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1.
Exp Brain Res ; 239(7): 2063-2075, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33928399

RESUMO

There is growing interest in how social processes and behaviour might be affected in Parkinson's disease. A task which has been widely used to assess how people orient attention in response to social cues is the spatial cueing task. Socially relevant directional cues, such as a picture of someone gazing or pointing to the left or the right have been shown to cause orienting of visual attention in the cued direction. The basal ganglia may play a role in responding to such directional cues, but no studies to date have examined whether similar social cueing effects are seen in people with Parkinson's disease. In this study, patients and healthy controls completed a prosaccade (Experiment 1) and an antisaccade task (Experiment 2) in which the target was preceded by arrow, eye gaze or pointing finger cues. Patients showed increased errors and response times for antisaccades but not prosaccades. Healthy participants made most anticipatory errors on pointing finger cue trials, but Parkinson's patients were equally affected by arrow, eye gaze and pointing cues. It is concluded that Parkinson's patients have a reduced ability to suppress responding to directional cues, but this effect is not specific to social cues.


Assuntos
Sinais (Psicologia) , Doença de Parkinson , Fixação Ocular , Humanos , Tempo de Reação , Movimentos Sacádicos
2.
J Cogn Neurosci ; 31(4): 497-509, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30513043

RESUMO

Analysis of eye movements can provide insights into processes underlying performance of cognitive tasks. We recorded eye movements in healthy participants and people with idiopathic Parkinson disease during a token foraging task based on the spatial working memory component of the widely used Cambridge Neuropsychological Test Automated Battery. Participants selected boxes (using a mouse click) to reveal hidden tokens. Tokens were never hidden under a box where one had been found before, such that memory had to be used to guide box selections. A key measure of performance in the task is between search errors (BSEs) in which a box where a token has been found is selected again. Eye movements were found to be most commonly directed toward the next box to be clicked on, but fixations also occurred at rates higher than expected by chance on boxes farther ahead or back along the search path. Looking ahead and looking back in this way was found to correlate negatively with BSEs and was significantly reduced in patients with Parkinson disease. Refixating boxes where tokens had already been found correlated with BSEs and the severity of Parkinson disease symptoms. It is concluded that eye movements can provide an index of cognitive planning in the task. Refixations on locations where a token has been found may also provide a sensitive indicator of visuospatial memory integrity. Eye movement measures derived from the spatial working memory task may prove useful in the assessment of executive functions as well as neurological and psychiatric diseases in the future.


Assuntos
Envelhecimento/fisiologia , Função Executiva/fisiologia , Movimentos Oculares/fisiologia , Aprendizagem em Labirinto/fisiologia , Memória de Curto Prazo/fisiologia , Doença de Parkinson/fisiopatologia , Desempenho Psicomotor/fisiologia , Memória Espacial/fisiologia , Adulto , Idoso , Medições dos Movimentos Oculares , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
3.
Clin Rehabil ; 30(9): 901-8, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27496699

RESUMO

OBJECTIVES: To evaluate rehabilitation outcomes in patients with moderate to severe cognitive impairment. DESIGN: Prospective observational cohort study. SETTING: Rehabilitation unit for older people. SUBJECTS: A total of 116 patients (70F) mean age (SD) 86.3 (6.4). Group 1: 89 patients with moderate cognitive impairment (Mini-Mental State Examination 11-20); and Group 2: 27 patients with severe cognitive impairment (Mini-Mental State Examination 0-10). INTERVENTION: A personalised rehabilitation plan. MAIN MEASURES: Barthel Activity of Daily Living score on admission and discharge, length of stay and discharge destination. RESULTS: Of 116 patients, 64 (55.2%) showed an improvement in Barthel score. Mini-Mental State Examination was significantly higher in those who improved, 15.4 (SD 3.7) vs.13.2 (SD 5.1): p = 0.01. The mean Barthel score improved in both groups; Group 1 - 14.7 (SD 19.1) vs. Group 2 - 9.3 (SD 16.3): p = 0.17. Of 84 home admissions in Group 1, more patients returning home showed improvements of at least 5 points in the Barthel score compared with nursing/residential home discharges (32/37 - 86.5% vs. 10/28 - 35.7%: p = 0.0001). In Group 2 of 17 home admissions, 6/6 (100%) home discharges showed improvement compared with 3/7 (42.8%) discharges to nursing/residential home (p = 0.07). In Group 1, a discharge home was associated with significantly greater improvement in number of Barthel items than a nursing/residential home discharge (3.27 (SD 2.07) vs. 1.86 (SD 2.32): p = 0.007). A similar non-significant pattern was noted for severe cognitive impairment patients (3.5 (3.06) vs. 1.14 (1.06); p = 0.1). CONCLUSION: Patients with moderate to severe cognitive impairment demonstrated significant improvements in Barthel score and Barthel items showing that such patients can and do improve with rehabilitation.


