Relationship between urodynamic findings and sexual function in multiple sclerosis patients with lower urinary tract dysfunction.

BACKGROUND AND PURPOSE: Sexual dysfunction (SD) is prevalent in multiple sclerosis (MS) patients and affects quality of life. Furthermore, lower urinary tract dysfunction (LUTD) is common in MS patients. Our aim was to determine the relationship between urodynamic findings and SD in a cohort of MS patients with LUTD. METHODS: From January 2011 to September 2013, 135 consecutive patients with MS in remission phase and LUTD underwent a first urodynamic examination, according to the International Continence Society criteria. Neurological impairment was assessed using the Expanded Disability Status Scale and SD was investigated with the Female Sexual Function Index (FSFI) or the International Index of Erectile Function (IIEF-15). Multivariate logistic regression analysis was performed to identify predictors of female SD (FSFI < 26.55) or moderate-severe erectile dysfunction (ED) (IIEF-EF ≤ 16), after adjusting for confounding factors including urodynamic findings. RESULTS: Subjects with maximum detrusor pressure during involuntary detrusor contraction (PdetmaxIDC) ≥20.0 cmH2 O had lower IIEF-EF, IIEF overall satisfaction (IIEF-OS), FSFI-Arousal, FSFI-Lubrication and FSFI-Orgasm. Subjects with maximum cystometric capacity (MCC) ≥135 ml had higher IIEF-EF, intercourse satisfaction (IIEF-IS), orgasmic function (IIEF-OF), sexual desire (IIEF-SD), FSFI-Arousal, FSFI-Lubrication, FSFI-Orgasm, FSFI-Satisfaction and FSFI-Pain. On multivariate logistic regression analysis, PdetmaxIDC ≥20 cmH2 O [odds ratio (OR) 6.7; P < 0.05] and MCC <135 ml (OR 6.80; P < 0.05) were predictors of moderate-severe ED. In a model including all previous variables, compliance ≤3 ml/cmH2 O was an independent predictor of moderate-severe ED (OR 14.49; P < 0.01). No relationship was found between the previous variables and FSFI <26.55. CONCLUSIONS: Neurogenic bladder is associated with SD in MS patients. The presence of PdetmaxIDC ≥20 cmH2 O, MCC <135 ml and compliance ≤3 ml/cmH2 O may significantly predict the presence of moderate-severe ED.

Former food products safety: microbiological quality and computer vision evaluation of packaging remnants contamination.

The use of alternative feed ingredients in farm animal's diets can be an interesting choice from several standpoints, including safety. In this respect, this study investigated the safety features of selected former food products (FFPs) intended for animal nutrition produced in the framework of the IZS PLV 06/14 RC project by an FFP processing plant. Six FFP samples, both mash and pelleted, were analysed for the enumeration of total viable count (TVC) (ISO 4833), Enterobacteriaceae (ISO 21528-1), Escherichia coli (ISO 16649-1), coagulase-positive Staphylococci (CPS) (ISO 6888), presumptive Bacillus cereus and its spores (ISO 7932), sulphite-reducing Clostridia (ISO 7937), yeasts and moulds (ISO 21527-1), and the presence in 25 g of Salmonella spp. (ISO 6579). On the same samples, the presence of undesired ingredients, which can be identified as remnants of packaging materials, was evaluated by two different methods: stereomicroscopy according to published methods; and stereomicroscopy coupled with a computer vision system (IRIS Visual Analyzer VA400). All FFPs analysed were safe from a microbiological point of view. TVC was limited and Salmonella was always absent. When remnants of packaging materials were considered, the contamination level was below 0.08% (w/w). Of note, packaging remnants were found mainly from the 1-mm sieve mesh fractions. Finally, the innovative computer vision system demonstrated the possibility of rapid detection for the presence of packaging remnants in FFPs when combined with a stereomicroscope. In conclusion, the FFPs analysed in the present study can be considered safe, even though some improvements in FFP processing in the feeding plant can be useful in further reducing their microbial loads and impurity.

Association between burnout and anger in oncology versus ophthalmology health care professionals.

The prevalence of burnout in oncology staff was compared with that of the ophthalmology staff, who normally present a low prevalence of burnout as described in this literature. The correlation of burnout with the emotion of anger was also investigated. Thirty-six subjects working in an oncology department and 32 working in an ophthalmology department were examined using the Maslach Burnout Inventory and the State-Trait Anger Expression Inventory. The oncology group showed higher mean scores on the MBI Emotive Exhaustion and Depersonalization scales with respect to ophthalmology staff. Correlation analysis showed that increasing burnout was associated with higher anger expressed towards the environment and loss of anger control. Anger, as a response to frustration, appears to be a feature constantly associated with the clinical expression of burnout and it should not be underestimated in theoretical and preventive contexts.

Parkinson disease survival: a population-based study.

