De novo depression and anxiety disorders and influence on adherence during peginterferon-alpha-2a and ribavirin treatment in patients with hepatitis C

BACKGROUND

Depression and anxiety have been associated with interferon treatment and low treatment adherence.

AIM

To study the incidence and associated risk factors of depressive and anxiety disorders during pegylated interferon plus ribavirin and treatment adherence in a prospective cohort of 176 patients with chronic hepatitis C patients.

METHODS

Patients were interviewed at baseline using the Structured Clinical Interview for DSM-IV Mental Disorders and the Patient Health Questionnaire and the Hospital Anxiety and Depression Scale were completed. Both questionnaires were completed also after 4, 12 and 24 weeks of treatment.

RESULTS

De novo depressive and/or anxiety disorders were diagnosed in 53 (36%) patients, in whom antidepressants and/or anxiolytics were administered. Higher baseline depression-subscale score (OR = 27.8, 95% CI = 2.82-333), primary education level (OR = 3.1, 95% CI = 1.40-7.03) and being an immigrant (OR = 3.2, 95% CI = 1.12-9.47) were predictors of psychiatric disorders during anti-viral therapy. The percentage of patients with good adherence was lower in those with depression and/or anxiety (79% vs. 90%, P < 0.04). Only one patient (1%) discontinued treatment because of a major depressive episode. Depression and/or anxiety disorders had no effect on attainment of sustained virological response.

CONCLUSION

Early detection and treatment of depressive and anxiety disorders favours good adherence to anti-viral treatment in hepatitis C.

Combining fetal nuchal fold thickness with second-trimester biochemistry to screen for trisomy 21

OBJECTIVE

To assess second-trimester screening for trisomy 21 by combining ultrasound nuchal fold (NF) measurement with maternal serum biochemistry.

METHODS

NF, maternal serum alpha-fetoprotein (AFP) and free beta-human chorionic gonadotropin (beta-hCG) were determined concurrently at 14-19 weeks' gestation in a study population comprising 1813 women with singleton pregnancies, including 1257 unselected women undergoing serum screening for trisomy 21 (1999-2002), and 556 high-risk pregnancies prior to amniocentesis (2003-2005), 402 of whom had positive serum screening tests. The results were expressed in multiples of the gestation-specific normal median (MoMs).

RESULTS

There were 1799 unaffected singleton pregnancies, and their NF values approximately fitted a log Gaussian distribution over a wide range. There was a weak but statistically significant correlation between log NF and log AFP (r = - 0.069, P < 0.005) and the correlation coefficient between log NF and log free beta-hCG was even smaller and not statistically significant (r = 0.038, P = 0.11). Among the seven trisomy 21 pregnancies, the median NF level was 1.53 MoM (geometric mean 1.75 MoM), a highly statistically significant increase compared with unaffected pregnancies (P < 0.0001, one-tail Wilcoxon Rank Sum Test). In pregnancies referred because of positive serum screening tests (391 unaffected, seven cases of trisomy 21, one of monosomy X and three other chromosomal anomalies) the use of NF to modify the serum screening risk would have reduced the invasive procedures in unaffected pregnancies by 46% without affecting the detection rate of trisomy 21 or other anomalies. Statistical modeling predicted that adding NF to AFP and free beta-hCG would increase detection more than would adding unconjugated estriol as well as inhibin-A, an analyte that is difficult to measure with precision.

CONCLUSIONS

The addition of NF measurement to second-trimester biochemical markers improves screening performance, and could overcome drawbacks in the implementation of inhibin-A assay in clinical practice.

