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Any fare-up of symptoms after the birth can The contraceptive pill won’t make a usually be dealt with quickly generic top avana 80mg online erectile dysfunction treatment mayo clinic. Discuss your plans Work with your doctor well in advance as you With modern treatments it’s usually may need to change your medications possible to keep on working top avana 80mg amex can you get erectile dysfunction age 17, unless your some time before you start trying generic top avana 80mg overnight delivery erectile dysfunction drugs and medicare. Help is available if your women to do – if either partner is taking workplace needs to be adapted because certain drug treatments before or at the of your condition order top avana 80mg line erectile dysfunction pills sold at gnc. The employment service time of conception, it can afect the ofers help if you do need to change baby’s development. Some employers worry that people with rheumatoid arthritis will have to take a lot of time of. Although you may need some time of work to attend outpatient clinics and Most mothers drug monitoring appointments, these can often be arranged for times that are with rheumatoid convenient for you so that your work is disrupted as little as possible. Patient stories Because rheumatoid arthritis is so variable, we can’t say these stories are typical and they don’t necessarily suggest what will happen to you, but they may help you to understand some of the diferent ways rheumatoid arthritis can afect people. Meera’s story Research and new I’ve had rheumatoid arthritis for developments 24 years now. This was the hardest time for me; speeding up the development of I felt rotten and very stif a lot of the treatments. Because I was very active, treating rheumatoid arthritis by preventing I was sent for a short spell of intensive damaging white blood cells from entering treatment in hospital and the condition the joints. I also use a wrist and researchers are now looking at ways of support in the kitchen and take tablets training healthcare professionals to deliver every day. I have to be We’re continuing to fund diferent strands careful about my arthritis, but I can still of research into the causes and treatments do the things I love and I have no trouble of rheumatoid arthritis – you can fnd getting out and about. I still get pain and out more at our website stifness, but it’s well controlled and I feel www. On the whole I’m just thankful that I can get on with my life and that the arthritis doesn’t get in the way of me living my life to the full. At one I felt stif in the mornings and ached all point I had fuid in my lungs, and I’ve the time. This started to take its toll on my everyday But the pain has improved and, on the life; I was struggling at work and couldn’t whole, I feel healthier. Sixteen years on and I’ve managed When I found out I had arthritis, I was to come to terms with my arthritis. At frst I was really angry – I’m still working, and I can even kick why had this happened to me? I just felt depressed, as if I was fnished and that all my hopes and expectations for the future were ruined. Glossary Cartilage – a layer of tough, slippery tissue that covers the ends of the bones Acupuncture – a method of obtaining in a joint. Pain relief is obtained by protein in the blood rises in response interfering with pain signals to the brain to infammation and a blood test for the and by causing the release of natural protein can therefore be used as a measure painkillers (called endorphins). It can also be a side-efect treat the disease itself rather than just of some drugs used to treat arthritis. Autoimmune disease – a disorder of Blood is separated in a machine with the body’s defence mechanism (immune a rapidly rotating container (a centrifuge), system), in which antibodies and other then left to stand in a test tube. Fatigue – a feeling of weariness that’s Capsule – the tough, fbrous sleeve more extreme than simple tiredness. It of ligaments around a joint, which can afect you physically, but it can also prevents the bones in the joint from afect your concentration and motivation, moving too far. The inner layer of the and often comes on for no apparent capsule (the synovium) produces a fuid reason and without warning. They include Common examples include ibuprofen, the thymus (a gland that lies behind the naproxen and diclofenac. Occupational therapist – a trained specialist who helps people reach their Immunosuppressant drugs – drugs goals and maintain their independence that suppress the actions of the by giving advice on equipment and immune system. They’re often used adaptations or by changing the way you in conditions such as rheumatoid arthritis do things. Osteoarthritis – the most common form of arthritis (mainly afecting the Infammation – a normal reaction joints in the fngers, knees, hips), causing to injury or infection of living tissues. Osteoporosis – a condition where bones become less dense and more fragile, which Ligaments – tough, fbrous bands means they break or fracture more easily. Physiotherapist – a trained specialist In the spine they’re attached to the who helps to keep your joints and vertebrae and restrict spinal movements, muscles moving, helps ease pain and therefore giving stability to the back. The terms podiatrist and chiropodist mean the same thing, although podiatrist tends to be