Partner notification for Chlamydia trachomatis urogenital infections: eight years of patient referral experience in the major Portuguese sexually transmitted infections clinic, 2000–07

The aim of this study was to perform a retrospective evaluation of the success of patient referral for partner notification of chlamydial infections to the major Portuguese sexually transmitted infection (STI) clinic. A total of 8277 patients were screened for Chlamydia trachomatis during 2000–2007, and 695 (8.4%) tested positive. The sexual partners of 34% of these index cases attended the clinic as contacts following partner referral. In univariate analysis, heterosexual men referred partners more frequently than men who have sex with men (MSM) and HIV-negative index cases referred partners four-fold more frequently than HIV-positives; however, these associations were non-significant after multivariate analysis (adjusted odds ratio [OR] 1.4, 95% confidence interval [CI] 0.7–2.6; adjusted OR 4.2, 95% CI 0.9–18.7, respectively). Index patients who reported lower numbers of partners referred more frequently, and this association remained significant after multivariate analysis. One-third of the referred individuals tested C. trachomatis-positive; the risk for infection was three-fold higher for referred partners from symptomatic index cases ( P < 0.001, adjusted OR, 95% CI 1.8–6.3). In conclusion, the results of the present study concerning sexual behaviour, HIV status and clinical signs highlight the need for further evaluations that may shape future partner notification strategies in order to reduce the chlamydial disease burden.

P01-225-A case of unipolar mania

Introduction

The concept of unipolar mania has been raised, rejected and resurrected by a number of authors, and its true position within bipolar affective disorders is still a subject of debate.

Clinical case

A 52-year-old Caucasian woman was presented to the emergency room accompanied by family members because she had seven days without sleeping, exaggerated self-confidence and was engaged in multiple activities.

Discussion

At the mental examination she presented irritability, agitation, elation of mood, verbiage, sexual disinhibition, delusional activity of persecutory content, absence of insight. She had three manic episodes earlier and she didn’t have therapeutic adherence. The patient maintained an optimal level of performance functioning between maniac episodes, and also had no earlier depressive episodes. She described herself as a very creative, original, friendly, outgoing, sociable, responsible person. She had no family history of bipolar disease or other psychiatric disorder. An hemogram, basic biochemical investigations, cerebral TC, ilicits drugs screen and EEG were preformed showing no relevant alterations. She was admitted at an acute care psychiatric unit for 16 days. She had a good response to risperidone 2 mg and 1000 mg of divalproex sodium and to cognitive behavioural treatment.

Conclusion

Due to her previous 3 and her current manic episodes, without history of depressive symptoms, we concluded by the diagnosis of unipolar mania. Although there are certain sociodemographic and clinical variables that overlap, there does seem to be recent evidence concerning clinical, psychopathological and treatment features indicating a nosological separation of unipolar mania from bipolar mania.

Delirium and parkinsonic syndrome in elderly

Delirium is an acute or subacute syndrome characterized by a fluctuating global disorder of cognition, impairment of attention and awareness, disorganization of thought and speech, perceptual disturbances, hallucinations, as well as hypo or hyperactivity.

We present a case report of a 76-year-old woman who developed disorientation, lack of familiar recognition and functional impairment, three days before admission. She was admitted to a Medicine Department and submitted to several laboratory and imaging studies.

During this period she presented attention, consciousness fluctuations and agitation that required several treatments, including neuroleptics. Like these symptoms were linked to an important life even that triggered reactive depression, she was transferred to a psychiatric ward. Progressively her clinical state worsened, she became permanently bedridden and was observed by Neurology. She presented moderate to severe parkinsonian signs, namely akinesia and rigidity, predominantly on her left side. Reviewing her clinical past, she had suffered these symptoms during the two years before this episode (apathy, small stepped gait, flexed posture, and left hand rest tremor). Treatment with antiparkinsonic drugs produced a dramatic improvement in the patient’s mental and physical status. A I-Ioflupane-SPECT (DaTscan) confirmed striatal presynaptic dopaminergic degeneration, more on the right side, which was the proof of the presence of a degenerative parkinsonian syndrome.

