scholarly journals Prescribing Pattern for Parkinson’s Disease in Indian Community before Referral to Tertiary Center

2017 ◽  
Vol 44 (6) ◽  
pp. 705-710 ◽  
Author(s):  
Pratibha Surathi ◽  
Nitish Kamble ◽  
Ketaki Swapnil Bhalsing ◽  
Ravi Yadav ◽  
Pramod Kumar Pal
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Dopamine Agonists ◽  
Care Center ◽  
Tertiary Care ◽  
Age At Onset ◽  
Tertiary Center ◽  
The Mean ◽  
Group 2 ◽  
Group 1

AbstractBackground: Several factors determine the choice of medications in patients with Parkinson’s disease (PD). We aimed to analyze the pattern of prescription of drugs in patients with PD before attending a tertiary-care center. Methods: The study included chart review of 800 PD patients attending the Department of Neurology of the National Institute of Mental Health and Neurosciences in Bangalore, India. Results: The mean age at onset was 51.1±11.8 years. The mean duration of illness was 41.7±43.6 months. At first visit, 79.4% (group 1, n=635) of patients were on medications, 10% (group 2, n=80) were on medications but later discontinued, and 10.6% (group 3, n=85) were drug-naïve. Overall, levodopa was prescribed in 94.8%, trihexyphenidyl in 40.4%, dopamine agonists in 23.2%, and amantadine in 17.2% either as monotherapy or in combination. In group 1, 37.8% were on monotherapy, with levodopa being the most commonly used agent (33.1%), followed by trihexyphenidyl (2.2%), dopamine agonists (1.6%), and amantadine (0.6%). Among those on polytherapy, levodopa plus trihexyphenidyl was the preferred combination (23.9%). In group 2, levodopa monotherapy was also most common (72.5%), followed by trihexyphenidyl monotherapy (7.5%). Conclusions: Levodopa and trihexyphenidyl were the most commonly prescribed drugs in our patients. A higher use of trihexyphenidyl could be due to its easy availability, low cost, and better tolerability in our patients, who were relatively young at the time of onset of their disease. The choice of antiparkinsonian medications at the primary and secondary care levels in India may be inappropriate, and newer guidelines tailored to the Indian context are warranted.

More than half of opioids prescribed to pediatric patients after ambulatory knee surgery are unused

2021 ◽  
Vol 17 (4) ◽  
pp. 311-320
Author(s):  
Pamela Wendel, MD ◽  
Danya DeMeo, BS ◽  
Madison R. Heath, BS ◽  
Alexandra T. Mackie, BA, PB-BS ◽  
Haoyan Zhong, MPA ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Knee Surgery ◽  
Opioid Medication ◽  
Prescribing Practice ◽  
Observational Cohort ◽  
The Mean ◽  
Group 2 ◽  
Study Participants ◽  
Group 1

Objective: To determine the number of opioid pills remaining after pediatric ambulatory knee surgery to provide insight into how many pills are actually used. Design: Prospective observational cohort study. Participants who were expected to be prescribed 20 (Group 1) versus 40 (Group 2) opioid pills according to the institutional policy (based on the type of surgery) were studied. Patient’s reported pain, medication use, and number of opioid pills remaining at postoperative days (PODs) 7 and 14. Participants were not randomly assigned to groups and no intervention was applied.Setting: An urban tertiary care musculoskeletal institution.Participants: Sixty adolescents between the ages of 12 and 19 undergoing ambulatory knee surgery.Interventions: Observational study, no experimental study intervention.Main outcome measure: The total number of opioid pills remaining.Results: By POD7, more than 70 percent of patients had stopped taking their prescribed opioid medication mainly because their knee pain was tolerable either without the opioid or by using other medications. By POD14, the mean number of pills taken was 6.3 ± 5.3 for Group 1 and 18.4 ± 13.9 for Group 2. The mean number of unused opioids was 13.5 ± 7.2 for Group 1 and 17.9 ± 13.7 for Group 2. Conclusions: Even with prescribing practice guidelines in place, opioids may be overprescribed and could be given in a smaller quantity without affecting the quality of acute postoperative pain control in adolescents undergoing ambulatory knee surgery. However, one needs to consider that some patients may need a larger than average amount in order to be appropriately treated for their level of pain and thus prescription amounts—preferably after reevaluation—should be individualized.

