Minerva medica
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The antimicrobial trimethoprim is structurally related to potassium-sparing diuretics and may consequently lead to derangements in electrolyte and acid-base balance. Since no report so far analyzed the literature documenting individual cases with electrolyte and acid-base derangements induced by trimethoprim, a systematic review was carried out. ⋯ High-dose trimethoprim, comedicated with drugs that have been associated with electrolyte and acid-base derangements, poor kidney function, age ≥80 years and diabetes mellitus predispose to trimethoprim-associated electrolyte and acid-base abnormalities. Clinicians must recognize patients at risk, possibly avoid drug combinations that may worsen the problem and monitor the laboratory values.
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Current investigations in pre-symptomatic dementia have suggested that depressive mood, a treatable condition, may play an important role in the development of the disorder. However, whether depression in adulthood constitute a risk factor, or a prodrome of dementia remains unclear. A major implication in such dispute is the analytic framework used to identify putative risk factors. ⋯ Additionally, the potential confounding effect of several variables on the risk association between depression and dementia, an aspect hardly investigated, is discussed. While early onset late-life depression - defined as starting before 60 years of age - increases the odds of developing dementia in predisposed subjects, late-onset depression appears to be a prodrome and a clear accelerating factor for cognitive deterioration. Since it is increasingly important to consider the potential of preemptive approaches to decrease the impact of dementia, evidence on potentially effective preventive strategies targeting depression as a risk factor, and next steps in further research are presented as concluding remarks.
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The neurologic complications of rheumatic diseases (RDs) are highly variable, and their manifestations are linked to the pathogenesis and clinical phenotype of the specific RDs. In rheumatoid arthritis, for example, the peripheral nervous system is most commonly involved and mononeuritis multiplex, nerve entrapment and vasculitic sensorimotor neuropathies are not uncommon. Often the therapy for these disorders is not easy and is characterized by the use of different drugs. Palmitoylethanolamide (PEA) has been tested in a wide variety of animal models and has been evaluated in several clinical studies for nerve compression syndromes, demonstrating that PEA acts as an effective and safe analgesic compound. Acetyl-L-Carnitine (ALC) has also been shown to be an effective and safe treatment in painful peripheral neuropathy. In the last years the synergistic effect between PEA and ALC has been demonstrated. The aim of our study was to evaluate the efficacy of supplementation of standard therapy (STh) with Kalanit® (Chiesi Italia Spa; Parma, Italy) in patients with peripheral neuropathy secondary to RDs. ⋯ The synergistic effect of PEA and ALC seems to have a further advantage in the treatment of this type of pathology, including the anti-inflammatory effect but also in terms of therapy optimization and therefore of better adherence to treatments. Our study shows that it is important to identify the type of pain to follow an accurate diagnostic algorithm, considering the clinical characteristics of the patient and carefully evaluate the indication, preferring a multimodal approach.