Prevention therapeutic interventions

While pharmacologic agents may help prevent relapse, psychotherapy should be the core therapeutic intervention. Motivational enhancement therapy (MET), cognitive-behavioral therapy (CBT), 12-step facilitation (TSF), behavioral couples therapy (BCT), community reinforcement approaches, and contingency management are the best-studied forms of psychotherapy in this group of patients. 

Therapeutic interventions for SCD should be targeted at preventing and/or minimizing the symptoms related to the disease and its complications. The goals of treatment are to reduce or eliminate the patient s symptoms decrease the frequency of sickle crises, including vaso-occlusive pain crises prevent the development of complications and maintain or improve the quality of life through decreased hospitalizations and decreased morbidity. Specific therapeutic options may... 

After acute PSVT is terminated, long-term preventive treatment is indicated if frequent episodes necessitate therapeutic intervention or if episodes are infrequent but severely symptomatic. Serial testing of antiarrhythmic agents can be evaluated in the ambulatory setting via ambulatory ECG recordings (Holter monitors) or telephonic transmissions of cardiac rhythm (event monitors) or by invasive electrophysiologic techniques in the laboratory. 

In principle, various targets for therapeutic intervention exist. A successful drug can interact with viral receptors, virally encoded enzymes, viral structural components, viral genes or transcripts, or cellular factors required for viral replication. In recent years, attention has been given to small molecules that can target viral-specific RNA sites and prevent the formation of key RNA-protein and RNA-RNA complexes. Aminoglycoside antibiotics have provided the impetus for this approach as discussed below. 

Much of the discussion about disease biomarkers is in the context of markers that measure some aspect of disease status, extent, or activity. Such biomarkers are often proposed for use in early detection of disease or as a surrogate endpoint for evaluating prevention or therapeutic interventions. The validation of such biomarkers is difficult for a variety of reasons, but particularly because the molecular pathogenesis of many diseases is incompletely understood, and hence it is not possible to establish the biological relevance of a measure of disease status. 

Hawley JA. Exercise as a therapeutic intervention for the prevention and treatment of insulin resistance. Diabetes Metab Res Rev. 2004 20 383-393. 

Acute renal failure secondary to ischemia-reperfusion or nephro-toxins represents a major cause of morbidity and mortality in hospitalized patients, particularly in the intensive care unit setting. The proximal tubule region of the nephron suffers the most damage in acute renal injury and is therefore the target site of therapeutic interventions. While several experimental therapies have been attempted to prevent or hasten recovery from acute renal injury,... 

Therapy for sickle cell disease has changed dramatically since the mid-1990s. Prior to the 1980s therapeutic interventions for sickle cell disease consisted of supportive care during acute illness, opioids for pain management, and occasional transfusions for severe anemia or life-threatening complications. At that time, sickle cell disease was considered a pediatric disease as there were few children who survived into adulthood. In 1986, the Penicillin Prophylaxis Study was conducted, providing evidence that early intervention with penicillin prevented... 

In addition to the effect of increased VLCFA on membrane and possibly cellular function, the rapid cerebral form of X-ALD is characterized by an inflammatory response that is believed to contribute to the demyelination that characterizes this phenotype and which is similar to that seen in multiple sclerosis. These cerebral lesions are characterized by breakdown in myelin with sparing of the axons accompanied by the accumulation of cholesterol ester in the neurons. A perivascular inflammatory response with infiltration of T cells, B cells, and macrophages also is present. Therefore, it is believed that the rapid cerebral disease has an im-munologically-mediated component. It has been suggested that the inflammatory response occurs in response to the elevated levels of VLCFA in lipids, which elicits an inflammatory cascade that may be mediated in part by cytokines. Once this cascade begins, it may be more difficult to intervene in the disease process, and in general therapeutic interventions studied to date have been most effective when initiated early. Therefore, prevention of the initiation of the immune response is important for improving outcome. 

Intermediate uveitis may not warrant any therapeutic intervention in mild cases where the visual acuity is 20/40 or better. However, medical therapy is required for most patients. Macular edema is a frequent complication and requires prompt management to prevent permanent vision loss. In general, topical steroids are minimally effective in intermediate uveitis, except in those patients who are aphakic. Periocular and systemic steroids are substantially more efficacious. Periocular steroid injections are preferable in unilateral presentations and in children, whereas oral or other systemic routes are required for bilateral cases. For steroid-resistant intermediate uveitis, immunosuppressive therapy or surgery (cryotherapy and vitrectomy) may be necessary. Complications associated with intermediate uveitis include persistent CME,... 

In addition to its essentiality, long chain (0-3 fatty acids (EPA DHA) have attracted a great deal of attention purred by the classical pt er on haemostatic fiinction and platelet polyunsaturated fatty acids in Eskimos. 1979", published in 1979 by Dyerberg and Bang (The Lancet, ii, 433-435). This paper has changed the face of fatty acid bi(x hemistry, moving the discussion much closer to the use of fatty acids for not only reducing the risk-ass(x iated factors as part of primary prevention but also for therapeutic intervention. The level of scientific interest and the number of papers that have appeared over the last few years clearly illustrates the importance of this classical paper. 

About 2% of all patients who receive paclitaxel with preventive premedication will develop a severe hypersensitivity reaction, characterized by dyspnea, hypotension, angioedema, and urticaria, and requiring treatment. Minor reactions occur in 39% of patients but do not require therapeutic intervention (7). 

Various animal models have been used to study the pathogenesis of acute kidney injury (AKl) and develop therapeutic interventions that prevent or amehorate the severity of tubular injury following an acute ischemic or toxic renal insult. Utilization of animal models has advantages over other in mtro models such as isolated perfused kidneys, isolated proximal tubules, or tubular cell culture. It reproduces the complex interactions of hemodynamics and local tubular factors seen in the whole animal with AKl. 

---