scholarly journals Postpartum Morbidity Associated With Advanced HIV Disease

2006 ◽  
Vol 2006 ◽  
pp. 1-5 ◽  
Author(s):  
Judette Louis ◽  
Mudathiru A. Buhari ◽  
Dianne Allen ◽  
Bernard Gonik ◽  
Theodore B. Jones
Keyword(s):  
Cesarean Delivery ◽  
Care Center ◽  
Tertiary Care ◽  
Wound Complication ◽  
Hiv Disease ◽  
Increased Risk ◽  
Group 3 ◽  
Group 2 ◽  
Advanced Hiv Disease ◽  
Group 1

Objective. To investigate the postpartum morbidity and postpartum management of febrile morbidity associated with advanced HIV infection. Methods. A case control study of HIV infected women at a tertiary care center during January 2000–June 2005 was performed. Postpartum morbidity was defined as endometritis, blood transfusion, wound complication, readmission, infectious morbidity, or unexpected surgery. Results. Women in Group 1 had AIDS (N=33), Group 2 were relatively immunocompetent HIV infected women (N=115), and Group 3 were uninfected women (N=152). Group 1 was more likely to have a postpartum morbidity (32.3 versus 19.3 and 13.2%,P=.03) and to have postpartum imaging 18.8 versus 7.9 and 2.6%,P=.002. After controlling for potential confounders, cesarean delivery (OR 6.2, 95%CI 2.1–505.5) but not advanced HIV disease was associated with an increased risk of postpartum morbidity. Conclusion. Cesarean delivery and not advanced HIV disease increases the risk of postpartum morbidity in women with AIDS.

scholarly journals Transepithelial versus Epithelium off Crosslinking for Treating Keratoconus among Jordanians

2019 ◽  
Vol 13 (1) ◽  
pp. 8-14 ◽  
Author(s):  
Khalid Al Zubi ◽  
Yaser Albakar ◽  
Rana Nasser
Keyword(s):  
Corneal Thickness ◽  
Tertiary Care ◽  
Cross Linking ◽  
Corrected Distance Visual Acuity ◽  
Corneal Collagen Crosslinking ◽  
The Mean ◽  
Group 2 ◽  
Collagen Cross Linking ◽  
Corneal Collagen ◽  
Group 1

Background: The progression of keratoconus is stabilized with the help of corneal collagen cross-linking (CXL) supported through photosynthesized riboflavin. Objective: This study aims to compare the effectiveness of the transepithelial procedure and epithelium off procedure of corneal collagen crosslinking among keratoconus patients in Jordan. Methods: The study recruited 80 patients suffering from progressive keratoconus, from a tertiary care setting in Jordan. These participants were randomly divided into two groups; group 1 with 40 participants subjected to transepithelial (Corneal collagen cross-linking) CXL; and 40 participants in group 2 received conventional epithelium off CXL. Results: Improvement was observed in the mean contact lens, which corrected distance visual acuity (CDVA) from logMAR 0.332 ± 0.09 (group 1), 0.35 ± 0.09 (group 2) to 0.241 ± 0.07 (group 1), 0.21 ± 0.07 (group 2), respectively at the end of follow-up (12 months). The mean pachymetry improved from 429.81 ± 18.96 μm (group 1), 430.08 ± 17.05 μm (group 2) to 436.5 ± 15.49 μm (group 1), 436.44 ± 12.53 μm (group 2), respectively, after twelve months. Additionally, the mean Sim K astigmatism declined from 7.0 ± 2.0 (group 1), 6.73 ± 1.98 (group 2) to 5.97 ± 1.88 (group 1), 5.53 ± 0.08 (group 2) respectively at twelve months post-treatment. Majority of the patients in group 2 experienced more pain as compared to group 1 participants. Conclusion: The effectiveness of a cross-linking procedure related to keratometry readings and corneal thickness showed that conventional (epithelium off) CXL method is more effective than transepithelial CXL.