Compound-specific carbon isotope analysis of volatile organic compounds in water using solid-phase microextraction

The compound-specific isotope analysis technique in conjunction with solid-phase microextraction using a carboxen-polydimethylsiloxane fiber was tested and implemented for isotopes analyses of organic compounds aiming for environmental application in contaminated groundwater. delta(13)C values of several chlorinated methanes and ethenes, toluene and chlorobenzene were determined using a gas chromatograph coupled to an isotope ratio mass spectrometer through a combustion interface. Direct and headspace solid-phase microextraction (D-SPME, HS-SPME) methods were tested in order to determine the optimum conditions to obtain reproducible delta(13)C values at very low concentration (microg/L range) and, to elucidate the carbon isotopic effects associated with the competitive extraction. For D-SPME, higher accuracy and precision of delta(13)C results were obtained with no salted aqueous standards. Despite that the delta(13)C of those compounds analyzed with both methods showed similar precision (<0.5 per thousand) and accuracy, the highest sensitivity was reached with HS-SPME. Furthermore, the delta(13)C values of cis-1,2-dichloroethylene, chorinated methanes and aromatic compounds obtained using HS-SPME showed measurable deviations with respect to the isotopic composition of pure phase compounds, however, these deviations are constant according to the analytical uncertainties, indicating that they are not affected by competitive extraction, and they could be corrected using standard correction technique based on internal calibrated standards.

Pseudodicentric 22;Y translocation transmitted through four generations of a large family without phenotypic repercussion

The most frequent Y-autosome translocations involve an acrocentric autosome and they are frequently familial with neither phenotypic nor reproductive repercussion. However, different Y-autosome translocations have been related to infertility, due to abnormal pairing of the X and Y chromosomes at meiosis and an abnormal XY-body formation or by the disruption of the AZFs (Azoospermic Factor). Rare forms of Y-autosome translocations are those resulting in an unbalanced 45-chromosome karyotype that includes a dicentric Y+autosome chromosome. We describe a new case of a familial pseudodicentric 22;Y that is carried by 19 male members of a large family without phenotypic repercussion. Cytogenetic analysis, fluorescence in situ hybridisation (FISH) and subtelomeric Multiplex Ligation-dependent Probe Amplification (MLPA) assay have been performed. All male members of the family showed the karyotype 45,X,psu dic(22;Y)(p11.2;qter).ish psu dic(22;Y) (SRY+,DYZ3+,D14/D22Z1+). In conclusion, the presence of the dicentric chromosome in the male members of the family reported does not seem to interfere with the correct progression of spermatogenesis.

Cognitive behavioural therapy for anxiety disorders in children and adolescents

BACKGROUND

Childhood and adolescent anxiety disorders are relatively common, occurring in between 5-18% of all children and adolescents. They are associated with significant morbidity and impairment in social and academic functioning, and when persistent, there is a risk of depression, suicide attempts and substance abuse in adulthood. There is accumulating evidence for the efficacy of cognitive behavioural therapy (CBT), with a number of randomised controlled trials (RCTs) suggesting benefit.

OBJECTIVES

To determine whether CBT is an effective treatment for childhood and adolescent anxiety disorders in comparison to waiting list or attention controls.

SEARCH STRATEGY

Search of the Cochrane Register of Controlled Trials and the Cochrane Depression, Anxiety and Neurosis Group Register, which includes relevant randomised controlled trials from the bibliographic databases - The Cochrane Library ( to January 2004), EMBASE, (1970-2004) MEDLINE (1970-2004) and PsycINFO (1970-2004). We also searched the references of all included studies and relevant textbooks, and contacted authors in order to identify further trials.

SELECTION CRITERIA

. Each identified study was assessed for possible inclusion by two reviewers independently. Inclusion criteria consisted of randomised controlled trials of CBT versus waiting list/attention controls in children (more than six years of age) and adolescents (under the age of 19 years) with a DSM (Diagnostic Statistical Manual) or ICD (International Classification of Diseases) anxiety diagnosis; and excluding simple phobia, obsessive compulsive disorder and post-traumatic stress disorder. Each study was required to conform to the principles of CBT through use of a protocol and comprising at least eight sessions of CBT.

