Treatment multifactorial

It is well accepted that hypertension is a multifactorial disease. Only about 10% of the hypertensive patients have secondary hypertension for which causes, ie, partial coarctation of the renal artery, pheochromacytoma, aldosteronism, hormonal imbalances, etc, are known. The hallmark of hypertension is an abnormally elevated total peripheral resistance. In most patients hypertension produces no serious symptoms particularly in the early phase of the disease. This is why hypertension is called a silent killer. However, prolonged suffering of high arterial blood pressure leads to end organ damage, causing stroke, myocardial infarction, and heart failure, etc. Adequate treatment of hypertension has been proven to decrease the incidence of cardiovascular morbidity and mortaUty and therefore prolong life (176—183). 

CIT2/)Therapeutic Response to a Multifactorial Treatment... 

Fig. 10.11 Cytochrome P450 (CYP) 2Z)d-related therapeutic response to a multifactorial treatment in Alzheimer s disease. (Adapted from ref. 42.)...

AFO -Related Therapeutic Response to Cholinesterase Inhibitors and Multifactorial Treatments... 

Fig. 10.25 Apolipoprotein E plus angiotensin-converting enzyme (ACE + APOE)-related antianxiety effect of a multifactorial treatment in patients with Alzheimer s disease...

Cacabelos, R. (2007) Molecular pathology and pharmacogenomics in Alzheimer s disease Polygenic-related effects of multifactorial treatments on cognition, anxiety, and depression. Meth. Find. Exper. Clin. Pharmacol., 29(suppl. B), 1-91. 

Athyros VG, Mikhailidis DP, Didangelos TP, Giouleme OI, Liberopoulos EN, Karagiannis A et al. Effect of multifactorial treatment on non-alcoholic fatty liver disease in metabolic syndrome a randomised study. Cur Med Res Opin 2006 22(5) 873-83. 

Violence and aggression are multifactorial in etiology, involving individual (genetic, brain) as well environmental and societal factors (Filley et al., 2001). The treatment of violence requires a multisystems approach, which in children and adolescents with clear neuropsychiatric conditions, may require psychophar-macologic intervention. 

Metabolic disturbances are frequent in patients with HIV infection and represent a multifactorial condition related both to the underlying disease and to the antiviral treatment. HIV infection itself appears to cause hyperlipidemia and insulin resistance in some patients. Protease inhibitor therapy is a major contributor to fat accumulation, hyperlipidemia, and insulin resistance. NNRTIs contribute mainly through augmentation of lipid concentrations and NRTIs to the development of lipid-associated toxicity. NRTIs can cause mitochondrial dysfunction. 

Perhaps the role of cognitive-behavioral treatments ought to be tested, as both depression and chronic pain tend to be responsive to cognitive and behavioral interventions. To our knowledge, very few, if any, treatments have studied the combined effects of pharmacotherapy and behavioral or physical therapies. Given the complex nature of FM, a multifactorial approach may be the most effective (40) and an important area to explore with more scientific rigor. 

The authors reviewed nine other reported patients with MDMA-related SIADH, all of whom were women. They concluded that MDMA-associated SIADH is multifactorial and that MDMA may stimulate vasopressin secretion in susceptible individuals. They further suggested that hyponatremia can also occur secondary to voluntary increases in fluid or water intake aimed at preventing the adverse effects of MDMA. With appropriate treatment, full recovery is possible in almost all cases of this life-threatening condition. 

The major clinical problem encountered is the resistance against cisplatin. Some types of cancer are intrinsically insensitive to cisplatin treatment, whereas other cancers develop resistance during chemotherapy. This phenomenon limits the applicability of cisplatin to a relatively narrow range of tumors. The cisplatin-resistance mechanism seems to be multifactorial. Several main factors have been identified as potential modulators of cellular resistance, and are discussed below. 

The simplest experiments are those in which one treatment (factor) is applied at a time to the samples. This approach is likely to give clear-cut answers, but it could be criticized for lacking realism. In particular, it cannot take account of interactions among two or more conditions that are likely to occur in real life. A multifactorial experiment (Fig. 10.4) is an attempt to do this the interactions among treatments can be analysed by specialized forms of analysis of variance. 

Multifactorial experiments are economieal on resources because of hidden replication . This arises when two or more treatments are given to a subject because the result acts statistically as a replicate for eaeh treatment. Choice of relevant treatments to combine is important in multifactorial experiments for instance, an interaction may be present at certain concentrations of a chemieal but not at others (perhaps because the response is saturated). It is... 

The multiple pathogenic possibilities interact syn-ergistically. For this reason, successful prevention or treatment of HE is only possible if consideration is given to its multifactorial pathogenesis. 

---