Prevalence of dysphagia in a consecutive cohort of subjects with MS using fibre-optic endoscopy.

INTRODUCTION: Multiple sclerosis (MS) refers to chronic inflammation of the central nervous system including the brain and spinal cord. Dysphagia is a symptom that represents challenges in clinical practice. The aim of the present study was to evaluate the prevalence of dysphagia in an Italian cohort of subjects with MS using the Dysphagia Outcome Severity Score (DOSS), based on fibre-optic endoscopy, and determine factors that correlate with the presence of swallowing problems. MATHERIALS AND METHODS: Data were collected in a multicentre study from a consecutive sample of MS patients, irrespective of self-reported dysphagia. The study included 215 subjects. Possible scores for DOSS range from 7 to 1, with 7 indicating normal swallowing. RESULTS: One hundred twenty-four (57.7%) subjects demonstrated abnormal swallowing and 57 (26.5%) of these had swallowing problems that required nutrition/diet modifications when evaluated objectively with fibre-optic endoscopy. Subjects with dysphagia were more severely disabled and more often had a progressive form of MS, compared to MS subjects with normal swallowing. In subjects with EDSS, < 4, 8 (13.3%), had a DOSS < 4. Seventy-five percent of subjects older than 60 years of age had dysphagia. CONCLUSION: In this sample of MS patients, more nearly 60% showed swallowing problems.

Facilitators and barriers to adaptive implementation of the Meeting Centers Support Program (MCSP) in three European countries; the process evaluation within the MEETINGDEM study.

ABSTRACTBackground:In the MEETINGDEM project, the Meeting Centers Support Program (MCSP) was adaptively implemented and evaluated in three European countries: Italy, Poland, and the United Kingdom. The aim of this study was to investigate overall and country-specific facilitators and barriers to the implementation of MCSP in these European countries. METHODS: A qualitative multiple case study design was used. Based on the theoretical model of adaptive implementation, a checklist was composed of potential facilitators and barriers to the implementation of MCSP. This checklist was administered among stakeholders involved in the implementation of MCSP to trace the experienced facilitators and barriers. Twenty-eight checklists were completed. RESULTS: Main similarities between countries were related to the presence of suitable staff, management, and a project manager, and the fact that the MCSP is attuned to needs and wishes of people with dementia and informal caregivers. Main differences between countries were related to: communication with potential referrers, setting up an inter-organizational collaboration network, receiving support of national organizations, having clear discharge criteria for the MCSP and continuous PR in the region. CONCLUSION: The results of this study provide insight into generic and country specific factors that can influence the implementation of MCSP in different European countries. This study informs further implementation and dissemination of MCSP in Europe and may also serve as an example for the dissemination and implementation of other effective psychosocial support interventions for people with dementia and their informal caregivers across and beyond Europe.

Not re-inventing the wheel: the adaptive implementation of the meeting centres support programme in four European countries.

OBJECTIVES: The implementation of new health services is a complex process. This study investigated the first phase of the adaptive implementation of the Dutch Meeting Centres Support Programme (MCSP) for people with dementia and their carers in three European countries (Italy, Poland, the UK) within the JPND-MEETINGDEM project. Anticipated and experienced factors influencing the implementation, and the efficacy of the implementation process, were investigated. Findings were compared with previous research in the Netherlands. METHOD: A qualitative multiple case study design was applied. Checklist on anticipated facilitators and barriers to the implementation and semi-structured interview were completed by stakeholders, respectively at the end and at the beginning of the preparation phase. RESULTS: Overall, few differences between countries were founded. Facilitators for all countries were: added value of MCSP matching needs of the target group, evidence of effectiveness of MCSP, enthusiasm of stakeholders. General barriers were: competition with existing care and welfare organizations and scarce funding. Some countries experienced improved collaborations, others had difficulties finding a socially integrated location for MCSP. The step-by-step implementation method proved efficacious. CONCLUSION: These insights into factors influencing the implementation of MCSP in three European countries and the efficacy of the step-by-step preparation may aid further implementation of MCSP in Europe.

Examining the validity of the multiple-sclerosis walking scale-12 with Rasch analysis: Results from an Italian study.

BACKGROUND: The Multiple Sclerosis Walking Scale (MSWS-12) has showed good psychometric properties in reports exploring its validity using Classical Test Theory methods. Findings from recent studies using Item Response Theory methods advance the idea that some aspects of the MSWS-12 does not fully comply with some requirements of sound measurement. RESEARCH QUESTION: The present study investigated whether the measurement properties of the Italian version of the MSWS-12 met the assumptions of the Rasch model. METHODS: Sample consisted of 199 patients with a diagnosis of MS (50% female; Mean age (SD) = 48.15 (12.33)). Analyses were performed using both unidimensional and multidimensional Rasch modeling techniques. RESULTS: Rating scale for items assessing need for support when walking, and ability to run, showed significant functioning problems. A revision of the rating scale improved the measurement properties of these items. Items assessing need for support showed signs of multidimensionality and differential item functioning when controlling for patients' disease course and EDSS score. Additionally, included items did not appear to cover the full range of impairment as observed in the sample. SIGNIFICANCE: Emerging findings are consistent with those from previous studies in highlighting the need for a revision of the current content of the MSWS-12, and the inclusion of new items assessing impairment at the lower end of the disability continuum.

