Systemic lupus erythematosus is a complex autoimmune disease that remains challenging to treat. Recent advances in the understanding of the pathogenesis of SLE pave the way for the evaluation of ...biologic medicine. The most promising therapeutic targets in SLE are those that interfere with B cells count or normal function, interferon inhibitors, JAK inhibitors and biologicals that alter the cytokines imbalance that characterizes SLE. Recent phase 3 clinical trials have evaluated the role of belimumab in lupus nephritis and the usefulness of anifrolumab in the treatment of moderate to severe SLE. Many more trials are currently underway and may improve the level of care of patients with SLE in the near future.
Chronic rhinosinusitis with nasal polyps is a severe form of chronic rhinosinusitis, which has a strong negative impact on quality of life. Rhinoscopy is helpful for diagnosis, and initial management ...depends on intra-nasal corticosteroids and sometimes short-term oral corticosteroids (1 to 3 weeks). If well-conducted drug therapy fails, surgery is considered. In the event of post-surgery recurrence or in case of concomitant severe asthma, biologic therapies represent an interesting option. These drugs include dupilumab, mepolizumab, benralizumab and omalizumab. The choice of medication depends on the individual patient context, which includes the presence of atopic dermatitis, eosinophilia, or asthma.
Allergy to furry animals: myth and reality Clottu, Aurélie; Mahdi Aljedani, Rima; Spertini, François
Revue médicale suisse,
2020-Apr-08, Letnik:
16, Številka:
689
Journal Article
Recenzirano
Allergy to furry animals is a frequent health issue, and should be suspected when investigating any yearlong rhinoconjonctivitis or asthma. A detailed medical history and skin prick tests are usually ...sufficient for diagnosis, and if necessary, specific IgE testing may be performed. In case of proven hypersensitivity, avoidance of animal allergens is the main therapeutic measure, primarily by removing the animal from the patient's environment, in association with symptomatic treatment. If animal removing is impossible, other measures exist to decrease allergen load, but not with the same -efficacy as removing the animal, particularly for asthma. Immunotherapy is available for cat and dog allergy, but indication is to be carefully discussed.
Lung abscess occurs in very pleomorphic according to germs initially involved. The mechanism commonly found is an aspiration of the oropharyngeal flora in patients with disorders of consciousness or ...swallowing. The infection is polymicrobial, with presence of anaerobic germs in 2/3 of the cases. The support consists of a prolonged antibiotic treatment, as well as anaerobic until resolution or stability of the radiological image. In case of prolonged toxic state, drainage of the abscess is to be discussed especially if there is no airways drainage. Surgical sanctions is rarely needed regardless of the size of the abscess, unless underlying carcinoma is present.
Equine Sarcoid (ES) is the most common skin tumour in horses with high recurrence rate. No single universal treatment is effective. Viscum album extracts (VAE) are used as adjunct in the treatment of ...human cancer. We hypothesized that therapy with VAE (Iscador® P) is also effective in Equine Sarcoids. Of 53 horses with ES, 42 were treated solely with VAE or placebo as monotherapy and 11 were treated after selective excision of ES. Horses were randomly assigned to the VAE (n=32) or placebo group (n=21). Horses received increasing concentrations of VAE from 0.1mg/ml to 20mg/ml or physiological NaCl solution 3 times a week over 105 days s.c. Number, localization, size and type of the ES were documented over 12 months. Cure or improvement rate (decrease of tumour size by 50% or more in at least half of the tumours) were assessed after one year. Sarcoid level assessment included analysis of 1 to 7 clinically relevant sarcoids per horse. In the VAE group, 13 horses (41%) showed improvement. Of these, 9 patients showed complete remission (28%). In the control group only 3 cases (14%), all showing complete remission, were classified as improved. In the VAE group 27 ES (38%) showed complete remission and 48 (67%) improvement after one year compared to 9 ES with complete remission (13%; n.s.) and 17 ES (40%; p<0.01) with improvement in the placebo group. VAE (Iscador® P) represent a safe and effective treatment for ES, particularly in cases with multiple sarcoids.
Mistletoe extracts (Viscum album extracts, VAE), such as ISCADOR, have been used successfully in human oncology for many years. In veterinary medicine, there have been reports of successful ...treatment, but scientific data on efficacy are lacking. Two studies were therefore conducted to assess whether VAE can serve as an adjunct to standard treatment in horses and cats.
As part of a placebo-controlled double-blind study (Study 1), 53 horses with equine sarcoid (a solitary or multifocal skin tumour) were treated with VAE pini (pine mistletoe) in progressively increasing doses (32) or with a sodium chloride solution (21) three times a week for 15 weeks. All horses were observed over a period of 12 months for tumour recurrence and cure. In an observational study (Study 2), 44 cats with fibrosarcoma, a very common skin tumour with a high rate of recurrence, were treated postoperatively with 0.1% (0.5ml per dose) oral VAE quercus (oak mistletoe) twice daily, and disease-free survival was measured.
In Study 1, treatment with ISCADOR led to significantly better results than placebo. Improvement was seen in 41% of cases (placebo: 14%), and cure was achieved in 28% of cases (placebo 14%). In Study 2, disease-free survival in cats treated postoperatively with VAE quercus was 438 days compared with 365–475 days for conventional chemotherapies and 120–261 days for surgery alone, as seen in the literature. Aggressive surgery combined with radiation and chemotherapy led to markedly superior results (661–986 days).
The results of the first study show that oral administration of mistletoe preparations also yields satisfactory prophylactic effects. The discussion surrounding oral treatment and the question of whether it can replace injection treatment must therefore be continued. The second study was able to demonstrate, for the first time, the efficacy of VAE compared to a placebo control. This study also showed that the effect of VAE apparently extends considerably beyond the treatment period; unexpectedly, only very few recurrences were observed between the end of treatment and the 12th month of observation.
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