Assuntos
Disfunção Cognitiva/reabilitação , Atividades Cotidianas , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/psicologia , Feminino , Hospitalização , Humanos , Masculino , Testes Neuropsicológicos , Estudos Prospectivos , Resultado do Tratamento
4.
Stroke ; 46(5): 1187-95, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25765726

RESUMO

BACKGROUND AND PURPOSE: Determining the underlying cause of stroke is important to optimize secondary prevention treatment. Increased blood levels of natriuretic peptides (B-type natriuretic peptide/N-terminal pro-BNP [BNP/NT-proBNP]) have been repeatedly associated with cardioembolic stroke. Here, we evaluate their clinical value as pathogenic biomarkers for stroke through a literature systematic review and individual participants' data meta-analysis. METHODS: We searched publications in PubMed database until November 2013 that compared BNP and NT-proBNP circulating levels among stroke causes. Standardized individual participants' data were collected to estimate predictive values of BNP/NT-proBNP for cardioembolic stroke. Dichotomized BNP/NT-proBNP levels were included in logistic regression models together with clinical variables to assess the sensitivity and specificity to identify cardioembolic strokes and the additional value of biomarkers using area under the curve and integrated discrimination improvement index. RESULTS: From 23 selected articles, we collected information of 2834 patients with a defined cause. BNP/NT-proBNP levels were significantly elevated in cardioembolic stroke until 72 hours from symptoms onset. Predictive models showed a sensitivity >90% and specificity >80% when BNP/NT-proBNP were added considering the lowest and the highest quartile, respectively. Both peptides also increased significantly the area under the curve and integrated discrimination improvement index compared with clinical models. Sensitivity, specificity, and precision of the models were validated in 197 patients with initially undetermined stroke with final pathogenic diagnosis after ancillary follow-up. CONCLUSIONS: Natriuretic peptides are strongly increased in cardioembolic strokes. Future multicentre prospective studies comparing BNP and NT-proBNP might aid in finding the optimal biomarker, the best time point, and the optimal cutoff points for cardioembolic stroke identification.


Assuntos
Embolia/diagnóstico , Peptídeo Natriurético Encefálico/sangue , Acidente Vascular Cerebral/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Eletrocardiografia , Embolia/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Acidente Vascular Cerebral/etiologia
5.
Prog Drug Res ; 69: 1-14, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25130037

RESUMO

Bradykinin and related kinins may act on two types of receptors designated as B1 and B2. It seems that the B2 receptors are most commonly found in various vascular and non-vascular smooth muscles, whereas B1 receptors are formed in vitro during trauma, and injury, and are found in bone tissues. These bradykinin (BK) receptors are involved in the regulation of various physiological and pathological processes. The mode of kinin actions are based upon the interactions between the kinin and their specific receptors, which can lead to activation of several second-messenger systems. Recently, numerous BK receptor antagonists have been synthesized with prime aim to treat diseases caused by excessive kinin production. These diseases are rheumatoid arthritis (RA), inflammatory diseases of the bowel, asthma, rhinitis and sore throat, allergic reactions, pain, inflammatory skin disorders, endotoxic and anaphylactic shock and coronary heart diseases. On the other hand, BK receptor antagonists could be contraindicated in hypertension, since these drugs may antagonize the antihypertensive therapy and/ or may trigger the hypertensive crisis. It is worth suggesting that the BK receptor agonists might be useful antihypertensive drugs.


