Background and purpose
Action tremor may occur in patients with Parkinson's disease and cause misdiagnosis with other movement disorders such as essential tremor and dystonia. Data on the frequency ...of action tremor in Parkinson's disease and on the relationships with other motor and non‐motor signs are limited.
Methods
A cross‐sectional study of 237 patients with Parkinson's disease staging 1–2 on the Hoehn−Yahr scale was conducted. Data on action tremor and other motor and non‐motor signs were collected using the Unified Parkinson's Disease Rating Scale part III and the Non‐Motor Symptoms Scale.
Results
Action tremor was found in 46% of patients and was associated with both severity of rest tremor (adjusted odds ratio 3.0, P < 0.001) and severity of rigidity (adjusted odds ratio 1.5, P = 0.004). No association was found between action tremor and severity of bradykinesia (adjusted odds ratio 0.97, P = 0.4) or axial symptoms (adjusted odds ratio 0.9, P = 0.3). Moreover, patients who had action tremor reported a significant lower mean number of non‐motor symptoms than those who had not (2.1 ± 1.3 vs. 2.4 ± 1.3; P = 0.04).
Conclusions
Action tremor is a relatively frequent motor sign in patients with Parkinson's disease staging 1–2 on the Hoehn−Yahr scale. Action tremor correlates with rest tremor and rigidity and may be associated with a lower burden of non‐motor symptoms. These findings suggest a contribution of non‐dopaminergic mechanisms to action tremor pathophysiology.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
There is increasing evidence of hypertension and microalbuminuria in HIV-infected patients, and these are two important risk factors for renal and cardiovascular disease. Anti-hypertensive drugs ...inhibiting the renin-angiotensin system exert an antiproteinuric effect. Telmisartan, an angiotensin II receptor blocker and partial peroxisome proliferator-activated receptor gamma (PPAR gamma) agonist that is approved for the treatment of hypertension, appears to exert a nephroprotective effect independent of blood pressure reduction in the general population.
The aim of this preliminary study was to evaluate possible nephroprotective effects of telmisartan in hypertensive HIV-positive patients with microalbuminuria.
Caucasian male patients with HIV infection (n=13) receiving stable combined antiretroviral therapy (without therapeutic changes for > 12 months) and a recent diagnosis of grade 1 hypertension were treated with daily oral telmisartan 80 mg for 6 months. Patients had suppressed viremia and a CD4 cell count > 300 cells/mL for 6 months, and microalbuminuria > 5 mg/dL. Systolic and diastolic blood pressure (SBP, DBP), triglycerides, total cholesterol, HDL cholesterol and LDL cholesterol, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), microalbuminuria, Modification of Diet Renal Disease-Glomerular Filtration Rate (MDRD-GFR), vascular endothelial growth factor (VEGF) and endothelin-1 were measured at baseline and at one, three and six months. All statistical analyses were performed using SAS 9.2.
A significant reduction of microalbuminuria (p < 0.001) with stable MDRD-GFR was observed, although the main indices of renal function showed no substantial change. A significant reduction in mean SBP and DBP was observed at T1 and confirmed at T3 and T6 (SBP p < 0.001 and DBP p < 0.001), and there was BP normalization. Metabolic assessments showed an improvement in lipid parameters, and a significant decrease in insulin resistance assessed by the homeostasis model assessment index-insulin resistance (HOMA-IR) (p = 0.04). In addition, there was a statistically significant reduction in ESR (p = 0.02) and a non significant reduction in CRP. Other results included a significant reduction in serum VEGF and endothelin-1 levels (p < 0.001).
From these preliminary findings, telmisartan has demonstrated efficacy in the control of hypertension and microalbuminuria in HIV-infected patients. Decreased microalbuminuria with stable MDRD-GFR may be indicative of a nephroprotective effect of telmisartan; mechanisms causing microalbuminuria in patients with HIV could be related to infection, chronic inflammation, and endothelial dysfunction. The decreased endothelin-1 and VEGF levels in patients in this study may be related to an endothelial protective effect of telmisartan. This study reports the first observation of renal and endothelial protective effects of telmisartan in HIV-positive patients.
