Arthritis Australia

By P. Ronar. Schiller International University.

Primary effusion lymphoma cell lines harbouring human herpesvirus type-8 discount mentax 15mg amex. HHV-8-positive body-cavity-based lymphoma: a novel lymphoma entity discount mentax 15 mg with amex. Progressive multifocal leukoencephalopathy following rituximab therapy in HIV negative patients: a report of 57 cases from the Research on Adverse Drug Event and Reports (RADAR) project. HIV-associated plasmablastic lymphoma: lessons learned from 112 published cases. Rituximab in combination with chemotherapy versus chemotherapy alone in HIV-asso- ciated non-Hodgkin lymphoma: a pooled analysis of 15 prospective studies. Human immunodeficiency virus-associated plasmablastic lymphoma: poor prognosis in the era of highly active antiretroviral therapy. Bortezomib in combination with infusional dose-adjusted EPOCH for the treatment of plasmablastic lymphoma. KSHV-positive solid lymphomas represent an extra-cavitary variant of primary effusion lymphoma. Survival of non-Hodgkin lymphoma patients with and without HIV infection in the era of combined antiretroviral therapy. Plasmablastic lymphoma in HIV+ patients: an expanding spectrum. Excessive neurotoxicity with ABVD when combined with protease inhibitor- based antiretroviral therapy in the treatment of AIDS-related Hodgkin lymphoma. Detrimental clinical interaction between ritonavir-boosted protease inhibitors and vinblastine in HIV-infected patients with Hodgkin’s lymphoma. Incidence and risk factors of HIV-related non-Hodgkin’s lymphoma in the era of combi- nation antiretroviral therapy: a European multicohort study. Potential hazard drug-drug interaction between boosted protease inhibitors and vinblastine in HIV patients with Hodgkin’s lymphoma. Intensive sequential chemotherapy with hematopoietic growth factor support for non-Hodgkin lymphoma in patients infected with the human immunodeficiency virus. The role of tumor histogenesis, FDG-PET, and short course EPOCH with dose-dense rituximab (SC-EPOCH-RR) in HIV-associated diffuse large B-cell lymphoma. Low-intensity therapy in adults with Burkitt’s lymphoma. Causes of death in HIV-infected patients from the Cologne-Bonn cohort. Epeldegui M, Breen EC, Hung YP, Boscardin WJ, Detels R, Martínez-Maza O. Elevated expression of activation induced cytidine deaminase in peripheral blood mononuclear cells precedes AIDS-NHL diagnosis. Incidence, predictors and significance of severe toxicity in patients with human immunodeficiency virus-associated Hodgkin lymphoma. Distinct subsets of primary effusion lymphoma can be identified based on their cellular gene expression profile and viral association. Safety and activity of a new intensive short-term chemoim- munotherapy in HIV-positive patients with Burkitt lymphoma. Changing patterns of cancer incidence in the early- and late-HAART periods: the Swiss HIV Cohort Study. Molecular histogenesis of plasmablastic lymphoma of the oral cavity. Characteristics of non-Hodgkin lymphoma arising in HIV-infected patients with suppressed HIV replication. Gibson TM, Morton LM, Shiels MS, Clarke CA, Engels EA. Risk of non-Hodgkin lymphoma subtypes in HIV- infected people during the HAART era: a population-based study. B-cell stimulation and prolonged immune deficiency are risk factors for non- Hodgkin’s lymphoma in people with AIDS. Allogeneic hematopoietic cell transplantation in human immunodefi- ciency virus-positive patients with hematologic disorders: a report from the center for international blood and marrow transplant research. Hocqueloux L, Agbalika F, Oksenhendler E, Molina JM. Long-term remission of an AIDS-related primary effusion lymphoma with antiviral therapy. No evidence for an early excess incidence of progressive mul- tifocal leukencephalopathy in HIV-infected patients treated with rituximab. Hodgkin lymphoma is as common as non-Hodgkin lymphoma in HIV- positive patients with sustained viral suppression and limited immune deficiency: a prospective cohort study. Successful autologous stem cell transplantation in a severely immuno- compromised patient with relapsed AIDS-related B-cell Lymphoma.