Prevalence of Parkinson's disease in the Republic of San Marino.

A prevalence survey on Parkinson's disease (PD) was performed in the Republic of San Marino, which is the smallest independent state in the world, and is located near the Adriatic coast, within Italy. On April 30, 1986, it had a population of 22,322. We found 34 cases of PD (17 men, 17 women). Crude prevalence ratio per 100,000 population was 152 (154 for men, 150 for women) with an age-adjusted ratio of 185 (both sexes). This study shows that the prevalence of PD in the Mediterranean area of South Europe is similar to that in North Europe and the United States.

Properties of the racemic species of verapamil hydrochloride and gallopamil hydrochloride.

It is well known that the stereoselective actions associated with the enantiomeric constituents of a racemic drug can differ markedly in their pharmacodynamic or pharmacokinetic properties. Nevertheless, molecular chirality manifests itself in the solid, that is, crystalline state. The aim of this work was to characterize the solid-state properties of verapamil HCl and gallopamil HCl, two well-known chiral calcium channel antagonists. The characterization of the solid state for the single enantiomers and equimolecular mixtures for both the calcium antagonists was performed by solid-state techniques such as Fourier transform infrared (FT-IR spectroscopy), X-ray powder diffractometry (XRD) and differential scanning calorimetry (DSC). The FT-IR spectra and XRD of the single enantiomers are different from those of the corresponding equimolecular mixture owing to their different crystalline structure. The thermal behavior of the racemates and pure enantiomers were examined by DSC, and the resultant experimental and theoretical binary phase diagrams are discussed. Spectroscopic solid-state techniques, such as FT-IR and XRD, are useful in combination with thermal analysis for characterizing the racemic species of chiral drugs. The data obtained prove that the equimolecular mixtures of both verapmil hydrochloride and gallopamil hydrochloride exist as racemic compounds. Determination of the enantiomeric purity of the enantiomers and racemic compounds of both the calcium antagonists analyzed was performed by DSC.

Solid-state study of polymorphic drugs: carbamazepine.

Polymorphs of a compound have solid crystalline phases with different internal crystal lattices; in pharmaceuticals, differences due to polymorphism and pseudopolymorphism can affect bioavailability and effective clinical use. The aim of this work was to obtain the different polymorphic modifications of the anticonvulsant drug, carbamazepine, and to characterise them by means of typical structure-sensitive analytical techniques, such as FT-IR spectroscopy, XRPD and DSC. Further investigations were also performed by Hot Stage FT-IR thermomicroscopy, which permitted the visible and spectroscopic characterisation of the polymorphic forms during heating. Our results confirm the existence of three different polymorphic forms for anhydrous carbamazepine: Form III, the commercial one, Form I, obtained by heating Form III and Form II, crystallised from ethanolic solution. Substantial differences were detected among the polymorphs with regard to solid-state properties. Moreover, Hot Stage FT-IR thermomicroscopy proved its analytical potential to characterise the drug's polymorphism.

Effects of alpha- and beta-cyclodextrin complexation on the physico-chemical properties and antioxidant activity of some 3-hydroxyflavones.

Inclusion complexes of some flavonols (3-hydroxyflavone, morin and quercetin) have been obtained with alpha- and beta-cyclodextrins, by the co-evaporation method. Different analytical techniques (DSC, XRPD, FT-IR, 1H-NMR, UV-Vis) have been employed for a throughout investigation of the structural characteristics of such supramolecular aggregates, which exhibited distinct spectroscopic features and properties from both "guest" and "host" molecules. The stoichiometric ratios and stability constants describing the extent of formation of the complexes have been determined by phase-solubility studies; in all cases type-AL diagrams have been obtained (soluble 1:1 complexes). The effect of molecular encapsulation on the flavonols antioxidant activity has been afterwards evaluated, by means of different biological assays (Bathophenanthroline test; Comet assay; Lipid peroxidation). Complexation with cyclodextrins further improved the antioxidant activity, increasing drugs solubility in the biological moiety.

Determination of azelaic acid in pharmaceuticals and cosmetics by RP-HPLC after pre-column derivatization.

This paper reports a RP-HPLC method for the determination in topics of azelaic acid, a keratolytic and anti-comedogenic agent widely used in the treatment of all types of acne. A derivatization step was needed prior to chromatographic analysis because the analyte is lacking in chromophore. A sample clean-up procedure by solid-phase extraction was also developed to analyse azelaic acid in complex matrices, such as pharmaceutical and cosmetic formulations.

S-aryl (tetramethyl) isothiouronium salts as possible antimicrobial agents, IV.