Assuntos
Anti-Inflamatórios/uso terapêutico , Antagonistas dos Receptores da Bradicinina , Fármacos Cardiovasculares/uso terapêutico , Transdução de Sinais/efeitos dos fármacos , Animais , Bradicinina/metabolismo , Humanos , Ligantes , Receptores da Bradicinina/metabolismo
6.
Prog Drug Res ; 69: 15-36, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25130038

RESUMO

Cardiovascular diseases are the most common causes of mortality worldwide. Hypertension and diabetes are the two major risk factors in the development of cardiac hypertrophy, ischemic heart disease, and cardiac failure. In Kuwait, high rate of prevalence of hypertension and diabetes has been documented. Previous studies have indicated altered activities of the BK-generating components in hypertension and diabetes. Bradykinin is pharmacologically active polypeptide that can promote both cardiovascular and renal function, for example, vasodilation, natriuresis, diuresis, and release of nitric oxide (NO). In addition, B2 kinin receptors are present in the cardiac endothelial cells which may enhance the biosynthesis and release of NO. It has been demonstrated that reduced urinary (renal) kallikrein levels may be associated with the development of high blood pressure in humans and spontaneously hypertensive and diabetic rats. The BK may produce its pharmacological effects via NO and cyclic GMP release. Furthermore, it is established that the BK has cardioprotective actions in myocardial ischemia and can prevent left ventricular hypertrophy. Also, transgenic mice carrying tissue kallikrein gene and overexpressing tissue kallikrein had reduced blood pressure. NO synthase and renal tissue kallikrein are both involved in blood pressure regulation. The ability of kallikrein gene delivery and the use of kinin B2 receptor agonists to produce a wide spectrum of beneficial effects make it a powerful candidate in treating hypertension, cardiovascular, and renal diseases. Strategies that activate kinin receptors might be applicable to the treatment of cardiovascular disease. Increased plasma prekallikrein levels in diabetic patients may serve as an indicator of developing hypertension and renal damage. Also high plasma and urine concentrations of tissue kallikrein may cause higher glucose levels in the blood.


Assuntos
Diabetes Mellitus/enzimologia , Hipertensão/enzimologia , Calicreínas/metabolismo , Cininas/metabolismo , Transdução de Sinais , Animais , Anti-Hipertensivos/uso terapêutico , Diabetes Mellitus/tratamento farmacológico , Diabetes Mellitus/fisiopatologia , Modelos Animais de Doenças , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/fisiopatologia , Hipoglicemiantes/uso terapêutico , Masculino , Transdução de Sinais/efeitos dos fármacos
7.
Inflammopharmacology ; 21(1): 1-9, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22527353

RESUMO

Cardiovascular diseases are the prime cause of death in the world. The kallikrein-kinin system has been implicated in the pathophysiology of the vascular smooth muscle and cardiac dysfunctions. In recent years, numerous observations obtained from clinical and experimental models of diabetes, hypertension, cardiac failure, ischemia, myocardial infarction and left ventricular hypertrophy, have suggested that the reduced activity of the local kallikrein-kinin system may be instrumental for the induction of cardiovascular-related diseases. The cardioprotective actions of the angiotensin-converting enzyme inhibitors are primarily dependent on protecting the kinin-forming components, which may cause regression of the left ventricular hypertrophy in hypertensive situations. The ability of kallikrein gene delivery to produce a wide spectrum of beneficial effects makes it an excellent candidate in treating hypertension, cardiovascular and renal diseases. In addition, stable kinin agonists may also be available in the future as therapeutic agents for cardiovascular and renal disorders.