DATA COLLECTION AND ANALYSIS

The methodological quality of included trials was assessed by two reviewers independently. The dichotomous outcome of remission of anxiety diagnosis was pooled using relative risk (RR) with 95% confidence intervals. Means and standard deviations of anxiety symptom continuous scores were pooled using the standardised mean difference (SMD). Heterogeneity was assessed and intention-to-treat (ITT) analyses undertaken. The presence of publication bias was assessed using funnel plots.

MAIN RESULTS

Thirteen studies with 498 subjects and 311 controls met the inclusion criteria and were included in the analyses. The studies involved community or outpatient subjects only, with anxiety of only mild to moderate severity. ITT analyses showed a response rate for remission of any anxiety diagnosis of 56% for CBT versus 28.2% for controls (RR 0.61,95%CI 0.53 to 0.69), with no evidence of heterogeneity. The number needed to treat (NNT) was 3.0 (95%CI 2.5 to 4.5). For reduction in anxiety symptoms, the SMD was -0.58 (95% CI 0.76 to -0.40) with no significant heterogeneity indicated. Individual, group and family/parental formats of CBT produced fairly similar outcomes.

AUTHORS' CONCLUSIONS

Cognitive behavioural therapy appears an effective treatment for childhood and adolescent anxiety disorders in comparison to waiting list or attention control. There was no evidence for a difference between an individual, group or parental/family format. CBT can be recommended for the treatment of childhood and anxiety disorders, although with only just over half improving, there is a need for further therapeutic developments.

Relative vs. absolute statistical analysis of compositions: a comparative study of surface waters of a Mediterranean river

Most hydrogeological research includes some sort of statistical study, which is generally conducted on the raw measures of chemical variables, though there are several theoretical and practical studies warning against this practice. Arguments refer mainly to the positive character of this type of data, and to the fact that they carry only information about the relative abundance of each component on the whole, what makes techniques based on correlation, like the widely used Principal Component Analysis (PCA), loose their meaning. The solution proposed by Aitchison (1982, Journal of the Royal Statistical Society, Series B 44(2), 139-177)-based on working with log-ratios of observations-is equivalent to define a new distance between compositions and to adapt usual statistical techniques to it. To illustrate its effect, our study compares the performance of the biplot-a PCA graphical technique-according to the usual Euclidean and to the Aitchison distance. The study is conducted on a set of 14 molarities measured monthly through the years 1997-1999 at 30 different stations along the Llobregat River and its tributaries (Barcelona, NE Spain). Ordinary analysis, implicitly based on an Euclidean distance, presents some deficiencies, mainly because it only captures major ion variations and the inferred relationship between them actually depends on other non-relevant variables, such as water mass. An analysis based on compositional distances captures variations of all the ions; it is robust against the inclusion of non-relevant variables in the analysis; and it offers a way to build factors expressed as equilibrium equations. In our case, two promising factors are extracted, showing the different anthropogenic and geological pollution sources of the rivers.

Improvement of coagulation-flocculation process using anionic polyacrylamide as coagulant aid

A physicochemical treatment (coagulation-flocculation) was applied to a slaughterhouse wastewater, using anionic polyacrylamide as coagulant aid to improve the settling velocity of the flocs formed with the coagulants used: ferric sulphate, aluminium sulphate and polyaluminium chloride. The optimum speed and stirring time for the flocculation stage were ascertained along with the optimum pH and coagulant and coagulant aid doses. The speed and coagulation time were initially set according to recommendations in the literature concerning the treatment of this type of water. Chemical oxygen demand (COD), biochemical oxygen demand at 5 days (BOD5) and total suspended solids (TSS) were recorded at the beginning and end of each experiment in order to monitor the process. Once the optimal conditions had been established, several parameters were measured in order to assess the coagulation-flocculation process: particle number and size, sludge volume, nutrients (ammonia nitrogen, total Kjeldahl nitrogen, albuminoid nitrogen, orthophosphate, total phosphorus) and the residual concentration of iron and aluminium in clarified water. Anionic polyacrylamide, when added with ferric sulphate or polyaluminium chloride led to a significant increase in the settling speed.