The 1-octanol/water partition coefficients of a series of antimicrobial S-aryl(tetramethyl)isothiouronium salts, were determined. The concentration of the solute in the two phases was measured by means of HPLC. The values of the hydrophobic parameters thus obtained were correlated to the corresponding capacity factors (log Kw) and compared with those expected on the basis of additive-constitutive principles. The deviations were interpreted quantitatively on the basis of electronic interactions of the substituents in the benzene ring. Equations correlating structural features and antimicrobial activity of some studied compounds by means of molecular parameters were formulated.

Subtotal and total femoral resection: an alternative to total femoral prosthetic replacement.

Two cases of chondrosarcoma involving the proximal femur and the soft tissues are reported. Both patients underwent subtotal femoral resection and quadriceps excision followed by reconstruction with a special prosthesis and arthrodesis of the knee. The tibial stem of the prosthesis was fixed with cement. The advantages of this method are discussed and compared with the use of total femoral prostheses.

New combined treatment of hypermelanosis: analytical studies on efficacy and stability improvement.

The aim of this work was to evaluate the synergy between different lightening agents when associated; depigmenting activity was tested in vitro by monitoring the appearance of dopachrome, an intermediate in the melanogenesis process. The results obtained were compared with the depigmenting activity of each single compound, keeping the same global concentration of inhibitor. Our studies showed that the combination of hydroquinone and kojic acid had a synergistic effect, and that the maximum inhibiting action was achieved with an equimolecular mixture. This result could serve in the cosmetics field to prepare skin-lightening formulations that are less irritant. We also investigated the feasibility of complexing hydroquinone with cyclodextrin and evaluated the effectiveness of the complex obtained in the treatment of hyperpigmentation.

Heteroarylalkanoic acids with possible antiinflammatoric activities. Part 6: 3-(4H-1,2,4-benzothiadiazine-1,1-dioxide-3-yl-thio)-propanoic acid derivatives.

A series of 3-(4H-1,2,4-benzothiadiazine-1,1-dioxide-3-yl-thio)-propanoic acids was synthesized in order to study their possible antiinflammatory in comparison with the corresponding lower homologues and isosters previously studied. Most of the compounds proved effective against carrageenan-induced plantar oedema. The possible influence of some chemico-physical parameters on the occurrence of this biological activity was investigated.

Corrective osteotomy for the treatment of genu procurvatun. Surgery.

The authors present the method known as proximal tibial osteotomy for the treatment of genu procurvatum. The importance of an accurate preoperative study, particularly aimed at avoiding negative repercussions on the position of the patella, and of a correct anatomical exposure with isolation of the peroneal nerve for any iatrogenic lesions, must be emphasized; a condylic plate was used to stabilize osteotomy was stabilized, adapting well to the anatomy of the region, and allowing us to obtain correction of any associated deformities on the frontal plane.

Resection of the vertebral arch in the treatment of neoplasms of the spine.

The authors describe the surgical technique of en bloc resection of musculoskeletal neoplasms that originate and invade the posterior arch of the thoracolumbar spine. Surgery is indicated for the treatment of aggressive benign tumors (Enneking stage 3) and malignant tumors. For surgical margins to be adequate, both pedicles must be free of the tumor.

Lateral retrovascular approach to the upper cervical spine.

The authors describe the surgical anatomy of lateral approach to the upper cervical spine. The approach is retrovascular retropharyngeal extraoral allowing for anterolateral exposure of the upper cervical column, and it may be enlarged posteriorly on the homolateral posterior hemiarch of C1 and C2, and/or inferiorly on the lower cervical column. Absolute indications to this approach are anterolateral fusion with transarticular screws C1-C2 and excision of skeletal neoplasms adjacent to the vertebral artery. For other indications such as the treatment of anterior neoplasms and spinal cord decompression it is preferable to use pre-vascular extraoral approach or transoral approach.

Lumbar vertebrectomy for the treatment of bone tumors: surgical technique.

The authors describe lumbar vertebral resection for the treatment of bone tumors by double approach (posterior longitudinal with the patient in prone position, and retroperitoneal lobotomy in lateral position), usually performed in one-stage surgery. The indication includes aggressive benign tumors (e.g., stage 3 giant cell tumor, osteoblastoma) and low-grade malignant tumors (e.g., chordoma, chondrosarcoma). In these cases an oncologically adequate surgical margin may be obtained, provided that the neoplasm is entirely or largely intracompartmental and at least one of the vertebral pedicles is uninvolved. The different stages of surgery and anesthesia-related problems are described, and possible complications are discussed.

Surgical technique: dorsal vertebral hemiresection for bone tumors.

The authors describe the technique of sagittal vertebral hemiresection used for the treatment of tumors of the thoracic spine involving one or more hemivertebrae. This type of treatment is not frequently indicated because of the rare asymmetrical distribution of vertebral tumors.

Use of the trans-abdominal rectus abdominis flap in sacrum surgery.

The authors describe the method used to reconstruct the posterior wall of the pelvis using a flap taken from the rectus abdominis muscle after resection of the sacrum to treat neoplasm.