Syphilis and neurosyphilis: HIV-coinfection and value of diagnostic parameters in cerebrospinal fluid

Background

Neurosyphilis might be difficult to diagnose particularly in asymptomatic patients and patients with HIV-coinfection. The objective of this study was to evaluate current diagnostic standards for neurosyphilis in HIV-positive and -negative patients.

Methods

We studied retrospectively patients with an active syphilis infection who had additionally undergone lumbar puncture. Patients where the criteria for the diagnosis of a definite or probable neurosyphilis were applicable were further analyzed for clinical symptoms, CSF, HIV-status as well as Treponema pallidum testing in serum and CSF. Correlation analysis of categorical variables was done by using the Chi-square test or in cases of small sample sizes the exact test of Fisher. p values ≤0.05 were considered significant.

Results

Eighty-nine patients were diagnosed with syphilis. All necessary criteria for the diagnosis of a neurosyphilis were available in 67 of them including 35 HIV-positive and 32 HIV-negative patients. A definite neurosyphilis could be retrospectively diagnosed in 13 and a probable in another 25 cases. Normal CSF results were more likely in HIV-negatives (p = 0.016). A neurosyphilis was correlated to a CSF pleocytosis > 5 cells/µl and to an albumin quotient >7.8 mg/dl regardless of a parallel HIV infection. HIV-positives had more frequently a CSF-RPR titre >1:4 than HIV-negatives (p = 0.031). However, the RPR test in CSF in definite or probable neurosyphilis had a sensitivity of only 21 %.

Discussion

Our data show that a pleocytosis and an elevated albumin quotient correlate with neurosyphilis. However, the CSF-RPR test as gold standard in neurosyphilis diagnostics has a very low sensitivity.

Associated occurrence of p75 neurotrophin receptor expressing aldynoglia and microglia/macrophages in long term organotypic murine brain slice cultures

Growth-promoting aldynoglia, characterized by the expression of the prototype immature Schwann cell marker p75 neurotrophin receptor (NTR) have been shown to occur in some demyelinating diseases. However, the mechanisms determining the emergence and fate of such cells are largely unknown. This study aimed at the identification of such cells and potential triggering factors using an in vitro slice culture approach. Organotypic cerebrum and brain stem slices of adult mice were cultivated for up to 18 days in vitro. Immunohistochemistry for the detection of p75(NTR), CD107b, periaxin, growth associated protein (GAP)-43, and glial fibrillary acidic protein (GFAP) was performed. The results for p75(NTR) were substantiated by the use of in situ hybridization. Cultivation was associated with a progressively increasing spontaneous occurrence of bi- to multipolar p75(NTR)-positive, but periaxin-negative glia, indicative of aldynoglial Schwann cell like cells. Similar cells stained intensely positive for GAP-43, a marker for non-myelinating Schwann cells. The number of p75(NTR) positive glia did not correlate with GFAP expression, but showed a strong correlation with a remarkable spontaneous response of CD107b positive phagocytic microglia/macrophages. Moreover, aldynoglial p75(NTR) immunoreactivity negatively correlated to neuronal p75(NTR) expression, which was lost during culturing. The present results demonstrate that the cultivation of organotypic murine brain slices is accompanied by a spontaneous response of both microglia/macrophages and p75(NTR) positive cells, suggestive of Schwann cell like aldynoglia. The findings highlights the role of microglia/macrophages, which seem to be an important triggering factor, facilitating the occurrence of this unique type of macroglia.

[Porencephaly in a female Greater Swiss Mountain Dog]

A 15-month-old female Greater Swiss Mountain Dog was presented after an epileptic episode. In addition, the owner had noticed a recent marked change in the animal's behaviour. Because of the progressive nature of the neurological signs, a magnetic resonance imaging scan of the brain was performed and porencephaly in the parietal lobe of the right hemisphere was diagnosed. The dog was euthanized and submitted for pathology. Because of the histopathological findings and the history of a craniocerebral injury whilst a puppy, a traumatic genesis of this rare cystic lesion is discussed.

Do unmet needs differ geographically for children with special health care needs?

