Resistance to treatment

The study most likely underestimated the actual percentage of drug reluctance among the total population of patients on the ward. Some, and perhaps many, patients disguised their reluctance to avoid angering the staff, while quietly throwing away their pills. 

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Viral infections continue to be significant causes of morbidity and mortality and at the same time continue to be resistant to treatment by small molecules. Avridine (6) is an antiviral compound which has shown some activity in a variety of animal tests apparently based upon its ability to stimulate a number of cells to produce the high molecular weight endogenous antiviral substance interferon. Thus, the compound is believed to operate indirectly by stimulating the body s own natural defenses against viral penetration into host cells. Avridine is synthesized by... 

The 5 -triphosphate metabolite of entecavir has been shown to accumulate in-tracellularly at concentrations that are inhibitory to 3TC-resistant HBV DNA polymerase (Levine et al. 2002). This would imply that entecavir should be active against HBV infections that have become resistant to treatment with lamivudine. Yet, it should be taken into account that treatment with lamivudine leads to the same... 

Epidermal growths such as actinic keratosis, lentigines or thin seborrheic keratoses can all be treated effectively with 25-35% TCA peels. Thicker epidermal growths or growths involving the dermis will be more resistant to treatment such as hypertrophic actinic keratoses and thicker seborrheic keratoses and may even be resistant to a medium-depth peel. Resistant lesions many times are best treated with a combination of a medium-depth chemical peel and other modalities such as manual dermasanding or CO, laser. 

Psychoses, when they occur, appear to be due to drug effect interacting with a vulnerable personality organization (Luisada 1978). Our experience has been that some adolescents with borderline personality disorders, as well as adolescents at risk of schizophrenic decompensation, may have this vulnerability. Although we do not have hard data to support the hypothesis that patients with PCP psychoses that are most resistant to treatment have the poorest long-term prognosis (Erard et al. 1980), our observations have been that persistence of symptoms of psychosis after the first 2 to 3 weeks of treatment often correlates with extended periods of impai rment. 

Cancer chemotherapy and the treatment of cancers are analogous to anti-infectives and the treatment of infections. Cancer cells may be sensitive to certain chemotherapy agents, but then with repeated exposure, the cells become resistant to treatment. The resistant cells then grow and multiply. While tumors may be tested for chemotherapy sensitivity, this area is still developing. Today, tumor sensitivity can demonstrate tumor resistance so that needless exposure to an inadequate therapy and its toxicity can be avoided. 

Polymorphisms of CYP2C19 cause differences in metabolism of omeprazole, a proton pump inhibitor used for treatment of gastroduodenal ulcers or reflux esophagitis. Such polymorphisms result in resistance to treatment at a standard dose regimen in nearly 20% of European Caucasians, and in an even higher percentage of Asians [12]. 

There is a high affinity of heavy metals for nucleoli. When the distribution of some metals in nuclei and nucleoli in rat liver was determined, there was a high affinity of nickel to nucleoli, which affinity was more resistant to treatment with nucleases than that of other metals [310]. 

Secondary aliphatic amines were found to give higher yields of thienothiophenes than did tertiary amines, which are weaker bases. A maximum ratio of thienothiophenes to thienothiopyrans of about 4 1 was achieved at 145° with diisopropylamine as cat yst and DMSO as solvent. Only thienothiopyrans were formed in DMF in the presence of the same catalyst The amines promote nucleophilic cyclization of Claisen rearrangement products into thienothiophenes. Since thienothiophenes are resistant to treatment with potassium t-butoxide in DMSO and thienothiopyrans form resinous products under these conditions, the method is a convenient route to pure thienothiophenes 35 and 42 in yields of up to 40%. ... 

A new cuithracycllne, aclacinomycin A (Fig. 9) which we discovered in 1976 (28), has been proved by clinical study to be indispensable in the treatment of leukemia. It exhibits a therapeutic effect against leukemia and lymphoma, even against cases resistant to treatment with daunonycin and adriamycin. Dantchev et al. (8) proved that aclacinonycin A has markedly a lower cardiac toxicity in hamsters than does adriamycin. This low cardiac toxicity has also been confirmed by clinical study. 

Guidance on the clinical indications for benzodiazepine therapy is available from various sources (Task Force Report of the American Psychiatric Association 1990 Ballenger et al. 1998a Bandelow et al. 2002). Long-term therapy is most likely to present problems with discontinuation and is usually reserved for cases that have proved resistant to treatment with antidepressants alone. Patients may benefit from a 2-4 week course of a benzodiazepine whilst antidepressant therapy is initiated, as this counteracts the increased anxiety caused by some drugs (Goddard et al. 2001). A benzodiazepine maybe useful as a hypnotic in some cases of anxiety disorder, and can be used by phobic patients on an occasional basis before exposure to a feared situation. 

Malignancy. The property or condition of being resistant to treatment (malignant). Mastocytoma. A nodular cutaneous mast cell infiltrate, which is usually present at birth or soon after as a solitary nodule, although three to four lesions may occur. Le-... 

Patients with COS may be more resistant to treatment than adults with the disorder (Meltzer et ah, 1997), possibly because their neurodevelopmental abnormalities render them less amenable to drug treatment. 

Potential reasons for noncompliance include resistance to taking medication in either the child, the parent, or both incomplete or poorly understood directions for taking the medication and poor organization of medication administration. In addition, parents or legal guardians may be resistant to treatment if they feel pressured to have the evaluation and treatment provided by outside agencies such as the school, child protective services, or the legal system. 

Comorbid anxiety and depressive features are common in clinical practice, and DSM-IV has included mixed anxiety-depression in its appendix of conditions needing nosological refinement. The presence of comorbid anxiety has prognostic implications. For example, prospective studies of patients with depression have found that the co-occurrence of panic attacks was correlated with a poor outcome (Coryell et al. 1988 van Valkenburg et al. 1984). Some evidence suggests that such patients do better with MAOls. Likewise, patients with depression and obsessive-compulsive disorder may be more resistant to treatment, even with SSRls (Hollander et al. 1991)... 

Treatment of psychiatric complications should generally be along standard lines for the respective conditions. Some syndromes appear to be brief and self-limiting once ecstasy use stops, but a more chronic course may also be seen, with cases in the literature of psychoses which prove resistant to treatment (Vecellio et al. 2003). Whichever psychiatric syndrome occurs, there is possibly a theoretical indication for specific serotonergic re-uptake inhibitors such as fluoxetine, sertraline or citalopram, given the effect of ecstasy in reducing serotonin transmission. This would purely be a pragmatic approach which has not yet been properly tested, and it may be that the transmission abnormalities are not amenable to this kind of enhancement. 

Additionally, Noordsy and colleagues ( 405) contribute data indicating that a family history of alcoholism in alcoholic schizophrenics is associated with a more severe course of illness, greater resistance to treatment, and more frequent abuse of other drugs. 

About 30% of patients with schizophrenia show no, or very poor response, to the drugs described above or may have unacceptabie adverse effects. Around haif of these wiii achieve better response on ciozapine. Ciozapine carries a 5-10% risk of neutropenia and 1% risk of agranuiocytosis, hence its use is restricted to patients resistant to treatment with other antipsychotics. Reguiar monitoring of the neutrophii count is mandatory. 

After several weeks of chemotherapy in the form of methotrexate, a cancer patient s tumor begins to show signs of resistance to treatment. Which of the following mechanisms is most likely to explain the tumor s methotrexate resistance ... 

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