preferred by the profession. The podiatrist or chiropodist can deal with many of the foot problems caused by arthritis. Although they’re less common on the feet they tend to be more troublesome when they develop there. Synovial fuid – the fuid produced within the joint capsule that helps to nourish the cartilage and lubricate the joint. Ultrasound scan – a type of scan that uses high-frequency sound waves to examine and build up pictures of the inside of the body. We have no control over the contents of those sites or resources Relate (relationship support) and we give no warranty about their Premier House, Carolina Court accuracy or suitability. If you would like Relate also ofer phone and email further information, or if you have any counselling services: visit their website for concerns about your treatment, you more details. We’ll do this by funding high-quality Thell us what you think research, providing information and campaigning. The original text was written by Dr David We also produce a range of separate Walker, who has expertise in the subject. Anisur Arthritis Today, which keeps you up to Rahman, is responsible for the overall content. To get more actively involved, please call us on 0300 790 0400, email us at enquiries@arthritisresearchuk. It causes joints to swell and can result in pain, stiffness, and progressive loss of function. Over time, other joints can be affected such as shoulders, elbows, knees, feet, and ankles. As this joint damage progresses, in severe cases, it can cause deformity of the joints and loss of function. It may begin to interfere with daily activities, making them more difficult and painful to do. For these reasons, it’s important to get an accurate diagnosis as early as possible. This can also cause the surrounding muscles, ligaments, and tendons to become weak and unable to work normally. Symptoms of the disease may appear, go away for some time, and then return, making diagnosis even more difficult. Symptoms may slowly develop over several years, or the disease may progress quickly. You may go through phases called “flares” or “flare-ups” when symptoms are severe. Make an appointment to see your family doctor or a rheumatologist, a specialist who deals with joint diseases. Be sure to tell him or her about all of your symptoms, even if some of them only happen once in a while. Condition in which the number of red blood cells is lower than normal; may be present in rheumatoid arthritis and cause you to feel tired. A network of special cells and organs that work together to defend the body against outside threats, such as bacteria and viruses.

Primary care professionals: Recent trends buy 80mg top avana mastercard impotence pump, projections order 80mg top avana overnight delivery erectile dysfunction drug related, and valuation of services purchase top avana 80 mg line erectile dysfunction treatment supplements. Changes in myocardial perfusion abnormalities by positron emission tomography afer long- term purchase top avana 80mg free shipping erectile dysfunction treatment in kenya, intense risk factor modifcation. Health and Behavior: The Interplay of Biological, Behavioral, and Societal Infuences. Health spending projections through 2017: The baby-boom generation is coming to Medicare. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. Socioeconomic factors, health behaviors, and mortality: Results from a nationally representative prospective study of us adults. A purchaser’s guide to clinical preventive services: Moving science into coverage. State-of-the-science conference statement: Multivitamin/ mineral supplements and chronic disease prevention. Persistence with statin therapy (source: National Drug Code Health Information Services, 1998), in the Science of Integrative Medicine. Efects of a vegetarian diet and selected yoga techniques in the treatment of coronary heart disease. Efects of stress management training and dietary changes in treating ischemic heart disease. Changes in prostate gene expression in men undergoing an intensive nutrition and lifestyle intervention. Proceedings of the National Academy of Sciences of the United States of America 105(24):8369- 8374. Mental practice in chronic stroke: Results of a randomized, placebo-controlled trial. The increasing disparity in mortality between socioeconomic groups in the United States, 1960 and 1986. A review and assessment of clinical and cost outcomes of comprehensive health promotion and disease management programs in the worksite: Update vii: 2004-2008. Stages and processes of self-change of smoking: Toward an integrative model of change. Interprofessional education: Efects on professional practice and health care outcomes. Risky families: Family social environments and the mental and physical health of ofspring. Comparing yoga, exercise, and a self-care book for chronic low back pain: A randomized, controlled trial. Infuence of piperine on the pharmacokinetics of curcumin in animals and human volunteers. Unloaded movement facilitation exercise compared to no exercise or alternative therapy on outcomes for people with nonspecifc chronic low back pain: A systematic review. Efect of psychosocial treatment on survival of patients with metastatic breast cancer. Efects of supportive-expressive group therapy on survival of patients with metastatic breast cancer: A randomized prospective trial. Transposable elements: Targets for