Assuntos
Doenças Cardiovasculares/fisiopatologia , Hipertensão/fisiopatologia , Sistema Calicreína-Cinina/fisiologia , Inibidores da Enzima Conversora de Angiotensina/farmacologia , Animais , Doenças Cardiovasculares/terapia , Terapia Genética/métodos , Humanos , Hipertensão/terapia , Calicreínas/metabolismo , Nefropatias/fisiopatologia , Nefropatias/terapia , Cininas/agonistas , Cininas/metabolismo , Músculo Liso Vascular/fisiopatologia
8.
Middle East J Anaesthesiol ; 22(2): 173-8, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24180166

RESUMO

INTRODUCTION: Post-Operative Sore Throat (POST) is an undesirable side effect ofendotracheal intubation. Pharmacological and non-pharmacological measures have been utilized for minimizing the morbidity caused by POST. We have tested whether medicated lozenges of Licorice provides efficacy in decreasing POST in smokers presenting for surgery under general anesthesia with endotracheal intubation. METHODS: 100 patients, 20 - 65 years, American Society ofAnaesthesiologists (ASA) physical status Grade I & II, of either sex, with history of smoking, and posted for elective surgical procedure lasting more than one hour and requiring general anesthesia with endotracheal intubation were included and randomly divided into two groups (n = 50) to receive Licorice lozenges (Group A) and Sugar Candy (Group B). The patients were assessed for cough, sore throat and hoarseness of voice immediately after extubation and then at 30 min, 12 hrs and 24 hrs after extubation utilizing scoring system of Harding and McVey. RESULTS: Overall incidence of postextubation cough was less in Group A (12 patients, 24%) compared to Group B (26 patients, 52%) (p = 0.002). Magnitude of sore throat (Grades 0/1/2/3) was seen in 48/2/0/0 patients (Group A) and 46/4/0/0 (Group B) at extubation (p = 0.40) and 34/16/0/0 (Group A) and 28/20/2/0 (Group B) at 30 min (p = 0.17). At 12 and 24 hours, the magnitudes of sore throats were 24/25/1/0 (Group A) & 12/38/0/0 (Group B) (p = 0.02) and 26/23/1/0 (Group A) & 15/35/0/0 (Group B) (p = 0.03) respectively. CONCLUSION: Use of licorice lozenges is efficacious for reducing the distressing complaint of POST in postoperative period among smokers.


Assuntos
Anestesia Geral/métodos , Tosse/prevenção & controle , Glycyrrhiza , Intubação Intratraqueal/efeitos adversos , Faringite/prevenção & controle , Fumar , Adulto , Idoso , Tosse/epidemiologia , Procedimentos Cirúrgicos Eletivos/métodos , Feminino , Rouquidão/epidemiologia , Rouquidão/prevenção & controle , Humanos , Incidência , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Faringite/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios/métodos , Resultado do Tratamento , Adulto Jovem
9.
Ann Med Surg (Lond) ; 85(11): 5728-5730, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-37915650

RESUMO

Introduction and importance: Neutropenic enterocolitis (NE) is a life-threatening necrotizing enterocolitis, particularly in neutropenic patients. Case presentation: We are presenting a case of a 22-year-old male who presented chief complaints of abdominal pain, reddish black stool, abdominal distention, and low-grade fever with laboratory and bone marrow findings suggestive of aplastic anemia. Computed tomography scan of the abdomen and pelvis with contrast was used to establish the diagnosis of necrotizing enterocolitis. Nonsurgical management including broad-spectrum antimicrobials, bowel rest, nasogastric suction, fluid and nutritional support, and blood product support, helped this patient to recover. Clinical discussion: NE is a life-threatening inflammatory condition of the small and large intestines. Typical symptoms of NE include diffuse abdominal pain, fever, and watery or bloody diarrhea. Diagnosis of NE is done by clinical and imaging findings. Management of the primary disease is important to improve the ultimate survival of the disease. Conclusion: Early identification and management of neutropenic enterocolitis help to reduce mortality.

