Pilot therapeutic education program in multiple system atrophy: Safety, quality of life and satisfaction from a national registry based longitudinal study

BACKGROUND

Therapeutic education programs are effective in several chronic conditions. However, evidence is lacking in multiple system atrophy (MSA). We aimed to assess efficacy and safety of a comprehensive therapeutic education program in people with MSA (PwMSA) and their caregivers.

METHODS

In this prospective longitudinal study we included 16 PwMSA and their main caregivers in 4 groups of 4 dyads each. The program consisted of eight 60-min interdisciplinary sessions: introduction, orthostatic hypotension, speech therapy, gait and respiratory physiotherapy, psychological support, urinary dysfunction, occupational therapy/social work. UMSARS, NMSS, PDQ39, EQ5 and Zarit scales were administered at baseline and 6 months later. After each session participants filled-out a modified EduPark satisfaction questionnaire and a Likert scale. Educational material was generated for each session after suggestions by participants.

RESULTS

At baseline PwMSA and caregivers were comparable in age and sex, with significant correlation between UMSARS-IV (disability) and PDQ39 (quality of life). Adherence to sessions was of 94,92 %. Total modified EduPark scores and Likert scales did not differ in PwMSA vs. caregivers, mild-moderate vs. severe-advanced cases or between genders. The significant difference in satisfaction across sessions (p = 0.03) was driven by higher scores in speech, respiratory and occupational therapy sessions. Longitudinally there was no significant worsening in any scale, nor a significant increase post-vs. pre-program in the number of consultations.

CONCLUSIONS

The healthcare education program in MSA was feasible, satisfactory, and safe for patients and caregivers. The educational material of the program is being forwarded to incident MSA cases attending our clinic.

Partially coherent stable and spiral beams

Stable and spiral coherent beams, which do not change the form of their intensity distribution apart from possible scaling and rotation during propagation and therefore possess self-healing properties, are widely applied in science and technology. On the other hand, it has been found that partially coherent light often provides better output than coherent light. Here we consider two methods for the design and experimental generation of partially coherent stable and spiral beams.

Socio-demographic and clinical factors influencing the adherence to treatment in Parkinson's disease: the ADHESON study

BACKGROUND

Symptoms of Parkinson's disease (PD) are usually controlled by a continuous titration of medication and addition of multiple therapies over the course of the disease. Therapeutic complex schemes, polymedication, comorbidities and the number of medications required contribute to non-adherence.

METHODS

This cross-sectional survey was performed in 418 patients with PD on treatment with any antiparkinsonian medication. Patient adherence was assessed through physicians' subjective perception and the Morisky-Green test (MGT). Several social, demographic and clinical features were correlated through bivariate and multivariate analyses.

RESULTS

According to the physician's opinion 93.7%, and according to the MGT 60.4% of patients were adherent to parkinsonian therapy. The bivariate analysis showed greater adherence in patients with a high level of knowledge about the disease (62.8%), good clinical control (63.6%), a spouse or life partner (63%) and higher incomes (66%). Negative correlation with psychiatric symptoms was found. In relation to the MGT, the logistic regression model showed a negative correlation between cognitive deterioration and psychiatric pathology and adherence to therapy.

CONCLUSIONS

The physician's impression overestimated the compliance of patients when compared with an objective evaluation such as the MGT. Cognitive impairment and psychiatric symptoms are the clinical variables associated with a lower level of adherence.

Efficacy and safety of pallidal stimulation in primary dystonia: results of the Spanish multicentric study

BACKGROUND

Dystonia is a complex clinical syndrome originated by a wide range of aetiologies. The diagnosis of dystonia is made after the evaluation of aetiological, phenomenological and genetic factors. Medications, except in patients with dopa-responsive dystonia, are of limited efficacy. Botulinum toxin injections are not applicable to patients with generalised dystonia, since many muscular groups contribute to disability. Clinical studies in children and adults with primary generalised dystonia (PGD) have reported beneficial effects of bilateral GPi deep brain stimulation (DBS) in both motor symptoms and disability produced by dystonia as well as a favourable impact of DBS in the health-related quality of life (HRQoL). Some clinical aspects of GPi stimulation in primary dystonia still remain controversial such as the influence of disease duration or age at onset in determining the postoperative clinical outcome.