Two of 3 studies comparing ziprasidone and olanzapine found ziprasidone to have worse 30 mentax 15 mg without prescription, 55 generic mentax 15mg fast delivery, 314 30 extrapyramidal symptoms outcomes. One found higher scores on ratings of akathisia, 55 while the other found higher scores on ratings of involuntary movements. In a short-term study comparing ziprasidone with aripiprazole (N=253), differences were not found between ziprasidone and aripiprazole, with very little adverse impact on extrapyramidal symptom 125 measures by either drug. A Cochrane review found that paliperidone was associated with higher rates or worse 315 severity of extrapyramidal symptoms compared with olanzapine. Significant differences included: “extrapyramidal disorder” (RR, 2. Differences were not found between paliperidone and risperidone. In 4 unpublished studies of asenapine and olanzapine, asenapine consistently resulted in 115, higher rates of extrapyramidal symptoms, with the most commonly reported being akathisia. In 1 study, 6% of asenapine and 2% of olanzapine patients were taking anti-parkinsonism drugs at study end. Based on a published pooled estimate, the severity of extrapyramidal symptoms present at baseline improved with all iloperidone doses, but there was no significant improvement with risperidone, although doses of risperidone were as high as 8 mg daily and may have influenced 266 these results. In a short-term trial, the proportion of patients reporting extrapyramidal symptoms was highest in the ziprasidone group (9 %) compared with the iloperidone 24 mg daily group (3%) or risperidone (1%) groups. Metabolic effects, weight gain, serum lipids, metabolic syndrome Weight gain under trial conditions. Weight gain within the trial setting has been measured in many studies. While this provides a more controlled assessment of changes, these are within highly selected patient populations, most are short-term, many have used doses that are not typical in the community at this time, and the impact of early discontinuations from study due to weight gain may not be fully accounted for in last-observation carried forward analyses. Therefore, this evidence had low generalizability for this outcome measure. Results from these trials were consistent with evidence from observational studies. Olanzapine was found to have higher rates of clinically significant (> 7% of body weight) weight gain compared with the other Atypical antipsychotic drugs Page 70 of 230 Final Report Update 3 Drug Effectiveness Review Project atypical antipsychotics as well as a greater mean weight gain (7-10 pounds more, depending on comparison and baseline risk of weight gain). Ziprasidone had the least impact on weight, with many patients losing weight. Risperidone, clozapine, and immediate-release quetiapine caused weight gain, with clozapine causing more than risperidone but not found to differ from olanzapine, and immediate-release quetiapine found not to differ from risperidone but to cause greater gain than ziprasidone. Differences between ziprasidone and risperidone were not statistically significant. Data for aripiprazole were limited and no comparative evidence for paliperidone was found. In CATIE Phase 1, olanzapine was found to cause more weight gain than any other group (immediate-release quetiapine, risperidone, ziprasidone, and perphenazine) with a mean gain of 2 pounds per month compared with 0. Also, more patients gained ≥ 7% of their body weight (30% compared with 60 7% to16%; P<0. In subsequent phases of CATIE, similar results were found: In Phase 1B the mean weight gain with olanzapine was 1. In both, significantly more 77, 78 patients gained ≥ 7% body weight with olanzapine. In Phase 1B 13% of patients discontinued the study due to weight gain with olanzapine, while only 5% did with risperidone and none did with immediate-release quetiapine. In Phase 2T, the discontinuation rates were 10% for olanzapine, 5% for risperidone, and 0 for ziprasidone. Table 11 shows our analysis of direct comparisons of olanzapine and risperidone, indicating a pooled difference of 2. Sensitivity analyses based on study duration < or > 6 months did not meaningfully change these findings but the analysis of amount of weight gain had a high level of statistical heterogeneity (I2 87% to 99%). Sensitivity analyses removing studies with potential heterogeneity (such as first episode) did not resolve this heterogeneity, confirming the need to use a random effects model. Atypical antipsychotic drugs Page 71 of 230 Final Report Update 3 Drug Effectiveness Review Project Table 11. Weight gain: Olanzapine compared with risperidone Atypical Weight Incidence of weight Study duration in Author, year antipsychotic gain (kg) gain (% patients) months Olanzapine 3. Data on differences in amount of weight gained was inadequate for pooling, with only 1 study reporting a difference of 6 kg. After 52 weeks, 1 of the Atypical antipsychotic drugs Page 72 of 230 Final Report Update 3 Drug Effectiveness Review Project trials reported weight gain from baseline of only 0. Similarly, the proportions with weight gain > 7% were 12% and 29%, respectively (P<0. Based on our pooled analysis of 3 trials of olanzapine and 99, 106, 316 aripiprazole, the pooled risk of weight gain ≥ 7% was 2. Five studies reported the gain in weight associated with clozapine compared with olanzapine, and the pooled result did not show a significant difference between clozapine and 25, 28, 64, 79, 317 olanzapine (weighted mean difference, -0.

