Treatment variability and its relationships to outcomes among patients with Wernicke's encephalopathy: A multicenter retrospective study

Background: Despite guidelines and recommendations, Wernicke's encephalopathy (WE) treatment lacks evidence, leading to clinical practice variability.Aims: Given the overall lack of information on thiamine use for WE treatment, we analyzed data from a large, well-characterized multicenter sample of patients with WE, examining thiamine dosages; factors associated with the use of different doses, frequencies, and routes; and the influence of differences in thiamine treatment on the outcome.Methods: This retrospective study was conducted with data from 443 patients from 21 centers obtained from a nationwide registry of the Spanish Society of Internal Medicine (from 2000 to 2012). Discharge codes and Caine criteria were applied for WE diagnosis, and treatment-related (thiamine dosage, frequency, and route of administration) demographic, clinical, and outcome variables were analyzed.Results: We found marked variability in WE treatment and a low rate of high-dose intravenous thiamine administration. Seventy-eight patients out of 373 (20.9%) received > 300 mg/day of thiamine as initial dose. Patients fulfilling the Caine criteria or presenting with the classic WE triad more frequently received parenteral treatment. Delayed diagnosis (after 24 h hospitalization), the fulfillment of more than two Caine criteria at diagnosis, mental status alterations, and folic acid deficiency were associated significantly with the lack of complete recovery. Malnutrition, reduced consciousness, folic acid deficiency, and the lack of timely thiamine treatment were risk factors for mortality.Conclusions: Our results clearly show extreme variability in thiamine dosages and routes used in the management of WE. Measures should be implemented to ensure adherence to current guidelines and to correct potential nutritional deficits in patients with alcohol use disorders or other risk factors for WE

Non-motor symptom burden in patients with Parkinson's disease with impulse control disorders and compulsive behaviours : results from the COPPADIS cohort

The study was aimed at analysing the frequency of impulse control disorders (ICDs) and compulsive behaviours (CBs) in patients with Parkinson's disease (PD) and in control subjects (CS) as well as the relationship between ICDs/CBs and motor, nonmotor features and dopaminergic treatment in PD patients. Data came from COPPADIS-2015, an observational, descriptive, nationwide (Spain) study. We used the validated Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease-Rating Scale (QUIP-RS) for ICD/CB screening. The association between demographic data and ICDs/CBs was analyzed in both groups. In PD, this relationship was evaluated using clinical features and treatment-related data. As result, 613 PD patients (mean age 62.47 ± 9.09 years, 59.87% men) and 179 CS (mean age 60.84 ± 8.33 years, 47.48% men) were included. ICDs and CBs were more frequent in PD (ICDs 12.7% vs. 1.6%, p < 0.001; CBs 7.18% vs. 1.67%, p = 0.01). PD patients had more frequent previous ICDs history, premorbid impulsive personality and antidepressant treatment (p < 0.05) compared with CS. In PD, patients with ICDs/CBs presented younger age at disease onset, more frequent history of previous ICDs and premorbid personality (p < 0.05), as well as higher comorbidity with nonmotor symptoms, including depression and poor quality of life. Treatment with dopamine agonists increased the risk of ICDs/CBs, being dose dependent (p < 0.05). As conclusions, ICDs and CBs were more frequent in patients with PD than in CS. More nonmotor symptoms were present in patients with PD who had ICDs/CBs compared with those without. Dopamine agonists have a prominent effect on ICDs/CBs, which could be influenced by dose

Micrometástasis en el ganglio centinela axilar por cáncer de mama. ¿Es necesaria la linfadenectomía axilar completa?