The purpose of this study was to identify geographic differences in health indicators for children with special health care needs (CSHCN). It was hypothesized that geographic differences in unmet health care needs exist among CSHCN by region in the United States. Data were obtained from the National Survey of Children with Special Health Care Needs, 2005-2006. Nine variables representing unmet needs were analyzed by geographic region. The region with the highest percent of unmet needs was identified for each service. Logistic regression was utilized to determine differences by region after controlling for age, gender, ethnicity, race, federal poverty level, relationship of responder to child, insurance status, severity of condition, and size of household. A total of 40,723 CSHCN were represented. Crude analysis demonstrated that the greatest unmet need for routine preventive care, specialist care, prescription medications, physical/occupational/speech therapy, mental health care, and genetic counseling occurred in the West. The greatest unmet need for preventive dental care, respite care, and vision care occurred in the South. Significant differences between regions remained for six of the nine services after controlling for potential confounders. Geographic differences in unmet health care needs exist for CSHCN. Further delving into these differences provides valuable information for program and policy planning and development. Meeting the needs of CSHCN is important to reduce cost burden and improve quality of life for the affected child and care providers.

Therapy and prophylaxis of opportunistic infections in HIV-infected patients: a guideline by the German and Austrian AIDS societies (DAIG/ÖAG) (AWMF 055/066)

INTRODUCTION

There was a growing need for practical guidelines for the most common OIs in Germany and Austria under consideration of the local epidemiological conditions.

MATERIALS AND METHODS

The German and Austrian AIDS societies developed these guidelines between March 2010 and November 2011. A structured Medline research was performed for 12 diseases, namely Immune reconstitution inflammatory syndrome, Pneumocystis jiroveci pneumonia, cerebral toxoplasmosis, cytomegalovirus manifestations, candidiasis, herpes simplex virus infections, varizella zoster virus infections, progressive multifocal leucencephalopathy, cryptosporidiosis, cryptococcosis, nontuberculosis mycobacteria infections and tuberculosis. Due to the lack of evidence by randomized controlled trials, part of the guidelines reflects expert opinions. The German version was accepted by the German and Austrian AIDS Societies and was previously published by the Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF; German Association of the Scientific Medical Societies).

CONCLUSION

The review presented here is a translation of a short version of the German-Austrian Guidelines of opportunistic infections in HIV patients. These guidelines are well-accepted in a clinical setting in both Germany and Austria. They lead to a similar treatment of a heterogeneous group of patients in these countries.

Detection and significance of glutathione-S-transferase pi in osteogenic tumors of dogs

In this study we describe a relationship between the percentage of tumor cells staining positive for GST pi and the response to cisplatin treatment in dogs with appendicular osteosarcoma. Clinical resistance to platinum compounds has been attributed to tumor cell resistance to the drug. An overexpression of glutathione-S-transferase pi has been implicated in the resistance of tumor cells in vitro to cisplatin. In this study, the relative concentration of GST pi was quantified immunohistochemically in formalin-fixed, paraffin-embedded histologic specimens obtained from dogs with appendicular osteosarcoma prior to cisplatin treatment. The percentage of tumor cells staining positive for GST pi was compared with patient response (remission and survival times) following treatment. Those osteosarcoma-bearing dogs having a low pre-treatment tumor expression of GST pi (<50%; n=13) had a significantly longer (p <0.01) median remission and survival time (24.0 and 33.7 weeks, respectively) than those dogs with a high pre-treatment tumor expression of GST pi (>50%; n=8; median remission and survival times 14.2 and 24.0 weeks, respectively). The relative staining of GST pi in primary canine bone tumors has therapeutic importance and warrants further evaluation as a therapeutic model for human osteosarcoma.

Dual-isotope SPECT imaging of striatal dopamine: a comparative study between never-treated and haloperidol-treated first-episode schizophrenic patients

The aim of this dual-isotope SPECT imaging study was to evaluate striatal dopamine transporter (DAT) and D2 receptor availability in first-episode never-treated and haloperidol-treated schizophrenic patients and whether the availability is associated with psychopathology. Twenty-four inpatients with a first acute schizophrenic episode were enrolled in the study; 12 of these patients were treated with haloperidol for 2 weeks before dual-isotope SPECT was performed, whereas the other 12 patients underwent the SPECT evaluation directly after enrollment. Twelve healthy control persons were also recruited and evaluated with the dual-isotope SPECT protocol. Psychopathology was assessed by the Positive and Negative Syndrome Scale and other scales. D2-radioligand binding did not differ between drug-naïve patients and the control group but was significantly lower in the haloperidol-treated group. DAT availability was also significantly lower in the haloperidol patients than in the other two groups and differed significantly between drug-naïve, positive-syndrome-type patients and healthy controls. The data obtained with the new dual-isotope SPECT technique reveal a direct effect of haloperidol at the D2 and DAT receptor level.