[Differences in the subjective effects of drugs in patients with a first psychotic episode. Preliminary results]

INTRODUCTION

The study of the subjective effects of abuse substances may facilitate comprehension of the high prevalence of substance abuse in psychosis.

OBJECTIVE

To assess the subjective effects of psychoactive substances in psychotic patients with substance use disorder in a prospective open study with a 6 month evaluation.

METHODS

Thirty patients consecutively admitted for the first time to a psychiatric hospital because of a psychotic disorder (DSM-IV) were included. Sociodemographic data, substance use history, drug urine test, and severity of psychotic symptoms measured by BPRS, SANS and SAPS were evaluated. The subjective effects of drugs were assessed with the short form of the ARCI questionnaire. Patients were re-assessed at six months followup.

RESULTS

Sixty-three percent of patients were male, mean age 29.2 years. A total of 46.6% presented at least one substance use disorder. Differences between substance users group and non-substance users group were only related to sex (more male in substance user group), and no other sociodemographic and clinical differences were found. The main abuse drugs found were: 86% cannabis, 17% cocaine, 17% alcohol, 3% heroin and 3% hypnosedatives. Fifty percent only consumed cannabis. The psychotic patients with substance use disorder showed higher punctuation in MBG scale (euphoria scale); no differences in other ARCI scales were found. At six months follow-up, 83.3% patients were re-assessed and no differences were found.

CONCLUSIONS

The psychotic patients with substance use disorder showed a higher subjective effect of euphoria than non-substance user psychotics, suggesting that drug use is mainly related to obtaining euphoria-like effects than sedatives in this group.

Ion regulation in the different life stages of Trypanosoma cruzi

Different ion and pH regulation mechanisms have been detected in the three main life stages of Trypanosoma cruzi: epimastigote, metacyclic trypomastigote and amastigote. Treatment with amiloride showed that the Na(+)/H(+) exchanger participated in all three forms. The Na(+)/K(+) ATPase exchanger appeared to be more active in the epimastigote than in the other forms. V-H(+)-ATPase inhibitors revealed the activity of this regulatory mechanism in the amastigote and epimastigote forms, while treatment with oligomycin only affected the amastigotes. The HCO(-)(3)/Cl(-) exchanger was found in all stages as well as in the intracellular pH-regulatory mechanism after abrupt basification. We deduce that ion regulation in T. cruzi is a complex process and depends upon the precise stage of the cell cycle of the parasite. It would seem to be an important mechanism, allowing the parasite to adapt to the changing environmental conditions within which it develops.

Microscopic observation of particle reduction in slaughterhouse wastewater by coagulation-flocculation using ferric sulphate as coagulant and different coagulant aids

A coagulation-flocculation treatment has been applied to a slaughterhouse liquid effluent, using ferric sulphate as coagulant and activated silica, powdered activated carbon, cationic polyacrylamide, polyvinyl alcohol, polyacrylic acid and anionic polyacrylamide as coagulant aids in order to improve the settling time. Once the optimal conditions had been established (speed and time of stirring during flocculation step, pH, coagulant and coagulant aid doses), the efficiency of the coagulation-flocculation process was studied by comparing the particle size distribution before and after the addition of the coagulant. When ferric sulphate was used without the coagulant aids, particle removal efficiency varied with size, although overall efficiency was quite substantial (87%). The use of coagulant aids improved the removal efficiency, except in the case of activated silica, when it fell to 78%. In all other cases removal efficiency values between 93% (for polyvinyl alcohol) and 99% (for anionic polyacrylamide) were reached.