early nutritional efects on epigenetic gene regulation. Systems biology, proteomics, and the future of health care: Toward predictive, preventative, and personalized medicine. This supply • The store should be divided into zones that provide model represents the traditional top-down system that a range of environmental conditions and degrees of is operated by a governmental or parastatal entity or a security. In addition, many supply • Stock should be stored of the foor on pallets, on systems contract out certain operations to private-sector pallet racks, or on shelves. Managing contracts requires skills such as requires specifc types of handling equipment. See Chapter 39 disposal of expired and damaged stock, recording for more information on contracting. The tenets of this of stock movements, and the management of secu- chapter, therefore, apply to stores operating in either the rity—should be maintained. Medical stores management should assist both the fow • Staf should be appropriately qualifed, trained, dis- and reliability of supplies from source to user as economi- ciplined, and rewarded. This • To promote efciency, staf should have good work- materials management process is implemented through ing conditions and facilities. Consequently, it tication of medical stores varies widely, and each store provides essential information for procurement manage- approaches its system and documentation diferently. Warehouse management comprises the physical Therefore, the basic features presented in this chapter are movement of stock into, through, and out of a medical adaptable, depending on the complexity of the medical store warehouse. A warehouse management system monitors the physi- cal fow of goods within the system, such as receipts, The goals of medical stores management are to protect storage, and issues. A performance monitoring system checks that the sys- manage the reliable movement of supplies from source to tems are operating efectively. Efective management of information is the key to achieving these Information is essential to management (see Chapter goals. A fully developed system has three key components— tion may seem costly, but the cost of developing and main- taining an information system should be balanced against 1. An inventory control system ensures that the right the costs of inefective inventory control (see Chapter 23). Even with a computerized system, data must be entered, manipulated, and interpreted by skilled and Manual versus computerized systems knowledgeable staf. The information system must include data on products Procurement information entering and leaving the warehouse, products in stock, products on order, and ways to monitor the progress of The procurement process (Chapters 18–21) involves medi- orders in the supply pipeline. Key elements of the system are cal stores input at all levels of the distribution system. These well-designed forms, computerized information systems, inputs are described below. Procurement can be handled from a department within Two decades ago, most public supply systems relied the medical stores or from an external unit. The medical completely on manual stock records, but now, many pro- stores unit provides the (internal or external) procurement grams have changed to computerized systems. Even with unit with a list of the types and quantities of medicines computerization, however, many countries still maintain needed for its operation. Afer a supplier is selected and a a manual system, such as bin cards, as a backup, espe- purchase order is placed, the procurement unit informs the cially during the transition to computerization. There is a medical stores unit about suppliers, unit prices, the quanti- widely held belief that computerization solves the problem ties on order, the expected arrival dates of shipments, and of inventory control. Both manual status, new shipments received and taken into stock, issues and computerized systems perform the same fundamental made to health facilities, expired medicines, damaged medi- information-processing tasks: data input, data storage, data cines, and audit data from physical stock checks. Many utes medicines and supplies to the two regional medical functions that could have been handled by the system stores, all district hospitals, and local hospitals and clinics were done manually or with spreadsheets. Moreover, in the surrounding regions, while the regional stores and management personnel reported that they did not have district hospitals are responsible for distributing to other enough time to acquire the additional skills that would facilities within their geographic jurisdictions. Because the regional stores and stock records and use the computerized inventory con- health facilities had no efective systems for deciding trol system to their best advantage. If the shipment is satisfactory, the receiving cifc products, and how budget allocations are used. This report brings the procurement lead-time monitored until it is received at the central medical stores period to an end. A good monitoring system makes it possible to Individual health facilities are the end users of medi- estimate realistic delivery times and to decide whether any cal supplies. Maintaining information from health facili- supplementary or emergency orders are needed, well before ties is essential in order to monitor consumption, forecast a stockout occurs.