Pain occurring in Parkinson’s disease (PD) may affect a large proportion of patients. Based on the results of the methodologically more robust case–control studies that detected a significantly ...greater frequency of pain in PD patients than in control subjects, pain should now be considered as a non-motor symptom of PD. The heterogeneous quality of pain, the variable relationship of pain with parkinsonian motor signs, and the mixed response of pain to dopaminergic drugs suggest complex mechanisms for pain in PD. Some evidence raises the possibility of common mechanisms shared by pain patients, regardless of the clinical heterogeneity of pain and its variable relationship with motor signs.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
In HIV-infected patients with metabolic disorders, as in the general population, there is evidence of hypertension requiring pharmacological treatment. The presence of diabetes constitutes a cluster ...of particularly high cardiovascular risks in patients, both regarding diabetic damage and hypertensive damage. We used telmisartan to manage high blood pressure values in an HIV-positive patient with insulin-dependent diabetes. Surprisingly, insulin therapy had to be suspended because of hypoglycemic fits and treatment with metformin was started. In conclusion, telmisartan was effective and well-tolerated for the control of hypertension in this case and improved sensitivity to insulin. There are interesting effects of this drug in HIV-positive diabetic patients. Thus, if further studies confirm these effects, telmisartan may be the anti-hypertensive drug of first choice in HIV-infected subjects on combined antiretroviral therapy affected with diabetes and metabolic disorders.
Compared with healthy controls, HIV patients already have abnormal lipoprotein concentrations before the initiation of highly active antiretroviral therapy (HAART), which worsen with the therapy. ...HAART-associated dyslipidaemia features fundamental proatherogenic changes such as increased plasma triglycerides (TGs), increased total cholesterol and low-density lipoprotein cholesterol as well as decreased high-density lipoprotein cholesterol (HDL-C). The current guidelines for managing HIV-associated dyslipidaemia recommend diet and exercise counselling, alteration of HAART regimen or addition of lipid-lowering medications such as statins, fibrates and omega-3 (OM-3) fatty acids. Given that cardiovascular risk significantly increases with elevated lipid levels, selecting a drug to manage dyslipidaemia is particularly important. A case is described of an HIV patient who had severe hypertriglyceridaemia and bad metabolic parameters treated with rosuvastatin and OM-3 fatty acids. So we obtained a more marked reduction of TG levels than has never been described before in the literature, associated with a significant increase in HDL-C levels.
In this cross-sectional study, we evaluate potential predictors of Metabolic Syndrome (MS) in a group of 54 Caucasian chronically HIV-infected patients with lipodystrophy. According to ATP-III ...criteria, 22 patients were affected by MS and 32 were not. The mean age of the sample was 41.2 ± 8.6 years, and most patients were males (74.1%); the two groups were homogeneous for gender, age, viro-immunologic status and the duration of antiviral therapy. The independent association between MS and several factors including demographic characteristics, type of highly-active antiviral therapy (HAART), viro-immunologic response, common cardiovascular risk factors (including Framingham scores), and selected cytokines (IFN-γ, TNF-α, IL-2, IL-4, IL-6, IL-10 and IL-18), was investigated using stepwise forward logistic regression. At multivariate analysis, the only independent predictors of the metabolic syndrome were triglycerides and IL-18. A10 mg/dL increase in triglycerides corresponds to an adjusted risk ratio for MS of 1.11 (95% IC: 1.04–1.19); and patients in the top tertile of IL-18 (those with IL-18 ≥ 530 pg/L) had more than three times the likelihood of MS, as compared to the bottom and medium fertiles of IL-18 (patients with IL-18 < 530 pg/L). This relationship was not attenuated by the inclusion of any other variable in the multivariate model. However, the association between metabolic syndrome and IL-18 is no longer significant when IL-18 is treated as a continuous variable (trend p = 0.087). Our results on HIV patients with lipodystrophy confirm previous findings on a strong independent association between IL-18 and MS in the general population. Further research is needed to clarify the mechanism of this association and its role in the development of cardiovascular disease in HIV patients.