OBJECTIVE: To evaluate whether the survival of patients with Parkinson disease (PD) is shorter than that of the general population. DESIGN: Survival was investigated in a cohort of patients with PD previously identified during a population-based prevalence study (prevalence day, November 1, 1987, reference follow-up date, October 31, 1995). The survival of patients with PD was compared with that of a control sample randomly selected from the same population (2 controls for each case, matched for age, sex, and study municipality). The causes of death in the 2 groups were also compared. Both univariate and multivariate survival analyses were performed to investigate the association with disease-related variables. SETTING: A door-to-door 2-phase prevalence survey performed in 3 Sicilian municipalities. PATIENTS: Fifty-nine patients with PD and 118 controls. RESULTS: Patients with PD showed a high risk of death (relative risk, 2.3; 95% confidence interval, 1.60-3.39). Greater age at November 1, 1987, high Hoehn-Yahr score, and lack of levodopa therapy were associated with a lower survival on univariate analysis. Multivariate analysis confirmed the association between shorter survival among patients with PD and greater age on November 1, 1987. One-way analysis of variance indicated a different effect of levodopa therapy according to age. Multivariate analysis did not confirm this finding. Pneumonia was the cause of death most frequently associated with PD. CONCLUSION: This study indicates that patients with PD have a shorter survival time than the general population.

Prevalence of Parkinson's disease and other types of parkinsonism: a door-to-door survey in three Sicilian municipalities. The Sicilian Neuro-Epidemiologic Study (SNES) Group.

We investigated the prevalence of Parkinson's disease and other types of parkinsonism in a Sicilian population using a door-to-door two-phase approach. This design called for the administration of a brief screening instrument to all subjects who, on November 1, 1987, were residents of Terrasini (Palermo Province), Santa Teresa di Riva (Messina Province), and Riposto (Catania Province), Sicily (N = 24,496). Study neurologists using specified diagnostic criteria extensively investigated those subjects who screened positive. We found 63 subjects affected by Parkinson's disease, 21 with secondary parkinsonism, and seven with unspecified parkinsonism. The crude prevalence per 100,000 population was 371.5 for all types of parkinsonism and 257.2 for Parkinson's disease; for both entities, prevalence increased steeply with age and showed an inconsistent sex pattern. Our prevalence figures for Parkinson's disease are higher than those previously reported in Italy or elsewhere, which may be due, in part, to more complete case-ascertainment.

Fahr's syndrome: local inflammatory factors in the pathogenesis of calcification.

Three cases of Fahr's syndrome are described. All patients had disturbances of calcium metabolism and had had a meningoencephalitis in childhood. It is suggested that gliovascular changes, induced by cerebral inflammation, can later facilitate the occurrence of calcification of the striopallidodentate system when abnormality of calcium metabolism develops.

Iron status in schizophrenic patients with acute neuroleptic-induced dystonic reactions.

1. Serum iron parameters were measured in a group of schizophrenic patients who had developed acute neuroleptic-induced dystonia (N = 17) and in control patients with no history of extrapyramidal disorders (N = 16). No differences were found between the two groups for iron, ferritin or transferrin levels. 2. Iron status was estimated in 44 schizophrenic patients starting treatment with high-potency neuroleptics before and after 3 weeks of medication. In the 6 patients developing dystonia serum iron levels as well as other iron parameters did not differ from the values observed in the remaining 38 patients either on admission or after neuroleptic treatment. In each group the haematological profile was not modified by neuroleptic medication. 3. These results do not support an association between low serum iron and the occurrence of neuroleptic-induced dystonic reactions.

Prevalence of acute dystonic reactions associated with neuroleptic treatment with and without anticholinergic prophylaxis.

The occurrence of acute dystonic reactions was intensively monitored in a population of 646 patients, 379 males and 267 females, aged 18-87 years, consecutively admitted to different psychiatric units and treated with neuroleptics alone or in combination with anticholinergic drugs. Thirty-four patients experienced acute dystonic reactions yielding a total incidence of 5.3%. There was a tendency towards a higher frequency of dystonia in males than in females, and in young patients than in older ones. Patients without anticholinergic medication had a higher frequency of the reaction than those receiving anticholinergic drugs (8.5% vs. 2.8%; p < 0.02). Neuroleptic-induced dystonia was more common in patients treated with butyrophenones than in those receiving phenothiazines or substituted benzamides.

Adjunctive fluoxetine in the treatment of negative symptoms in chronic schizophrenic patients.

The effect of adjunctive fluoxetine on negative schizophrenic symptoms was evaluated in 34 chronic schizophrenic in-patients on maintenance therapy with neuroleptics. They received randomly, on a double-blind basis, fluoxetine (20 mg/day) or placebo for 12 weeks. In the fluoxetine group, three patients dropped out because of side effects. Negative symptoms, as measured by change on the Scale for Assessment of Negative Symptoms at the end point compared to baseline values, were significantly improved in fluoxetine-treated patients (p < 0.001), but not in the placebo group. Fluoxetine treatment did not influence positive schizophrenic symptoms, while it induced a slight, but statistically significant, decrease (p < 0.05) in depressive symptoms, as measured by the Hamilton Rating Scale for Depression. Unwanted effects were more common among patients receiving fluoxetine. These data suggest that the addition of fluoxetine to neuroleptic treatment may be beneficial in some schizophrenic patients with negative symptoms.