10.
J Med Life ; 16(5): 782-793, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-37520491

RESUMO

Healthcare workers (HCWs) are at high risk of COVID-19 infection despite vaccination. Limited data exist on COVID-19 cases among vaccinated HCWs. This study aimed to describe the clinical characteristics and outcomes of RT PCR-confirmed COVID-19 cases in vaccinated HCWs, at a COVID clinic in a medical college hospital. This single-center, prospective cohort study included HCWs who received at least one dose of the COVID-19 vaccine and tested positive for COVID-19 within 6 months. Data on demographics, symptoms, work category, COVID-19 vaccination interval, and infection severity were collected. Of 2381 vaccinated HCWs, 105 tested positive and were categorized as mild, moderate, or severe cases. Among vaccinated HCWs, 4.41% had post-vaccine COVID-19 infections. All 105 cases received the first dose, and 79 received the second dose. Of the cases, 47.6% were partially vaccinated, and 53.3% were breakthrough cases. The mean age was 30.90±8.69 years, with 63.8% male and 36.2% female cases. Most cases (85.7%) acquired infection in the hospital, and 47.6% had direct contact with COVID-19 patients. Common symptoms included fatigue (85.7%), fever (82.9%), and cough (64.8%). Among cases, 93.3% were mild, 5.7% were moderate, and 0.9% were severe. Hospital admission and supplemental oxygen therapy were required for moderate and severe cases. No mortality was reported. Certain variables were associated with age, preventive measures, workplace type, symptoms, and comorbidities. Breakthrough infections can occur among fully vaccinated HCWs but with reduced severity and mortality. Monitoring and infection control measures remain crucial even in vaccinated individuals. This study provides insights into clinical presentations, oxygen therapy requirements, and outcomes of post-vaccine COVID-19 cases among HCWs. The data will inform strategies for booster doses to prevent COVID-19.


Assuntos
COVID-19 , Vacinas , Humanos , Feminino , Masculino , Adulto Jovem , Adulto , Vacinas contra COVID-19 , COVID-19/epidemiologia , COVID-19/prevenção & controle , Estudos Prospectivos , Hospitais Universitários , Índia/epidemiologia , Pessoal de Saúde , Oxigênio
11.
Cureus ; 15(11): e49351, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-38146570

RESUMO

Tacrolimus, widely known as Prograf, has become the preferred immunosuppressant for preventing graft rejection in solid organ transplant recipients, particularly in steroid-sparing regimens. Its efficacy and reduced risk of acute and chronic rejection compared to cyclosporine have made it the preferred treatment option for transplant patients. However, tacrolimus has drawbacks as it is associated with adverse effects, such as renal tubular necrosis, kidney failure, hypertension, metabolic acidosis, and new-onset diabetes mellitus. Among the less common but potentially severe complications is thrombotic microangiopathy linked to tacrolimus usage. Identifying and addressing this condition early on is crucial given its severity and potential complications. Manifestations of this microangiopathy can vary, encompassing renal, neurological, cardiac, and respiratory symptoms, and, in some cases, presenting as pancreatitis, intestinal ischemia, or skin abnormalities. Although conventional management often involves plasma exchange as the primary therapeutic option, recent insights into the pathophysiology have led to newer drugs, such as eculizumab and belatacept, offering promising outcomes. In this narrative review, we delve deeper into the underlying pathophysiological mechanisms of tacrolimus-induced thrombotic microangiopathy and aim to provide clinicians with valuable recommendations for efficient and timely treatment strategies. By understanding the complexities of this condition and staying abreast of the latest advancements in therapeutic options, healthcare providers can optimize patient outcomes and ensure safer tacrolimus administration in solid organ transplant recipients.

12.
Postgrad Med J ; 88(1035): 34-7, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22121248

RESUMO

Antiplatelet therapy has proven efficacy in the secondary prevention of recurrent non-cardioembolic ischaemic stroke. Recent evidence suggests clopidogrel is as effective as combined therapy with aspirin and extended-release dipyridamole for the prevention of recurrent stroke. As cerebrovascular and ischaemic heart disease are closely related, it would be sensible to use a drug shown to prevent vascular events in both territories. Clopidogrel meets these criteria, is superior to aspirin monotherapy, and has fewer side effects compared with extended-release dipyridamole. While there is no direct evidence supporting the use of clopidogrel in transient ischaemic attacks, it is likely that clopidogrel is effective because transient ischaemic attacks and stroke are part of the same disease spectrum. Clopidogrel could thus be useful as first line secondary prevention therapy in all non-cardioembolic stroke subtypes and transient ischaemic attacks, to prevent recurrent ischaemic events in all vascular territories.