High prevalence of vitamin D deficiency and reduced bone mass in Parkinson's disease [RETRACTED]

Neurology ◽  
1997 ◽  
Vol 49 (5) ◽  
pp. 1273-1278 ◽  
Author(s):  
Yoshihiro Sato ◽  
Munetsugu Kikuyama ◽  
Kotaro Oizumi
Keyword(s):  
Parkinson’S Disease ◽  
Vitamin D ◽  
Parkinson's Disease ◽  
Vitamin D Deficiency ◽  
Hip Fractures ◽  
Mineral Density ◽  
Yahr Stage ◽  
Z Scores ◽  
Group 2 ◽  
Group 1

Despite excessive hip fractures in patients with Parkinson's disease (PD), little is known about bone changes in these patients. We measured bone mineral density (BMD; Z scores) in PD patients and analyzed its relation to serum biochemical indices and sunlight exposure. We measured BMD in 71 patients in the second metacarpals and divided the patients into two groups according to functional independence: group 1, Hoehn and Yahr stages 1 and 2; and group 2, stages 3 to 5. In four of 20 patients in group 1 (20%), the Z scores was less than -1.0, indicating osteopenia. In 51 patients in group 2, 31 (61%) had a Z score less than -1.0. The group 1 patients showed a normal mean serum level of 25-hydroxyvitamin D (25-OHD; 21.7 ng/ml), while most group 2 patients were in a deficiency range (group mean 8.9 ng/ml). Many group 2 patients were sunlight deprived. Both groups had elevated serum ionized calcium levels correlating positively with Hoehn and Yahr stage and markedly depressed serum 1,25-dihydroxyvitamin D(1,25-[OH]2D) concentrations, indicating that immobilization-induced hypercalcemia had inhibited 1,25-[OH]2D production. Z scores correlated positively with 25-OHD levels and negatively with parathyroid hormone concentration and Hoehn and Yahr stage. Vitamin D deficiency due to sunlight deprivation and hypercalcemia induces compensatory hyperparathyroidism, which contributes to reduced BMD in PD patients, particularly those who are functionally dependent. Low BMD increases risk of hip fractures in patients with PD but may be improved by vitamin D supplementation.

scholarly journals Prevalence, Clinical and Biochemical Spectrum, and Treatment Outcome of Acromegaly With Normal Basal GH at Diagnosis

2018 ◽  
Vol 103 (10) ◽  
pp. 3919-3924 ◽  
Author(s):  
Ana Laura Espinosa de los Monteros ◽  
Ernesto Sosa-Eroza ◽  
Baldomero Gonzalez ◽  
Victoria Mendoza ◽  
Moises Mercado
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Real Life ◽  
Success Rates ◽  
Distinctive Features ◽  
Group 4 ◽  
Patient Groups ◽  
Group 2 ◽  
Design And Methods ◽  
Group 1

Abstract Context The term micromegaly has been used to describe a subset of patients who have elevated IGF-1 levels but apparently normal basal GH (bGH) concentrations and often a glucose-suppressed GH of <1 ng/mL. Objective To evaluate the prevalence, clinical spectrum, and therapeutic outcome of acromegaly with normal bGH at diagnosis. Design and Methods Retrospective analysis of a cohort of patients with acromegaly diagnosed and treated at a tertiary care center. Results A cohort of 528 patients with acromegaly was stratified according to bGH at diagnosis: group 1, <2 ng/mL, n = 16; group 2, 2 to 9.9 ng/mL, n = 202; group 3, 10 to 99 ng/mL, n = 294; and group 4, ≥100 ng/mL, n = 16. Patients in group 1 (normal bGH) constituted 3% of the total cohort and were significantly older and more likely to be male than patients in the other groups. The frequency of acromegalic symptoms, signs, and comorbidities was similar between the four patient groups. Patients in group 1 more often harbored microadenomas (75%) and had significantly lower median IGF-1 and postglucose GH levels. Surgical success rates were similar between patients from groups 1 (53.8%), 2 (54.1%), and 3 (36.9%), whereas only 13.3% of patients in group 4 achieved remission. Conclusion Normal bGH acromegaly is uncommon in real life. These patients have some distinctive features that argue against this being simply acromegaly in its early stages.

