Evaluation of the pressure ulcers risk scales with critically ill patients: a prospective cohort study / Avaliação das escalas de risco para úlcera por pressão em pacientes críticos: uma coorte prospectiva / Evaluación de las escalas de riesgo para úlcera por presión en pacientes críticos: una cohorte prospectiva

AIMS: to evaluate the accuracy of the Braden and Waterlow risk assessment scales in critically ill inpatients. METHOD: this prospective cohort study, with 55 patients in intensive care units, was performed through evaluation of sociodemographic and clinical variables, through the application of the scales (Braden and Waterlow) upon admission and every 48 hours; and through the evaluation and classification of the ulcers into categories. RESULTS: the pressure ulcer incidence was 30.9%, with the Braden and Waterlow scales presenting high sensitivity (41% and 71%) and low specificity (21% and 47%) respectively in the three evaluations. The cut off scores found in the first, second and third evaluations were 12, 12 and 11 in the Braden scale, and 16, 15 and 14 in the Waterlow scale. CONCLUSION: the Braden scale was shown to be a good screening instrument, and the Waterlow scale proved to have better predictive power. .

OBJETIVOS: avaliar a acurácia das escalas de avaliação de risco de Braden e de Waterlow, em pacientes críticos internados. MÉTODO: trata-se de uma coorte prospectiva, com 55 pacientes nas unidades intensivas, por meio de avaliação de variáveis sociodemográficas e clínicas, de aplicação das escalas (Waterlow e Braden), na admissão e a cada 48 horas, da avaliação e classificação das úlceras em categorias. RESULTADOS: a incidência de úlcera por pressão foi de 30,9%, as escalas de Braden e de Waterlow apresentaram, nas três avaliações, alta sensibilidade (41% e 71 %) e baixa especificidade (21% e 47%), respectivamente. Os escores de coorte encontrados na primeira, segunda e terceira avaliações foram de 12, 12 e 11, na escala de Braden, e de 16, 15 e 14 na escala de Waterlow. CONCLUSÃO: a escala de Braden apresentou-se como bom instrumento de triagem, e a de Waterlow com melhor poder preditivo. .

OBJETIVOS: evaluar la precisión de las escalas de evaluación de riesgo de Braden y de Waterlow en pacientes críticos internados. MÉTODO: se trata de una cohorte prospectiva, con 55 pacientes en las unidades intensivas, por medio de evaluación de variables sociodemográficas y clínicas, de aplicación de las escalas (Waterlow y Braden) en la admisión y a cada 48 horas; de la evaluación y clasificación de las úlceras en categorías. RESULTADOS: la incidencia de úlcera por presión fue de 30,9%, las escalas, de Braden y de Waterlow, presentaron, en las tres evaluaciones, alta sensibilidad (41% y 71 %) y baja especificidad (21% y 47%), respectivamente. Los puntajes de corte encontrados en la primera, en la segunda y en la tercera evaluación fueron de 12, 12 y 11, en la escala de Braden, y de 16, 15 y 14, escala de Waterlow. CONCLUSIÓN: la escala de Braden se presentó como un buen instrumento de detección, y la de Waterlow con mejor poder de predicción. .

Levosulpiride in premature ejaculation

Premature ejaculation is one of the most common sexual disorders. A large number of treatment options have been used so far for the treatment of this dysfunction and still a large number of experts are doing research in this field. Here we have tried to research on the beneficial effects of levosulpiride in the treatment of PE. Eighty-eight patients form different areas of Hazara division suffering from PE were chosen. Sixty-four patients were given levosulpiride and the remaining 24 patients were given Placebo. Out of 64 patients who have been given levosulpiride, 30 patients showed very good improvement, 14 patients showed some improvement, 14 patients showed little and 06 patients showed no improvement. levosulpiride have very good beneficial effects in the treatment of PE

Ekbom Syndrome.

A patient with Ekbom Syndrome with Leprosy, who responded to Amisulpride is described.

An Open Label Study on Amisulpride in Augmentation with Atypical Antipsychotics in Treatment Resistant Patients of Schizophrenia and Schizoaffective Disorders.

