Archivists with an Attitude - Rescuing the Archives from Foucault

Englis

Clinical utility of Opicapone in the management of Parkinson's Disease : a short review on emerging data and place in therapy

© 2021 Azevedo Kauppila et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.Parkinson’s disease (PD) is a prevalent neurodegenerative disorder, and levodopa (L-dopa) remains the most efficacious drug treatment for PD and a gold-standard for symptom control. Nonetheless, a significant majority of PD patients develop motor fluctuations over their disease course, with a significant impact on quality-of-life, meaning control of such complications translates into a fundamental clinical need. Catechol-O-methyl transferase (COMT) inhibitors (COMT-i) are used as first-line adjuvant therapy to L-dopa for endof-dose (EoD) motor fluctuations, since they increase L-dopa availability in the brain by inhibiting its peripheral metabolism. Opicapone (OPC), a once-daily, long-acting COMT-i, is the most recent and potent of its class, having been licensed in Europe in 2016 as an add-on to preparations of L-dopa/DOPA decarboxylase inhibitors in PD patients with EoD motor fluctuations. More recently, it has also received approval in the USA and Japan in 2020. Two high-quality positive efficacy studies (double-blind Phase III clinical trials) established OPC efficacy with significant reduction in OFF time (average 60 minutes vs placebo), without concomitant increase of distressing dyskinesias during ON time. These beneficial effects were sustained in open-label extension studies, without unexpected safety issues or adverse events, with dyskinesia having been the most frequent complaint. OPC also avoids liver toxicity and gastrointestinal issues compared with previous COMT-i. In this review, we aimed to cover OPC’s lifecycle (synthesis to commercialization), its clinical pharmacological data, safety, tolerability and pharmacovigilance evidence, and discuss its role in the management of motor fluctuations in PD as well as its emerging place in international recommendations.info:eu-repo/semantics/publishedVersio

Madelung disease (multiple symmetric lipomatosis)

Madelung disease or multiple symmetric lipomatosis (MSL) is a rare entity among the overgrowth syndromes. It is characterized by painless non-encapsulated and symmetric fatty deposits in the neck, torso, mammary, and abdominal areas, and in the upper and lower limbs. The etiology of the disease is still unknown. Chronic alcohol consumption may play a role in adipocyte hyperplasia in genetically susceptible individuals. Besides the overgrowth of adipose tissue, patients with MSL present features of metabolic syndrome. Patients seek medical attention usually for esthetic reasons. We present the case of a middle-aged man who sought the outpatient clinic complaining of bulging masses in the posterior upper part of the thorax, the occipital area, and the neck. The masses grew over a period of 2 years. The physical examination and imaging study revealed the presence of symmetric lipomatosis. A two-step surgical treatment was undertaken for the excision of the lipomatous tissue. The postoperative outcome was uneventful with satisfactory esthetic results

Stroke outcomes in a socio-economically disadvantaged urban community

AIMS: To determine survival, disability and functional outcomes of stroke patients following their discharge from an acute stroke unit in an urban community with limited rehabilitative resources. METHODS: Stroke patients were recruited from a district hospital in Cape Town and followed-up for 6 months. Clinical characteristics, demographic and socioeconomic data, and disability and function as measured by modified Rankin Score (mRS), modified Barthel Index (mBI) at recruitment and 3 follow-up visits, were recorded. RESULTS: The study included 196 patients. Median age was 60 (IQR 51 - 69) years, 135 (68.9%) were female, 57.7% black, 42.3% coloured, and 45 (23%) died within 6 months. At discharge, median mBI score was 7 (IQR 3 - 12) and median mRS 4 (IQR 3 - 5). In the multivariate regression models, only function (mBI OR 0.88, 95% confidence interval (CI) 0.79 - 0.96, p<0.0001) and disability (mRS 0R 2.34, 95%CI 1.20 - 4.54, p<0.0001) were independently associated with risk of death. Shack housing was independently associated with moderate or severe disability (odds ratio 3.42, 95%CI 1.22 - 9.59, p=0.02). Despite limited rehabilitation resources, 67% of survivors had mild to moderate disability at 6 months. CONCLUSION: Apart from initial stroke severity, risk factors for poor survival were a severe disability category and the presence of impaired swallowing at discharge. Shack housing was independently associated with poor functional outcomes. These findings should be helpful in allocating home-based care and inpatient rehabilitation resources to high-risk groups to improve outcomes

Management of older patients presenting after a fall - an accident and emergency department audit

Background. It is common for older patients to present to accident and emergency (AE) departments after a fall. Management should include assessment and treatment of the injuries and assessment and correction of underlying risk factors in order to prevent recurrent falls. Objectives. To determine management of older patients presenting after a fall to the AE department of Groote Schuur Hospital in Cape Town, South Africa. Method. Hospital records were reviewed for a random sample of 100 patients aged 65 years and older presenting to the AE department after a fall, between December 2001 and May 2002. Results. The mean age of the sample was 78.6 years (range 65 - 98 years); 72% of subjects were female. History of a previous fall, and history of drug or alcohol intake, were recorded in less than 20% of cases. Blood pressure and pulse rate were recorded in approximately 90% of cases, and pulse rhythm and postural blood pressure in 2%. Examination of the musculoskeletal system was done in 86% of cases and that of other systems in less than 50%; cognitive assessment was conducted in less than 30%. Radiological investigations were performed in 89% of cases, glucose and haemoglobin in 32%, renal profile and electrocardiogram in 5%, and urinalysis in 4%. Three-quarters of the patients were referred for further management: 52% to orthopaedic surgery, 12% to other surgical subspecialties, 6% to the general medical department, and 6% to other hospitals and clinics. No referrals were made to geriatric medicine, physiotherapy or occupational therapy. Conclusions. In managing elderly patients after a fall, the AE department focused on injuries sustained. Little effort was made to establish and manage risk factors, hence to prevent recurrent falls. Guidelines are needed for the management of such patients in AE departments. South African Medical Journal Vol. 96(8) 2006: 718-72