Sulphur isotopes as tracers of the influence of potash mining in groundwater salinisation in the Llobregat Basin (NE Spain)

Conventional chemical data for spring and river waters are presented together with sulphur isotopic data for dissolved sulphate to elucidate the source of water salinisation in the middle section of the Llobregat River. As dilution processes do not affect sulphur isotopic composition, the analysis of delta34S of dissolved sulphate in waters provides an excellent tool for quantifying the environmental impact caused by the mining activity existing in the area. The delta34S of dissolved sulphate from mining effluents and saline springs unrelated to mining activity was analysed. The results obtained range from + 18 per thousand to + 20 per thousand (VCDT) for mining effluents and from + 10 per thousand to + 14 per thousand (VCDT) for natural saline springs. These values are in accordance with the pattern of sulphur isotopic composition of sulphates from the evaporite materials of this area. This distinctive isotopic composition has allowed us to determine the origin of salinity in those cases in which chemical features are not conclusive. In addition, two fertilisers widely used in the studied area are chemically and isotopically characterised and their contribution to groundwater salinisation is assessed.

Nutrient removal and sludge production in the coagulation-flocculation process

Nutrient removal and sludge production in the coagulation-flocculation process, applied to a slaughterhouse effluent, have been studied. Fe2(SO4)3, Al2(SO4)3 and polyaluminium chloride were used as coagulants. Inorganic products were used as coagulant aids: activated silica, powdered activated carbon and precipitated calcium carbonate and synthetic polyelectrolytes: cationic polyacrylamide, polyacrilic acid, anionic polyacrylamide and polyvinyl alcohol. Performances were measured under optimum conditions for the products used. They were found after studying the different variables which influence the process. Phosphorus removal is very high (approximately 100% for the orthophosphate and between 98.93% and 99.90% for the total phosphorus). Ammonia nitrogen removal is very low although appreciable performances are observed for albuminoid nitrogen (73.9-88.77%). The use of coagulant aids reduces the volume of the sludge produced up to 41.6%.

An antifungal exo-alpha-1,3-glucanase (AGN13.1) from the biocontrol fungus Trichoderma harzianum

Trichoderma harzianum secretes alpha-1,3-glucanases when it is grown on polysaccharides, fungal cell walls, or autoclaved mycelium as a carbon source (simulated antagonistic conditions). We have purified and characterized one of these enzymes, named AGN13.1. The enzyme was monomeric and slightly basic. AGN13.1 was an exo-type alpha-1,3-glucanase and showed lytic and antifungal activity against fungal plant pathogens. Northern and Western analyses indicated that AGN13.1 is induced by conditions that simulated antagonism. We propose that AGN13.1 contributes to the antagonistic response of T. harzianum.

Salt stress increases the Ca2+-independent phosphoenolpyruvate carboxylase kinase activity in Sorghum leaves

In C4 plants, the photosynthetic enzyme phosphoenolpyruvate carboxylase (PEPCase; EC 4.1.1.31) is subjected to a phosphorylation process via the light-dependent up-regulation of a Ca2+-independent PEPCase-kinase. The present work aimed to study the effect of salt stress on PEPCase phosphorylation in Sorghum vulgare Pers. leaves. The growth of salt-treated plants was reduced compared with that of the control plants. PEPCase activity modestly increased (around 20-40%) whereas PEPCase phosphorylation was markedly enhanced, on a protein basis, in extracts from illuminated leaves. The enhanced protein kinase activity was found to display a low molecular mass in the range 32-35 kDa, to be independent of Ca2+ and to be up-regulated by light. Furthermore, up-regulation was blocked in vivo by the cytosolic protein synthesis inhibitor cycloheximide. Collectively, these data demonstrated that salinity stress altered the Ca2+-independent PEPCase-kinase, presumably by increasing the mesophyll content of the enzyme. Potassium chloride, but not abscisic acid, mimicked the effect of NaCl on PEPCase-kinase activity.