The present clinical case shows Delirium with degenerative Parkinsonism comorbidity, worsened by the use of neuroleptics. We emphasize the importance previously undiagnosed Parkinsonism in old age which is highlighted by usefulness of dopamine transporter imaging in this scenery.

Sexually transmitted infections and related sociodemographic factors in Lisbon's major Venereology Clinic: a descriptive study of the first 4 months of 2007

OBJECTIVES

To assess the prevalence of sexually transmitted infections (STI) and relationships between them and sociodemographic/behavioural data in the major Venereology Clinic in Lisbon.

METHODS

Every patient attending this STI clinic for the first time in the first 17 weeks of 2007 was enrolled in this study. Early syphilis, Chlamydia trachomatis infection, gonorrhoea, human immunodeficiency virus (HIV) first diagnosed and genital warts were considered for the study of statistical associations with sociodemographic/behavioural variables or other STI. Data were analysed with an exact significance level of 5%.

RESULTS

A total of 743 patients were included. In women (n = 296), the only significant associations found were for C. trachomatis and being non-Caucasian (OR = 2.13, CI 1.17-3.9) or being younger than 25 years (OR = 1.9, CI 1.31-2.79). Men who have sex with men (176 of the 447 male patients) contributed to 39% of the STI, although more than half of the early syphilis, gonorrhoea and HIV cases were diagnosed in this group.

CONCLUSIONS

Despite its limitations, our study allows some insight into the relationships between sociodemographic factors and STI in a selected population attending Lisbon's major Venereology Clinic. The results were similar to those of other European studies and to recent trends in STI, but differ in the association between C. trachomatis infection and non-Caucasian women, which is similar to cities with significant African minorities. Attention should be given to the associations found between men who have sex with men and STI such as gonorrhoea, syphilis and HIV, as these associations can lead to serious difficulties in the control of HIV infection in Portugal.

Sexual Health in Parkinson’s Disease

Introduction:

The changes in sexual health of patients with Parkinson's disease must be a concern to the clinicians. The effects in sexual health of patients submitted to functional cirurgy is still a matter of debate.

Objectives:

To describe and evaluate the sexual health of patients with Parkinson's disease following deep brain stimulation (DBS) of the subthalamic nucleus (STN).

Methods:

Patients with Parkinson's disease bilaterally implanted for DBS of STN and those only pharmacologically treated, will be evaluated. Sexual functioning will be assessed using the international erectile function indices (IEFI) and the female sexual function indices (FSFI). Depression and anxiety will be evaluated using the Beck depression inventory and the brief symptom indices. Relations between sexual functioning and modifications in the severity of disease (Hoehn and Yahr stage), reduction in levodopa equivalent daily dosage (LEDD), age, and duration of disease will be analyzed.

Results and conlusions:

We expect to find positive changes in the sexual health of these patients, given the fact of the procedure improve the overall burden of the disease by reduction of medication and motor symptoms.

New Potential Molecular Targets for Cannabis Addition

Cannabis is considerer the most widely abused illicit drug in the world. The recent rising prevalence of cannabis use by young adults and increasing evidence of adverse health effects makes the search for new pharmacotherapy to reduce cannabis abuse extremely important. To date no medication has been approved for the treatment of cannabis addition.

This study reviews recent results with potential interest for future pharmacological treatment of Cannabis dependence. Most of the relevant data obtained for treatment of cannabis dependence target the endocannabinoid or the central cholinergic systems, both involved and interact in brain systems implicated drug reinforcement. In laboratory animals blockade of cannabinoids CB1 receptors reverses central effects of cannabinoids. Rimonabant is a selective, orally active, cannabinoid CB1 receptor antagonist (inverse agonist) that has been shown in animals to modulate cannabinoid signaling in brain reward circuit. In humans, it has been shown that rimonabant, single or repeated oral doses blocked psychological and physiological effects of smoked marijuana (1). Although psychiatric adverse side affects like depression were reported with rimonabant, this compound was already been approved for treatment of obesity and metabolic syndrome. Very recently, blockade of α7 nicotinic receptors was shown to reverse abuse-related behavioral and neurochemical effects of cannabinoids in rats (2).

