The effects of safinamide according to gender in Chinese parkinsonian patients.

The incidence and prevalence of Parkinson's disease (PD) is expected to raise dramatically over the next decades. Gender-related differences are not yet widely recognized, particularly regarding the response to dopaminergic medications. To analyse gender differences in the clinical effects of safinamide, compared to placebo, in Chinese PD patients of the pivotal XINDI trial. The XINDI study was a phase III, randomized, double-blind, placebo-controlled, multicenter trial. Patients were followed for 16 weeks receiving safinamide or placebo as add-on to levodopa. The primary efficacy endpoint was the change in the mean total daily OFF time. Secondary efficacy endpoints included total daily ON time, ON time with no/non-troublesome dyskinesia, Unified Parkinson's Disease Rating Scale and Parkinson's Disease Questionnaire-39 items. A post-hoc analysis was performed to describe the efficacy of safinamide in both genders on motor symptoms, motor fluctuations and quality of life. 128 (42%) out of 305 patients enrolled were women and 177 (58%) men. Our additional analyses of the XINDI study have shown that safinamide, compared to placebo, was associated with improvements in motor symptoms, motor fluctuations and quality of life in both genders, with some differences in the response that did not reach statistical significance, possibly due to sample size limitation and post-hoc design of the study. The changes from baseline at week 16 were > 50% higher in the females compared to males for the total daily OFF time (- 1.149 h vs - 0.764 h in males), the total daily ON time (1.283 h vs 0.441 h in males), the UPDRS total score (- 8.300 points vs - 5.253 points in males) and the UPDRS part II score (- 2.574 points vs - 1.016 points in males). The changes from baseline at week 16 were higher in the females compared to males in the "ADL" domain (- 6.965 points vs - 5.772 points in males), the "Emotional well-being" domain (- 6.243 points vs - 4.203 in males), the "Stigma" domain (- 6.185 points vs - 4.913 points in males) and the "Bodily discomfort" domain (- 5.196 points vs 1.099 points in males), while were higher in males in the "Mobility" score (- 6.523 points vs - 4.961 points in females) and the "Communication" score (- 3.863 points vs - 1.564 points in females). Safinamide was shown to improve PD symptoms and quality of life in both male and female Chinese patients. Possible differences in the response between genders need to be further studied in larger and different ethnic populations.

[Nosocomial infections: secular trends of a control program in Mexico]. / Infecciones nosocomiales: tendencias seculares de un programa de control en México.

OBJECTIVE: To know the trend of nosocomial infections rates at a third level hospital since the beginning of the infection control program until the present and to evaluate the impact in mortality and length of hospital stay. MATERIAL AND METHODS: A study descriptive, retrospective and retrolective was done in a reference hospital providing tertiary care in Mexico City. Recorded data included rates, type of nosocomial infections and distribution of nosocomial infections from the database of Hospital Epidemiology Division between 1991 to 1996. In every patient the degree of severity disease was evaluated according to the McCabe-Jackson's scale, we also collected age and the length of stay. Statistical analysis was done with chi 2 test for tendencies of different evaluated parameters. This study was divided in three periods: before remodel (1991-1993), to remodel (1994-1995) and after remodel (1996). Compared the before remodel period against after remodel period. RESULTS: In the study period, mean nosocomial infections ratio was of 8.6 by 100 discharges, showing a decrease of 20% (p < 0.01). Hospital area with the highest infections rate was ICU (26.9 by 100 discharge), followed by general ward of hospitalization with shared rooms (9.47) and private rooms (7.5). Urinary tract infections was the most frequent (26.6%), followed by surgical wound infection (24.4%), pneumonia (12.1%) and primary bacteremia (9.5%). Rates of urinary tract infections and primary bacteremias had decreased significantly (p < 0.05 and p < 0.00001 respectively), while surgical wound infections and pneumonias increased (p < 0.005 and p < 0.00001 respectively). Associated mortality diminished in 36% (p < 0.00001). The length of stay diminished 42.8%. There was not differences in the severity of disease along this period. CONCLUSIONS: Since the establishment of the nosocomial infections surveillance and control program at the INNSZ on 1985, nosocomial infections rate (56%) and the associated mortality (36%) have diminished. These changes are consequence of the establishment of a nosocomial infections control program and the decrease of length of stay and does not seems to be related to the age or to the severity of the disease of the hospitalized patients.

Salmonella gastroenteritis outbreak among workers from a tertiary care hospital in Mexico City.

OBJECTIVE: To describe an outbreak of Salmonella gastroenteritis among employees of the National Institute of Nutrition (INNSZ) of Mexico City during July, 1994. METHODS: Employees who developed diarrhea or fever associated with gastrointestinal symptoms starting on July 14th were included for study as well as 50 healthy controls. A questionnaire was applied to all, and they also provided a stool sample, along with other 80 asymptomatic people (included the kitchen workers) in whom only stool culture was done. RESULTS: Ninety-seven employees that ate regularly at the Hospital's cafeteria were affected by the outbreak, and 67 of them (69%) could be evaluated. Most of them were nurses (34%), and handymen (27%). Most common symptoms were abdominal pain (97%), diarrhea (95%), nausea (91%), and fever (89%). Cultures from suspicious food items were all negative, but stool cultures from 10/70 cases were positive for Salmonella enteritidis vs. 0/133 in the controls. The ten S. enteritidis isolates resulted identical either by serotyping and by rapid amplified polymorphic DNA (RAPD) analysis. Cultures from all kitchen employees were negative for S. enteritidis. Breakfast meal on July 14th was associated with the development of gastroenteritis (61/67 cases vs 26/50 controls, p < 0.001), and particularly with an egg-covered meat plate (61/62 vs 13/26 controls, p < 0.0001). CONCLUSIONS: This outbreak was probably caused by eggs contaminated with Salmonella, since no one of the kitchen personnel was found to be an asymptomatic carrier, and the implicated recipe allows for inappropriate cooking. Recommendations to improve cooking procedures must be added to the usual regulations to diminish the frequency of foodborne disease outbreaks in hospitals.

Quistes de giardia en aguas negras / Giardia cysts in raw sewage

El estudio de las aguas negras ha sido propuesto para conocer el estatus de infección de una comunidad y para indicar la presencia y variación estacional de los agentes infecciosos. Esta investigación fue llevada a cabo para evaluar un método para determinar la concentración de quistes de Giardia en aguas negras. En una primera etapa se realizó la prueba de eficiencia de recuperación de quistes siguiendo el método de floculación con carbonato de calcio descrito por Vesey y Cols., 1993, a partir de muestras estériles de aguas negras y agua destilada sembradas con una concentración conocida de quistes. En una etapa siguiente fueron analizadas muestras de aguas negras. Los quistes de Giardia fueron cuantificados con un hemocitómetro luego de la concentración de estos en solución de sacarosa (gravedad específica 1,15) o mediante centrifugación simple. La eficiencia de recuperación osciló entre 66 por ciento y 75 por ciento para las muestras de aguas negras y agua destilada respectivamente. Las recuperaciones mayores (87 por ciento) fueron obtenidas cuando se omitió el paso de clarificación. Las concentraciones de quistes de Giardia estuvieron entre 2 por diez elevado a la tres y 3.7 por diez elevado a la cuatro quistes/ml