scholarly journals Overweight is more prevalent in patients with Parkinson's disease

2012 ◽  
Vol 70 (11) ◽  
pp. 843-846 ◽  
Author(s):  
Hugo Morales-Briceño ◽  
Amin Cervantes-Arriaga ◽  
Mayela Rodríguez-Violante ◽  
Juan Calleja-Castillo ◽  
Teresa Corona
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Care Center ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Normal Weight ◽  
Sectional Study ◽  
Normal Range ◽  
Cross Sectional ◽  
Significant Difference

Underweight and malnutrition are well documented in Parkinson's disease (PD), while overweight has been less reported. We carried out a cross-sectional study including 177 healthy controls and 177 PD patients attending a tertiary care center. We recorded weight and height for all participants. A statistically significant difference was found in body mass index (BMI) between controls and PD patients (29.1±5.4 versus 27.2±4.7, p<0.001). In the PD Group, two patients were underweight, 32.7% were within normal range, 46.9% had overweight, and 19.2% were obese. Overweight and normal weight were more prevalent in the PD Group (p=<0.01 and <0.001, respectively) when compared to controls. In conclusion, overweight/obesity are common among patients with PD, while underweight is almost negligible.

Reliability and Validity of a Questionnaire to assess Swallowing Disorders in Parkinson's Disease Cases

2016 ◽  
Vol 6 (1) ◽  
pp. 35-39
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Care Center ◽  
Tertiary Care ◽  
Reliability And Validity ◽  
Swallowing Disorders ◽  
Internal Reliability ◽  
Maximum Information ◽  
Swallowing Problems ◽  
Significant Difference

ABSTRACT Background Swallowing problems have significant subjective component. Their evaluation necessitates the use of questionnaires to know both the extent of symptoms and the effect on quality of life. Questionnaires should be designed to get maximum information with minimum trouble to the patient. Parkinson's disease (PD) involves swallowing disorder as a symptom, often unreported. Hence, this needs to be assessed separately. Aims This study aims to develop a questionnaire, in the vernacular, to check for the presence of swallowing problems in PD patients, and to study its reliability and validity. Materials and methods We developed an 11-item questionnaire in English, modeled on the Tel Aviv swallowing disturbance questionnaire (SDQ), chosen for its brevity. This was translated into the vernacular (Malayalam, native tongue of the state of Kerala in India), and administered to patients (n = 106) attending the weekly PD clinic of a tertiary care center, in consultation with the attending neurologist in charge of movement disorder patients. The same questionnaire was also administered to age-matched controls (patients without any swallowing disorders; n = 63), attending the ENT, neurology, and geriatric clinics. The scores were documented and statistical analysis done, to check for internal reliability and validity. Results Comparison of mean total scores between cases (2.89) and controls (1.51) showed a statistically significant difference indicating statistical validity (p = 0.009). Guttman's split-half correlation showed fairly good reliability for both cases (0.812) and controls (0.851). Conclusion The present questionnaire to assess dysphagia in PD patients was found to be reliable and valid for use. We recommend it as a screening tool in the neurology OPD. How to cite this article Menon U, Radhakrishnan SK, Sundaram KR. Reliability and Validity of a Questionnaire to assess Swallowing Disorders in Parkinson's Disease Cases. Int J Phonosurg Laryngol 2016;6(1):35-39.

scholarly journals Reliability and Validity of a Questionnaire to Assess Swallowing Disorders in Parkinson's Disease Cases