In conclusion, besides cannabinoid CB1 receptor, the homomeric α7 nicotinic receptors are novel molecular targets in the development of new drugs for treatment of cannabis addition.

Assessment of luteal function by ultrasonographic appearance and measurement of corpora lutea in goats

In order to characterize the evolution pattern of the corpora lutea (CL) and to compare luteal function with their ultrasonographic appearance, 37 estrous cycles of Serrana goats (n=22) were studied during breeding season. A daily transrectal ultrasound scanning was performed through two successive estrous cycles. Both solid and fluid-filled CL were observed and measured in both ovaries of each goat. Additionally, each CL was classified as CL(ICHE) (CL with irregular contours and heterogeneous echotexture) or CL(RCGE) (CL with regular contours and granular echotexture). Ovarian cyclic activity and luteal function were evaluated by biweekly plasma progesterone (P4) determination. The CL (n=60) were first visualized on day 2.9+/-1.0 after the day of ovulation (day 0), showing 7.1+/-1.8mm of diameter and reach their maximum size (12.5+/-1.6mm) on day 10.7+/-3.2 (P<0.001). Two days before the following ovulation (day -2), the CL regressed to 8.4+/-1.3mm (P<0.001). The central cavity was found in 78.3% of CL, and had a persistence of over 50% until the last days of estrous cycle. The ratio CL length/cavity length was low during the first-third and high during the remaining two-thirds of estrous cycle. On day 2, the percentage of CL(ICHE) was 33.3%, and began to decrease to 16.7% on day 6, reaching the minimum of 3.3% on day 10 (P<0.001). This proportion increased on day -3 to 48.3% and reached 90% on day -1 (P<0.001). The correlation between CL size and plasma P4 levels was r=0.63 (n=87; P<0.001). A negative correlation between the daily proportion of CL(ICHE) and plasma P4 levels was found (r=-0.95; n=18; P<0.001). These results suggest that the ultrasonographic appearance of CL is a reliable parameter for the assessment of luteal function in goats. Both the characterization of echotexture and size of central cavity could be valuable tools to differentiate between phases of normal estrous cycles.

Follicular dynamics in Serrana goats

Twenty-two Serrana goats were studied through two successive estrous cycles in order to characterize their follicular dynamics during the breeding season. The ovaries of the goats were scanned daily by real-time ultrasonography and all follicles >or=3mm were measured and classified. The data were classified by the number of follicular waves per goat to test the hypothesis that temporal and morphological differences between the last follicular wave of an ovary, irrespective of ovulation, will affect the selection of the next ovulatory wave. The mean interovulatory interval was 20.7+/-1.0 days (mean+/-S.D.). Three to five waves per estrous cycle were observed and 61.3% (19/31) of cycles had four waves. In estrous cycles with four waves, the day of onset of the first, second, third and fourth wave was 1.4+/-1.0, 6.9+/-1.4, 11.6+/-1.8 and 16.8+/-1.6, respectively. No differences (P>0.05) were found between the day of onset of the first and second waves for estrous cycles with three, four or five waves. However, the day of onset of the third and fourth waves occurred later when the number of waves per estrous cycle increased (P<0.001). The duration of the interwave interval (time between the day of onset of two consecutive waves) was longer when the second wave was ovulatory. The length of the growth phase (2.4+/-0.9 days) and size (5.9+/-0.7 mm) of the dominant follicle in the second wave were lower (P<0.01) than for the first wave (3.3+/-1.2 days and 6.6+/-0.9 mm, respectively) and the fifth wave (4.1+/-1.2 days and 7.5+/-1.0mm, respectively). Within pairs of ovaries, the onset of the last wave occurred later (P<0.05) and was less variable in ovulatory ovaries (day 16.8+/-1.4, n=20) than in anovulatory ovaries (day 15.1+/-3.7, n=20). The length of the growing phase was longer (P<0.001) in the last waves of ovulatory ovaries (3.1+/-0.9 days) than in the last waves of anovulatory ovaries (1.7+/-0.8 days). These results support the hypothesis that the day of onset of the ovulatory wave is related to or, at least, conditioned by the luteolysis and the decrease in plasma progesterone. In summary, the estrous cycle of Serrana goats is characterized by sequential follicular wave growth with a great variability in their onset and duration, with the exception of the ovulatory wave. The temporal and morphological differences observed in the last wave of estrous cycle provide strong evidence for the role of progesterone in their regulation.