Indole-3-pyruvic acid as a possible hypnotic agent in insomniac subjects.

In a single-blind study six male patients (mean age 39.5 years) with moderate insomnia were treated with placebo for three nights, 100 mg indole-3-pyruvic acid (IPA) for three nights, 200 mg IPA for three nights, 100 mg IPA for two nights and placebo for two nights. Polygraphic recordings were made and total sleep time, sleep efficiency, sleep latency, slow wave sleep latency, rapid eye movement (REM) sleep latency, number of arousals (greater than 1 min), percentage and duration of wakefulness after sleep onset, percentage and duration of wakefulness after sleep onset, percentage and duration of sleep stages 1, 2, 3, 4 and REM were recorded. At the end of 13 days, total sleep time, duration of stage 2 sleep and total non-REM were significantly increased when compared with baseline. Total sleep time and duration of stage 2 and total non-REM sleep on completion were significantly decreased when compared with after 200 mg IPA (night 9). Results suggest an action of IPA on human sleep similar to that of exogenous melatonin and L-tryptophan, thus confirming that IPA could be used to increase serotonin and melatonin turnover.

Voiding disorders in patients with cerebrovascular disease.

Eighty patients affected by ischemic cerebrovascular disease (ICVD) in stable conditions were studied: brain CT scan was performed in all patients to evaluate site/extension of brain injury, while urodynamic tests were employed in those patients who showed urinary bladder symptomatology (n = 30). Twenty-six complained of urgency and urge incontinence, only 4 patients showed urinary retention. Micturition abnormalities seem to occur mostly in patients with multiple infarcts and cerebral atrophy and particularly among those with bilateral lesions.

Neuroleptic malignant syndrome: description of two cases with prolonged clinical course.

Two cases of neuroleptic malignant syndrome presenting an unusual clinical course are reported. The first patient was untreated for the syndrome and recovered completely only after four months, while the other one was given dopaminergic and myorelaxing drugs only 10 days after the onset of the symptoms and died about six months later with an unmodified clinical picture. In both cases the treatment seemed to influence the clinical course, a delay or lack of drug intake worsening the prognosis.

Functional hyperthermia due to central dopaminergic impairment.

The clinical cases described are characterized by rigidity, mutism and hyperthermia, with cutaneous pallor and diaphoresis. This symptomatology marks the "malignant neuroleptic syndrome" and can be found, at times, in parkinsonians on "drug holiday". The cases described, which comprehend patients with both disorders, lead us to a single pathogenetic hypothesis: a central dopaminergic impairment. Hyperthermia, secondary to functional hypothalamic deficiency, is maintained by defective heat dispersion due to the lack of cutaneous vasodilation.

Parkinson-like side effects during prolonged treatment with flunarizine.

Forty-two elderly patients affected by a generic cerebrovascular disease developed a parkinsonian syndrome after prolonged treatment with flunarizine. Following flunarizine withdrawal the extrapyramidal symptomatology remitted slowly and progressively for 12 weeks, leading to the belief that the observed parkinsonian syndrome is directly linked to the chronic use of this compound. Similar side effects are not described in young populations, however. A periodic flunarizine discontinuation in chronically treated subjects aged 65 or more is suggested.

Involvement of mitochondrial dysfunction in the adverse effect exerted by seminal plasma from men with spinal cord injury on sperm motility.

The aetiology of severe asthenozoospermia in men with spinal cord injury includes an adverse impact of seminal plasma (SP) on sperm motility. In this study we investigated the effect exerted by SP from men with SCI on donor sperm mitochondrial activity and its reflection on motility. Donor spermatozoa were exposed (1 h) to SP from 22 ejaculates of men with SCI. Only SP from samples exhibiting both a low fructose level and an inhibitory effect on mitochondrial membrane potential (ΔΨm), assessed at flow cytometry with JC-1, affected donor sperm motility when evaluated 1 h after co-incubation. This effect was reverted by washing from SP and sperm re-suspension in medium containing glucose, in spite of persistently depressed ΔΨm. In the same samples, sperm motility and vitality dramatically decreased when evaluated 6 h after washing and re-suspension in the glucose-containing medium. Seminal plasmas which induced a disruption of ΔΨm, also enhanced a mitochondrial ROS generation, as assessed by MitoSOX red. The enhanced mitochondrial ROS generation was associated with a late induction of sperm membrane lipid peroxidation, as assessed by BODIPY C11 , when evaluated at 6 h, but not at 1 h, after washing from SP. Furthermore, activation of caspase-9 and caspase-3 accompanied the loss of ΔΨm. In conclusion, a double energetic blockage (glycolysis and mitochondrial respiration) can represent a metabolic determinant of the early adverse effect exerted by SP from men with SCI on sperm motility. Mitochondrial dysfunction-related oxidative/apoptotic mechanisms can account for later consequences on sperm motility/vitality.