1.Early Effect of 0.005% Estriol Vaginal Gel on Symptoms and Signs of Vulvovaginal Atrophy
Jesús Lázaro-Carrasco de LA FUENTE ; Marcos Cuerva GONZÁLEZ ; Silvia González RODRÍGUEZ ; Juan Luis Delgado MARÍN ; Carmen Cuevas CASTILLO ; Concepción Nieto MAGRO
Journal of Menopausal Medicine 2022;28(2):60-69
Objectives:
This study aims to assess the effect of ultralow dose 0.005% estriol vaginal gel in women with genitourinary syndrome of menopause (GSM).
Methods:
In this prospective and multicenter single-arm study, efficacy was assessed by the evaluation of the epithelial maturation value (MV), vaginal pH, symptoms and signs of vulvovaginal atrophy. Tolerability, acceptability, and the effect on intimate relationships were also evaluated.
Results:
We included 35 postmenopausal women with moderate-to-severe vaginal dryness. The most bothering symptom reported was vaginal dryness. The mean increase in the MV after 7 and 14 days of treatment were 22.1 (P < 0.001) and 39.9 (P < 0.001) points, with an increase in the superficial cells of 17.7 percentage points (pp) (95% confidence interval [CI], 7.9–27.4; P < 0.001) and 41.4 pp (95% CI, 28.2–54.6; P < 0.001) observed at the timepoints. Additionally, the pH decreased by 0.6 ± 0.7 (mean ± SD) at 7 days (P < 0.0001) and by 1.1 ± 0.8 at 14 days (P < 0.0001) from a baseline mean value of 6.3 ± 0.8. The severity of vaginal dryness (range, 0 [none] to 3 [severe]) was significantly reduced by a mean of 1.4 points (P < 0.0001) at 7 days and 2 points (P < 0.0001) at 14 days.
Conclusions
Ultralow dose 0.005% estriol vaginal gel produced a rapid improvement of most relevant symptoms and signs of GSM. This clinically meaningful response was observed from the initial days of treatment, confirming a fast onset and a progressive action.
2.Risk of Cognitive Impairment in Patients With Parkinson’s Disease With Visual Hallucinations and Subjective Cognitive Complaints
Diego SANTOS-GARCÍA ; Teresa de Deus FONTICOBA ; Carlos Cores BARTOLOMÉ ; Maria J. Feal PAINCEIRAS ; Jose M. Paz GONZÁLEZ ; Cristina Martínez MIRÓ ; Silvia JESÚS ; Miquel AGUILAR ; Pau PASTOR ; Lluís PLANELLAS ; Marina COSGAYA ; Juan García CALDENTEY ; Nuria CABALLOL ; Ines LEGARDA ; Jorge Hernández VARA ; Iria CABO ; Lydia López MANZANARES ; Isabel González ARAMBURU ; Maria A. Ávila RIVERA ; Víctor Gómez MAYORDOMO ; Víctor NOGUEIRA ; Víctor PUENTE ; Julio Dotor GARCÍA-SOTO ; Carmen BORRUÉ ; Berta Solano VILA ; María Álvarez SAUCO ; Lydia VELA ; Sonia ESCALANTE ; Esther CUBO ; Francisco Carrillo PADILLA ; Juan C. Martínez CASTRILLO ; Pilar Sánchez ALONSO ; Maria G. Alonso LOSADA ; Nuria López ARIZTEGUI ; Itziar GASTÓN ; Jaime KULISEVSKY ; Marta Blázquez ESTRADA ; Manuel SEIJO ; Javier Rúiz MARTÍNEZ ; Caridad VALERO ; Mónica KURTIS ; Oriol de FÁBREGUES ; Jessica González ARDURA ; Ruben Alonso REDONDO ; Carlos ORDÁS ; Luis M. López DÍAZ L ; Darrian MCAFEE ; Pablo MARTINEZ-MARTIN ; Pablo MIR ;
Journal of Clinical Neurology 2023;19(4):344-357
Background:
and Purpose Visual hallucinations (VH) and subjective cognitive complaints (SCC) are associated with cognitive impairment (CI) in Parkinson’s disease. Our aims were to determine the association between VH and SCC and the risk of CI development in a cohort of patients with Parkinson’s disease and normal cognition (PD-NC).
Methods:
Patients with PD-NC (total score of >80 on the Parkinson’s Disease Cognitive Rating Scale [PD-CRS]) recruited from the Spanish COPPADIS cohort from January 2016 to November 2017 were followed up after 2 years. Subjects with a score of ≥1 on domain 5 and item 13 of the Non-Motor Symptoms Scale at baseline (V0) were considered as “with SCC” and “with VH,” respectively. CI at the 2-year follow-up (plus or minus 1 month) (V2) was defined as a PD-CRS total score of <81.
Results:
At V0 (n=376, 58.2% males, age 61.14±8.73 years [mean±SD]), the frequencies of VH and SCC were 13.6% and 62.2%, respectively. VH were more frequent in patients with SCC than in those without: 18.8% (44/234) vs 4.9% (7/142), p<0.0001. At V2, 15.2% (57/376) of the patients had developed CI. VH presenting at V0 was associated with a higher risk of CI at V2 (odds ratio [OR]=2.68, 95% confidence interval=1.05–6.83, p=0.039) after controlling for the effects of age, disease duration, education, medication, motor and nonmotor status, mood, and PD-CRS total score at V0. Although SCC were not associated with CI at V2, presenting both VH and SCC at V0 increased the probability of having CI at V2 (OR=3.71, 95% confidence interval=1.36–10.17, p=0.011).
Conclusions
VH were associated with the development of SCC and CI at the 2-year follow-up in patients with PD-NC.