The authors report an open label study in treatment resistant patients of schizophrenia and schizoaffective disorders. The patients who were earlier being treated with atypical antipsychotics were put on combination of amisulpride and atypical antipsychotics and efficacy as well as safety of the combination was assessed. Method: A study of 6 weeks duration was conducted on 30 patients (9 women, 21 men).The mean dose of amisulpride used was from 250.00 mg/day + 91.65. SAPS, SANS, CGI-S scales were applied. 4 patients dropped out of study. 26 patients completed 6 weeks duration. Results: There was significant improvement in negative symptoms, positive symptoms, cognition especially in old chronic schizophrenics.Only two patients developed extrapyramidal symptoms.Improvement in all symptoms was remarkable. Conclusion: The combination of amisulpride with atypical antipsychotics is a promising option in patients who are resistant to treatment.

Delusional Parasitosis.

A patient with delusional parasitosis, who responded to amisulpride is described.

Amisulpride: a Brief Review.

Amisulpride, belonging to second generation antipsychotics, is a substituted benzamide derivative indicated for the treatment of acute and chronic schizophrenia with prominent positive and/or negative symptoms. Amisulpride has high affinity for the dopamine D2/D3 receptors. It inhibits dopamine transmission by blocking postsynaptic D2/D3 receptors in the limbic system, which is predicative of potent antipsychotic activity. The elimination half-life is 12 hours. Metabolism is limited with most of the drug excreted unchanged in the feces (64%). Clinical studies have supported that Amisulpride (400-1200mg/day) is at least as effective as Haloperidol and Risperidone and more effective than flupenthixol in acute exacerbation. In the treatment of patients with predominantly negative symptoms, Amisulpride was more effective than placebo. Recently some studies have shown it to be having efficacy in dysthymia also. Its favorable characteristics also include low incidence of EPSE and weight gain, however, it has a high incidence of prolactin elevation.

Trastornos del movimiento inducidos por trazodone y veralipride: casos clínicos / Trazodone and veralapride-induced movement disorders: case reports

Comunicamos la aparición de movimientos anormales inducidos por dos fármacos de común uso en el adulto: trazodona y veralipride. El primer paciente desarrolla un parkinsonismo luego de una semana de usar Trazodona: la sintomatología se revierte al cabo de algunas semanas de suspendida la droga. El segundo paciente se presenta con una distonía tardía que comprometió extremidades inferiores, pared abdominal y región oro-mandibular luego de 2 meses de usar Veralipride: la sintomatología desaparece luego de 1 mes de suspendida la droga. Esta comunicación enfatiza la necesidad de mayor reconocimiento de este tipo de reacciones adversas de estos fármacos de común uso en nuestro medio.

We report the occurrence of abnormal movements induced by two drugs of common use in middle-aged patients: trazodone and veralipride. The first patient developed a akinetic-rigid syndrome after 1 week of using trazodone; the parkinsonism subsided completely a few weeks after drug withdrawal. The second patient presented with a tardive dystonia involved lower limbs, abdominal wall and face after two months of taking veralipride, the movements also gradually disappeared after stopping veralipride. Our report emphasizes the need for more awareness by clinicians of these secondary effects which can severely affect patients.

New perspectives in the treatment of schizophrenia

Following the introduction of chlorpromazine in 1950s, for many years little progress was made in the discovery of new drugs for schizophrenia. Dopamine D2 receptors blockade was recognized as the only therapeutic target for antipsychotic drugs and formed the basis for further developments in this area. Later on enhanced efficacy of clozapine in both positive and negative symptoms in schizophrenia opened a new channel for discovery of new pharmacological treatments for this illness. Further developments looked at designing compounds, which were chemically similar to clozapine and have efficacy in both negative and positive symptomatology with diminished risk of extrapyramidal side effects. This new family of drugs, the so-called atypical antipsychotics, mainly act as serotonin- dopamine antagonists [SDA] and have shown wider spectrum of antipsychotic activity than conventional antipsychotic drugs. Their use in clinical practice is now well established and despite some limitations, clinicians prefer their use as first line treatment in schizophrenia and other related illnesses. This paper summarises current findings in the pharmacological treatment of schizophrenia and attempts to provide a review of these new drugs with future directions in this area