Disease which is limited in extent may be suitable for inter- membrane giving off muscular branches to the extensor compartment ventional procedures such as percutaneous transluminal angioplasty of the leg cheap mentax 15 mg fast delivery. The artery crosses the front of the ankle joint midway be- (PTA) or stent insertion order 15mg mentax mastercard. The arteries of the lower limb 95 43 The veins and lymphatics of the lower limb From lower abdomen Inguinal lymph nodes From perineum and gluteal region Vein linking great and small saphenous veins Great saphenous vein Popliteal lymph nodes Short saphenous vein Fig. The arrows indicate the direction of lymph flow Superficial epigastric Inguinal ligament Femoral Pubic tubercle artery Edge of saphenous opening Superficial Femoral vein circumflex Deep fascia of thigh iliac Superficial external pudendal Great saphenous vein Fig. Failure of this ‘muscle pump’ to work efficiently, towards becoming varicose and consequently often require surgery. It passes anterior to the medial malleolus, Varicose veins along the anteromedial aspect of the calf (with the saphenous nerve), These are classified as: migrates posteriorly to a handbreadth behind patella at the knee and • Primary: due to inherent valve dysfunction. It pierces the • Secondary: due to impedance of flow within the deep venous circula- cribriform fascia to drain into the femoral vein at the saphenous open- tion. These can occur in pregnancy or due to obstruction caused by ing. The terminal part of the great saphenous vein usually receives pelvic tumours or previous deep venous thrombosis. At surgery these help to distinguish the saphenous sure and become varicose. Anteromedial and posterolateral femoral (lateral The lymphatics of the lower limb (Fig. The superficial inguinal group lie in the superficial fascia and ous opening. They receive lymph from the majority of the superficial tis- below the medial malleolus, in the gaiter area, in the mid-calf region, sues of the lower limb. The valves • Horizontal chain: these lie parallel to the inguinal ligament. They in the perforators are directed inwards so that blood flows from receive lymph from the superficial tissues of the: lower trunk below the superficial to deep systems from where it can be pumped upwards level of the umbilicus, the buttock, the external genitalia and the lower assisted by the muscular contractions of the calf muscles. The superficial nodes drain into the deep nodes tem is consequently at higher pressure than the superficial and thus, through the saphenous opening in the deep fascia. In addition they • The small saphenous vein arises from the lateral end of the dorsal also receive lymph from the skin and superficial tissues of the heel and venous network on the foot. It passes behind the lateral malleolus and lateral aspect of the foot by way of the popliteal nodes. The deep nodes over the back of the calf to pierce the deep fascia in an inconstant posi- convey lymph to external iliac and thence to the para-aortic nodes. Obstruction of lymphatics results in lymphoedema (Fig. This can be congenital, due to aberrant lymphatic formation, or acquired The deep veins of the lower limb such as post radiotherapy or following certain infections. In develop- The deep veins of the calf are the venae comitantes of the anterior and ing countries infection with Filaria bancrofti is a significant cause of posterior tibial arteries which go on to become the popliteal and lymphoedema that can progress to massive proportions requiring limb femoral veins. The deep veins form an extensive network within the reduction or even amputation. The veins and lymphatics of the lower limb 97 44 The nerves of the lower limb I Anterior superior iliac spine Inguinal ligament Lateral cutaneous External oblique aponeurosis nerve of thigh Femoral nerve Femoral artery Iliacus Femoral vein Femoral canal Psoas tendon Lacunar ligament Pubic tubercle Lateral cutaneous nerve of thigh Pectineus Iliacus Inguinal ligament Femoral nerve Pubic tubercle Nerve to sartorius To pectineus Tensor fasciae latae Pectineus To vastus lateralis Adductor longus Psoas Femoral vein To vastus intermedius Great saphenous vein and rectus femoris Femoral artery Sartorius Saphenous nerve Intermediate To vastus medialis cutaneous nerve Medial cutaneous of thigh nerve of thigh (Skin of front of thigh) (Skin of medial thigh) Rectus femoris Gracilis Obturator externus Pectineus Posterior division Adductor Adductor brevis longus Anterior division Gracilis Deep fascia (Skin of medial leg Branch to and foot) Fig. The upper diagram shows the structures that pass under the inguinal ligament Fig. The latter supply • Course: the majority of the branches of the plexus pass through the sartorius and pectineus. The latter nerve is the only branch to extend • Intra-abdominal branchesathese are described in Chapter 21. It pierces the deep fascia overlying the adductor • Femoral nerve (L2,3,4)asee below. Obese patients sometimes describe paraesthesiae over the • Origins: the anterior divisions of the anterior primary rami of lateral thigh. This is termed meralgia paraesthetica and results from L2,3,4. It descends through the iliac fossa to pass under the inguinal compartment: ligament. At this point it lies on iliacus, which it supplies, and is situ- • Anterior divisionagives rise to an articular branch to the hip joint ated immediately lateral to the femoral sheath. It branches within the as well as muscular branches to adductor longus, brevis and gra- femoral triangle only a short distance (5 cm) beyond the inguinal liga- cilis.

