A Double-Blind,Randomised, Crossover Trial of Two Botulinum Toxin Type A in Patients with Spasticity

Background

Botulinum toxin type A (btxA) is one of the main treatment choices for patients with spasticity. Prosigne® a new released botulinum toxin serotype A may have the same effectiveness as Botox® in focal dystonia. However, there are no randomized clinical trials comparing these formulations in spasticity treatment. The aim of our study was to compare the efficacy and safety of Prosigne® with Botox® in the treatment of spasticity.

Methodology/Principal Findings

We performed a double-blind, randomized, crossover study consisting of 57 patients with clinically meaningful spasticity. The patients were assessed at baseline, 4 and 12 weeks after Prosigne® or Botox® administration. The main outcomes were changes in the patients’ Modified Ashworth Scale (MAS), Functional Independence Measure (FIM) and Pediatric Evaluation of Disability Inventory (PEDI) scores and adverse effects related to the botulinum toxin. Both of the toxins were significantly effective in relieving the level of spasticity in adults and children. There were no significant differences found between the Prosigne® and Botox® treatments regarding their MAS, FIM and PEDI scores. Likewise, the incidence of adverse effects was similar between the two groups.

Conclusion

Our results suggest that Prosigne® and Botox® are both efficient and comparable with respect to their efficacy and safety for the three month treatment of spasticity.

Trial Registration

ClinicalTrials.gov {"type":"clinical-trial","attrs":{"text":"NCT00819065","term_id":"NCT00819065"}}NCT00819065.     

Parathyroidectomy Improves Survival In Patients with Severe Hyperparathyroidism: A Comparative Study

Background and objectives

Secondary hyperparathyroidism (SHPT) in CKD is associated with an increased risk for mortality, but definitive data showing that parathormone control decreases mortality is still lacking. This study aimed to compare the mortality of patients with severe SHPT submitted to parathyroidectomy(PTX) with those who did not have access to surgery.

Methods

This is a retrospective study in a cohort of 251 CKD patients with severe SHPT who were referred to a CKD-MBD Center for PTX from 2005 until 2012.

Results

Most of our patients had indication of PTX, but only 49% of them had access to this surgical procedure. After a mean follow-up of 23 months, 72 patients had died. Non-survivors were older; more often had diabetes, lower serum 25 vitamin D and mostly had not been submitted to surgery. The relative risk of death was lower in the PTX patients (0.428; 95% CI, 0.28 to 0.67; p<0.0001). After adjustments, mortality risk was dependent on age (1.04; 95% CI, 1.01 to 1.07; p = 0.002), 25 vitamin D (0.43; 95% CI, 0.24 to 0.81; p = 0.006) and no access to PTX (4.13; 95% CI, 2.16 to 7.88; p<0.0001). Results remained the same in a second model using the PTX date as the study start date for the PTX group.

Conclusions

Our data confirms the benefit of PTX on mortality in patients with severe SHPT. The high mortality encountered in our population is significant and urges the need to better treat these patients.     

Mortality,Morbidity, and Developmental Outcomes in Infants Born to Women Who Received Either Mefloquine or Sulfadoxine-Pyrimethamine as Intermittent Preventive Treatment of Malaria in Pregnancy: A Cohort Study

Background

Little is known about the effects of intermittent preventive treatment of malaria in pregnancy (IPTp) on the health of sub-Saharan African infants. We have evaluated the safety of IPTp with mefloquine (MQ) compared to sulfadoxine-pyrimethamine (SP) for important infant health and developmental outcomes.