Mitochondrial involvement in antiretroviral therapy-related lipodystrophy

OBJECTIVES

The management of HIV infection has greatly improved during recent years essentially because of the appearance of new antiretroviral drugs. Highly active antiretroviral therapy (HAART) has achieved important reductions of viraemia and significant recoveries of CD4(+) cell counts in HIV-infected patients. Nonetheless, cases of HIV-infected individuals experiencing lipodystrophy (LD) are being increasingly reported. The purpose of this work was to analyse whether the presence of mitochondrial abnormalities is a frequent feature in LD, since we previously detected mitochondrial abnormalities in an HIV-patient. The second main objective was to study whether LD could be associated with a specific drug.

DESIGN

Seven HIV patients presenting LD and five HIV non-LD controls participated in the study. LD patients met the following criteria: (1) LD was their only clinical abnormality, (2) LD was clinically relevant, (3) compliance with antiretroviral treatment was higher than 90% and (4) patients did not have personal or familial history suggestive of mitochondrial disease or neuromuscular disorder.

METHODS

Histological stainings, histo-enzymatic reactions, enzymatic and respiratory activities of mitochondrial respiratory chain complexes, and mitochondrial DNA (mtDNA) depletion and rearrangements were examined on muscle mitochondria.

RESULTS

Structural muscle abnormalities, mitochondrial respiratory chain dysfunction or mtDNA deletions were detected in all HIV lipodystrophic patients.

CONCLUSIONS

The mitochondrial abnormalities found suggest that mitochondrial dysfunction could play a role in the development of antiretroviral therapy-related lipodystrophy.

Neoplasia of plasma cells with atypical presentation and infection by the human immunodeficiency virus. A presentation of two cases

Neoplasia of plasma cells acquires special clinical characteristics in patients infected by human immunodeficiency virus (HIV). These patients are much younger at the time of diagnosis, and when they are compared with the general population they show an atypical clinical evolution, with a greater frequency of solitary plasmacytomas, less evidence of a monoclonal plasmatic component, or greater aggressiveness of the neoplastic process. This paper provides the most significant data on two patients infected by HIV and diagnosed for plasma cell neoplasia. Recent pathogenetic hypotheses for plasma cell neoplasias that include immune alterations, chronic viral infections, and hyperexpression of cytokines exist in patients infected by HIV, and this could suggest that this type of neoplasia is another malignant haematological process associated with AIDS.

An hydroalcoholic extract of curcuma longa lowers the apo B/apo A ratio. Implications for atherogenesis prevention

It is generally accepted that free-radical induced blood lipid peroxidation and especially peroxidized LDL play a central role in the pathogenesis of atherosclerosis and related cardiovascular disease. Moreover, recent research highlights the key contribution of apolipoprotein B (apo B) to atherogenesis as the main inductor of one of its earlier steps, i.e. macrophage proliferation. This has led us to investigate the apo B response to a very effective phenolic lipid-antioxidant, namely an hydroalcoholic extract of Curcuma longa, which according to our previous work does not show any toxic effects and decreases the levels of blood lipid peroxides, oxidized lipoproteins and fibrinogen. The present study shows that a daily oral administration of the extract decreases significantly the LDL and apo B and increases the HDL and apo A of healthy subjects. This and recent data on the increased anti-atherogenic action of the physiological antioxidant tocopherol in the presence of phenolic co-antioxidants (which eliminate the tocopheroxyl radical), justifies planned clinical research to test the usefulness of the curcuma extract as a co-antioxidant complement to standard treatments to prevent or retard atherosclerosis.

[Changes in emergency visits of patients infected by human immunodeficiency virus since the widespread use of protease inhibitors]

OBJECTIVE

To evaluate the changes in the urgent visits made by HIV+ patients after generalisation of the protease inhibitors.

PATIENTS AND METHODS

Comparison on the visits made during a period prior to and after use of protease inhibitor.

RESULTS

After the generalisation of the protease inhibitors the visits rate decreased, the motives for consulting with the physician and complementary examinations changed, invasive therapeutic procedures, admissions from urgencies and death rates decreased.

CONCLUSIONS

The protease inhibitors have changed the urgent visits profile of HIV+ patients.