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Prescribing for a first episode of schizophrenia-like psychosis
Published in Kathy J Aitchison, Karena Meehan, Robin M Murray, First Episode Psychosis, 2021
Kathy J Aitchison, Karena Meehan, Robin M Murray
Consolidation refers to the continuation of treatment when the acute symptoms are resolving, in order to consolidate the response. Many clinicians would advise continuing antipsychotic therapy for approximately a year (minimum of 6 months) after a first psychotic episode. However, in McGorry's first-episode work reported to date, less than half of the sample were still receiving neuroleptics at 6 months.8 One of the reasons for this is that only 30.5% of the sample initially met the diagnostic criteria for schizophrenia; for those with a diagnosis of schizophrenia or schizo-phreniform disorder, the aim is 6 to 12 months of antipsychotic treatment. This may be further extended if positive symptoms persist, and beyond that into a period of remission to allow for consolidation. With affective psychoses a similar duration of therapy was aimed for, but 6 to 9 months was probably more common. There are therefore no absolute guidelines as to the length of remission into which treatment should continue for consolidation, but a minimum of 6 months would seem reasonable.
Diagnosis and Treatment of COVID-19
Published in Wenguang Xia, Xiaolin Huang, Rehabilitation from COVID-19, 2021
At the early stage of the disease, multiple small patchy shadows and interstitial changes appear, which are more obvious in the periphery of the lung. Then it develops into multiple ground-glass opacities (GGOs) and infiltration shadows. In severe cases, pulmonary consolidation may occur. Pleural effusion is rare.
Legionnaire’s Disease and Severe Pneumonia Mimics in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Some pneumonia etiologies may have CXR findings with a focal/localized but are not confirmed to a particular lung segment/lobe. Such “localized” but not lobar infiltrates are common with RSV, adenovirus, and Legionnaire’s disease. While the appearance of Legionnaire’s disease on the CXR is non-diagnostic, its radiologic behavior is that of a rapidly progressive unilateral/bilateral pneumonia with fluffy or nodular interstitial infiltrates. Consolidation occurs with typical bacterial CAP, e.g., S. pneumoniae. However, consolidation is not uncommon with viral pneumonias, e.g., RSV, adenovirus, and Legionnaire’s disease. Excluding K. pneumoniae in alcoholics and lung abscesses (from massive aspiration), cavitation is an uncommon but important diagnostic clue in severe CAPs, if due to influenza with simultaneous S. aureus pneumonia (Table 14.3).
Effect of concomitant antibiotics use on patient outcomes and adverse effects in patients treated with ICIs
Published in Immunopharmacology and Immunotoxicology, 2023
Jiuhang Yu, Yichuang Yin, Yang Yu, Mengfei Cheng, Shuo Zhang, Shuai Jiang, Mei Dong
In the field of tumor treatment, ICIs have made breakthroughs in recent years and provided a more effective way for the treatment of various advanced malignant tumors [1]. Immune checkpoints play an important role in controlling the activation or apoptosis of human T cells. Mice born without immune checkpoints will suffer from serious autoimmune diseases or even die [2]. ICIs by binding specifically to human immune checkpoint sites, prevent their overactivation by tumor cells, interrupt the abnormal apoptosis of T cells, and in turn re-stimulate the immune system to participate in the killing of cancer cells [3]. Compared with clinical first-line platinum-based chemotherapy regimens (such as platinum-pemetrexed or platinum-paclitaxel), in NSCLC patients with more than 50% of tumor/immune cells expressing PD-L1 protein, single immunotherapy probably improved PFS (hazard ratio (HR),0.68; 95% confidence interval (CL) [0.52–0.88]), and also prolonged OS (HR, 0.68; 95% CL [0.60–0.76]) with fewer side effects (risk rate (RR), 1.40; 95% CL) [4]. Notably, current monotherapy with ICIs may provide clear survival benefits only in a small subset of patients. The bulk of patients develop complications and drug resistance during treatment (up to 60–70% in advanced cancers like melanoma, metastatic renal cell carcinoma (mRCC), et al.) [5–7]. In clinical practice, consolidation therapy with concomitant medication has become a commonly used treatment method. Therefore, improving the therapeutic response rate of ICIs and evaluating the effects of combined therapy with ICIs are still hot issues in current research [8].
Guidelines for high dose chemotherapy and stem cell transplantation for systemic AL amyloidosis: EHA-ISA working group guidelines
Published in Amyloid, 2022
Vaishali Sanchorawala, Mario Boccadoro, Morie Gertz, Ute Hegenbart, Efstathios Kastritis, Heather Landau, Peter Mollee, Ashutosh Wechalekar, Giovanni Palladini
Taken together, the available data suggests a potential role for a limited course of consolidation in patients with < VGPR post-SCT with the goal of inducing deeper remission. Consolidation therapy may certainly have a role in those who achieved a < VGPR post-SCT and did not receive induction therapy prior to SCT. However, the potential benefit of consolidation must be balanced with the risk of toxicity. For patients who achieve ≥ VGPR after SCT but have ongoing organ impairment or organ deterioration, it must be recognised that deeper haematologic response may not confer organ response or improvement. Maintenance after high dose therapy and SCT has not been routinely used or systematically studied in AL amyloidosis and there does not appear to be a role for long term lenalidomide-based maintenance therapy. Lenalidomide-based dose adjusted maintenance therapy can be instituted post-SCT for those with multiple myeloma defining biomarkers (e.g. plasmacytosis >60% and/or serum free light chain ratio of >100) and multiple myeloma associated CRAB findings of hypercalcemia, renal failure, anaemia and lytic bone lesions. Ongoing studies will hopefully provide insight into the use ixazomib and daratumumab in this setting.
Consolidation with a short course of daratumumab in patients with AL amyloidosis or light chain deposition disease
Published in Amyloid, 2021
Efstathios Kastritis, Pantelis Rousakis, Ioannis V. Kostopoulos, Maria Gavriatopoulou, Foteini Theodorakakou, Despina Fotiou, Ioanna Dialoupi, Magdalini Migkou, Maria Roussou, Nikolaos Kanellias, Maria-Irini Tselegkidi, Evangelos Eleutherakis-Papaiakovou, Asimina Papanikolaou, Charikleia Gakiopoulou, Erasmia Psimenou, Marylin Spyropoulou-Vlachou, Anastasia Gatou, Evangelos Terpos, Ourania Tsitsilonis, Meletios A. Dimopoulos
From February 2018 to February 2019, 25 patients (19 with AL amyloidosis and 6 with LCDD) received daratumumab consolidation, as described in Patients and Methods section. The baseline characteristics of the patients (at the time of diagnosis) and their characteristics at the time of consolidation initiation are shown in Tables 1 and 2. Briefly, median age was 67 years and 73% were males; among patients with AL amyloidosis, kidneys and heart were involved in 74% and in 63% respectively; baseline Mayo stage was 15%, 74% and 10% for stages 1, 2 and 3 respectively. All patients with LCDD had renal involvement only. At diagnosis immunofixation in serum or urine was positive in all patients (14/19 of AL amyloidosis patients and 1/6 of LCDD had lambda clones). The median time interval from the start of first line treatment to daratumumab consolidation was 7 months and all patients had completed the planned therapy or discontinued earlier due to toxicity (median number of cycles of VCD was 6, range 3–8). At the time of initiation of daratumumab consolidation, 21 patients (84%) were in VGPR and 4 (16%) in PR; the median level of dFLC was 10.7 mg/L (range 3 to 169), all had positive serum or urine immunofixation and in all patients MRD was detectable by NGF.