Methods and Findings

In the context of a multicenter randomized controlled trial evaluating the safety and efficacy of IPTp with MQ compared to SP in pregnancy carried out in four sub-Saharan countries (Mozambique, Benin, Gabon, and Tanzania), 4,247 newborns, 2,815 born to women who received MQ and 1,432 born to women who received SP for IPTp, were followed up until 12 mo of age. Anthropometric parameters and psychomotor development were assessed at 1, 9, and 12 mo of age, and the incidence of malaria, anemia, hospital admissions, outpatient visits, and mortality were determined until 12 mo of age. No significant differences were found in the proportion of infants with stunting, underweight, wasting, and severe acute malnutrition at 1, 9, and 12 mo of age between infants born to women who were on IPTp with MQ versus SP. Except for three items evaluated at 9 mo of age, no significant differences were observed in the psychomotor development milestones assessed. Incidence of malaria, anemia, hospital admissions, outpatient visits, and mortality were similar between the two groups. Information on the outcomes at 12 mo of age was unavailable in 26% of the infants, 761 (27%) from the MQ group and 377 (26%) from the SP group. Reasons for not completing the study were death (4% of total study population), study withdrawal (6%), migration (8%), and loss to follow-up (9%).

Conclusions

No significant differences were found between IPTp with MQ and SP administered in pregnancy on infant mortality, morbidity, and nutritional outcomes. The poorer performance on certain psychomotor development milestones at 9 mo of age in children born to women in the MQ group compared to those in the SP group may deserve further studies.

Trial registration

ClinicalTrials.gov {"type":"clinical-trial","attrs":{"text":"NCT00811421","term_id":"NCT00811421"}}NCT00811421     

Offshore and coastal common bottlenose dolphins of the western South Atlantic face‐to‐face: What the skull and the spine can tell us

The taxonomy of Tursiops truncatus in the western South Atlantic is not resolved. Two different hypotheses have been proposed: (1) offshore and coastal ecotypes with a parapatric distribution, and (2) two species, T. truncatus and T. gephyreus, living in sympatry. To test these hypotheses, we examined a total of 100 physically mature skulls and 35 vertebral columns from the suggested overlap zone in southern Brazil. In all skulls, 24 measurements, four alveoli counts and two categorical variables were analyzed. Vertebral formula was determined and five measurements were taken from selected vertebrae. Multivariate analyses were conducted for skull and vertebral data. Results revealed the presence of two well‐separated groups. Specimens of Group1 had smaller skulls and shorter body lengths, but more vertebrae, than Group2. The morphological characteristics of each group corresponded well with two ecotypes of common bottlenose dolphins reported in other ocean basins. Therefore, we assigned the specimens of Group1 to the offshore ecotype, and Group2 to the coastal ecotype. Differences in the geographic locations and ratio of strandings supported the parapatric hypothesis. The significant morphological differentiation observed suggests the presence of different subspecies, but an additional independent line of evidence is needed to hypothesize whether they represent different species.     

Phytoremediation and natural attenuation of sulfentrazone: mineralogy influence of three highly weathered soils

Abstract

This study evaluated remediation of the herbicide sulfentrazone in soils with three different mineralogies (kaolinite, hematite, and gibbsite) and three remediation sulfentrazone treatments (Canavalia ensiformis L., Crotalaria juncea L., and natural attenuation). This study was conducted in a factorial scheme, in triplicate with randomized block design. Sulfentrazone was applied at 0 and 400?g ha^?1. We analyzed sulfentrazone residue in the soils by high-performance liquid chromatography and confirmed the results with bioassays of Pennisetum glaucum. Herbicide movement was greater in the kaolinitic soil without plant species. The retention of herbicide in the kaolinitic soil occurred in larger quantities in the 0–12?cm layer, with higher levels found in the treatments with plants. In the hematitic soil with C. juncea, all applied herbicides were concentrated in the 0–12?cm layer. In the other hematitic soil treatments, sulfentrazone was not detected by chemical analysis at any soil depth, although in many treatments, it was detected in the bioassay. Phytoremediation was more efficient with C. ensiformis grown in gibbsitic soil, reducing the sulfentrazone load by approximately 27%. Natural attenuation was more efficient than phytoremediation in oxidic soils due to soil pH and texture soils favored microbial degradation of the compound.

• Highlights

• The influence of soil mineralogy of herbicide sulfentrazone retention was evaluated.

• Canavalia ensiformis and Crotalaria juncea were evaluated as phytoremediation plants.

• Kaolinite soils presented great movement of sulfentrazone in the soil.

• Natural attenuation is more efficient in oxide soils than phytoremediation.