Production of histamine and tyramine by bacteria isolated from Portuguese vacuum-packed cold-smoked fish

An agar medium containing histidine or tyrosine incubated anaerobically was used for detecting the decarboxylating activity of bacteria isolated from Portuguese vacuum-packed cold-smoked fish during chilled storage. The capacity of each bacterial isolate to produce histamine and tyramine was studied at 25 and 5 C incubated for 48 h and 10 days, respectively. More strains produced histamine and tyramine at 25 C compared with 5 C although lactic acid bacteria (LAB) strains exhibited similar results at the two different temperatures. Tyramine was produced by majority of the isolates tested although very low concentrations were produced at 5 C as confirmed by high-pressure liquid chromatography (HPLC). Tyrosine-agar was shown to be a good indicator medium for detection of bacteria that produced high levels of tyramine, since typical colonies surrounded by a translucent halo were easily recognised. LAB identified as Lc. Lactis lactis 1 and Carnobacterium divergens were detected as tyramine-producing bacteria. Acinetobacter spp. and Pseudomonas spp., isolated from all Portuguese smoked fish products, were negative on histidine-agar, but HPLC identified considerable quantities of histamine produced in a broth medium

Intrathoracic gastric volvulus: an autopsy case report

First described by Berti in 1866, gastric volvulus (GV) is an uncommon and potentially lethal entity. GV occurs when the stomach twists by more than 180º resulting in obstruction of the alimentary tract, visceral ischemia, necrosis, and perforation. It is classified according to the rotation axis in organoaxial, mesenteroaxial or a combination of both. The clinical presentation can be acute, and is usually severe or chronic, which sometimes may be asymptomatic. It predominantly occurs in the fifth decade of life, but children, mainly those under the age of 1 year, may be affected. No ethnicity or gender was observed to show predominance. This entity is related to gastric, diaphragmatic disorders as well as laxity of gastric ligaments. Acute GV may complicate with incarceration and strangulation of the stomach when gastric necrosis ensues. These cases show a mortality rate of 60%. The authors report the fatal case of a surgically treated GV in a 43-year-old female patient who looked for medical care only after 1 month of initial symptoms. Diagnosis was confirmed with a thoracic and abdominal axial computed tomography. Besides the entire stomach being herniated and twisted into the thoracic cavity, the pancreas was pulled up through the hiatal orifice, provoking acute pancreatitis. Because of gastric necrosis and perforation, gastroenteric fluid drained into the mediastinum and left pleural space. The postoperative outcome was unfavorable resulting in the patient’s death. The authors call attention to the severeness of the disease, and therefore the need of precocity of diagnosis and surgical treatment

Tracheal stenosis due to endotracheal tube cuff hyperinflation: a preventable complication

Endotracheal intubation injuries are rare, but may be devastating—mostly among the pediatric patients or when these occur in the distal trachea. Such complications typify a therapeutic challenge, which, besides requiring intellectual and technical resources, takes a long time to reach a resolution. The authors present the case of a 15-year-old girl admitted with an abnormal state of consciousness due to diabetic ketoacidosis. She was submitted to endotracheal intubation with hyperinflation of the tube cuff, which rendered tracheal necrosis and detachment of the tracheal mucosa, and consequent obstruction. Later, she developed scarring retraction and stenosis. The patient was successfully treated with an endotracheal prosthesis insertion. The aim of this report is to illustrate a preventable complication

Manutenção do ser

Na seguinte dissertação apresenta-se uma proposta de estudo no campo da Perceção na Arquitetura, com a finalidade de obter resultantes sobre as relações que ambas exercem mutuamente no utilizador do espaço de forma a lograr diretrizes sobre como estes elementos podem melhorar as necessidades de uma faixa etária do homem, os idosos. Devido á realidade sentida na população portuguesa, em particular nas zonas do Interior, com o cada vez maior envelhecimento populacional e com o muitas vezes “esquecimento” que estes sofrem por parte da sociedade, este tema pareceu-me bastante importante e cativante de abordar. Para isto, torna-se necessário obter conhecimentos de como diferentes elementos arquitetónicos são analisados e processados pelo usuário do espaço e o que tais elementos são capazes de transmitir, estudando um pouco sobre o desenvolvimento de teorias da perceção humana. Assim tornar-se-á possível indicar quais os elementos arquitetónicos que afetam positivamente a faixa etária alvo do estudo, os idosos, de forma a seguidamente se conceptualizar e realizar um projeto de arquitetura que empregue os preceitos encontrados de forma correta para a estimulação dos experienciadores espaciais, transcendendo a Arquitetura, de uma mera característica de funcionalidade e estética a criadora de reacções e impulsos.The following dissertation presents a study proposal in the field of Perception in Architecture, with the purpose of obtaining results on the relationships that both exercise each other in the space user in order to achieve guidelines on how these elements can improve the needs of a band age of the man, the elderly. Due to the reality felt in the Portuguese population, in particular in the interior areas, with the increasing population aging and the often “forgetfulness” that they suffer from society, this topic seemed quite important and captivating to address. For this, it is necessary to obtain knowledge of how different architectural elements are analyzed and processed by the space user and what these elements are capable of transmitting, studying a little about the development of theories of human perception. Thus, it will be possible to indicate which architectural elements positively affect the target age group of the study, the elderly, in order to subsequently conceptualize and carry out an architectural project that employs the precepts found correctly for the stimulation of experimenters spatial, transcending architecture, from a mere characteristic of functionality and aesthetics to the creation of reactions and impulses