Jean-Jacques Perrenoud

PRACTICING DERMATOLOGY IN AN INTEGRATED GERIATRIC SWISS HOSPITAL

1. Nelson TD, ed. Ageism: Stereotyping and Prejudice Against Older Persons. Cambridge, MA: MIT Press, 2002. 2. Falconer M, O’Neill D. Out with ‘‘the old,’’ elderly, and aged. BMJ 2007; 334:316. 3. United Nations Committee on Economic Social and Cultural Rights. The Economic, Social and Cultural Rights of Older Persons. Geneva: United Nations High Commissioner for Human Rights, 1995. 4. Gill TM, Baker DI, Gottschalk M et al. A program to prevent functional decline in physically frail, elderly persons who live at home. N Engl J Med 2002;347: 1068–1074. 5. Smedley BD, Stith AY, Nelson AR, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington DC: National Academies Press, 2002.

ANTIEPILEPTIC DRUGS IN THE TREATMENT OF NEUROPATHIC PAIN: DRUG‐TO‐DRUG INTERACTION IN ELDERLY PEOPLE

500 MU per 2.5 mL of saline. The appropriate conversion factor of Botox:Dysport varies from 1:3 to 1:6 MU in studies using these agents in dystonia. The different potency of these agents in treating sialorrhea in PD is unknown. Therefore, given a conversion factor of 1:6 MU, our dosage of 80 MU appeared to be similar to that used in the report by Nóbrega et al. Moreover, our study showed that BTX-A decreased the volume and the frequency of sialorrhea, as demonstrated in other studies, whereas in the study by Nóbrega et al., only the volume was reduced. We agree with Nóbrega et al. on the possibility that in patients with PD, sialorrhea may be secondary to swallowing disorders, although in our study, the effect of the toxin on drooling frequency was less relevant than that on the volume, and it may be linked to the severity of PD in our patients, which was not specified in the report by Nóbrega et al. Finally, another important issue to discuss may be the duration of effectiveness of treatment with BTX-A in Parkinsonian-related sialorrhea. Some patients treated with BTX-A develop secondary immune resistance or do not obtain effective control of symptoms. Therefore, given the efficacy and safety of botulinum toxin type B (BTX-B) also in the management of sialorrhea in PD, we propose switching therapy from BTXA to BTX-B in patients who are nonresponders or poor responders to BTX-A.

Unusual evolution of a non-hacek Gram-negative endocarditis in a patient with Turner syndrome

Non-HACEK Gram-negative endocarditis is a rare but severe illness, and the diagnosis can be difficult to establish. Here, we report the case of a 72-year-old woman with Turner syndrome suffering from non-typhoid Salmonella endocarditis of the triscupid valve, who benefited from prompt antibiotic treatment allowing a quick and complete recovery.

PRACTICING DERMATOLOGY IN AN INTEGRATED GERIATRIC SWISS HOSPITAL: LETTERS TO THE EDITOR

1. Nelson TD, ed. Ageism: Stereotyping and Prejudice Against Older Persons. Cambridge, MA: MIT Press, 2002. 2. Falconer M, O’Neill D. Out with ‘‘the old,’’ elderly, and aged. BMJ 2007; 334:316. 3. United Nations Committee on Economic Social and Cultural Rights. The Economic, Social and Cultural Rights of Older Persons. Geneva: United Nations High Commissioner for Human Rights, 1995. 4. Gill TM, Baker DI, Gottschalk M et al. A program to prevent functional decline in physically frail, elderly persons who live at home. N Engl J Med 2002;347: 1068–1074. 5. Smedley BD, Stith AY, Nelson AR, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington DC: National Academies Press, 2002.