Role of lifestyle factors on plasma homocysteine levels in Parkison's disease patients treated with levodopa

Many papers documented that Parkinson's disease (PD) patients treated with levodopa (L-dopa) shows elevated plasma homocysteine (Hcy) levels. Several lifestyle factors are able to influence plasma Hcy levels. We review the evidence that L-dopa therapy is related with an increase in plasma Hcy levels and that several behaviours could be able to cause changes in plasma Hcy concentrations. Therefore, there are reasons to suggest that a healthy lifestyle lowering Hcy may prevent this potential iatrogenic complication during L-dopa therapy. Moreover, at present, no controlled prospective studies have evaluated this phenomenon.     

帕金森病患者营养不良的研究进展

帕金森病是第二常见神经系统变性疾病。帕金森病患者除常见的运动和非运动症状外,还常伴有营养不良等营养状况方面的症状,但相比于运动症状以及抑郁、焦虑、睡眠障碍等非运动症状,帕金森病患者的营养不良症状并未得到足够的重视。本文从帕金森病患者营养不良发生情况、营养不良发生的危险因素、营养不良的类型、具体缺乏的营养素、饮食习惯以及营养不良的干预措施等方面综述了帕金森病患者营养状况方面的研究现况。     

帕金森病患者医院感染临床分析

目的 分析帕金森病患者的医院感染情况,探讨其相关因素,以采取有效的控制措施.方法 对2008年1月1日-2010年12月31日神经内科出院的165例帕金森病患者的医院感染情况进行回顾性调查分析.结果 医院感染17例25例次,感染率为10.30％,例次感染率为15.15％;多发生在住院2周内;呼吸道感染最多,占55.43％,其次为泌尿道,占24.00％;共分离出33株病原菌,居首位的为肺炎克雷伯菌,占42.42％;年龄、病程、侵入性操作、抗菌药物预防性应用、住院天数、血浆白蛋白与医院感染的发生相关.结论 帕金森病患者的医院感染发生率高,应重视医院感染的相关因素,采取预防治疗措施,减少医院感染发生率,促进患者康复.     

Long-term creatine supplementation is safe in aged patients with Parkinson disease

The food supplement creatine (Cr) is widely used by athletes as a natural ergogenic compound. It has also been increasingly tested in neurodegenerative diseases as a potential neuroprotective agent. Weight gain is the most common side effect of Cr, but sporadic reports about the impairment of renal function cause the most concerns with regard to its long-term use. Data from randomized controlled trials on renal function in Cr-supplemented patients are scarce and apply mainly to healthy young athletes. We systematically evaluated potential side effects of Cr with a special focus on renal function in aged patients with Parkinson disease as well as its current use in clinical medical research. Sixty patients with Parkinson disease received either oral Cr (n = 40) or placebo (n = 20) with a dose of 4g/d for a period of 2 years. Possible side effects as indicated by a broad range of laboratory blood and urine tests were evaluated during 6 follow-up study visits. Overall, Cr was well tolerated. Main side effects were gastrointestinal complaints. Although serum creatinine levels increased in Cr patients because of the degradation of Cr, all other markers of tubular or glomerular renal function, especially cystatin C, remained normal, indicating unaltered kidney function. The data in this trial provide a thorough analysis and give a detailed overview about the safety profile of Cr in older age patients.     

Experiences of patients with a hydraulic erection prosthesis

To evaluate the psychological effect of implantation of an inflatable hydraulic penile prosthesis, a follow-up investigation was carried out among 25 patients who between November 1985 and March 1989 received such a prosthesis in the department of Urology at St. Radboud Hospital, and among their partners. The methods consisted of written questionnaires and personal interviews. The mean time between implantation and evaluation was 20 months. Implantation did not improve sexual or general partner relationship. However, the great majority of patients (84%) and their partners (75%) would decide again to have the prosthesis implanted. Some elements of dissatisfaction (concerning the limited length of the erect penis, difficult coital position, and failing ejaculation) were found, that draw attention to the necessity of improving information and psychosexual counselling.     

Experiences of physicians who frequently use e-mail with patients

Despite its potential, the use of e-mail for physician-patient communication has not been widely adopted. Our purpose was to survey the experiences of physicians who are early adopters of the technology. Physicians, identified through a professional Internet information portal, completed a survey, including an assessment of satisfaction with using e-mail with patients. We identified 204 physicians who reported using e-mail with patients on a daily basis. Average age of the respondents was 49 years, 82% were male, and 35% were primary-care physicians. Among the 204 frequent users, commonly reported e-mail topics were new, nonurgent symptoms, and questions about lab results. Despite their daily use, 25% were not satisfied with physician-patient e-mail. The most important reasons for using e-mail with patients among those who were satisfied were "time saving" (33%) and "helps deliver better care" (28%) compared with "patient requested" (80%) among those who were not satisfied (p <.01). Dissatisfied physicians reported concerns about time demands, medicolegal risks, and ability of patients to use e-mail appropriately. Although the majority of these "vanguard" physicians reported benefits, some did not recommend that colleagues adopt this new technology. Increasing integration into practice to enhance time-saving aspects and improve patient education might lead to more sustained use of this promising communication tool.     

Experiences of patients with the semi-rigid Jonas penile prosthesis

A questionnaire was used to investigate the results of the implant of a semirigid Jonas penile prosthesis in 75 men, operated at the department of Urology of the University Hospital Leiden. The results of 31 patients were available for analysis. Sexual intercourse was possible for 77% of patients. The length of the penis was satisfactory in 52%, the rigidity of the penis in 77%. In half the patients, the frequency and the quality of the intercourse was comparable with the period before the erectile dysfunction, in the other half of the cases, both positive and negative changes were mentioned. Orgasm was possible for 3/4 of patients. The overall satisfaction was 74%, in the partner group 65%. Of the patients 87% did not regret the operation. Several patients mentioned that the implant of the prosthesis did reinforce their self-confidence.     

Thyroid dysfunctions in patients with viral hepatitis treated with interferon-alpha

INTRODUCTION: Many studies have explored that thyroid dysfunctions can be induced by cytokine therapy. Most observations were collected in connection with the treatment of viral hepatitis with interferon-alpha. AIM AND METHODS: Frequency and types of thyroid dysfunction developed during and after recombinant interferon-alpha treatment were studied in 138 patients with viral hepatitis C or B. Therapy lasted 12 months or more, subjects having thyroid dysfunction at the start of therapy were excluded from the study. Thyroid parameters (TSH, FT4, FT3 and anti-TPO) were controlled every third month. In patients in whom thyroid dysfunction occurred the measurements were repeated monthly and other tests were also performed (anti-Tg, IL-6, TSH receptor antibody, thyroid scan and 99mTc-pertechnetate uptake). RESULTS: Thyroid function disturbances were found in 30 (21.7%) patients, 12 of them (8.7%) showed persistent hypothyroidism. Hyperthyroidism was transitory in all cases. The clinical course of thyroid dysfunction might be monophasic (hyper- or hypothyroidism), biphasic (hyperthyroidism followed by hypofunction) or triphasic. Immune and non-immune forms can be clearly distinguished. CONCLUSIONS: Every fifth patient with chronic hepatitis showed thyroid dysfunction during interferon-alpha therapy, it is necessary therefore to control the hormonal status and the thyroid antibody titer. Treated patients have to be informed in advance that as a "side effect" persistent hypothyroidism may develop.