Assessment of therapeutic strategies for management of impulse control disorder in Parkinson's disease.

BACKGROUND: Impulse control disorders (ICD) occur frequently in individuals with Parkinson's disease. So far, prevention is the best treatment. Several strategies for its treatment have been suggested, but their frequency of use and benefit have scarcely been explored. OBJECTIVE: To investigate which strategy is the most commonly used in a real-life setting and its rate of response. METHODS: A longitudinal study was conducted. At the baseline evaluation, data on current treatment and ICD status according to QUIP-RS were collected. The treatment strategies were categorized as "no-change", dopamine agonist (DA) dose lowering, DA removal, DA switch or add-on therapy. At the six-month follow-up visit, the same tools were applied. RESULTS: A total of 132 individuals (58.3% men) were included; 18.2% had at least one ICD at baseline. The therapeutic strategy most used in the ICD group was no-change (37.5%), followed by DA removal (16.7%), DA switch (12.5%) and DA lowering (8.3%). Unexpectedly, in 20.8% of the ICD subjects the DA dose was increased. Overall, nearly 80% of the subjects showed remission of their ICD at follow-up. CONCLUSIONS: Regardless of the therapy used, most of the subjects presented remission of their ICD at follow-up Further research with a longer follow-up in a larger sample, with assessment of decision-making processes, is required in order to better understand the efficacy of strategies for ICD treatment.

Assessment of therapeutic strategies for management of impulse control disorder in Parkinson's disease / Evaluación de las estrategias terapéuticas en trastornos del control de impulsos en enfermedad de Parkinson

ABSTRACT Background: Impulse control disorders (ICD) occur frequently in individuals with Parkinson's disease. So far, prevention is the best treatment. Several strategies for its treatment have been suggested, but their frequency of use and benefit have scarcely been explored. Objective: To investigate which strategy is the most commonly used in a real-life setting and its rate of response. Methods: A longitudinal study was conducted. At the baseline evaluation, data on current treatment and ICD status according to QUIP-RS were collected. The treatment strategies were categorized as "no-change", dopamine agonist (DA) dose lowering, DA removal, DA switch or add-on therapy. At the six-month follow-up visit, the same tools were applied. Results: A total of 132 individuals (58.3% men) were included; 18.2% had at least one ICD at baseline. The therapeutic strategy most used in the ICD group was no-change (37.5%), followed by DA removal (16.7%), DA switch (12.5%) and DA lowering (8.3%). Unexpectedly, in 20.8% of the ICD subjects the DA dose was increased. Overall, nearly 80% of the subjects showed remission of their ICD at follow-up. Conclusions: Regardless of the therapy used, most of the subjects presented remission of their ICD at follow-up Further research with a longer follow-up in a larger sample, with assessment of decision-making processes, is required in order to better understand the efficacy of strategies for ICD treatment.

Resumen Antecedentes: Los trastornos del control de impulsos (TCI) son frecuentes en personas con enfermedad de Parkinson. A la fecha, la prevención es el mejor tratamiento. Existen varias estrategias sugeridas para su tratamiento, pero su frecuencia de uso y beneficio ha sido escasamente explorada. Objetivo: Investigar qué estrategia es la más utilizada en un entorno de la vida real y su tasa de respuesta. Métodos: Se realizó un estudio longitudinal. En la evaluación inicial, se recopiló el tratamiento actual y el estado del TCI de acuerdo con el QUIP-RS. La estrategia de tratamiento se clasificó como "sin cambios", reducción de la dosis de agonista de la dopamina (AD), eliminación de AD, cambio de AD o terapia complementaria. En la visita de seguimiento a los 6 meses, se aplicaron las mismas herramientas. Resultados: Se incluyeron un total de 132 (58.3% hombres) personas. El 18.2% tenía al menos un TCI al inicio del estudio. La estrategia terapéutica más utilizada en el grupo de TCI fue sin cambios (37.5%), seguida de eliminación de DA (16.7%), cambio de AD (12.5%) y reducción de DA (8.3%). En el 20.8% de los sujetos con TCI se aumentó la dosis de AD. Casi el 80% de los sujetos tuvieron una remisión del TCI al seguimiento. Conclusiones: Independientemente de la terapia utilizada, la mayoría de los sujetos tuvieron una remisión del TCI. Se requiere más investigación con un seguimiento y una muestra mayor para evaluar l proceso de toma de decisiones para comprender mejor la eficacia de las estrategias.

Short communication: Characterization of methicillin-resistant Staphylococcus aureus isolated from raw milk fresh cheese in Colombia.