[Expert consensus statement on interventional renal sympathetic denervation for hypertension treatment]

This commentary summarizes the expert consensus and recommendations of the working group 'Herz und Niere' of the German Society of Cardiology (DGK), the German Society of Nephrology (DGfN) and the German Hypertension League (DHL) on renal denervation for antihypertensive treatment. Renal denervation is a new, interventional approach to selectively denervate renal afferent and efferent sympathetic fibers. Renal denervation has been demonstrated to reduce office systolic and diastolic blood pressure in patients with resistant hypertension, defined as systolic office blood pressure ≥ 160 mm Hg and ≥ 150 mm Hg in patients with diabetes type 2, which should currently be used as blood pressure thresholds for undergoing the procedure. Exclusion of secondary hypertension causes and optimized antihypertensive drug treatment is mandatory in every patient with resistant hypertension. In order to exclude pseudoresistance, 24-hour blood pressure measurements should be performed. Preserved renal function was an inclusion criterion in the Symplicity studies, therefore, renal denervation should be only considered in patients with a glomerular filtration rate > 45 ml/min. Adequate centre qualification in both, treatment of hypertension and interventional expertise are essential to ensure correct patient selection and procedural safety. Long-term follow-up after renal denervation and participation in the German Renal Denervation (GREAT) Registry are recommended to assess safety and efficacy after renal denervation over time.

Occupational exposure to trichloroethylene and cancer risk for workers at the Paducah Gaseous Diffusion Plant

OBJECTIVE

The Paducah Gaseous Diffusion Plant (PGDP) became operational in 1952; it is located in the western part of Kentucky. We conducted a mortality study for adverse health effects that workers may have suffered while working at the plant, including exposures to chemicals.

MATERIALS AND METHODS

We studied a cohort of 6820 workers at the PGDP for the period 1953 to 2003; there were a total of 1672 deaths to cohort members. Trichloroethylene (TCE) is a specific concern for this workforce; exposure to TCE occurred primarily in departments that clean the process equipment. The Life Table Analysis System (LTAS) program developed by NIOSH was used to calculate the standardized mortality ratios for the worker cohort and standardized rate ratio relative to exposure to TCE (the U.S. population is the referent for ageadjustment). LTAS calculated a significantly low overall SMR for these workers of 0.76 (95% CI: 0.72-0.79). A further review of three major cancers of interest to Kentucky produced significantly low SMR for trachea, bronchus, lung cancer (0.75, 95% CI: 0.72-0.79) and high SMR for Non-Hodgkin's lymphoma (NHL) (1.49, 95% CI: 1.02-2.10).

RESULTS

No significant SMR was observed for leukemia and no significant SRRs were observed for any disease. Both the leukemia and lung cancer results were examined and determined to reflect regional mortality patterns. However, the Non-Hodgkin's Lymphoma finding suggests a curious amplification when living cases are included with the mortality experience.

CONCLUSIONS

Further examination is recommended of this recurrent finding from all three U.S. Gaseous Diffusion plants.

Stage at presentation for medically underserved gastric cancer patients

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Background: Survival disparities in the United States exist for nearly all malignancies. The relationship between stage at presentation and outcome is not well understood. Our hypothesis is that medically un- and underinsured gastric cancer (GC) patients present at advanced stage leading to worse outcomes.

Methods: Institutional review board approved review of the departmental gastrointestinal cancer database from 04/08/2000 to 11/18/2008. All patients diagnosed with gastric adenocarcinoma were included; clinicopathologic, treatment and outcome data was recorded. Statistical analysis was performed using STATA 10.

Results: A total of 185 patients (108 male, 77 female) were included in this study. Mean age at diagnosis for all patients was 55.3 yrs. The mean age at diagnosis was lower for Hispanics (52.4 years) when compared to other races (ANOVA p = 0.00). The majority of Hispanic patients presented with stage IV disease (55%, chi square p = 0.01). The age range and minimum age at diagnosis was different for Hispanics. Median survival for the entire cohort was 12.3 mo. Although not significant (log rank p = NS), median survival was lowest for African Americans (AA) and Asians. Cox proportional hazards model demonstrated surgical resection and adjuvant therapy (chemoradiation) to be independent predictors of survival.

Conclusions: Hispanic patients in medically un- and underinsured populations showed significantly younger age at presentation and more advanced stage of GC. However, median survival for Hispanic GC patients was not significantly shortened compared to other races in this cohort. Survival for AA and Asian patients in a public safety net hospital remains poor and investigation into factors contributing to such disparities is ongoing.

[Table: see text]

No significant financial relationships to disclose.