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By A. Samuel. Indiana University - Purdue University, Fort Wayne.

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Death may result from severe brain abnormalities generic midamor 45mg fast delivery, breathing problems, prematu- Treatment and management rity, and surgical complications. Even without accompa- nying hydrocephalus, developmental delays and mental Children with Pfeiffer syndrome usually see a team retardation are common (in types 2 and 3). This team typ- placement of the eyes may be so severe that the infant is ically includes plastic surgeons, neurosurgeons, orthope- unable to close his or her eyelids. Individuals with types dists, ear, nose, and throat doctors (otolaryngologists), 2 and 3 may also have seizures. Diagnosis Developmental, psychosocial, and financial issues are additional concerns. Unfortunately, treatment is aimed at The diagnosis of Pfeiffer syndrome is based prima- the symptoms, not the underlying cause. Although genetic iosynostosis is discovered prenatally, only the symptoms testing is available, the diagnosis is usually made based can be treated. Multiple surgeries are usually performed to progres- Often the doctor can determine which cranial suture sively correct the craniosynostosis and to normalize closed prematurely by physical examination. A team of surgeons is often involved, mation, an x ray or computerized tomography (CT) scan including a neurosurgeon and a specialized plastic sur- of the head may be performed. Patients is involved is crucial in making the correct craniosynos- with syndromic craniosynostosis often require surgery tosis diagnosis. The first surgery is usually performed early in the genetic abnormality, or it may be due to other, nongenetic first year of life, even in the first few months. In Pfeiffer syndrome, the tissue itself is abnormal Additional surgeries may be performed for other and causes the suture to fuse prematurely. Limb abnormalities often are not cor- consider nongenetic causes of craniosynostosis.

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The resultant mature virus particles spread to in- transcriptase inhibitors (NTRTIs) discount 45 mg midamor visa, and protease in- fect other susceptible cells. The majority of viral replication occurs in recently Single agents are seldom used to treat HIV infec- infected CD4 lymphocytes and depletes them during tion. Macrophage popula- rapid mutation rate of HIV and to minimize drug toxic- tions are depleted or cease to function properly in 3 to ity. It is during this time that an HIV- combinations of reverse transcriptase inhibitors and infected person becomes immunodeficient and can die protease inhibitors (Table 51. In this system, drugs of infections that under normal conditions are not life working by different mechanisms produce a sequential threatening. It is 586 VI CHEMOTHERAPY can produce a potentially fatal syndrome of lactic acido- TABLE 51. Those at highest risk include women, obese individuals, alcoholics, and patients with prolonged ex- Combinations of Choice posure to NRTIs. All patients should be monitored for the development of hepatotoxicity; the drug should be 2 NRTIs and 1 PI 2 NRTIs and 1NNRTI discontinued if this occurs. Resistance generally re- sults from the appearance of mutations in reverse tran- Secondary Alternatives scriptase; cross-resistance to multiple NRTIs also occurs. It is a thymidine analogue that is ef- that provide it with resistance to the multiple drugs that fective against HIV-1, HIV-2, and human T-cell lym- act via different mechanisms. It is available as a tidrug regimens, it has been estimated that viruses in single agent (Retrovir) or in fixed combinations with 85% of infected people develop resistance to one or lamivudine (Combivir) or lamivudine and abacavir more of the antiretroviral agents. Zidovudine, in combination with one or more sary to produce drugs that either inhibit this resistance other antiretroviral agents, is approved for the treat- or find compounds that produce no resistance. In addition, a variety of drugs under devel- nation for the prevention of prenatal and perinatal opment act as inhibitors of viral fusion or viral entry transmission to the baby by HIV-infected pregnant into the host cell. The most common adverse reactions to zidovudine Current therapies do not enhance the host defense sys- are headache, nausea, vomiting, and anorexia.