Assuntos
Inibidores da Agregação Plaquetária/uso terapêutico , Prevenção Secundária , Acidente Vascular Cerebral/prevenção & controle , Ticlopidina/análogos & derivados , Aspirina/uso terapêutico , Clopidogrel , Dipiridamol , Humanos , Isquemia , Ataque Isquêmico Transitório/complicações , Ataque Isquêmico Transitório/prevenção & controle , Inibidores da Agregação Plaquetária/farmacologia , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/etiologia , Ticlopidina/farmacologia , Ticlopidina/uso terapêutico , Resultado do Tratamento
13.
Middle East J Anaesthesiol ; 21(5): 679-84, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23265030

RESUMO

UNLABELLED: This prospective, randomized, double control study was carried out in 84 children aged 2-24 months posted for elective cleft lip surgery. METHODS: Patients were randomally divided into 2 groups of 42 patients each. In Group A patients were induced and maintained on sevoflurane while in Group B patients were induced with sevoflurane and maintained on isoflurane. Standardized anesthesia technique was used. Recovery milestones and post operative complications were recorded. RESULTS: Incidence of emergence delirium in sevoflurane group was 11.9% while in isoflurane group is 2.38%. The overall incidence of emergence delirium in the study was 7.14%. There was no significant difference (p > 0.05) in the incidence of emergence delirium between the two groups. There was no effect of duration of exposure of sevoflurane and time taken for achievement of recovery milestones while we observed a positive correlation with isoflurane. In sevoflurane the recovery endpoint first reached was limb movement > spontaneous respiration > spontaneous eye opening. In isoflurane group the recovery end point first reached was spontaneous respiration > limb movement = spontaneous eye opening. CONCLUSION: Our study confirms that the recovery profile of sevoflurane in children less the two years is superior compared to isoflurane.


Assuntos
Período de Recuperação da Anestesia , Anestésicos Inalatórios/efeitos adversos , Fenda Labial/cirurgia , Delírio/induzido quimicamente , Delírio/epidemiologia , Isoflurano/efeitos adversos , Éteres Metílicos/efeitos adversos , Pré-Escolar , Método Duplo-Cego , Feminino , Humanos , Incidência , Lactente , Masculino , Estudos Prospectivos , Sevoflurano
14.
Cureus ; 14(10): e30665, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36439584

RESUMO

Penetrating injuries to the precordium are life-threatening and require early detection and immediate intervention. We present a case of penetrating cardiac injury who presented with a definitive airway and hemodynamically unstable. During the primary survey, the patient had a cardiac arrest with pulseless ventricular tachycardia. The patient was resuscitated as per advanced cardiac life support (ACLS) and advanced trauma life support (ATLS) guidelines with manual digital compression at the penetrating site leading to a return of spontaneous circulation (ROSC). After ROSC, he was shifted for emergency explorative median sternotomy. During the sternotomy, we found a clotted rent in the anterior wall of the left ventricle, which was repaired. Aggressive resuscitation and appropriate management strategy in the emergency department (ED) resulted in a successful outcome, and he was discharged after 10 days of hospital stay. Our case highlights the importance of early diagnosing and managing penetrating cardiac trauma.

15.
NPJ Parkinsons Dis ; 8(1): 95, 2022 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-35918350

RESUMO

Unexplained weight changes that occur in Parkinson's disease (PD), are often neglected and remain a poorly understood non-motor feature in patients with PD. A specific 'Park-weight' phenotype with low body weight has been described, and our aim was to evaluate the clinical and prognostic trajectories and biomarkers of weight variability in PD. We evaluated body weight-related biomarkers in 405 de novo PD patients and 187 healthy controls (HC) over a 5-year follow-up period from the PPMI database. Body-weight variability was defined as intra-individual variability in body weight between visits. PD patients were categorized as weight losers, gainers, or patients with stable weight. The differential progression of motor and non-motor clinical variables between groups was explored using linear mixed-effects models. Finally, we estimated longitudinal changes in weight as a function of baseline and longitudinal striatal presynaptic dopaminergic transporter imaging. PD patients presented a greater weight variability compared to HC (p = 0.003). Patients who developed weight loss had lower CSF amyloid-beta 1-42 (p = 0.009) at baseline. In addition, patients with weight loss showed a faster cognitive decline (p = 0.001), whereas patients with weight gain showed a slower motor progression (p = 0.001), compared to patients with stable weight. Baseline right striatal denervation was a predictor of weight variability in both PD patients and HC (p < 0.001). Similarly, weight variability in PD patients was associated with the progression of right striatal denervation (p < 0.001). Weight variability and specifically weight loss are more frequent in PD compared to HC, and are associated with specific motor, non-motor and cognitive progression patterns. A greater CSF amyloid burden was present at baseline in patients with subsequent weight loss. Presynaptic dopaminergic imaging in the right striatum may serve as a predictor of future weight changes in PD and HC.