El significado de la micrometástasis en el ganglio centinela en el control de la enfermedad en las pacientes con cáncer de mama en estadio inicial se plantea como cuestión emergente desde finales de los años 90. Varios estudios observacionales permiten adivinar un escaso valor de la micrometástasis en la evolución de la enfermedad loco-regional y a distancia y más dudoso en la supervivencia de las pacientes. La pregunta de investigación permanece y parece necesario un enfoque experimental para darle respuesta. OBJETIVO: Determinar si es necesaria la práctica de una linfadenectomía axilar completa en las pacientes con cáncer de mama en estadio inicial a las que se determina la presencia de una micrometástasis en el ganglio centinela axilar. MÉTODOS: Ensayo clínico prospectivo aleatorizado en dos grupos, uno con pacientes con micrometástasis en el ganglio centinela sometidas a observación clínica (grupo experimental) y otro similar pero con linfadenectomía en un segundo tiempo quirúrgico (grupo control). Las pacientes fueron seguidas detalladamente durante cinco años. Para valorar la calidad de vida se estudió la morbilidad postquirúrgica durante el primer año tras la cirugía. RESULTADOS: Se reclutaron un total de 247 pacientes (14 abandonos): 112 pacientes en el grupo control y 121 en el experimental. En el grupo control, 15 pacientes (13%) resultaron positivas tras la linfadenectomía axilar. El tiempo medio de seguimiento fue de 62 meses. Se observó recurrencia de la enfermedad en 4 pacientes: 1/108 (1%) en el grupo control y 3/119 (2.5%) en el experimental (diferencia en supervivencia libre de enfermedad y riesgo relativo calculados no significativos). No se observaron muertes por enfermedad. Se constataron peores parámetros de morbilidad postquirúrgica en el grupo control. CONCLUSIONES: 1. En las pacientes con cáncer de mama en estadio inicial la biopsia selectiva del ganglio centinela tras hallazgo de una micrometástasis es suficiente para el control de la enfermedad axilar no precisando de una linfadenectomía completa en la mayoría de los casos. 2. Los parámetros de supervivencia global y de supervivencia libre de enfermedad en el grupo de pacientes con biopsia selectiva del ganglio centinela, en comparación con el grupo de pacientes sometidas a linfadenectomía axilar completa, son iguales. 3. La incidencia de enfermedad axilar residual tras el hallazgo de una micrometástasis es baja. 4. La biopsia del ganglio centinela se asocia a una menor morbilidad en la extremidad ipsilateral y a una mejor calidad de vida de las pacientes, en comparación con la disección axilar completa.To date, many reports have suggested that selective Sentinel Node (SN) biopsy only could be used to manage early breast cancer. However, definitive prove is lacking. AIM: To prove that in early breast cancer patients with a SN biopsy showing micrometastases, refraining from completion axillary lymph-node dissection (ALND) is enough to produce the same prognostic information and disease control as proceeding with completion ALND. METHODS: A randomized prospective clinical trial was devised with two arms. In one arm, patients with SN micrometastases were subject to clinical follow-up (experimental arm). In the other arm, patients were submitted for completion ALND (control arm). All patients were evaluated for recurrence and survival. RESULTS: A total of 247 patients were entered (14 withdrawals): 112 patients in the control arm and 121 in the experimental arm. In the control arm, 15 (13%) completion ALND turned out positive (low burden). Mean time follow-up was 62 months. Four patients recurred: 1/108 (1%) in the control arm and 3/119 (2.5%) in the experimental arm. No differences in disease-free survival were found (p=0.325). No cancer related deaths were seen. Morbidity was more common in the control arm. CONCLUSIONS: Our results strongly suggest that in early breast cancer patients with micrometastasis, selective SN biopsy is enough to provide for loco-regional and distant disease control, without significant deleterious effects on survival

Micrometástasis en el ganglio centinela axilar por cáncer de mama : ¿es necesaria la linfadenectomía axilar completa?