Perennial allergic rhinitis Direct evidence We identified 2 head-to-head trials in adults with perennial allergic rhinitis (Evidence Tables 3 57 mentax 15mg mastercard, 58 57 and 4) purchase 15mg mentax with amex. One of these was not published, but results are available at ClinicalTrials. In this 2-week trial, there was no significant difference between levocetirizine 5 mg and loratadine 57 10 mg in the change from baseline in Total Symptom Score. A 4-week placebo-controlled trial 58 compared levocetirizine to desloratadine, both at 5 mg daily. Although both treatments improved total nasal symptom scores more than placebo, there was no significant difference between the treatment groups. Indirect evidence Ten placebo-controlled trials demonstrated efficacy in adults with perennial allergic rhinitis. Details of these studies are shown in Evidence Tables 3 and 4. We identified 2 trials of 59, 60 61-63 64-66 67- azelastine, 2 of cetirizine, 3 of desloratadine, 3 of levocetirizine (in 4 publications), 71 72 and 1 of loratadine. Most of the efficacy trials were short term, however 2 trials of 67, 68 levocetirizine 5 mg reported improved quality of life compared with placebo at 6 months. Urticaria Direct evidence Five head-to-head trials in adults with urticaria are shown in Table 4 and in Evidence Tables 5 73-77 74, 77 and 6. Two fair-quality, head-to-head trials compared cetirizine to loratadine. In 1 trial, loratadine reduced mean Total Symptom Score more than cetirizine. Response rates were higher with loratadine in both trials, but the difference was not statistically significant in one (63% 74 compared with 45%) and the P value was not reported in the other (81% compared with 77 60%). The latter study reported that the number, size, and duration of lesions was significantly improved in patients taking loratadine (P<0. Cetirizine 10 mg daily was more 75 efficacious than fexofenadine 180 mg daily at 28-day follow-up. This study was limited by an attrition rate of 16%, and data were presented only for those completing the study. Antihistamines Page 20 of 72 Final Report Update 2 Drug Effectiveness Review Project 73, 76 Two head-to-head trials compared levocetirizine to another newer antihistamine. A trial of 886 adults with urticaria compared mean pruritus score of levocetirizine 5 mg compared 76 with desloratadine 5 mg after 4 weeks of treatment. Levocetirizine decreased pruritus severity significantly more than desloratadine after 1 week, the primary outcome. Mean symptom scores were improved more with levocetirizine. Levocetirizine was also significantly better than desloratadine on patients’ global satisfaction at 1 week and 4 weeks, and on investigators’ global satisfaction at 1 week, but not on endpoint. Quality-of-life was assessed, and was improved in both treatment groups, but no analysis was done. In a crossover trial, 45 patients who had achieved complete symptomatic control with cetirizine 10 mg after 6 weeks were then switched 73 to levocetirizine 5 mg for an additional 6 weeks. Wheal and flare response was similar with both drugs, but the itch response was better with cetirizine in 70% of patients. This study was open-label and had a high dropout rate. Antihistamines Page 21 of 72 Final Report Update 2 Drug Effectiveness Review Project Table 4. Head-to-head trials in adults with urticaria Author Year Drug, dosage Condition Number of subjects Quality Duration Results Cetirizine compared with fexofenadine Cetirizine vs. Indirect evidence 78-86 Nine placebo-controlled trials examined efficacy in adults with chronic idiopathic urticaria. Of the 7 fair- or better- 78, 81, 83, 84 80, 82 quality trials, 4 included desloratadine 5 mg, 2 included levocetirizine 5 mg, and 1 79 included fexofenadine 180 mg. All found the active treatment group superior to placebo for Antihistamines Page 22 of 72 Final Report Update 2 Drug Effectiveness Review Project reducing symptoms. Indirect comparisons that can be made from these studies were limited due to differences in outcome measures and reporting. Improved quality-of-life was reported with desloratadine and levocetirizine compared with placebo in 2 studies, both using the validated 78, 80 Dermatology Life Quality Index. A search for literature on the efficacy or effectiveness of newer antihistamines in other 88-92 types of urticaria in adults identified only poor-quality studies.