Attitude toward alternative therapy, compliance with standard treatment, and need for emotional support in patients with melanoma

The extent of use of alternative therapies, psychosocial and disease-specific variables predictive of alternative therapy use, and factors motivating the use of alternative therapies in HIV-infected patients receiving highly active antiretroviral therapy (HAART) have not been well defined. Types of alternative therapies used, demographic and medical data, coping (Billing and Moos inventory of coping with illness styles), social support (Irwing and Sarason questionnaire), sense of personal control (Pearlin's Mastery scale), quality of life (Medical Outcome Study scale), health beliefs, and adherence rate were prospectively assessed in 118 HIV-infected patients receiving HAART. Of 38% (45/118) of the patients who used alternative therapies, 56% (25/45) began using alternative therapies since the initiation of HAART. While Caucasian patients were more likely to use alternative therapies than all other patients ( P = 0.015), new users of alternative therapies were more likely to be African-American ( P = 0.022). Alternative therapy users reported less satisfaction with their emotional support ( P = 0.027), and had greater psychological distress ( P = 0.048), but were more likely to utilize problem-focused coping ( P = 0.015). Patients who used alternative therapies were less likely to believe that HAART was beneficial ( P = 0.06). Physicians were unaware of patients' alternative therapy use in 40% (18/45) of all patients who used alternative therapies, in 67% of herbal therapy users, and in 100% of dietary supplement users. Adherence to antiretroviral therapy, CD4 count, and HIV-RNA level were neither predictive nor affected by alternative therapy use. Despite scepticism about the benefits of HAART, resort to alternative therapies did not undermine adherence with antiretroviral therapy. Although able actively to cope with their illness, users of alternative therapies had greater psychological distress and were less satisfied with their emotional support. Interventions aimed at promoting their psychological well-being and enhancing the emotional support should be considered in these patients.

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Mycophenolate Mofetil for the Treatment of Autoimmune Hepatitis in Patients Refractory or Intolerant to Conventional Therapy

Canadian Journal of Gastroenterology ◽

10.1155/2010/891252 ◽

2010 ◽

Vol 24 (10) ◽

pp. 588-592 ◽

Cited By ~ 54

Author(s):

Kaveh Sharzehi ◽

Mary Ann Huang ◽

Ian R Schreibman ◽

Kimberly A Brown

Keyword(s):

Mycophenolate Mofetil ◽

Autoimmune Hepatitis ◽

Conventional Therapy ◽

Standard Treatment ◽

Alternative Therapy ◽

Complete Response ◽

Refractory Disease ◽

Henry Ford ◽

Standardized Treatment

BACKGROUND: Autoimmune hepatitis is characterized by hepatocellular inflammation often progressing to cirrhosis. Standard treatment consists of corticosteroids and azathioprine. For the 20% of patients with refractory disease or those who are intolerant to medication, there is no standardized treatment.OBJECTIVE: To evaluate mycophenolate mofetil (MMF) as an alternative therapy for autoimmune hepatitis.METHODS: The present retrospective study identified all patients with autoimmune hepatitis who were treated with MMF over a 10-year period at the Henry Ford Hospital (Michigan, USA). These patients were evaluated for tolerance and response.RESULTS: Of the 90 patients participating in the study, 48% had a complete response, 32% experienced relapses and 21% were refractory. MMF was initiated in 21 patients – 12 (57%) for refractory disease and nine (43%) for medication intolerance. Of the 12 patients converted for refractory disease, all showed biochemical improvement but none had a complete response. Of the patients converted due to intolerance, 88% maintained complete remission. For all patients converted to MMF, there was a mean decrease in steroid dose from 18.9 mg/day to 7.8 mg/day (P=0.01).CONCLUSIONS: In patients with autoimmune hepatitis who were intolerant to conventional therapy, MMF was well tolerated, with 88% of patients maintained in remission. MMF did not induce remission in those refractory to conventional therapy; however, it resulted in a significant decrease in steroid use. Prospective studies are needed to better assess the role of MMF as an alternative therapy.

