Objective: The objective of this review is to evaluate the safety and efficacy of polyethylene glycol 400/propylene glycol/hydroxypropylguar (Systane® Ultra [PEG/PG with HP-guar], Alcon Laboratories, Inc., Fort Worth, TX, USA) lubricant eye drops in reducing the signs and symptoms of dry-eye disease. Methods: A systematic literature search utilizing MEDLINE was conducted to identify peer-reviewed articles related to dry-eye disease and PEG/PG with HP-guar lubricant eye drops. The search covered the period prior to October 2009. Additionally, a manual search based on citations in the published literature was conducted. Results: The PEG/PG with HP-guar artificial tears shows in-vitro viscoelastic properties with pH optimization. The pH of the solution adjusts to the pH of the ocular surface upon instillation, which results in tear film elasticity and viscosity similar to that of subjects without dry-eye disease. The reviewed literature demonstrated that this delivery system showed a reduction in corneal and conjunctival staining in dry-eye disease, an improvement in tear film stability, a low coefficient of friction in an in-vitro model, and improved maintenance of best-corrected visual acuity over time. Conclusion: A few small-sized studies with short-term follow-up demonstrated that PEG/PG with HP-guar is a safe and effective lubricant eye drops for the treatment of dry-eye disease. Larger studies with longer duration are warranted to assess the long-term safety and efficacy of this formulation in patients with dry‑eye disease.

Nowadays, there is no consensus about the best treatment for patients with follicular lymphoma (FL) in differing situations. In frontline treatment, a watchful waiting policy remains a good option if the patient has no risk criteria; the role of rituximab is under investigation in this setting. In patients needing therapy, immunotherapy or immunochemotherapy are the best options; although it has not been established which chemotherapy, including cyclophosphamide, vincristine, and prednisone (CVP); cyclophosphamide, adriamycin, vincristine, and prednisone (CHOP); fludarabine, or bendamustine combinations, is the best partner for rituximab. Following frontline treatment, recent and still unpublished data strongly suggest a role for maintenance with rituximab, instead of observation only. At relapse, immunochemotherapy is the standard induction approach. The role of maintenance after induction is well established, although comparative studies with autologous stem-cell transplantation (ASCT) or other combinations are warranted. The role of ASCT in this setting is a matter of discussion. Other monoclonal antibodies, as well as vaccines and other immunotherapies, are currently under investigation. Finally, allogeneic transplantation should be reserved for a very select group of young high-risk patients in the setting of clinical trials.

Opioid-induced constipation (OIC) is associated with negative impact of opioid analgesics on opioid receptors located in the gut wall. Until recently, OIC was treated symptomatically only, with different laxatives which did not target the pathophysiology of OIC. Recently, several opioid receptor antagonists have been introduced in the treatment of OIC. Methylnaltrexone (MNTX) is a peripheral mu-opioid receptor antagonist for subcutaneous administration, which does not evoke symptoms of opioid abstinence. MNTX is indicated for patients with OIC who are not amenable to therapy with oral laxatives. In clinical trials, the effectiveness of MNTX assessed as its ability to induce spontaneous bowel movement, is 50%‑60% of treated patients; MNTX demonstrates significant superiority over placebo. Another product is combination of oral formulation of prolonged release oxycodone and prolonged release naloxone (PR oxycodone/PR naloxone), indicated for patients who require opioid administration for chronic pain and have already developed OIC, and for those who need opioid therapy and take the drug to prevent OIC. Naloxone administered orally
displays local, antagonist effects on opioid receptors in the gut wall, negligible systemic bioavailability, and significantly reduces the oxycodone constipating effect. PR oxycodone/ PR naloxone has similar analgesic efficacy, but causes less constipation and less laxative consumption in comparison with patients treated with oxycodone alone. Both products are expensive, therefore their administration should be carefully considered. On the other hand, uncontrolled OIC and the necessity to perform rectal invasive procedures (enema, manual evacuation) lead not only to increased health care costs, but most importantly, cause severe patient suffering.