This paper asks, "How might Hannah Arendt guide an understanding of cyberbullying attentive to its implications for the public, private, and social realms of contemporary life?" Arendt's ...philosophical distinctions can guide understandings of cyberbullying and response strategies that can constructively shape user communication in cyberspace. This paper contends that attentiveness to public and private differentiations can supply a background that informs foreground communication in online contexts that mitigate instances of cyberbullying. The paper first examines the ways in which cyberspace changes interpersonal communication in public and private life. Next, the paper identifies response strategies to cyberbullying from the field of communication, including corporate/institutional cyber discourse, regulatory mechanisms, and bystander intervention. Third, the paper turns to Arendt and theorists extending her work to understand the communication constituting private, public, and social spheres. The paper concludes with implications from the study grounded in the contention that Arendt's vita contemplativa can act as an antecedent to the vita activa - contemplation and reflection should accompany action to ensure that communication is thoughtful.
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BFBNIB, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
This study aimed to detect if continuous local infusion of levobupivacaine with the On-Q Painbuster system provided postoperative analgesia of similar quality to morphine + ketorolac i.v. in patients ...undergoing cesarean section.
Using a randomized prospective double-blind study, 20 women undergoing cesarean section with a standardized spinal technique were randomly assigned into two groups to receive either 10 mg morphine + 120 mg ketorolac + saline solution up to 96 ml with an elastomeric pump i.v. (group A) or local infusion of levobupivacaine 0.2% with the On-Q PAINBUSTER system (group B). Both groups were administered ketorolac i.v. in bolus in case of pain.
The two groups differed in their VAS scores with group A experiencing significantly less pain than group B; the consumption of analgesics was significantly lower in group A than in group B.
The i.v. system with morphine and ketorolac is more effective than levobupivacaine subcutaneous infusion in reducing postoperative pain associated with cesarean section.
Pregnancy in immigrant women Corosu, R; Fedeli, A; Rossetti, A ...
Clinical and experimental obstetrics & gynecology,
2006, Volume:
33, Issue:
3
Journal Article
Peer reviewed
We wanted to study how foreign women face pregnancy and childbirth in a society quite different from their own.
In 2004 we studied 328 pregnant women at the Department of Gynaecology at the "General ...Hospital Umberto I" in Rome. Information on patients' personal lives and experiences was collected.
Women were classified into six (6) groups based on nationality, race, religion and culture.
Arabian women had the most natural childbirths. African women had a longer duration of gestation. Women from Eastern Europe underwent frequent tests and examinations, but had the highest chance of having preterm births. Chinese women did not usually undergo many examinations and were able to tolerate pain during childbirth quite well.
The aim of this study was to evaluate the effect of β-glucan in women with ASCUS or L-SIL, as detected by cervical cytologic screening.
A total of 356 women with ASCUS or L-SIL were enrolled and ...divided into two groups: 1) 176 patients, treated with topical β-glucan; and 2) 180 patients who were only followed-up. The treatment consisted of two cycles of topical β-glucan applied once a day for 20 consecutive days and treatment separated by ten days. The effect of β-glucan was evaluated comparing Pap cytology results and colposcopic findings between treated patients and controls after 6 and 12 months of follow-up.
After 6 months from enrollment, 63.1% (111/176) of patients treated with β-glucan had a negative Pap smear versus 45% (81/180) of controls (P<0.001), and 43.4% (36/83) of treated patients versus 18.2% (14/77) of controls experienced the disappearance of colposcopic lesions (P=0.001). At the end of the 12-month follow up, 83.5% (147/176) of treated patients versus 60% (108/180) of controls had a negative Pap smear (P<0.001), and 55.4% (46/83) of treated patients versus 24.7% (19/77) of controls experienced the disappearance of colposcopic lesions (P<0.001). No side effects were observed in treated patients.
β-glucan increases the spontaneous regression rate of low-grade cytologic abnormalities as well as cervical findings.
