in ten normal control subjects who were receiving maintenance dosages (0.25 to 0.75 mg) of digoxin. In atrial fibrillation, therapy with practolol decreased the mean heart rate at rest from 99.8 beats per minute to 77.5 beats per minute (23 percent reduction; P less than 0.01) and during mild exercise from 148.9 beats per minute to 105.4 beats per minute (29 percent) reduction (P less than 0.001). Fifteen patients had clinically significant heart failure; therapy with practolol did not worsen it. Reversible side effects were detected in two patients. When therapy with digoxin is not sufficient to control atrial fibrillation, the addition of a beta-adrenergic blocking agent is recommended as adjunctive treatment in selected patients.
Administration, Oral↗
Outcome of paediatric bacterial meningitis 1979-1989.
OBJECTIVE: To determine the outcome of all cases of paediatric bacterial meningitis over the 11-year period 1979-1989 and discuss the role of adjunctive therapy with dexamethasone. DESIGN AND SETTING: The study was performed by retrospective case review at Flinders Medical Centre, a general teaching hospital. RESULTS: There were 80 episodes in 79 patients. The age range was 2 days to 15 years (mean, 1.7 years). Haemophilus influenzae type b was the commonest organism (60 of 80 cases; 75%). There were five deaths (6.3%). Sensorineural hearing loss was found in six of 71 children (8.5%) and was bilateral and severe in four (5.6%). Other problems included learning difficulties (12.7%), motor problems (7%), speech delay (7%), hyperactivity (4.2%), blindness (2.8%), obstructive hydrocephalus (2.8%) and recurrent seizures (2.8%). CONCLUSIONS: Bacterial meningitis remains a disease with significant morbidity and mortality. Adjunctive therapy with dexamethasone should be considered, and vaccination against Haemophilus influenzae type b should be routine.
Adolescent↗
[Clinical and bacteriological evaluation of sisomicin in sixteen cases of severe bronchopulmonary infection (author's transl)].
Sisomicin, an aminoglycoside antibiotic, was used as sole bactericidal therapy in sixteen cases of severe bronchopulmonary infection for an average of 11,5 days (range 7 to 14) with a dose of 3,5 mg/kg per day in three intramuscular injections. Fifteen of these hospitalized patients presented with chronic airway obstruction which resulted in lowered O2 saturation (SaO2 congruent to 86,1%, range 74 to 93) and, in twelve patients, hypercapnia (PaCO2 = 55,7 torr, range 33--73). Two of these patients were under continuous assisted ventilation. Two patients had a lower lobe infiltrate and a lung abscess respectively. Proteus (n = 3), Pseudomonas (n = 9), K. pneumoniae (n = 2), E. Coli (n = 1), Enterobacter (n = 1), S. aureus (n = 1) and D. pneumoniae (n = 1) were the dominant organisms in the bronchial secretions isolated by Mulder's method; P. aeruginosa was associated with K. pneumoniae, P. rettgeri and E. coli respectively in three cases. In thirteen cases, either a clinical cure (n = 2) or a definite improvement was observed (sputum volume and purulence, auscultatory signs, temperature). However, among these patients were three cases of superinfection/colonization and two cases of persistent organisms. In addition, in two of the three cases showing no improvement colonization occured. The favorable results of this study appear to be due to vigorous antibiotic therapy combined with intensive adjunct therapy. No adverse local or systemic reactions clearly attributable to the drug were observed.
Adult↗
Acquired mesio-occlusion in adults: treatment without appliances.
1. The two types of mesio-occlusion are developmental (true Class III) and acquired. 2. In acquired mesio-occlusion the mandible can be retruded comfortably so that maxillary and mandibular incisors meet edge to edge. This cannot be done by the patient with developmental mesio-occlusion. 3. The extent and severity of periodontal disease cannot be predicted from the severity of the malocclusion. 4. In most patients the treatment of choice for acquired mesio-occlusion is coronal reshaping and periodontal therapy if periodontal disease is present. 5. Orthodontic therapy may be used as an adjunctive therapy in selected patients. However, disadvantages are often greater than advantages when orthodontic therapy is used to treat acquired mesio-occlusion in adults.
Adult↗
Comparison of the effectiveness of phototherapy and exchange transfusion in the management of nonhemolytic neonatal hyperbilirubinemia.
The relative effectiveness of phototherapy and exchange transfusion for nonhemolytic neonatal hyperbilirubinemia was compared in two closely matched groups of infants. Although the exchange transfusion achieved an immediate reduction of bilirubin level, the "rebound" was rapid and tended to offset this reduction. The more gradual and steady effect of phototherapy resulted in a significantly lower serum bilirubin level at 1, 2, and 3 days after commencement of therapy; the rebound after phototherapy was small. Phototherapy was demonstrated to be more effective than exchange transfusion in achieving prolonged reduction of bilirubin levels for nonhemolytic hyperbilirubinemia. With more efficient lamps delivering more energy in the desired spectrum, it would seem feasible to treat hyperbilirubinemia of whatever etiology with this safer and more convenient form of therapy, though sometimes only as in adjunct therapy.