RESULTS

The authors report the results of a multicentric study designed to assess the tolerability and clinical effects of bilateral pallidal DBS on motor impairment, functional disability, quality of life, pain and mood in patients with medically refractory primary generalised or segmental dystonia.

The role of mononuclear blood cells in experimental Junin virus spread to the central nervous system

The neuroinvasiveness of Junin virus depends on the viral strain, animal species, and age. The role of infected blood cells in hematogenous Junin virus spread to the central nervous system (CNS) was studied by determining the growth in pheripheral mononuclear cells and brain tissue of Candid 1 and XJCL3 laboratory strains, in Calomys musculinus and guinea pigs. The present study demonstrated that Junin virus replicates in circulating peripheral lymphocytes and macrophages of 11-day-old guinea pigs and 6 +/- 1-day-old Calomys musculinus. Moreover, the observation that mononuclear phagocyte depletion did block Junin virus neuroinvasion firmly indicates that the cellular viremia (circulating monocytes) is one of the mechanisms of Junin virus attenuated strains spread to the CNS in animal hosts.

[Presence of antibodies against Venezuelan equine encephalitis virus subtype VI in patients with acute febrile illness]

In Argentina, there is no record of human cases produced by Dengue virus (Flavivirus), but Paraguay and Brasil (neighbouring countries) have notified human outbreaks of Dengue Haemorrhagic Fever. In this report, we inform the serological results of a limited human outbreak of a Dengue-like acute illness that occurred in General Belgrano Island, Formosa, Argentina in April 1989. This island is 35 km far from Clorinda city of Paraguay river, with a human population of 150 inhabitants. The weather of this area is humid with abundant rainfall, favouring mosquitoes proliferation. Two samples of serum from 28 human notified cases were studied using hemagglutination inhibition test (HI), complement fixation (CF), and plaque reduction neutralization (NT) test in Vero cell cultures. All tested sera were negative to Dengue, St. Louis encephalitis, Yellow Fever, Bussuquara, Rocio, Eastern and Western Equine Encephalitis arboviruses as well as Influenza and Rubella viruses. By contrast, infection with Venezuelan equine encephalitis virus (VEE), subtype VI-AG80-663 strain was demonstrated (34.5% positive by HI, 39.1% by CF and 51.6% by NT). Seroconversion was detected by NT in six cases and only five were positive by CF. The 26.8% of the sera reacted also with VEE subtype I AB by NT. Considering that no cross reaction were detected in NT with these two subtypes, our results suggest that both viruses are concomitantly circulating in the studied area. Furthermore, the seroconversions detected with AG80-663 strain firmly indicate that during the outbreak this virus subtype was circulating in the island, although we could not assure that it was the causal agent of the acute disease.

[Concomitant activity of 2 bunyaviruses in horses in Argentina]

A serologic survey of horses for Kairi (KRI) and Cache Valley (CV), two related Bunyaviruses, was conducted simultaneously in Cordoba and Santa Fe provinces, Argentina, during late 1983 and 1984. The prevalence of neutralizing antibodies only for KRI was 13.3% and only for CV was 40.0%; but if the total positive sera for KRI and CV were taken into account, the prevalence reached 48.3 and 75.0%, respectively. The prevalence for CV was higher than for KRI in Cordoba (p less than 0.01), but both were similar in Santa Fe province. The demonstration of seroconversion in horses of the two zones for both viruses indicates that these viruses have a concomitant activity. The infection rates (number of infections per 100 horses-month) were very high in Cordoba (4.4 and 7.1 for KRI and CV) but also in Santa Fe (2.9 and 9.5 for the two viruses respectively), without significant difference in each province. Despite this high activity, no signs of illness or death imputed to these viruses were registered, in these areas during the period of observation. This apparent absence of associated equine disease may be the consequence of the low or null virus pathogenicity or the underrecognition or underreporting of the clinical cases.