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Reactivation of hepatitis B virus replication in patients receiving cytotoxic therapy: report of a prospective study best top avana 80 mg erectile dysfunction at age 20. The effect of tumor necrosis factor blockade on the Gastroenterology 1991;100:182–8 buy cheap top avana 80mg on-line new erectile dysfunction drugs 2013. Randomized controlled trial of entecavir prophylaxis Arthritis Rheum 2004;33:283–8 generic 80 mg top avana visa goal of erectile dysfunction treatment. Ann schedule for adults aged 19 years or older cheap top avana 80mg without a prescription erectile dysfunction jackson ms, United States, Oncol 2011;22:1170–80. A revisit of prophylactic lamivudine for chemotherapy- Disease Control and Prevention. Recommended adult associated hepatitis B reactivation in non-Hodgkin’s lympho- immunization schedule, United States 2014. National Center for Immunization and Respiratory Dis- patients receiving transarterial chemo-lipiodolization. Going from evidence to recommenda- to target: 2014 update of the recommendations of an inter- tions. Minimal disease activity for rheumatoid arthritis: matoid arthritis for use in clinical practice. Targeted tuber- ty scale for clinical practice, observational studies, and culin testing and treatment of latent tuberculosis infection. Discovery With Metrics Capital Population 26 33 Goals and References Targets 35 42 51 54 56 Appendix 1: Appendix 2: Appendix 3: Appendix 4: Appendix 5: Alignment with Learning from Research Research Acknowledgments Arthritis and Complementary Advisory and Strategic Related Disease Approaches Committee Planning Organizations Task Theam 4 “Science has Arthritis on the Run. Population tatistics show that arthritis and related rheumatic conditions (23 percent, mostly vasculi- The facts presented here are serious, and fnding diseases probably affect every family tis), and rheumatoid arthritis (22 percent). Approximately 22 the 20-year period, an additional 585,446 people always will be, a priority for the Arthritis Founda- Spercent of U. We believe that science is advancing every More than 5 million people) aged 18 years or older self-report as an associated cause of death. These estimates day, and the optimism and energy we pour into doctor-diagnosed arthritis. Prevalence estimates for systemic lupus 2 problems and heart trouble are among the top erythematosus range as high as 1. In addition, complica- trouble walking a distance equal to walking from 294,000 tions from treatment of arthritis can result in death. Another instance of scientifc discov- a request for letters of interest open to every- Trelated diseases. Scientifc research ery is the knowledge made available by genomics, one everywhere to submit their scientifc ideas We are collaborating and development holds the key to fnding better proteomics, imaging and other technologies. Please building For almost 70 years, the Arthritis Foundation has knowledge to accelerate real-world applications of refer to the appendices for more information about initiated and supported scientifc discoveries that scientifc fndings to improve human health. The Arthritis Foundation continues to with information to choose the correct biological scientifc strategy includes three interconnected lead the way in advancing scientifc discoveries and targets so that a therapeutic product will work scientifc pillars: delivering on discovery, decision seeking solutions that will positively impact the lives against the disease it is intended to treat. Our commitment to fnding a For this strategy, arthritis refers to more than 100 For our scientifc strategic planning process, cure is unwavering. Together, we can have “arthritis on the For the purposes of this scientifc strategy, scien- of interviews with a wide range of experts and run” by accelerating the movement of scientifc tifc discovery includes a continuum of scientifc constituents, including people with arthritis and 13 knowledge to a faster cure. Each stage related diseases, fndings documented in scientifc research of scientifc research and development can infu- ence the other stages. Each scientifc discovery for arthritis and stage is informed by people with arthritis and Scientifc Strategy Goals related diseases. People with arthritis beneft from The scientifc strategy is the direction the Arthritis Foundation Science Department is going each stage in the continuum. The goal for each pillar is the impact of the inputs and outputs for each pillar (see Figures 2-4). To illustrate the continuum of scientifc discovery, consider the following examples. Decision Studies Scientific Making Discovery Continuum Population Systematic Health Reviews/ Surveillance Synthesis & Studies 10 “Science has