Edison Iglesias de Oliveira Vidal

Unexpected Improvement in Levodopa-Induced Dyskinesia and On-Off Phenomena After Introduction of Memantine for Treatment of Parkinson's Disease Dementia

Geriatrics Division Department of Internal Medicine Universidade Estadual Paulista, Botucatu, SP

Complex regional pain syndrome

The authors explore how doctors in primary care can identify, approach, and refer patients with regional pain syndrome

The Neuraxial Effects of Intraspinal Amitriptyline at Low Concentrations

BACKGROUND:As a result of amitriptylines vast array of actions, it could potentially be used as an intraspinal adjuvant in neuraxial anesthesia and/or in the treatment of refractory neuropathic pain. None of the previous studies examining the safety profile of intraspinal single doses of amitriptyline found signs of toxicity at concentrations below 15.4 mM/L (0.5%) and the current hypothesis regarding the pathophysiology of amitriptyline toxicity suggests it might be safe at low concentrations while still having relevant clinical effects. Hence, we conducted this study to assess the clinical and histological toxicity of intraspinal amitriptyline at the lowest dosages previously known to be effective. METHODS:Twenty-one dogs were randomized to receive a 1-mL single intraspinal dose of one of the three solutions: saline (0.9%), amitriptyline (0.15%), or amitriptyline (0.3%). The dogs were evaluated clinically 1 h after awakening from anesthesia and 21 days later. At 21 days, all animals were killed, and histological sections of the spinal cord and surrounding meninges were retrieved for analysis. RESULTS:All dogs recovered motor function, anal sphincter tone and sensibility. With the exception of one dog in the 0.15% amitriptyline group, all animals in both amitriptyline groups had marked adhesive arachnoiditis, which was absent in the control group. No evidence of direct neural damage was found on histological sections stained by glial fibrillary acidic protein technique in any of the study animals. CONCLUSION:The intraspinal administration of amitriptyline to dogs even in low concentrations is strongly associated with the development of intense meningeal adhesive arachnoiditis and is not safe even at low concentrations for which there was no previous evidence of toxicity.

Physical Frailty As a Clinical Marker of Biological Age and Aging

Canadians relative to the 2011 Dietary Reference Intakes: An examination in children and adults with and without supplement use. Am J Clin Nutr 2011;94:128–135. 4. Cameron ID, Gillespie LD, Robertson MC et al. Interventions for preventing falls in older people in care facilities and hospital. Cochrane Database Syst Rev 2012;12:CD005465. 5. Bolland MJ, Grey A, Gamble GD et al. Vitamin D supplementation and falls: A trial sequential meta-analysis. Lancet Diabetes Endocrinol 2014;2:1–8. 6. American Geriatrics Society Workgroup on Vitamin D Supplementation for Older Adults. Recommendations abstracted from the American Geriatrics Society consensus statement on vitamin D for prevention of falls and their consequences. J Am Geriatr Soc 2014;62:147–152. 7. Papaioannou A, Morin S, Cheung AM et al. 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: Summary. Can Med Assoc J 2010;182:1864–1873.

Influenza among adults in Latin America, current status, and future directions: a consensus statement

In Latin America, adult influenza is a serious disease that exacts a heavy burden in terms of morbidity, mortality, and cost. Although much has been written about the disease itself, relatively little information has been compiled on what could be done to reduce its impact across the region, particularly from the perspective of clinicians with first-hand experience in confronting its effects. To fill this data gap, in 2011, the Pan American Health and Education Foundation (PAHEF) and the U.S.-based nonprofit Fighting Infectious Diseases in Emerging Countries (FIDEC) organized a conference and convened a panel of Latin American scientist-clinicians with experience and expertise in adult influenza in the region tol) discuss the major issues related to the disease and 2) develop and produce a consensus statement summarizing its impact as well as current efforts to diagnose, prevent, and treat it. The consensus panel concluded a more concerted and better-coordinated effort was needed to reduce the adverse impact of seasonal influenza and future pandemics, including more surveillance, more active involvement by both governmental and nongovernmental organizations, and a much greater effort to vaccinate more adults, especially those at high risk of contracting the disease. In addition, a new approach for diagnosing influenza was recommended.

Frailty in older adults: perspectives for research and practice in Public Health.

Fragilidade em idosos: perspectivas para a pesquisa e a prática em Saúde Coletiva A revisão sistemática de Mello et al.

Authors’ reply to Ninan

We agree with Ninan that urinary tract infections (UTIs) are often overdiagnosed in older people and that too often asymptomatic bacteriuria is treated with antibiotics.1 However, correctly …

Anticonvulsants for chronic low‐back pain

UNESP - Univ Estadual Paulista Department of Anaesthesiology Botucatu Medical School, Distrito de Rubiao Junior, s/n

Fragilidad en ancianos: perspectivas para la investigación y la práctica en salud pública

Fragilidade em idosos: perspectivas para a pesquisa e a prática em Saúde Coletiva A revisão sistemática de Mello et al.

Picture-based memory impairment screen: A major achievement for cognitive assessment of older adults in developing countries

Geriatrics Division Internal Medicine Department Universidade Estadual Paulista, Botucatu Sao Paulo