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Duplex-Guided Angioplasty of Failing or Nonmaturing Arteriovenous Access

Journal for Vascular Ultrasound ◽

10.1177/154431670903300101 ◽

2009 ◽

Vol 33 (1) ◽

pp. 9-12

Author(s):

Natalie Marks ◽

Anil Hingorani ◽

Enrico Ascher

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Renal Insufficiency ◽

Standard Treatment ◽

Alternative Therapy ◽

Contrast Material ◽

Significant Stenosis ◽

Arteriovenous Access ◽

Artery Disease ◽

Therapeutic Problem

Objective Patients not yet on dialysis with nonmaturing arterio-venous (AV) accesses present a therapeutic problem. Because the standard treatment with balloon angioplasty requires nephrotoxic contrast use for diagnosis and treatment, we have sought an alternative therapy. Methods Five consecutive patients with chronic renal insufficiency and failing arteriovenous (AV) access underwent duplex-guided balloon angioplasties at our institution. These were 3 women and 2 men with age ranging from 70 to 85 years (mean 77 ± 7 years). All patients were hypertensive, 4 (80%) were diabetics, and 3 (60%) had coronary artery disease. Three patients (60%) had target AV access used for dialysis. Preoperative volume flows (VF) measured by duplex ranged from 200 mL/min to 1160 mL/min (mean 755 ± 358 mL/min). Peal systolic velocity obtained at the most significant stenosis preoperatively ranged from 428 cm/sec to 656 cm/sec (mean 555 ± 87 cm/sec). Technique All procedures were performed via short sheath inserted under duplex guidance. Wire and balloon passage and inflation were performed under duplex surveillance as well. Results None of these procedures required use of fluoroscopy or contrast material. One patient had a stent placed for recoiling lesion. Postoperative VF ranged from 520 mL/min to 1750 mL/min (mean 1272 ± 486 mL/min). Peal systolic velocity obtained at the most significant stenosis postoperatively ranged from 142 cm/sec to 321 cm/sec (mean 233 ± 64 cm/sec). Conclusions Angioplasty of failing AV access can be performed under duplex guidance alone. Duplex guidance offers advantages of hemodynamic evaluation for recoiling lesions and need for stenting.

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Bio-Optimized Curcuma as Adjuvant Therapy of Osteoarthritis and Its Influence on Gene Regulation (Sirt1), Metabolic Inflammation and Associated Symptoms

Nutrition and Food Processing ◽

10.31579/2637-8914/052 ◽

2021 ◽

Vol 04 (04) ◽

pp. 01-16

Author(s):

Sara Bianchi

Keyword(s):

Oxidative Stress ◽

Vitamin D ◽

Inflammatory Markers ◽

Metabolic Regulation ◽

Standard Treatment ◽

Alternative Therapy ◽

Degenerative Disease ◽

Chronic Degenerative Disease ◽

Inflammatory State

Background and aim: Osteoarthritis (OA) is a chronic degenerative disease characterized by an inflammatory state and significant oxidative stress. As curcuma is known for its anti-inflammatory and antioxidant activities, it could be used as alternative therapy next to or together with the standard treatment. This treatment consists of analgesics, steroids or non-steroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation related symptoms. The current study investigates the effect of bio-optimized curcuma on genetic (SIRT1) and metabolic regulation of inflammation and associated symptomatology in patients with osteoarthritis. Materials and methods: In the in vitro study, Hela human cells were seeded in 12-well plates, incubated with curcuma at different concentrations and incubated for 3, 6 and 24 hours. The targeted protein expression/phosphorylation was evaluated by immunoblotting, while cytotoxicity tests were performed by CellTiter-Blue Cell Viability Assay. In the in vivo study, a total of 33 patients were recruited and divided into 3 subgroups based on the treatment: standard treatment (ST), ST + curcuma and ST + curcuma + Vitamin D (2000UI). The health status (SF36) and osteoarthritis index (WOMAC score) were analyzed at 0; 1,5 and 3 months with blood sampling at 0 and 3 months for the evaluation of inflammation markers, 25 (OH) VitD and SIRT1. Results: in vitro data showed no statistically significant decrease (p>0.05) in the number of viable cells. The expression of SIRT1 and the activation of AMP activated protein kinase (AMPK) were significantly increased in all experimental groups compared with the control group (p<0.001). A significant increase in 25(OH) VitD values in the ST + curcuma + VitD group (p <0.007) and in SIRT1 in all groups taking curcuma (p <0.001) was shown. Also for IL-1 (p=0.031), IL-6 (p=0.031) and IFN-γ (p=0.013), all groups taking curcuma showed significantly lower inflammatory markers with no added value of vitamin D. Conclusions: Curcuma as an adjuvant to ST leads to a positive modulation of the SIRT1 pathway, a significant decline of blood inflammatory markers and a better osteoarthritis outcome. Osteoarthritis, a chronic degenerative disease characterized by an inflammatory state and significant oxidative stress Curcuma as alternative therapy next to or together with the standard treatment Effect of bio-optimized curcuma on genetic and metabolic regulation of inflammation Positive modulation of SIRT1 pathway, decline of blood inflammatory markers and a better OA outcome

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