2016 ◽  
Vol 6 (2) ◽  
pp. 78-82
Author(s):  
Suresh K Radhakrishnan ◽  
KR Sundaram
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Care Center ◽  
Tertiary Care ◽  
Reliability And Validity ◽  
Swallowing Disorders ◽  
Internal Reliability ◽  
Maximum Information ◽  
Swallowing Problems ◽  
Significant Difference

ABSTRACT Introduction Swallowing problems have significant subjective component. Their evaluation necessitates the use of questionnaires to know both extent of symptoms and effect on quality of life. These should be designed to get maximum information with minimum trouble to the patient. Parkinson's disease (PD) involves swallowing disorder as a symptom, often unreported. Hence, this needs to be assessed separately. Aim To develop a questionnaire, in the vernacular, to check for the presence of swallowing problems in PD patients and to study its reliability and validity. Materials and methods We developed an 11-item questionnaire in English, modeled on the Tel Aviv swallowing disturbance questionnaire (SDQ), chosen for its brevity. This was translated into the vernacular (Malayalam, native tongue of the state of Kerala in India) and administered to patients (n = 106) attending the weekly PD clinic of a tertiary care center, in consultation with the attending n in charge of movement disorder patients. The same questionnaire was also administered to age-matched controls (patients without any swallowing disorders) (n = 63) attending the ear, nose, and throat (ENT); neurology; and geriatric clinics. The scores were documented and statistical analysis done, to check for internal reliability and validity. Results Comparison of mean total scores between cases (2.89) and controls (1.51) showed a statistically significant difference, indicating statistical validity (p = 0.009). Guttman's split-half correlation showed fairly good reliability for both cases (0.812) and controls (0.851). Conclusion The present questionnaire to assess dysphagia in PD patients has been found to be reliable and valid for use. We recommend it as a screening tool in the neurology outpatient department (OPD). How to cite this article Menon U, Radhakrishnan SK, Sundaram KR. Reliability and Validity of a Questionnaire to Assess Swallowing Disorders in Parkinson's Disease Cases. Int J Phonosurg Laryngol 2016;6(2):78-82.

Leg stereotypy syndrome: phenomenology and prevalence

2018 ◽  
Vol 89 (7) ◽  
pp. 692-695 ◽  
Author(s):  
Mitesh Lotia ◽  
Michele K York ◽  
Adriana M Strutt ◽  
Joseph Jankovic
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Movement Disorders ◽  
Screening Tool ◽  
Age At Onset ◽  
Positive Family History ◽  
Healthy Individuals ◽  
History Of ◽  
The Mean ◽  
Leg Movement

ObjectivesTo describe the phenomenology and prevalence of leg stereotypy syndrome (LSS), characterised chiefly by repetitive, rhythmical, stereotypic leg movement, especially when sitting.MethodsWe sought to characterise LSS in two groups of subjects: (1) general population (GP) group, defined as individuals accompanying patients during their visits to Baylor College of Medicine Parkinson’s Disease Center and Movement Disorders Clinic who are not genetically related to the patients; and (2) movement disorders (MD) group, composed of consecutive patients with diagnoses of restless legs syndrome, Parkinson’s disease, Tourette syndrome and tardive dyskinesia.ResultsThere were 92 participants enrolled in this study; 7% of 57 individuals in the GP group and 17% of those in the MD group met the diagnostic criteria for LSS. The mean age of individuals with LSS was 44.5 (±11.9) years and mean age at onset of LSS was 17.5 (±5.7) years. In half of the individuals, the ‘shaking’ involved predominantly one leg. All had a positive family history of similar disorder and none had diurnal variation. The seven-item Leg Stereotypy Syndrome Questionnaire was developed as a screening tool to aid in differentiating LSS from other movement disorders.ConclusionsLSS is a common condition, occurring in up to 7% of otherwise healthy individuals, and it is even more common in patients with hyperkinetic movement disorders. Although it phenomenologically may overlap with other stereotypic disorders, we argue that it is a distinct, familial, neurological syndrome.

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