Morphometry of ovarian structures by transrectal ultrasonography in Serrana goats

The accuracy of transrectal real-time ultrasonography (RTU) scanning technique to detect ovarian structures (follicles and corpus luteum) of Serrana goats was compared to the data obtained by observation of ovarian sequential slices. This slicing technique (SLI) was considered as reference method. The laparoscopy and laparotomy techniques were also used for corpora lutea identification. For this purpose the ovaries of 14 females were observed, 7-8 days after ovulation, by transrectal ultrasonography followed by laparoscopic examination. Then ovaries were removed and studied by slicing. In the sliced sections of each ovary (n=28), follicles and corpus luteum (CL) were identified and counted. CL and follicular diameters were measured using a millimetre scale. The total number of follicles, counted by RTU, was significantly lower than that observed by SLI (P <0.01). This difference was mainly due to the under estimation of <2 mm follicles category. The correlation coefficient between category data obtained by RTU and SLI methods for the number of follicles > or =3 mm was high (r2=0.95, P <0.001), which highlights the use of UTR as a potential methodology to study the follicular dynamic of goats. There were no significant differences (P >0.05) between the average number (mean +/- S.D.) of corpus luteum identified per ovary by RTU (0.71 +/- 0.75), laparoscopy (0.58 +/- 0.71), laparotomy (0.67 +/- 0.76) or SLI (0.83 +/- 0.76) methods. The accuracy for the identification of ovulation, validated by CL detection on D7-D8 by SLI (100%), was 91.7%, 87.5% and 83.3% by RTU, laparotomy and laparoscopy, respectively. The negative predictive value of RTU, laparotomy and laparoscopy to verify the absence of a CL in the ovary was 81.8%, 75.0% and 69.2%, respectively. The specificity of all three methods for the CL identification was 100%. No significant differences (P >0.05) were found in the probability to detect the exact number of CL (0, 1 or 2) counted in each ovary between the RTU (87.5%), laparotomy (83.3%) and laparoscopy (75.0%) methods when compared with the reference method. The diameter of spherical CL could be estimated with reliability (r2=0.86; P <0.001). The real-time ultrasonographic scanning proved to be a highly accurate method for detection and measurement of several categories of follicles and CL size in Serrana goats. The results of the present study show that laparoscopy and RTU are similarly reliable techniques for CL detection. However, the RTU represents a non-traumatic technique with advantages to animal welfare both in experimental and reproductive evaluation of the size of ovarian structures.

Evaluation of the passive particle agglutination test in the serodiagnosis and follow-up of syphilis

We performed the present study to determine the rate of concordance of the fluorescent treponemal antibody absorption test (FTA-ABS) and of the microhemagglutination assay for antibodies to Treponema pallidum (MHA-TP) with the passive particle agglutination test (TP.PA) in patients with early syphilis and to observe the reactivity of the rapid plasma reagin (RPR), MHA-TP, and the TP.PA tests for 1 year after therapy. The study included 449 people who were given therapy if they had syphilis and followed up for 1 year. The rate of concordance of the TP.PA with the MHA-TP was 98.4%, and it was 98.9% with the FTA-ABS. During follow-up, a significant decrease of antibodies was found in 56%, 26%, and 70% of the patients when using the RPR, the MHA-TP, and the TP.PA, respectively. The TP.PA seems to be an adequate routine assay for the diagnosis of syphilis, being as sensitive as the FTA-ABS test in primary syphilis and as useful as the RPR test in monitoring therapy.