16.
Neurodegener Dis Manag ; 12(2): 77-91, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35313124

RESUMO

Aim: This subanalysis of the OPTIPARK study aimed to confirm the effectiveness and safety of opicapone in patients with Parkinson's disease and motor fluctuations in clinical practice specifically in the UK and to assess the impact of opicapone on treatment costs. Methods: Patients received opicapone added to levodopa for 6 months. Clinical outcomes were assessed at 3 and 6 months and treatment costs at 6 months. Results: Most patients' general condition improved at 3 months, with sustained improvements reported at 6 months. Opicapone improved motor and non-motor symptoms at both timepoints, was generally well tolerated and reduced total treatment costs by GBP 3719. Conclusion: Opicapone added to levodopa resulted in clinical improvements and reduced treatment costs across UK clinical practice.


Patients with Parkinson's disease (PD) often experience motor fluctuations (reduced and variable response to medication) following prolonged treatment with levodopa, which is currently the most effective treatment for the symptoms of PD. Opicapone has been developed for use in combination with levodopa to reduce the occurrence of motor fluctuations and was shown to be effective in two large clinical trials. This study describes the effectiveness, safety and cost-saving impact of opicapone when used to treat patients with PD and motor fluctuations across everyday clinical practice in the UK. Six months' treatment with opicapone was generally well tolerated, resulted in an improvement of the patients' overall PD condition and reduced treatment costs. Clinical trial registration: Registered in July 2016 at NCT02847442 (ClinicalTrial.gov).


Assuntos
Levodopa , Doença de Parkinson , Antiparkinsonianos/efeitos adversos , Inibidores de Catecol O-Metiltransferase/uso terapêutico , Custos e Análise de Custo , Método Duplo-Cego , Humanos , Levodopa/efeitos adversos , Oxidiazóis , Doença de Parkinson/tratamento farmacológico , Reino Unido
17.
Stroke ; 42(1): 217-20, 2011 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21106953

RESUMO

Carotid intervention in severe carotid stenosis after an anterior circulation ischemic event reduces the risk of further infarcts if the surgery is performed soon after the incident event. At present, there is no recommendation to differentiate among subtypes of anterior circulation infarcts or transient ischemic events. However, evidence is mounting that demonstrates a difference in pathophysiology of lacunar and nonlacunar (large artery) infarcts. The natural history of lacunar strokes is different from large artery infarcts for recurrence and mortality. Stroke is a heterogenous disease and consideration needs to be directed to manage different stroke subtypes differently. Lacunar infarcts mostly do not arise from large artery atheromatous disease or by cardioembolic phenomena, and there is a negative predictive value for severe carotid stenosis in lacunar strokes. Thus, current evidence suggests that lacunar strokes may not warrant investigation for carotid stenosis.


Assuntos
Infarto Encefálico , Estenose das Carótidas , Infarto Encefálico/etiologia , Infarto Encefálico/mortalidade , Infarto Encefálico/patologia , Infarto Encefálico/fisiopatologia , Estenose das Carótidas/complicações , Estenose das Carótidas/mortalidade , Estenose das Carótidas/patologia , Estenose das Carótidas/fisiopatologia , Humanos , Recidiva , Fatores de Risco
18.
Med Sci Monit ; 17(11): CR663-668, 2011 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22037747

