Treatment Difficult (treatment + difficult)

Distribution by Scientific Domains

Selected Abstracts

The impact on parents of developments in the care of children with bleeding disorders

HAEMOPHILIA, Issue 1 2008
Summary., This research considered the impact on parents of children with bleeding disorders of the increased use of home-based treatment and greater parental responsibility for management of the condition. Although they have undoubted advantages, these changes also present parents with new challenges. Some found administration of the treatment difficult, and decisions about treatment and the everyday management of the condition can also prove problematic. Services should be aware of these issues and help parents access appropriate support. [source]

Analysis of drug resistance and virulence-factor genotype of Irish Helicobacter pylori strains: is there any relationship between resistance to metronidazole and cagA status?

Summary Background,Helicobacter pylori infection is eradicated with antimicrobial agents and drug-resistant strains make successful treatment difficult. Geographical variations in virulence-factor genotype also exist. Aim, To evaluate prevalence of drug resistance and virulence-factor genotype in Irish H. pylori strains and to investigate if there is any relationship between drug resistance and genotype. Methods,Helicobacter pylori strains isolated from 103 patients were examined. Antimicrobial susceptibilities were tested by Etest. The virulence-factor genotypes were determined using PCR. Frequencies of spontaneous metronidazole-resistance were measured in vitro. Results, Metronidazole resistance was present in 37.9% of strains examined. 16.5% of strains were clarithromycin-resistant and resistance to both agents observed was found in 12.6% of strains. 68% of strains were cagA+. The dominant vacA type was s1/m2, followed by s1/m1 and s2/m2. The metronidazole resistance rate in cagA, group was significantly higher than in cagA+ (P = 0.0089). Spontaneous resistance to metronidazole in cagA, occurred in higher frequency when compared with cagA+. Conclusions,cagA+ and vacAs1/m2 type was the dominant genotype in Irish H. pylori strains. Significant rates of metronidazole resistance were observed in cagA, group. cagA, strains tend to acquire metronidazole resistance in vitro. Absence of cagA might be a risk factor in development of metronidazole resistance. [source]

A dramatic response to a single dose of infliximab as rescue therapy in acute generalized pustular psoriasis of von Zumbusch associated with a neutrophilic cholangitis

Nisha Suyien Chandran
ABSTRACT Generalized pustular psoriasis of von Zumbusch is an unstable, inflammatory form of psoriasis, with the hallmark of neutrophil infiltration in cutaneous as well as extracutaneous lesions. It is often recalcitrant, making treatment difficult. Tumour necrosis factor-, antagonists including infliximab have been used with success in treating recalcitrant cases. We report a case of a 48-year-old Chinese female patient with a long-standing history of poorly controlled generalized pustular psoriasis which was resistant to multiple therapies. During a severe flare, a single dose of infliximab resulted in rapid clearing of cutaneous lesions, together with resolution of liver function abnormalities that are likely secondary to neutrophilic cholangitis. Subsequent maintenance therapy with acitretin allowed remission of pustular disease for 7 months. This demonstrates the efficacy of single-dose infliximab for both cutaneous lesions and systemic hepatic involvement in generalized pustular psoriasis. [source]

Aquagenic pruritus responding to intermittent photochemotherapy

S. A. Holme
Aquagenic pruritus is a rare but distinct entity in which intense itching develops after contact with water, in the absence of cutaneous signs or underlying disorders that could explain the symptoms. The aetiology is currently unknown, and treatment difficult, with a poor response to antihistamines. Psoralen-ultra violet A (PUVA) photochemotherapy can be effective, but frequent maintenance therapy may be required to prevent relapse of symptoms. We present a patient with typical aquagenic pruritus who responded well to PUVA, and who has remained well controlled on infrequent maintenance. [source]