Doppler tissue imaging

This paper try to give a general overview of the main areas of DTI clinical application, its main technical limitations, new directions still under investigation and some potential future developments of this emerging imaging technique. In this review article we pretend to discuss the main aspects of the new DTI method, its present "state of the art" and future perspectives of scientific and technical development.

Current status of three-dimensional echocardiography

Volume rendered three-dimensional echocardiography (3DE), a rapidly emerging imaging method, offers clinicians and surgeons a new perspective for visualizing the heart. Using both transthoracic and transesophageal approach this new methodology enables qualitative and quantitative information of cardiac disorders to be obtained. 3DE image projections have allowed visualization of intracardiac structures and great vessels and delineation of their pathology in a comprehensive manner. Experimental and clinical studies suggest that 3DE is likely to play a valuable role in the evaluation of various cardiac and flow disorders and in planning interventions and surgery. In addition, 3DE has been applied to derive quantitative measurements of volume, mass and dimensions of the left and right ventricles and also other cardiac lesions, such as atrial and ventricular septal defects. Every aspect of 3DE is in continuous evolution. Faster and more highly automated image processing could make the technique more easily applicable in the clinical scenario.

Importance of lipoprotein metabolism parameters in the clinical and angiographic severity of coronary artery disease

Coronary artery disease that is clinically and angiographically significant is associated to important biochemical parameters with direct interference in lipoprotein and apoprotein metabolism. The purpose of our study was to evaluate the importance of several lipoprotein metabolic parameters in the clinical and angiographic severity of chronic coronary artery disease. In a population with the diagnosis of ischemic coronary artery disease, we assessed the degree of angiographic (single- versus multivessel disease) and clinical (C.C.S. I-IV classification) severities. In each patient, we determined the value of total cholesterol, triglycerides, HDL and LDL cholesterol, HDL 2 and 3, apoprotein AI and B, lipoprotein (a), anti-phospholipid antibodies and C reactive protein. Our results showed that some parameters were significant in the comparison between a normal group and the global coronary artery disease population, such as the value of total cholesterol, HDL cholesterol, HDL 2, apoprotein AI and B lipoprotein (a) and anti-phospholipid antibodies. In the distinction of coronary artery disease subgroups, in relation to C.C.S. < or = 2 and > or = 3 classes, some factors could be discriminated, such as HDL cholesterol, HDL 2, total cholesterol/HDL, lipoprotein (a), anti-phospholipid antibodies and C reactive protein. In the distinction between classes C.C.S. < or = 2 and AMI, the levels of triglycerides, HDL cholesterol, HDL 2, total cholesterol/HDL, lipoprotein (a) and anti-phospholipid antibodies were significant. In the division between single vessel versus multivessel coronary artery disease we found significant values of HDL cholesterol, HDL 2, total cholesterol/HDL, apoprotein AI, lipoprotein (a), anti-phospholipid antibodies and C reactive protein. In conclusion, our present study endorses the clinical role of lipids and plasma lipoproteins in the determination of several cardiovascular risk factors, but introduction of new parameters such as lipoprotein (a) and the anti-phospholipid antibodies can be very useful for a better and global understanding of the pathophysiological processes and distinction of higher risk subgroups for extension and degree of severity of ischemic coronary artery disease.

Myocardial architecture, texture and left ventricular heterogeneity in the pulsed Doppler tissue imaging pattern