El significado de la micrometástasis en el ganglio centinela en el control de la enfermedad en las pacientes con cáncer de mama en estadio inicial se plantea como cuestión emergente desde finales de los años 90. Varios estudios observacionales permiten adivinar un escaso valor de la micrometástasis en la evolución de la enfermedad loco-regional y a distancia y más dudoso en la supervivencia de las pacientes. La pregunta de investigación permanece y parece necesario un enfoque experimental para darle respuesta. OBJETIVO: Determinar si es necesaria la práctica de una linfadenectomía axilar completa en las pacientes con cáncer de mama en estadio inicial a las que se determina la presencia de una micrometástasis en el ganglio centinela axilar. MÉTODOS: Ensayo clínico prospectivo aleatorizado en dos grupos, uno con pacientes con micrometástasis en el ganglio centinela sometidas a observación clínica (grupo experimental) y otro similar pero con linfadenectomía en un segundo tiempo quirúrgico (grupo control). Las pacientes fueron seguidas detalladamente durante cinco años. Para valorar la calidad de vida se estudió la morbilidad postquirúrgica durante el primer año tras la cirugía. RESULTADOS: Se reclutaron un total de 247 pacientes (14 abandonos): 112 pacientes en el grupo control y 121 en el experimental. En el grupo control, 15 pacientes (13%) resultaron positivas tras la linfadenectomía axilar. El tiempo medio de seguimiento fue de 62 meses. Se observó recurrencia de la enfermedad en 4 pacientes: 1/108 (1%) en el grupo control y 3/119 (2.5%) en el experimental (diferencia en supervivencia libre de enfermedad y riesgo relativo calculados no significativos). No se observaron muertes por enfermedad. Se constataron peores parámetros de morbilidad postquirúrgica en el grupo control. CONCLUSIONES: 1. En las pacientes con cáncer de mama en estadio inicial la biopsia selectiva del ganglio centinela tras hallazgo de una micrometástasis es suficiente para el control de la enfermedad axilar no precisando de una linfadenectomía completa en la mayoría de los casos. 2. Los parámetros de supervivencia global y de supervivencia libre de enfermedad en el grupo de pacientes con biopsia selectiva del ganglio centinela, en comparación con el grupo de pacientes sometidas a linfadenectomía axilar completa, son iguales. 3. La incidencia de enfermedad axilar residual tras el hallazgo de una micrometástasis es baja. 4. La biopsia del ganglio centinela se asocia a una menor morbilidad en la extremidad ipsilateral y a una mejor calidad de vida de las pacientes, en comparación con la disección axilar completa.To date, many reports have suggested that selective Sentinel Node (SN) biopsy only could be used to manage early breast cancer. However, definitive prove is lacking. AIM: To prove that in early breast cancer patients with a SN biopsy showing micrometastases, refraining from completion axillary lymph-node dissection (ALND) is enough to produce the same prognostic information and disease control as proceeding with completion ALND. METHODS: A randomized prospective clinical trial was devised with two arms. In one arm, patients with SN micrometastases were subject to clinical follow-up (experimental arm). In the other arm, patients were submitted for completion ALND (control arm). All patients were evaluated for recurrence and survival. RESULTS: A total of 247 patients were entered (14 withdrawals): 112 patients in the control arm and 121 in the experimental arm. In the control arm, 15 (13%) completion ALND turned out positive (low burden). Mean time follow-up was 62 months. Four patients recurred: 1/108 (1%) in the control arm and 3/119 (2.5%) in the experimental arm. No differences in disease-free survival were found (p=0.325). No cancer related deaths were seen. Morbidity was more common in the control arm. CONCLUSIONS: Our results strongly suggest that in early breast cancer patients with micrometastasis, selective SN biopsy is enough to provide for loco-regional and distant disease control, without significant deleterious effects on survival

Clinical behavior of posterior fixed partial dentures with a biologically oriented preparation technique: a 5-year randomized controlled clinical trial

Statement of problem. Evidence of the behavior of the periodontal tissues around anterior teeth restored with the biologically oriented preparation technique (BOPT) is available. However, outcomes of this technique in posterior teeth restored with fixed partial dentures (FPDs) are lacking. Purpose. The purpose of this randomized controlled clinical trial was to evaluate the clinical, mechanical, and biological behavior of posterior 3-unit FPDs placed on teeth prepared with BOPT. Material and methods. Forty participants received a 3-unit zirconia FPD in the posterior region of the mandible or maxilla. Twenty FPDs were placed on teeth prepared with BOPT (study group) and 20 on teeth with a horizontal chamfer finishing line (control group). Follow-up examinations were performed 1, 3, and 5 years after treatment to evaluate periodontal responses around the prepared teeth by means of the following parameters: plaque index, gingival index, probing depth, and marginal stability (MS). Mechanical behavior was also assessed, as were any complications. Results. After the 5-year follow-up, 57.9% of the control group and 35% of the BOPT group presented a plaque index of 1. The gingival index was 1 in 68.4% of the control group and 30% of the BOPT group after the follow-up period. In the analysis of probing depth, 26.3% of teeth in the control group had pockets of more than 3 mm in depth, whereas the BOPT group had only 10%. Marginal stability appeared in 100% of the BOPT group, whereas only 10.5% of the control group exhibited gingival stability. Complications during the follow-up period were similar, 20% in the control group and 15% in the BOPT group. Conclusions. Posterior FPDs prepared by using BOPT had a good clinical response over a 5-year follow-up, with a low gingival index, a small increase in pocket depth, and a 100% marginal stability of the surrounding tissues. High survival rates after 5 years indicated that the technique produced predictable outcomes.Depto. de Odontología Conservadora y PrótesisFac. de OdontologíaTRUEpu