RESUMO

BACKGROUND: This study aimed to analyze the epidemiological and mycological profile of candidemia in intensive care unit (ICU) patients attending a tertiary care teaching hospital in the Himalayan region of northern India. MATERIAL/METHODS: A 15-bed medico-surgical ICU and a 5-bed pediatric ICU. Ninety-one consecutively admitted ICU patients were screened for the presence of candidemia by performing blood cultures at periodic intervals. RESULTS: The recovered Candida isolates were speciated and subjected to antifungal susceptibility testing using standard procedures. Forty-one of the recruited patients (45%) were found to be candidemic, with the majority of patients being in the extremes of age (13 neonates and 15 >65 years of age). Four risk factors were found to be significantly associated with the occurrence of candidemia in our patients - a period of hospitalization exceeding 7 days (p=0.0008), previous use of antibiotics (p=0.001), presence of chronic renal failure (p=0.003), and ongoing cancer chemotherapy (p= 0.041). Ninety-six Candida isolates were recovered from the 41 culture-positive patients, with Candida albicans being the commonest isolate recovered (n=75, 78.1%), followed by Candida tropicalis (n=15, 16%), and Candida glabrata (n=6, 6.5%). Fluconazole resistance was observed among 26% of all Candida isolates and 17.3% of C. albicans isolates. CONCLUSIONS: Contrary to the majority of recent reports, species shift towards non-albicans candidemia has not been observed in our center, though the prevalence of azole resistance is alarmingly high even among the C. albicans isolates.


Assuntos
Candida/isolamento & purificação , Candidemia/epidemiologia , Candidemia/etiologia , Candidemia/microbiologia , Unidades de Terapia Intensiva , Adulto , Idoso , Antibacterianos/efeitos adversos , Criança , Pré-Escolar , Farmacorresistência Fúngica , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Feminino , Fluconazol , Humanos , Índia/epidemiologia , Recém-Nascido , Falência Renal Crônica/complicações , Falência Renal Crônica/epidemiologia , Masculino , Fatores de Risco , Especificidade da Espécie
19.
Cureus ; 12(11): e11467, 2020 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-33329964

RESUMO

Chediak-Higashi syndrome (CHS) is a rare, autosomal-recessive disorder characterized by oculocutaneous albinism, recurrent bacterial infections, progressive neurologic abnormalities, coagulation defects and a high risk of developing hemophagocytic lymphohistiocytosis characterized by pancytopenia, high fever, and lymphohistiocytic infiltration of liver, spleen, and lymph nodes. Treatment of accelerated-phase CHS is difficult with poor prognosis. Here, we report a two-and-a-half-year-old male child who was diagnosed with Chediak-Higashi Syndrome based on silvery hair, pathognomonic hair microscopy and giant azurophilic granules in granulocytes. The patient was in advanced stage of HLH induced by an Epstein-Barr virus (EBV) infection and given etoposide, cyclosporine and dexamethasone according to hemophagocytic lymphohistiocytosis (HLH)-2004 protocol but did not survive.

20.
Diabetes Metab Syndr Obes ; 13: 889-896, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32273740

RESUMO

PURPOSE: Metabolic syndrome is associated with several medical risk factors including dyslipidemia, hyperglycemia, and obesity, which has become a worldwide pandemic. The sequelae of this condition increase the risk of cardiovascular and neurological disease and increased mortality. Its pathophysiology is associated with redox dysregulation, excessive inflammation, and perturbation of cellular homeostasis. Molecular hydrogen (H2) may attenuate oxidative stress, improve cellular function, and reduce chronic inflammation. Pre-clinical and clinical studies have shown promising effects of H2-rich water (HRW) on specific features of metabolic syndrome, yet the effects of long-term, high-concentration HRW in this prevalent condition remain poorly addressed. METHODS: We conducted a randomized, double-blinded, placebo-controlled trial in 60 subjects (30 men and 30 women) with metabolic syndrome. An initial observation period of one week was used to acquire baseline clinical data followed by randomization to either placebo or high-concentration HRW (> 5.5 millimoles of H2 per day) for 24 weeks. RESULTS: Supplementation with high-concentration HRW significantly reduced blood cholesterol and glucose levels, attenuated serum hemoglobin A1c, and improved biomarkers of inflammation and redox homeostasis as compared to placebo (P < 0.05). Furthermore, H2 tended to promote a mild reduction in body mass index and waist-to-hip ratio. CONCLUSION: Our results give further credence that high-concentration HRW might have promising effects as a therapeutic modality for attenuating risk factors of metabolic syndrome.

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