Bilirubin↗
The creative arts therapies as "real therapies".
Elements of a standard definition of psychotherapy are used to support the argument that the creative arts therapies should not be characterized as adjunctive therapies, or discredited as not being "real therapies." Two concepts widely acknowledged as important in the application of the creative arts therapies are discussed: first, that the nonverbal media employed by creative arts therapists tap emotional rather than cognitive processes and evoke responses more directly and immediately than traditional verbal therapies, and, second, that creative arts therapies are reality-based and provide a more immediate and real link to a patient's experience than something he can portray only verbally.
Attitude of Health Personnel↗
Pharmacotherapy of essential hypertension.
Practical clinical aspects of the evaluation and treatment of essential hypertension are reviewed. Drug therapy discussed includes diuretics, and as adjunctive therapy, sympathoplegic agents, peripheral vasodilators and beta blockers. Also covered are treatment of less common forms of essential hypertension, other forms of antihypertensive therapy, and the use of fixed combinations of antihypertensive drugs.
Adrenergic beta-Antagonists↗
Nutrients, vitamins and minerals as therapy.
Nutrients as therapy for patients with cancer are important as adjunctive therapy, i.e., adequate nutrition may be important for the success of whatever form of therapy is administered. Diets deficient in certain amino acids have some selectivity when tested against experimental tumors propagated in vivo. Such diets have had limited clinical trial and have been characterized by poor patient acceptance. Enzymes that produce deficiencies of certain amino acids, e.g., asparaginase, glutaminase, methioninase appear to offer a more reasonable approach to development of selective amino acid deficiencies in man. Trace metals in excessive amounts may be toxic or carcinogenic to the host. Two heavy metal salts, Cis-diamine dichloroplatinum and gallium nitrate, have recently been shown to have anti-neoplastic effects in man. There is no conclusive evidence that vitamins, administered in large doses, have significant antineoplastic effects although large doses of vitamin A, vitamin C, and vitamin B12 have been used for this purpose. In contrast, certain vitamin analogs such as folate antimetabolites can cause tumor regression and are useful clinical treatment. An enzyme, carboxypeptidase G1, by splitting naturally occurring folates, may also have promise as a method of producing enzymic folate deficiency.
Amino Acids↗
Juvenile fibromatosis.
Juvenile fibromatosis is a benign lesion with locally aggressive characteristics. Wide surgical excision is the treatment of choice. Radiation therapy can be used for inoperable cases or as adjunctive therapy. Steroid therapy has not been used extensively and deserves further evaluation. In the head and neck area, juvenile fibromatosis must be very carefully diagnosed and treated due to the serious consequences that result from inadequate control.
Ear Neoplasms↗
Surgery and chemotherapy in early breast cancer.
The updated results are reported of a prospective controlled clinical trial employing combined chemotherapy with cyclophosphamide, methotrexate and fluorouracil (CMF) as adjuvant treatment in patients with operable breast cancer and positive homolateral axillary lymph nodes (N+). At 36 months from surgery, actuarial analysis shows that there is a significant difference in the relapse rate in favor of adjuvant chemotherapy (45.7% in the control group vs. 26.3% in the CMF group). Distant recurrences were the most frequent site of treatment failure and occurred particularly in the skeleton. The therapy was fairly well tolerated. Both the influence of adjunctive therapy on overall survival after mastectomy and the incidence of long-term side effects are still unknown.
Antineoplastic Agents↗
Memantine Augmentation for Obsessive-Compulsive Symptoms in Bipolar Disorder: A Randomized, Double-Blind, Placebo-Controlled Trial.
BACKGROUND: Obsessive-compulsive symptoms are frequently observed in patients with bipolar disorder and present a significant therapeutic challenge. This study evaluated the efficacy and safety of memantine as an adjunctive therapy for obsessive-compulsive disorder in patients with bipolar disorder. METHODS: In this randomized, double-blind, placebo-controlled trial, 46 patients with bipolar disorder and obsessive-compulsive disorder, stabilized on quetiapine and lithium, were randomly assigned to receive either memantine (n = 23) or placebo (n = 23) for 6 weeks. RESULTS: The memantine group showed a significant reduction in Yale-Brown Obsessive-Compulsive Scale scores compared with the placebo group (Cohen d = 1.57 vs 0.42, P < 0.001). Nausea was the most common side effect, but overall adverse effects were minimal. CONCLUSION: Memantine appears to be a safe and effective adjunctive treatment for obsessive-compulsive disorder in patients with bipolar disorder, warranting further investigation.
Humans↗