The aim of this study was the characterization of a collection of 8 methicillin-resistant Staphylococcus aureus (MRSA) isolates, obtained from samples of fresh cheese (Doble Crema) produced from raw cow milk in small dairies in Colombia. All the isolates harbored the mecA and Panton-Valentine leukocidin (PVL) genes, presented with SCCmec type IV, and belonged to multilocus sequence type 8 and spa type 024. Seven isolates presented 3 closely related pulsed-field gel electrophoresis profiles. Three of them carried the staphylococcal enterotoxin B gene. The isolates were resistant to cefoxitin, oxacillin, penicillin, and ampicillin and susceptible to all non-ß-lactams antibiotics tested, with minimum inhibitory concentration values for oxacillin of 4 to 8mg/L. The isolates belonged to the community-acquired MRSA group, suggesting a human source of contamination. The risk of human infection by MRSA via contaminated foods is considered low, but contaminated food commodities can contribute to the worldwide dissemination of clones of community-acquired MRSA.

Occurrence of Plesiomonas shigelloides in displayed portions of saltwater fish determined by a PCR assay based on the hugA gene.

PCR primers were designed and used to amplify a 435-bp fragment from the Plesiomonas shigelloides hugA gene. The PCR assay combined with a non-selective enrichment step proved to be a reliable procedure for P. shigelloides detection in fish meat. The incidence of this bacterium was investigated in 52 lots of pre-packed saltwater fish portions (conger, swordfish, sole, grouper, whiting and halibut) displayed at two hypermarkets by a conventional two-step procedure and the PCR assay. Using the former, P. shigelloides was isolated from three lots of grouper fillets and one lot of halibut fillets. When PCR was performed with non-selective enriched cultures of fish portions, amplification products were obtained from samples that were positive by the culturing method and from eight additional lots of grouper fillets that gave negative results with the conventional procedure. After a secondary enrichment in tetrathionate broth without iodine, all PCR-positive non-selective enrichments yielded P. shigelloides colonies. Overall, P. shigelloides was found in 23% of the examined lots of marine fish (11 of grouper and one of halibut).

Incidencia de esquizofrenia en el hospital psiquiátrico Julio Endara, 1995 / Incidence of schizophrenia in the psychiatric Hospital Julio Endara, 1995

Se realizó un estudio retrospectivo analizando las historias clínicas de 60 pacientes con diagnóstico de esquizofrenia hospitalizados en el año de 1995, tomando en cuenta la edad, sexo, primera hospitalización, sintomatología y tipo de tratamiento. Los resultados demostraron que hay mayor frecuencia de varones ingresados (63.3xciento), con edad promedio de 32,38 años. La edad promedio de los primeros contactos hospitalarios tanto en hombres como en mujeres fueron similares (28.6a vs. 28.2a), con un rango de 16 a 58 años. La sintomatología más frecuente fueron los delirios autorreferenciales y persecutorios (13.1xciento), luego de los de contenido místico (8.8xciento). Entre los síntomas sensoperceptivos se encuentra en primer lugar las alucinaciones auditivas (15xciento). El tratamiento farmacológico de primera elección y de mejor alcance económico para nuestro hospital fue el haloperidol (34.2xciento). El decaonato de flufenazina como antipsicótico de depósito se lo utiliza por tener mayor comodidad para el paciente y el psiquiatra.

Incidencia de esquizofrenia y sus tratamientos en el Hospital Psiquiátrico Julio Endara en 1995

Se realizó un estudio clínico retrospectivo analizando las historias clínicas de 60 pacientes con diagnóstico de esquizofrenia, hospitalizados en el año 1995, tomando en cuenta la edad, sexo, primera hospitalización, sintomatología y tipo de tratamiento. Los resultados demostraron que hay mayor frecuencia de varones ingresados (63.3 por ciento) con una edad promedio de 32.38 años. La edad promedio de los primeros contactos hospitalarios tanto en hombres como en mujeres fueron similares (28.6 años vs. 28.2 años), con un rango de 16 a 58 años. La sintomatología más frecuente fueron los delirios autorreferenciales y persecutorios (13.1 por ciento) luego de los de contenido místico (8.8 por ciento). Entre los síntomas sensoperceptivos se enccuentra en primer lugar las alucinaciones auditivas (15 por ciento). El tratamiento farmacológico de primera elección por el diagnóstico y por su mejor alcance económico para nuestro hospital fue el haloperidol (34.2 por ciento). El decanoato de flufenazina como antipsicótico de depósito se lo utiliza por ser de mayor comodidad para el paciente y el psiquiatra.