Aids Mania – Is It A Potential Indicator to Initiate HAART?

Introduction

Mania occurs in higher rates among individuals with HIV/AIDS, especially with the progression of HIV infection, and constitutes an additional risk factor for facilitate the HIV spread.

Objective

To provide an overview of secondary mania in HIV-infected patients.

Methods

Literature review based on PubMed/Medline, using the keywords “HIV”, “AIDS” and “mania”.

Results

Secondary mania or AIDS mania may be due to illicit or prescribed drugs, CNS infection with HIV, medical illness, including opportunistic infections. Of these, HIV neurotoxicity has been proposed to be the most important factor in its pathogenesis. Mania AIDS differs from primary mania with regard to clinical presentation, course, management and prognosis. The authors will analyze them. Besides decrease to treatment adherence, maniac symptoms also predispose to HIV risk behaviors, which may lead to further HIV transmission. Importantly, the occurrence of HIV mania may announce the transition from HIV infection to AIDS perhaps before other clinical signs are evident. Early recognition and treatment of manic symptoms with mood stabilisers, antipsychotics and HAART improve quality of life, protect from further cognitive deterioration and decrease mortality. In these patients, medication side-effects toxicity, drug interactions, and adherence require special attention.

Conclusions

Mania has been associated with HIV/AIDS and in many instances acts as a barrier to achieving best treatment outcomes. Thus, psychiatrists need to be aware of the complexities involved in the emergence of manic episodes in HIV-infected patients in order to deal with them in the most appropriate and effective manner.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Depression Among HIV-Infected Patients–A Reality that Must Not be Forgotten

Introduction

HIV-infection is a very stigmatized, chronic disease with increased rates of psychiatric disorders, being major depression the most common.

Objective

To review the recent research related to depression in HIV-infected patients.

Methods

Literature review based on PubMed/Medline, using the keywords “HIV” and “depression”.

Results

HIV-infected patients have a chance 2-7 times higher of developing major depression, around the time of diagnosis or during the course of their illness. However, only fewer than 50% of the cases are recognized clinically. Several factors contribute to its under-recognition and under-treatment, such as the overlap between the neurovegetative symptoms of depression, the somatic symptoms of HIV disease, and the effects of comorbid diseases; the mistaken belief that depressive symptoms are expected in this group; the neuropsychiatric side effects associated with some antiretrovirals. Besides, major depression presents important diagnostic challenges due to biological, psychological, and social components associated with the infection. The authors will analyze the clinical presentation.

Depression has been associated with a negative impact on quality of life, poorer HAART adherence, faster HIV disease progression and increased mortality risk. Importantly, however, appropriate psychiatric intervention can do it over. In fact, studies suggest that patients receiving SSRI treatments for depression have rates of adherence and CD4+ T-cell counts similar to non-depressed patients receiving HAART.

Conclusions

The high prevalence of major depression in HIV-positive individuals and its serious consequences if untreated, increase even further the importance of its effective identification and subsequent treatment in this group of patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

The influence of espresso coffee on neurocognitive function in HIV-infected patients

The aim of our study was to evaluate the impact of coffee intake on cognitive function in persons living with HIV (PLWH). 130 PLWH with CD4 > 200 cells/mm(3), undetectable viral load, treated with HAART were included. A structured interview was applied and relevant clinical and laboratory data were assessed, including coffee intake. For neuropsychological assessment, the HIV Neurobehavioral Research Center Battery was chosen. Univariate nonparametric statistics and multivariate regression model were used. A significant association between espresso coffee use and a better cognitive function was verified in five of the eight psychometric measurements. In the multivariate analysis, after variable adjustment, linear regression analysis showed that coffee intake was a positive predictor for attention/working memory, executive functions and Global Deficit Score. Although the mechanisms behind the influence of caffeine on cognitive functioning are controversial, regular espresso coffee intake may have favourable effects on cognitive deterioration caused by HIV.

Comparative efficiency of TiO2 nanoparticles in suspension vs. immobilization into P(VDF–TrFE) porous membranes

Optimized photocatalytic membranes based on TiO₂ and NaY immobilized into P(VDF–TrFE) have been developed showing a degradation efficiency of 96%.