Effects of levosulpiride in patients with functional dyspepsia accompanied by delayed gastric emptying

OBJECTIVES: Levosulpiride is the levo-enantiomer of sulpiride, a well-known antiemetic, antidyspeptic and antipsychotic drug. This study was undertaken to investigate the effects of levosulpiride on dyspeptic symptoms and gastric motor function in a group of patients with functional dyspepsia showing delayed gastric emptying. METHOD: Forty two eligible patients were entered into a 3 week, double-blind randomized comparison of 25mg of levosulpiride or placebo t.i.d.. Symptom assessment and gastric scintigraphy following the intake of scrambled egg sandwich, were performed in each patient before and after treatment. RESULTS: The improvement of symptom score in levosulpiride group was higher than the placebo group (p < 0.05). We assessed global efficacy, which was excellent in 1 (6%), good 11 (65%), fair 4 (24%), nil 1 (6%) of those receiving levosulpiride, and fair 9 (60%), nil 5 (33%), poor 1 (6%) of those receiving placebo. Levosulpiride tended to be more effective than placebo in relieving the dyspeptic symptoms especially in the subgroups of dysmotility-like (p < 0.05) and nonspecific (p < 0.05) as compared to other subgroups (p = 0.16). The reduction of gastric emptying time after levosulpiride treatment was more marked than Placebo group (p < 0.05). We found a significant correlation between changes of symptom score and gastric emptying time (r = 0.47, p = 0.01). No serious adverse effects were reported after administration of either levosulpiride or placebo. Only two patients reported mild somnolence during levosulpiride administration. CONCLUSIONS: Levosulpiride is effective and well tolerated in patients with functional dyspepsia accompanied by delayed gastric emptying. Its efficacy may be related to its action on the gastric motor function by improving the delayed gastric emptying.

Comparación del efecto de la amisulprida y la viloxacina en el tratamiento de la distimia / Comparison of the amisulpride and viloxazine effect in the dysthymia treatment

El presente trabajo se propone evaluar la eficacia terapéutica de la amisulprida, comparándola con la viloxacina en un grupo de pacientes diagnosticados como distímicos de acuerdo con los criterios de clasificación del DSM-III-R. Se trata de un estudio controlado doble ciego con asignación aleatoria, de una serie de 80 pacientes evaluados en un examen incial y a lo largo de 4 semanas de tratamiento. Entre los instumentos empleados para la evaluación figuran la escala de depresión de Hamilton, la del retardo psicomotor de Widlocher y la de síntomas negativos de Andreasen. Se evalúa tanto la eficacia como la seguridad de los medicamentos. Se presentan un análisis de los resultados que sugiere una mejor respuesta terapéutica en el grupo de la amisulprida

Ensaio clínico do GRI 1665 (prosulprida) no tratamento das depressöes neuróticas e reativas / Clinical trial with GRI 1665 (prosulpride) in the treatment of reactive and neurotic depressions

Quarenta pacientes de ambos os sexos, portadores de depressäo neurótico-reativa grave com componente ansioso, foram tratados com o GRI 1665 (um comprimido de 100 mg três vezes ao dia), novo antagonista dopaminérgico de açäo central. O estudo foi aberto e destinado a avaliar a eficácia e a tolerabilidade da droga, durante e ao final de oito semanas de tratamento. A melhora dos sintomas foi verificada já a partir do 4§ dia de administraçäo e manteve-se em progressäo até o término do ensaio. Os resultados finais mostraram uma eficácia altamente significativa (p < 0,001) sobre todos os critérios avaliados para depressäo. Terapia ansiolítica concomitante só foi instituída na metade dos casos. A tolerabilidade, tanto clínica como biológica, foi muito boa. Somente em quatro oportunidades foram referidas reaçöes adversas de moderada intensidade que, em nenhum caso, levaram à interrupçäo do tratamento. Conclui-se que o GRI 1665 (prosulprida) pode ser um tratamento eficaz e de ampla tolerabilidade, para o tratamento das condiçöes neurótico-depressivas graves com componente ansioso