Arthritis on the Run. In the past, it took an average complexities of clinical research and practice, as Tof 17 years for only 14 percent of new well as the many other challenges that occur on the scientifc discoveries to be available to the people in scientifc discovery continuum. A key to medicines and therapies for the prevention, early delivering on discovery is that each team — no matter detection, diagnosis and treatment of disease. Whether we main repository of medical images, patient data are facilitating better evidence-based decision and bio-samples. Data from the Million candidates to: development of new diagnostics and pharmaceutical Veteran Program26 are being analyzed to create a. Plan for translation of scientifc knowledge into the products people need to treatments. Measure metrics that matter and validating the most promising biological targets diagnosing arthritis earlier. When the algorithms are Provide leadership and oversight in building collaborative, interdisciplinary teams who 03  for rheumatoid arthritis and systemic lupus erythe- confrmed, clinicians can use the decision-making achieve meaningful results and accelerate scientifc discovery to fnd a faster cure for matosus (lupus). These new targets will inform the tools to diagnose people with arthritis and identi- people with arthritis and related diseases development of new diagnostics and drugs to treat fy those who need to be referred to rheumatol- Engage people with arthritis and related diseases in the scientifc discovery process 04  people with rheumatoid arthritis and lupus. Eventually the tools will be ready to use for telehealth and may even lead to pre-clinical diagno- In our collaborations with the Patient-Centered sis. The data and  Discovery and translation of scalable new products, tools and technologies of the process, from study design to study imple- methods for this demonstration project are made for diagnostics, interventions and a cure mentation and interpretation of the fndings. Every possible by years of scientifc discovery and technol- person, no matter how arthritis affects their life, is ogy research and development. The demonstration  Improved decision making and better lives through improved prevention, welcome to participate. There is an ongoing need for updated and awareness and use of advanced medical imaging. The Bone and Joint Initiative published a a combination of metrics, but not enough data are burden of disease report that included economic available to fully answer the questions. Although many of treating these individuals in addition to the cost to physical and social benefts are enjoyed by people society in the form of decreased wages is estimated playing sports, more than 2. If the arthritis Health to fnd ways to answer questions that have outcomes associated with chronic conditions registries in the United States agree to collecting not yet been answered, as well as continuing to such as arthritis and related conditions standardized core metrics, then the data can be update existing facts as new information becomes A specifc source of data to produce metrics for public pooled together to have statistical power to answer available. The Arthritis Foundation is a Healthy health surveillance and health research is registries. Registries provide People Consortium Partner to take actions to A registry is a collection of information about individ- overall acceleration of the research process and also strengthen policies and improve practices that are ual people, usually focused around a specifc diagno- 15 expertise from existing efforts such as Outcome provide data to design more effective clinical trials. For highly reliable, precise measures of patient-reported injury and premature death. One option discretionary social activities and satisfaction with prevention and treatment of comorbidities, such as arthritis can be prevented. Each registry has a focus for developing such a pain index is by combining social roles. Travel to in-person trainings will be research for arthritis and related diseases covered for both trainees and experts. This training has a strong interdisciplinary pipeline program would be symbiotic with existing training Tof scientists to implement our frst two and mentoring programs. For example, this new program can opportunities is a challenge for many investigators. This challenge was intended to crowd- and development for arthritis and related diseases source human genetics with the ultimate objective by recruiting 1) trainees who are experts in arthritis of identifying genetic predictors that could improve research but would beneft from training in interdis- treatment for those suffering from rheumatoid ciplinary scientifc research and development skills, arthritis.

