Relapse

Plasmodium vivax, responsible for the most prevalent form of malaria (benign tertian), has an incubation period of 8—27 days (14 average). A variety seen in northern and northeastern Europe has an incubation period as long as 8—10 months. The disease can cause splenic mpture and anemia. Relapses (renewed manifestations of erythrocytic infection) can occur with this type of malaria. Overall, P. vivax is stiU susceptible to chloroquine however, resistant strains have been reported from Papua New Guinea and parts of Indonesia. Plasmodium malariae the cause of quartan malaria, has an incubation period of 15—30 days and its asexual cycle is 72 hours. This mildest form of malaria can cause nephritis in addition to the usual symptoms. It is a nonrelapsing type of malaria but the ted blood ceU infection can last for many years. No resistance to chloroquine by this plasmodium has been reported. Plasmodium ovale responsible for ovale tertian malaria, has an incubation period of 9—17 days (15 average). Relapses can occur in people infected with this plasmodium. No chloroquine resistance has been reported for this parasite. 

Tissue Schizonticides. These eradicate the Hver stages of the parasite and thereby prevent their entry into the blood. As a class, therefore, they ate useful for prophylaxis. Some tissue schizonticides can act on the long-Hved tissue forms (hypnozoites) of P. vivax and P. ovale and thus can cure the latter infections by preventing relapses. 

Blood Schizonticides. These destroy the erythrocytic stages of the parasites and are useful for the clinical cure of falcipamm malaria or suppression of relapsing infections. 

Riick-erinnerung, /. reminiscence, -fahrt, /. return, -fall, m. relapse reversion pi., Riickfalle) matter fallen back, returns, -feinerung, /. recovery regeneration. 

Resistance of P. vivctx to chloroquine occurs, but is geographically limited. P. vivctx and P. ovale produce hypnozoites, parasite stages in the liver that can produce multiple relapses. The drug of choice for blood stage infections to date remains chloroquine for all three species. To achieve radical cure of P. vivctx and P. ovale infection, this must be followed by primaquine. 

Moore J, Seiter K, Kolitz J et al (2006) A Phase II study of Bcl-2 antisense (oblimersen sodium) combined with gemtuzumab ozogamicin in older patients with acute myeloid leukemia in first relapse. Leuk Res 30(7) 777-783... 

O Brien S, Moore JO, Boyd TE et al (2007) Randomized phase III trial of fludarabine plus cyclophosphamide with or without oblimersen sodium (Bcl-2 antisense) in patients with relapsed or refractory chronic lymphocytic leukemia. J Clin Oncol 25(9) 1114-1120... 

Treatment with radioiodine or surgery If relapse after 1 year of antithyroid drug treatment After euthyroid ism is achieved... 

Individuals experiencing dmg withdrawal can become conditioned to environmental situations. Previously neutral stimuli can elicit many of the symptoms of dmg withdrawal, and this conditioned withdrawal has motivational significance especially in alcohol and opiate addiction. Thus conditioned withdrawal may trigger craving and relapse in a particular situation. 

Drug addiction is defined as a syndrome in which drug use (e.g., psychostimulants, opiates, alcohol) pervades all life activities of the user. Life becomes governed by the drug and the addicted patient can lose social compatibility (e.g., loss of partner and friends, loss of job, crime). Behavioral characteristics of this syndrome are compulsive drug use, craving, and chronic relapses that can occur even after years of abstinence. 

Treatment of drug addicts can be sqDarated into two phases detoxification and relapse prevention. Detoxification programs and treatment of physical withdrawal symptoms, respectively, is clinically routine for most drugs of abuse. However, pharmacological intervention programs for relapse prevention are still not veiy efficient. 

Substitution therapy with methadone or buprenorphine has been veiy successfiil in terms of harm reduction. Some opiate addicts might also benefit from naltrexone treatment. One idea is that patients should undergo rapid opiate detoxification with naltrexone under anaesthesia, which then allows fiuther naltrexone treatment to reduce the likelihood of relapse. However, the mode of action of rapid opiate detoxification is obscure. Moreover, it can be a dangerous procedure and some studies now indicate that this procedure can induce even more severe and long-lasting withdrawal symptoms as well as no improvement in relapse rates than a regular detoxification and psychosocial relapse prevention program. 

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