Induction of chagasic-like arrhythmias in the isolated beating hearts of healthy rats perfused with Trypanosoma cruzi-conditioned medium

Chagas' myocardiopathy, caused by the intracellular protozoan Trypanosoma cruzi, is characterized by microvascular alterations, heart failure and arrhythmias. Ischemia and arrythmogenesis have been attributed to proteins shed by the parasite, although this has not been fully demonstrated. The aim of the present investigation was to study the effect of substances shed by T. cruzi on ischemia/reperfusion-induced arrhythmias. We performed a triple ischemia-reperfusion (I/R) protocol whereby the isolated beating rat hearts were perfused with either Vero-control or Vero T. cruzi-infected conditioned medium during the different stages of ischemia and subsequently reperfused with Tyrode's solution. ECG and heart rate were recorded during the entire experiment. We observed that triple I/R-induced bradycardia was associated with the generation of auricular-ventricular blockade during ischemia and non-sustained nodal and ventricular tachycardia during reperfusion. Interestingly, perfusion with Vero-infected medium produced a delay in the reperfusion-induced recovery of heart rate, increased the frequency of tachycardic events and induced ventricular fibrillation. These results suggest that the presence of parasite-shed substances in conditioned media enhances the arrhythmogenic effects that occur during the I/R protocol.

Staphylococcus aureus nasal and hand carriage among students from a Portuguese health school

This study aims to compare the frequency of Staphylococcus aureus nasal carriage among students from a Portuguese higher health school. Antimicrobial susceptibility testing was also assayed in order to detect methicillin-resistant S. aureus (MRSA) strains among the isolates. Nasal swabs and fingerprints from 60 healthy nursing and pharmacy students were collected, followed by inoculation and incubation at 37 degrees C for 24 h. All suspected S. aureus isolates were identified by routine laboratory procedures. The susceptibility to antimicrobial agents (tetracycline, gentamicin, chloramphenicol, amoxicillin/clavulanic acid, trimethoprim/sulphamethoxazole, oxacillin and vancomycin) of confirmed isolates was determined by a disc-diffusion method. Results showed 41.7% S. aureus colonisation among participants, and that the difference between nursing and pharmacy students was statistically significant. Antibiotic susceptibility testing demonstrated that S. aureus isolates showed variable sensitivity to antibiotics but, most importantly, were resistant to oxacillin and vancomycin. Although the frequency and prevalence of colonisation found is within the range previously described in healthy populations, increased resistance to antimicrobials and higher prevalence of MRSA among the student community was found.

Dayhospital of the Psychiatry Department of Hospital De São João: The Last Three and a Half Years

The Day Hospital of Hospital de São João was one of the pioneers in Portugal, and it began to work in July 1970. In those days, the main purpose was to reduce the number of full hospitalizations, and to aid the reinsertion of patients discharged from the Inpatient Unit. In a previous study, presented in the I Congresso Nacional de Psiquiatria (2005, Portugal), the first 34 years of this Day Hospital (from 1970 to 2004) were analyzed - some changes were noted during that period, namely the type of diagnosis and the hospitalization length. The main purpose of the present study was to characterize the patients that were treated in the Day Hospital of Hospital de São João during the last 3 and half years (Jan 2005- Jul 2008; n = 302), according to age, gender, diagnosis, length of hospitalization, and occupation rate. Then, these data were compared to the data of the previous study (firsts 34 years, in groups of 5 years). For this purpose, the authors used the Qui Square Test and the Kruskal - Wallis Test. It was also analyzed the distribution of the diagnosis according to gender and to length of hospitalization.

Compared Diagnostic Stability Between Mood Disorders and Psychotic Disorders in a Day-care Psychiatric Unit

Psychiatric diagnosis depends more from the experts' opinion than from the biological basis of the diseases. Therefore the lack of diagnostic stability among the psychiatric practice is not a rare situation. This usually results in increased costs in treatment and sometimes in worst outcome for the patient who is misdiagnosed at the onset of the illness.

The authors evaluated diagnostic stability among a population of 302 patients receiving psychiatric treatment in a day-care unit of a central hospital between January/2005 and June/2008. The study compared diagnostic stability of 146 patients diagnosed as mood disorder with diagnostic stability of 83 patients diagnosed as psychotic disorder.

There was high diagnostic stability either for mood disorders as for psychotic disorders. This fact provides the chance of planning more accurate treatment strategies and better outcome.

