The Journal of infectious diseases
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Review
Heterogeneity of pathogenesis in multiple sclerosis: implications for promotion of remyelination.
Enhancing myelin repair remains an important therapeutic goal in primary demyelinating diseases of the central nervous system (CNS) such as multiple sclerosis (MS). The emerging heterogeneity of pathology within MS lesions, and differential oligodendrocyte survival in particular, suggests that therapeutic strategies may need to be tailored to an individual patient's requirements. A number of therapeutic strategies have been proposed to enhance myelin repair in the CNS: cell transplantation, growth factor therapy, and antibody therapy, but each proposed therapy has different implications with respect to pathogenetic mechanisms of demyelination. Of these, antibody therapy is the most amenable to immediate application in patients-but a combination of therapeutic approaches may be required in practice.
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Postherpetic neuralgia (PHN) is a common complication of herpes zoster, particularly in the elderly and in persons with severe symptoms at presentation. Unless varicella vaccination reduces the incidence of herpes zoster and attenuates the risk and/or severity of complications, PHN will continue to result in significant suffering and remain a consumer of health care and related social support resources. ⋯ Other interventions require further evaluation (nerve blocks, acute-phase tricyclic antidepressant or anticonvulsant use). Because prevention of PHN requires early recognition and prompt management of patients presenting with herpes zoster, public education and dissemination of information to all health care personnel involved with the disease are essential.
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After herpes zoster, immunocompetent persons frequently experience chronic pain and considerable suffering. Zoster-associated pain has a complex pathophysiology that begins with viral damage and increased sensitization of peripheral sensory neurons. ⋯ There is no clear consensus regarding the optimal means of determining the benefits of antiviral therapy in the management of pain of herpes zoster. A novel statistical approach utilizing rates of disappearance of pain of differing pathophysiologic mechanisms is proposed.
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Vitamin A deficiency impairs epithelial integrity and systemic immunity and increases the incidence and severity of infections during childhood. However, findings from vitamin A supplementation trials are not consistent. Supplementation has resulted in significant reductions in mortality in several (but not all) large community-based trials among apparently healthy children. ⋯ Vitamin A supplements also reduced the severity of diarrhea in most (but not all) trials. Potential explanations for the differences in efficacy across trials are reviewed. While vitamin A supplementation is effective in reducing total mortality and complications from measles infections, it is likely to be more effective in populations suffering from nutritional deficiencies.
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Review Comparative Study
Granulocyte colony-stimulating factor and granulocyte-macrophage colony-stimulating factor: comparisons and potential for use in the treatment of infections in nonneutropenic patients.
Granulocyte colony-stimulating factor (G-CSF) and granulocyte-macrophage colony-stimulating factor (GM-CSF) enhance the antimicrobial functions of mature neutrophils. G-CSF differs from GM-CSF in its specificity of action on developing and mature neutrophils, its effects on neutrophil kinetics, and its toxicity profile. The toxicity profile of recombinant (r) GM-CSF is consistent with priming of macrophages for increased formation and release of inflammatory cytokines, whereas rG-CSF induces production of antiinflammatory factors, such as interleukin-1 receptor antagonist and soluble tumor necrosis factor receptors, and is protective against endotoxin- and sepsis-induced organ injury. The low toxicity of rG-CSF, results of animal models of infection, and extensive experience with neutropenic subjects have promoted clinical studies in nonneutropenic subjects, which indicate that rG-CSF may be beneficial as adjunctive therapy for treatment of serious bacterial and opportunistic fungal infections in nonneutropenic patients, including those with alterations in neutrophil function.