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home:alternate:spontaneous_remission [10.19.2018] – [Spontaneous remission is a myth] sallieqhome:alternate:spontaneous_remission [10.19.2018] – [Sarcoidosis] sallieq
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 ===== Relapsing/remitting nature of infection ===== ===== Relapsing/remitting nature of infection =====
  
-One of the important factors in why symptoms of illness relapses and remits is that infections relapse and remit. For example, //Staphylococcus aureus// is a major human pathogen which plays a role in deep tissue infections, osteomyelitis, and chronic lung infections. A key characteristic of these infections is that relapses can occur months or years after an apparent cure. These relapses, Dr. Bettina Löffler and her team from the Institut für Medizinische Mikrobiologie in Münster, Germany, [[http://www.sciencedaily.com/releases/2011/01/110126081521.htm|believe]] are due to phenotype switching, a change in the bacterial behaviour. After infection and invasion of the patient's host cells, the bacteria form small colony variants (SCVs), tiny bacterial subpopulations that can evade the immune system as well as many antibiotics and grow slowly.(({{pubmed>long:21268281}}))+One of the important factors in how symptoms of illness relapse and remit, is that infections relapse and remit. For example, //Staphylococcus aureus// is a major human pathogen which plays a role in deep tissue infections, osteomyelitis, and chronic lung infections. 
  
-Microbes ability to easily switch between forms explains both their persistence and the variability in patients' symptom presentation from one time point to another. +A key characteristic of these infections is that relapse can occur months or years after an apparent cure. These relapses, Dr. Bettina Löffler and her team from the Institut für Medizinische Mikrobiologie in Münster, Germany, [[http://www.sciencedaily.com/releases/2011/01/110126081521.htm|believe]] are due to phenotype switching, a change in the bacterial behaviour. After infection and invasion of the patient's host cells, the bacteria form small colony variants (SCVs), tiny bacterial subpopulations that can evade the immune system and many antibiotics and grow slowly.(({{pubmed>long:21268281}}))
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 +Microbes ability to easily switch between forms explains both their persistence and the variability in patients' symptom presentation from one time point to another.
  
  
 ===== Research with insufficient follow up ===== ===== Research with insufficient follow up =====
  
-As it happens, members of the medical community who put credence in spontaneous remission tend to base their information on studies that are notoriously poor at following subjects for long periods of time – periods of time that would allow researchers to take note of the declines that occur after bacteria have spread and any temporary periods of [[home:patients:assessing_literature:palliative|palliation]] have subsided. These studies would have to last for at least 5-10 years, with endpoints assessing systemic illness. Such studies would surely find that disease symptoms persist even in those people who had once experienced temporary periods of relief.+As it happens, members of the medical community who put credence in spontaneous remission tend to base their information on studies that are notoriously poor at following subjects for long periods of time – periods of time that would allow researchers to take note of the declines that occur after bacteria have spread and any temporary periods of [[home:patients:assessing_literature:palliative|palliation]] have subsided. These studies would have to last for at least 5-10 years, with endpoints assessing systemic illness. Such studies would surely find that disease symptoms persist even in those people who had once experienced long periods of relief.
  
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 Researchers at Jefferson Medical Center in Philadelphia found a 74% relapse rate in sarcoidosis patients with treatment-induced remission, while only 60% of patients identified as having a favorable prognosis actually sustained remission over 130 months.(({{pubmed>long:9118698}})) Researchers at Jefferson Medical Center in Philadelphia found a 74% relapse rate in sarcoidosis patients with treatment-induced remission, while only 60% of patients identified as having a favorable prognosis actually sustained remission over 130 months.(({{pubmed>long:9118698}}))
  
-Many argue that the most accurate study of sarcoidosis to date is the 2003 NIH ACCESS study, which followed 215 sarcoidosis patients for two years - a period during which it is sometimes mistakenly thought that the disease can go into remission. The study found that measures of sarcoidosis severity remained unchanged over the two-year period, despite the fact that many patients were using corticosteroids and other drugs.+Many argue that the most accurate study of sarcoidosis to date is the 2003 NIH ACCESS study, which followed 215 sarcoidosis patients for two years - a period during which it is sometimes mistakenly thought that the disease can go into remission. The study found that measures of sarcoidosis severity remain unchanged over the two-year period, despite the fact that many patients were using corticosteroids and other drugs.
  
 In fact, in the NIH ACCESS study there were no documented cases of spontaneous remission. Even in the positive-sounding “improved” category for clinical markers, the percentages described were at best “improved”, not "substantially better" and certainly not "cured." An indication of lack of substantial improvement in the improved group is the fact that there were essentially no change in use of corticosteroid therapy during the two year period. The study also concluded that most patients with persistent sarcoidosis at two years were “unlikely to have resolution of the illness” and that "end-stage pulmonary sarcoidosis usually develops over one or two decades." In fact, in the NIH ACCESS study there were no documented cases of spontaneous remission. Even in the positive-sounding “improved” category for clinical markers, the percentages described were at best “improved”, not "substantially better" and certainly not "cured." An indication of lack of substantial improvement in the improved group is the fact that there were essentially no change in use of corticosteroid therapy during the two year period. The study also concluded that most patients with persistent sarcoidosis at two years were “unlikely to have resolution of the illness” and that "end-stage pulmonary sarcoidosis usually develops over one or two decades."
home/alternate/spontaneous_remission.txt · Last modified: 09.14.2022 by 127.0.0.1
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