Day Hospital and Then…follow-up Two and a Half Years After the Hospitalization

Psychiatry Day Hospitals deal with a wide spectrum of disorders, being responsible for a psychosocial intervention that intends to improve patient's quality of life. The Psychiatry Day Hospital Department of Hospital de São João has thirty-eight years of activity, and has been one of the first in Portugal. The aim of this Psychiatry Unit, composed by a multidisciplinary team, is to prevent relapses and rehospitalisations, promoting the patients’ social rehabilitation, building a bridge between inpatient hospitalization and their re-entry into the community.

The primary objective of this cross-sectional study was to evaluate important aspects of service's quality, such as the use of health resources and results in functional terms. The authors made the follow-up of the patients that had been admitted in 2005 (Jan 2005 - Dez 2005; n= 77). For this purpose, it was assessed the number of attendances to the Emergency Department and hospitalizations two and a half years before and after the treatment in Day Hospital. It was also compared their current employment situation to that which preceded the Day Hospital care.

This study was performed in clinical setting among a reduced sample, with the inherent limitations. It would be appealing to replicate this investigation in a larger population and including some other variables.

Diagnostic Stability of Mood Disorders in a Psychiatry Day-hospital

Mood disorders are common and account for one of the greatest causes of disability worldwide. Accordingly, those conditions are frequent among patients treated in Psychiatry Day-Hospitals facilities. Patients referred for treatment in Hospital de São João Day-Hospital have a previous variable period of follow-up in ambulatory clinic or hospitalization, commonly, with an established diagnosis. Notwithstanding, during the Day-Hospital stay, diagnosis may be reviewed because of new clinical data. Diagnostic stability over time is an important issue in clinical practice because it may influence treatment and, therefore, the final outcome. It is closely related with the contact between the patient and the healthcare system. Diagnostic instability is commonly due to fluctuation of disease manifestation over time or presence of co-morbid psychiatric illness in combination with rigid diagnostic criteria. The main objective of this study is to evaluate the diagnosis stability of Mood Disorders among patients treated in a Psychiatry Day-Hospital, applying ICD-10. The clinical sample includes patients admitted to Hospital de São João Psychiatry Day-Hospital whose main diagnosis is a Mood Disorder (F30-39), in the period between January 2005 and June 2008. Admission and delivery diagnosis were compared for each patient in this diagnostic category. Results suggest a high level of stability in this diagnostic group in the Day Hospital setting. For global conclusions about stability of Mood Disorders it would be interesting to replicate this study with larger samples and in different settings.

The prevalence of multiple sclerosis in the District of Santarém, Portugal

The prevalence of multiple sclerosis (MS) in Portugal is still unknown. Recent studies conducted in southern European countries showed higher than expected rates of MS prevalence. In an attempt to evaluate the MS prevalence in Santarém--a district with 62621 inhabitants (1991 census) located in the centre of Portugal--we have conducted a population survey in this district for five years. The crude prevalence rate found was 46.3/100,000. This figure is not different from findings recently reported in studies conducted at similar latitudes in neighbour southern European countries. This was the first population survey conducted in Portugal, and it is the first accurate contribution to the knowledge of the MS prevalence in this country.

[Multicenter study of isolated micro-organisms resistant to antimicrobials in 10 Portuguese hospitals in 1994]

In 1994, Microbiology Laboratories of ten Portuguese hospitals analysed isolated microorganisms found in blood and urine samples and studied antimicrobial susceptibilities of the most frequent bacterial pathogens. From 63780 blood samples, the most frequent were Staphylococcus spp. and from 69189 urine samples significant numbers of Escherichia coli, Enterococcus spp., Pseudomonas aeruginosa and Candida spp. were isolated. Escherichia coli strains (c.7000) revealed a low percentage of resistance to antibiotics with the exceptions of ampicillin (48%) and co-trimoxazol (25%). Klebsiella pneumoniae isolates (c.2000) revealed important resistance to ampicillin (98%), cephalotin (31%), co-trimoxazol (38%) and gentamicin (28%), while values for 3rd generation cephalosporins varied among hospitals, with several strains showing phenotype of extended-spectrum beta-lactamase. A great variation in resistance values of P. aeruginosa (c.4000) was found in relation to the antibiotics as well as to the hospitals. Resistance to methicillin in S. aureus (c.6000) was high, reaching an average of 47%, and it was even higher with S. epidermidis (c.3000) and S. haemolyticus (c.650). Only vancomycin was always active against these strains. In E. faecalis (c.2500) resistance was of 2% to ampicillin, 35% to gentamicin, 45% to streptomycin and 1% to vancomycin. E. faecium isolates (c.300) showed the most worrying results with 70% resistance to ampicillin, 42% to gentamicin, 59% to streptomycin and 9% (30 strains isolated in 5 hospitals) to vancomycin. Vancomycin resistant strains were also resistant to all other antibiotics.