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Applied and Environmental ribonucleic acid coliphages in south and east Microbiology 69 discount top avana 80 mg without prescription erectile dysfunction treatment in lucknow, 6507–6514 buy cheap top avana 80mg which antihypertensive causes erectile dysfunction. Microbiological Immunology 27 buy top avana 80 mg fast delivery erectile dysfunction 20s, Applied and Environmental Microbiology 56 generic top avana 80 mg without a prescription protein shake erectile dysfunction, 347–358. Applied and Environmental water: a sufficient condition to assume infectious Microbiology 59, 2956–2962. In: Society for comparison with other waterborne outbreaks in Applied Microbiology Summer Meeting, the developed world. Water Science and human from animal faecal contamination in Thechnology 31, 223–230. Journal of Applied fragilis bacteriophages as indicators of the Bacteriology 56, 439–447. Journal of Applied enteroviruses and bacteriophage in farm pond Bacteriology 60, 255–262. Applied and Environ- the replication of somatic coliphages in the mental Microbiology 47, 1290–1294. Journal of and typing assay to detect and source track Virological Methods 88, 163–173. Phage Detection as an Indication of Faecal Contamination 167 Rosen, G (1993) A History of Public Health. The wastewater reuse for agriculture in the suburbs Johns Hopkins University Press, Baltimore, of Asmara city, Eritrea. Letters in Applied methodologies for direct pathogen monitoring Microbiology 23, 49–54. Ann Arbor Science Publishers, Ann Arbor, Environmental Microbiology 72, 1226–1230. Southeast Asian experiences with the coliphage (2002) Distribution of genotypes of F-specific test. Applied and Applied and Environmental Microbiology 68, Environmental Microbiology 55, 2696–2701. A growing body of data shows that bac- be present in phage preparations; these com- teriophages are omnipresent in the environ- ponents may also be released from bacteria in ment. For example, phages are present in vivo following phage-induced lysis of high numbers in different ecosystems bacterial cells. A thorough analysis of the including water ecosystems, the rhizosphere literature on phage therapy, however, clearly and soil. Moreover, phages have been shows that phages are safe antibacterial detected in some foodstuffs and drinks; they agents. In fact, phages translocation from the gut to mesenteric can affect a wide range of functions of dif- lymph nodes and then to the extranodular ferent populations of immune cells involved space. Several important issues need to be taken into consideration when discussing the safety of Background phage therapy. First, only virulent phages should be used for therapeutic purposes; With the discovery of penicillin, a period of temperate phages should be excluded from intensive development of antibiotic therapy therapy (see Christie et al. A the antibacterial range of phages is very number of factors, including overuse of narrow, so they are not likely to disturb the antibiotics in clinical medicine, animal balance of the natural microflora. Abedon) Phage Translocation, Safety and Immunomodulation 169 multidrug-resistant bacterial strains. A large stantially affect antiviral immune responses number of studies have been conducted on by interfering with the activity of cytokines, the use of phages in humans, and of particular such as the production by adenoviruses and importance are studies that were carried out Epstein–Barr virus of proteins with activity in Georgia and Poland. However, it is modulatory activity have been identified essential to conduct formal clinical trials to (Ploegh, 1998). Thus, it is not unreasonable confirm the efficacy and safety of phage that phages infecting pathogenic and normal therapy before bacteriophages become flora bacteria would also be able to evolve widely available as therapeutic agents (see immunomodulating proteins to aid in their Burrowes and Harper, Chapter 14, this retention in the body. An understudied aspect of phage biology is their potential effects on the immune Prevalence of Bacteriophages and system. It is known that infections with the Safety of Phage Therapy pathogenic viruses – a category that does not include bacteriophages – are associated with Prevalence of bacteriophages in the activation of coordinated mechanisms of environment immune responses (Horst et al. At first, non-specific immune responses are induced There is a surprising abundance and following the recognition by immune cells of diversity of bacteriophages in the environ- pathogen-associated molecular paterns in ment. Primary immune responses to viral 104 and 108 phages ml–1 in water ecosystems infections are mediated by macrophages, (Weinbauer, 2004). Bacteriophages have also natural killer cells, granulocytes, complement been isolated from sewage (mean con- and interferons. Humoral in yogurt (Lactobacillus phages) and sauer- and cellular specific immune responses are kraut, where as many as 26 different phages induced, resulting in the neutralization of were found (Kiliç et al. Phages are however, many pathogenic viruses have particularly abundant in the intestines of developed mechanisms to avoid elimination mammals in view of the presence of by the immune system. This issue is can avoid recognition by the host immune discussed in detail by Letarov (Chapter 2, system as a result of high antigenic diversity, this volume). A lack of any deleterious considerations effects of phages on the microflora was found in a study by Brutin and Brüssow (2005). The omnipresence of bacteriophages in the They reported that oral administration of T4 environment implies constant exposure of phage at a titre of 103 or 105 plaque-forming humans to phages. Furthermore, no side effects effects of phage therapy are observed very atributable to the administration of phage rarely. This problem is discussed by endotoxin release following phage-mediated Christie et al. They showed that the administration preparations, which are released from the of phages to mice infected by Pseudomonas bacteria in which phages are propagated. However, so far, phage the treatment compared with the cor- lysates have been used for most treatment of responding values found in the patients prior humans, as purification of phage preparations to phage administration. Moreover, between from endotoxins is associated with a loss of days 9 and 32 of the treatment, significant active phage particles. These results suggest that orally or topically (Sulakvelidze and Kuter, lysis of bacteria by phages does not exert any 2005). Studies on using phage lysates in the pro-inflammatory effects; in fact, they treatment of chronic bacterial infections in indicate that phages could exert anti- humans have been conducted since 1952 at inflammatory activity (Międzybrodzki et al. A strong argument for the safety of No significant side effects of phage therapy phage therapy is the high specificity of the have been observed so far (Weber-Dąbrowska antibacterial activity of phages. Therefore, unlike antibiotics, they Preparations of phages specific to Gram- are less likely to disturb the balance of the positive bacteria can also contain some Phage Translocation, Safety and Immunomodulation 171 components of bacterial cells. There are data lysates and purified preparations of T4 phage in the literature, however, to show that it and staphylococcal phage A3/R induced only is possible to obtain safe preparations of a weak respiratory burst in human monocytes these phages. These species, including super- oxide, hydrogen peroxide, hydroxyl radicals Inactivation of phages by mechanisms of and singlet oxygen, exert bactericidal activity. When there are no host bacteria syndrome, atherosclerosis and neuro- in which phages could replicate, they are degenerative diseases, especially Alzheimer’s fairly rapidly removed from the blood and disease and Parkinson’s disease (Knight, the majority of internal organs. Kupffer cells within 30 min of their This result suggests that lysis of bacteria by intravenous administration. As well as phages is not likely to induce oxidative stress Kupffer cells, spleen macrophages can also in cells, arguing for the safety of phage eliminate phages, but their activity in this therapy. Consequently, phage titre in the liver which suggests that the presence of decreases rapidly, while in the spleen phages neutralizing antibodies does not always remain at high titre for up to 5–7 days afer result in a lower therapeutic efficacy. It has been suggested that phages entrapped in the Immunogenic properties of X174 phage spleen can be a source of antigen necessary for antibody generation (Geier et al.

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