Impulse control disorders in Parkinson's disease patients treated with pramipexole and ropinirole: a systematic review and meta-analysis.

BACKGROUND: This analysis is the first systematic review and meta-analysis assessing occurrences of ICD in PD patients treated with oral DAs: ropinirole (ROP) and pramipexole (PRX). This study compares the two oral DAs to a transdermal patch, rotigotine (RTG). METHODS: We performed an extensive systematic search for eligible studies from PubMed, Embase, Cochrane Library, and Google Scholar. The data was analyzed by various software, including EndNote, Rayyan, PRISM, and RevMan. Two studies incorporating 658 patients collectively were assessed. RESULTS: This meta-analysis shows a significant correlation between the usage of PRX (25.3%) or ROP (21.8%) and the development of ICD in PD patients. Compared to the transdermal patch, RTG, PRX was found to have a significant relative risk (P < 0.0001) of 3.46 (95% CI 2.07-5.76), and ROP was found to have a significant relative risk (P < 0.0001) of 2.98 (95% CI 1.77-5.02). The data collected shows RTG is approximately three times less likely to cause ICDs than oral PRX and ROP. CONCLUSION: The present investigation provides insight into ICD occurrences with PRX, ROP, and RTG to allow physicians to make more informed decisions on risk versus reward when deciding how to treat a PD patient with these drugs. However, related to various disclosed limitations, our conclusion cannot provide definitive practice protocols.

Unusual Origin of the Posterior Circumflex Humeral Artery: A Case Report.

Prior knowledge of possible variations in human anatomy is essential for basic medical and clinical training. Many surgeons can avoid uncharacteristic situations by having sources and availability of resources that document potential irregularities in human anatomy. In this case, a human cadaver is identified as having an altered origin of the posterior circumflex humeral artery (PCHA). While it usually stems from the axillary artery, this cadaver had a left-sided PCHA originating from the subscapular artery (SSA) and continuing into the quadrangular space. This irregularity of the PCHA from the SSA is not commonly discussed in the literature. Physicians and anatomists need to be fully aware of this possibility and be prepared for any unexpected differences in anatomy during procedures.