The regional contribution for the global ventricular functional performance is complex and heterogeneous, the myocardial texture could reflect this particular aspect, during the phases of myocardial contraction and relaxation. The objective of our clinical study was to evaluate the relationship between the segmental myocardial velocity pattern by Doppler tissue imaging and the ultrasound characteristics of the left ventricular myocardium analysed by computerized ultrasound densitometry with the calculation of its intensity (dB), in a population of 22 subjects without clinical history of cardiovascular pathology, 50% female gender, mean age 43 +/- 11 years (19-66 years). In the methodology of study, the left ventricular myocardium was divided in 16 segments, according with the transthoracic echocardiographic recommendations of the American Society of Echocardiography (A.S.E.). During one cardiac cycle interval, the ultrasound characteristics of the left ventricular myocardium were evaluated continuously and in a quantitative manner, applying the computerized ultrasound densitometry method on the gray scale images of the ventricular myocardium, with the sample size identical to the myocardial wall thickness. The peak (Vmax-cm/sec) and mean (Vm-cm/sec) pulsed Doppler tissue imaging velocities, individuals, segmental and a total velocities, contraction and relaxation velocities of the left ventricular myocardium were obtained immediately after the computerized ultrasound densitometry analysis. Ultrasound densitometry and Doppler tissue imaging data were obtained in a total number of 352 left ventricular myocardial segments. Using the multiple linear correlation matrix analysis, the ultrasound intensity registered inverse significant correlation's with the Doppler tissue imaging Vmax and Vm for the systolic "s" wave in the total segments and each one of them (r = -0.66; p = 0.001; interval 2-18 cm/sec; r = -0.52 to -0.70) and with the early diastolic "e" wave (r = -0.42; p = 0.01; interval 2-19 cm/sec; r = -0.35 to -0.55). Direct correlation's were obtained for the computerized ultrasound densitometry intensity and Doppler tissue imaging Vmax and Vm of the late diastolic "a" wave in the total number of the left ventricular myocardial wall segments and in each one of them (r = 0.51; p = 0.01; interval 1-17 cm/sec; r = 0.42 a 0.66). We conclude that in our study and under physiological conditions of myocardial performance, a direct correlation was obtained between the ultrasound characteristics of the ventricular myocardial imaging and its velocities of contraction and relaxation. These facts reflect the close relationship between left ventricular myocardial structure and function, analyzed by the new ultrasound Doppler technologies.

Regional diastolic function in ischaemic heart disease using pulsed wave Doppler tissue imaging

AIMS

The aim of this study was to determine the utility of pulsed wave Doppler tissue imaging in the evaluation of regional left ventricular diastolic function in patients with ischaemic heart disease.

METHODS AND RESULTS

In 30 normal subjects and 43 patients with ischaemic heart disease, Doppler tissue imaging was performed in each of the 16 segments of the myocardium. The following diastolic pulsed wave Doppler tissue imaging parameters were obtained for each segment: (1) regional early diastolic peak velocity (regional e wave cm.s-1); (2) regional late diastolic peak velocity (regional a wave cm.s-1); (3) regional diastolic e/a velocity ratio; and (4) the regional isovolumic relaxation time, defined as the time interval from the second heart sound to the onset of the diastolic E wave. In patients with ischaemic heart disease, each of these parameters was evaluated and compared in ischaemic and normally perfused segments, based on the presence or absence of obstructive lesions of the supplying coronary artery. In patients with coronary artery disease, several differences were observed between diseased and normal wall segments: the mean segmental peak early diastolic velocity (e wave) was reduced (mean +/- SD: 6.4 +/- 2.1 cm.s-1 vs 8.5 +/- 2.8 cm.s-1; P < 0.01); the e/a diastolic velocity ratio was decreased (0.95 +/- 0.3 vs 1.5 +/- 0.6, respectively; P < 0.01) and the regional isovolumic relaxation time was prolonged (104 +/- 36.7 ms vs 69.6 +/- 30 ms; P < 0.01. No differences were observed in any of these parameters between the normally perfused segments of ischaemic patients and normal subjects. Patients with a normal transmitral diastolic Doppler inflow pattern had a mean of 3.7 +/- 2.7 myocardial segments with a local e/a pulsed wave Doppler tissue imaging velocity ratio < 1, fewer than those with an inverted diastolic transmitral Doppler inflow pattern (10.3 +/- 3 segments; P < 0.001). Overall sensitivity and specificity for an inverted local e/a ratio and a local isovolumetric relaxation time > or = 85 ms were of 62% and 72% and 69% and 80%, respectively.

CONCLUSION

Regional diastolic wall motion is impaired at baseline in ischaemic myocardial segments, even when systolic contraction is preserved. Pulsed wave Doppler tissue imaging is a useful non-invasive technique which allows the assessment of regional diastolic performance and dynamics of the left ventricular myocardium. Further studies are required to define this role in the evaluation of coronary heart disease.