RESUMEN
Although motor fluctuation can often be severe in Parkinson's disease (PD), it is rare for an 'off period' to result in coma. The case presented here is of a patient with longstanding PD who was admitted to our hospital with a Glasgow Coma Scale of three after missing just one or two doses of her medication. Investigation for infective, neurovascular and metabolic causes of coma were negative and the patient recovered very rapidly following reinstitution of dopaminergic therapy via nasogastric tube. This case highlights how florid the presentation of motor fluctuations in PD can be and the importance of restarting treatment as quickly as possible. Guidance is provided on how to administer dopaminergic medications in patients who are unable to swallow.
Asunto(s)
Coma/etiología , Dopaminérgicos/administración & dosificación , Enfermedad de Parkinson/tratamiento farmacológico , Anciano , Deshidratación/complicaciones , Proteínas en la Dieta/efectos adversos , Fatiga/complicaciones , Femenino , Vacaciones y Feriados , Humanos , Enfermedad de Parkinson/complicacionesAsunto(s)
Aneurisma de la Aorta/complicaciones , Aneurisma de la Aorta/diagnóstico , Disección Aórtica/complicaciones , Disección Aórtica/diagnóstico , Cefalea/etiología , Adulto , Disección Aórtica/cirugía , Aneurisma de la Aorta/cirugía , Insuficiencia de la Válvula Aórtica/etiología , Dolor en el Pecho/etiología , Humanos , Masculino , Náusea/etiología , Oxígeno/sangreRESUMEN
In animals, effective immune responses against malignancies and against several infectious pathogens, including malaria, are mediated by T cells. Here we show that a heterologous prime-boost vaccination regime of DNA either intramuscularly or epidermally, followed by intradermal recombinant modified vaccinia virus Ankara (MVA), induces high frequencies of interferon (IFN)-gamma-secreting, antigen-specific T-cell responses in humans to a pre-erythrocytic malaria antigen, thrombospondin-related adhesion protein (TRAP). These responses are five- to tenfold higher than the T-cell responses induced by the DNA vaccine or recombinant MVA vaccine alone, and produce partial protection manifest as delayed parasitemia after sporozoite challenge with a different strain of Plasmodium falciparum. Such heterologous prime-boost immunization approaches may provide a basis for preventative and therapeutic vaccination in humans.