The relationship between treatment goals and recidivism among child molesters

Preliminary findings from a longitudinal outcome study of sex offender treatment are presented. Ss included 76 child molesters who were treated in a comprehensive relapse prevention program, and 79 molesters who were randomly assigned to a control (no treatment) condition. Three sets of findings are reported: survival analyses of time to reoffense; in-treatment change data relevant to the program's treatment goals; and the relationships between treatment measures and risk of reoffense. Over an average followup period of 38 months, there was a trend for treatment Ss to be at lower risk for both sex and violent crimes than were controls. Treatment Ss showed significant progress towards treatment goals of increased acceptance of personal responsibility for their crimes and decreased levels of deviant sexual arousal. Measures of personal responsibility, however, were not related to risk of rearrest for new sex crimes. Treatment Ss with high levels of both deviant and nondeviant sexual arousal were more likely to commit new sex offenses, but not other violent offenses. The strongest predictor in the study was a measure of the Ss' skills in applying the relapse prevention model, with highly skilled Ss being less likely to commit new sex crimes.

Thyroid hormone receptor modulates the expression of the rabbit cardiac sarco (endo) plasmic reticulum Ca(2+)-ATPase gene

We have analyzed the effect of thyroid hormone (T3) on SERCA2 gene expression using fetal chicken primary cardiac myocytes and C2C12 skeletal muscle cells in culture. Northern blot analysis of both cell types demonstrated that T3 induced a 3-fold accumulation of SERCA2 mRNA compared with cells grown in medium lacking T3. We have engineered deletion constructs containing various lengths of the 5'-flanking region from the rabbit SERCA2 gene which we have cloned previously (Zarain-Herzberg, A., MacLennan, D. H., and Periasamy, M. (1990) J. Biol. Chem. 265, 4670-4677). A stable transfectant in C2C12 containing a chimeric SERCA2/CAT gene construct including -254 base pairs (bp) of SERCA2 5'-flanking region showed increased transcription activity upon the addition of 50 nM T3. We have analyzed the expression of several deletion constructs spanning 1,102 bp of the 5'-up-stream sequence of the SERCA2 gene by functional expression assays. Transient coexpression of the T3 receptor alpha 1 with various SERCA2/CAT deletion constructs showed trans-activation of chimeric constructs containing more than -267 bp, indicating that a thyroid hormone-responsive element was localized, at least in part, to the region -267 to -72 bp. T3 receptor-DNA binding assays demonstrated binding of the rat T3 receptor alpha 1 to a fragment containing a proposed T3 response element located between position -254 and -72 in the 5'-flanking region of the SERCA2 gene.

Talocalcaneal coalition: diagnosis and surgical management

The authors studied 22 patients who had 32 feet with symptomatic talocalcaneal coalition. All feet were treated with excision of the bar and interposition of an autogenous free fat graft. These cases were assessed clinically and radiographically before and after the operation. They conclude that this technique is a good surgery with gratifying results. In the final outcome, 78.1% of feet became completely painless and 21.8% achieved relief of pain. There was improvement of the deformity in 68.7% and of range of motion in 75%.

Cytogenetics in ophthalmology

The development of human clinical cytogenetics has been comparatively recent. The authors made an analytical study of chromosomes in patients presenting ocular coloboma with mental deficiency, strabismus with malformation, and other disorders in order to define the genetic aspect of these diseases. They obtained in these patients chromosomal alterations, including translocation, aneuploidies, suggesting the importance of cytogenetic analysis in eye affections even if these are considered of monogenic character.

Dermatoglyphics in color blindness

In four families of color blind subjects, a dermatoglyphic analysis was made and the results compared with data from normal subjects. The Student's t test, howeverf failed to show any significant differences in the means of the two groups.