Declining sexually transmitted infections among female sex workers: the results of an HIV and sexually transmitted infection prevention strategy in Honduras, 2006-08

In 2006, we implemented an HIV and sexually transmitted infection (STI) prevention programme for female sex workers (FSWs) in three Honduran cities. All FSW attending STI clinics underwent regular examinations and STI testing. Information on condom use with different partners was collected at each visit. After three years, we detected a significant decline in the prevalence of syphilis from 2.3% at the first screening to 0.0% at the third screening (P = 0.05), and of chlamydia, from 6.1% to 3.3% (P = 0.01). No changes were observed in the prevalence of gonorrhoea or trichomoniasis. The cumulative HIV prevalence remained constant (P = 0.44). Reports of condom use with clients increased from 93.8% to 98.9% (P < 0.001). The implementation of an HIV/STI prevention programme in FSW has contributed to increases in condom use with clients and the reduction in syphilis and chlamydia prevalence. The intervention should be strengthened and considered as part of a national health policy strategy.

Conversion to everolimus in liver transplant patients with renal dysfunction

Calcineurin inhibitor (CNI) immunosuppressive therapy post-liver transplantation (OLT) is important to reduce graft rejection episodes. However, these drugs show important side effects, particularly renal dysfunction (RDF). Changing from CNI to a nonnephrotoxic drug, as mammalian target of rapamycin (mTOR) inhibitor may solve the problem. Our objective was to evaluate renal function (RF) among liver transplant patients initially receiving CNI, among whom the patients with RDF were converted completely or partially to an mTOR inhibitor like everolimus (EVE). We performed a prospective study in liver transplant patients from 2000 to 2009. Creatinine levels and creatinine clearances (Cockroft-Gault) expressed as mean values ± standard deviations were measured pre- and postswitch for comparisons using Wilcoxon nonparametric tests. Six patients were converted fully or partially to EVE. Their mean age at the moment of introducing the new therapy was 52.2 ± 13.6 years (range = 28-60). Immunosuppression time prior to switching from CNI to EVE was 23.8 ± 26.6 months (range = 6-70). Postconversion follow-up was 25.8 ± 16.5 months (range = 8-42). All patients showed improvement in RF. The creatinine level improvement was significant (P = .03) namely, from a mean of 2.26 ± 0.49 to 1.21 ± 0.57 mg/dL. Glomerular filtration rate improved from a mean of 40 ± 15.13 to 72.60 ± 17.3 mL/min/m(2) (P = .03). Conversion from CNI to EVE improved creatinine concentrations and creatinine clearances with long-term effects free of graft rejection.

Infliximab salvage therapy after failure of ciclosporin in corticosteroid-refractory ulcerative colitis: a multicentre study

BACKGROUND

Ciclosporin has proven to be effective in patients with corticosteroid-refractory ulcerative colitis (UC). When therapy with this drug fails, infliximab can be considered to avoid colectomy. The efficacy and safety of this sequential approach remain unknown.

AIM

To assess the efficacy and safety profile of treatment with infliximab after failure of ciclosporin in patients with a corticosteroid-refractory flare of UC.

METHODS

Retrospective review of medical records of patients with a corticosteroid-refractory flare of UC who did not respond to ciclosporin and received salvage therapy with infliximab within a month of discontinuing ciclosporin. The severity of the flare and response to the treatment were graded using the Lichtiger index. Cumulative rates of colectomy were calculated using Kaplan-Meier analysis. Cox regression analysis was performed to identify predictors of colectomy. To evaluate the safety profile of this treatment strategy, any adverse event occurring after the first infusion of infliximab was considered.

RESULTS

The study population comprised 47 patients with corticosteroid-refractory UC treated with infliximab after failure of ciclosporin. The median baseline Lichtiger index was 13. The mean time from the last ciclosporin dose to the first infliximab infusion was 6 days. After the first infliximab infusion, 13% of patients achieved remission, and 74% partial response. Of the 35 patients who received the third infliximab infusion, 60% achieved remission, and 37% partial response. Fourteen patients (30%) underwent colectomy. The rate of adverse events was 23%. One death occurred in a 40-year-old man who failed ciclosporin and infliximab and underwent surgery 10 days after the first infliximab infusion; he died of nosocomial pneumonia.

CONCLUSIONS

Treatment with infliximab makes it possible to avoid colectomy in two-thirds of corticosteroid-refractory UC patients in whom ciclosporin fails. However, the rates of adverse events and mortality mean that the decision to administer sequential therapy (ciclosporin-infliximab) should be taken on an individual basis.

Emotional intelligence in psychiatry: A review

Background

Emotional intelligence is a term coined by Salovey & Mayer and is defined by these authors as a form of social intelligence that involves the ability to perceive and identify emotions, to discriminate among them and to use the information to improve cognitive processes, and manage one's and others’emotions. There are also mixed models of emotional intelligence that imply a broader concept of intelligence, including mental abilities and personality characteristics.

Aim

To discuss the relevance of emotional intelligence in Psychiatry. To review recent studies of emotional intelligence in psychiatric disorders.

Methods

Review of the literature. MEDLINE and PubMed databases searches for peer-reviewed studies, published between 2000 and 2010, using combinations of the Medline Subject Heading terms emotional intelligence, trait emotional intelligence, ability emotional intelligence and psychiatry, mental disorders, schizophrenia, bipolar disorder, social phobia, eating disorders.

Results

There are few studies in the literature addressing this topic. Emotional intelligence is a complex concept, with different theories defending distinct conceptualizations. The studies reviewed showed lower levels of emotional intelligence across different psychiatric disorders.

Conclusions

The field of affective neuroscience is of major importance in Psychiatry and has added important clues to the understanding of psychopathology. Although emotional intelligence is a recent and understudied topic in Psychiatry it can help to understand mental disorders and bring new insights to the comprehension of psychopathology.

Impact of a secondary treated bleached Kraft pulp mill effluent in both sexes of goldfish (Carassius auratus L.)

The aim of the present study was to assess the toxic effects of a secondary treated effluent from a modern pulp mill processing Eucalyptus globulus on both sexes of goldfish. The effects in the exposed fish were investigated by measuring biomarkers which have been used to assess the effects of BKME on aquatic biota, with particular emphasis in fish. However, few studies have been focused on effluents from pulp mill plants processing eucalyptus. The relative proportion of cytochrome P450 (CYP1A) and vitellogenin (VTG) induction were analyzed in the livers of males and females goldfish, exposed to different concentrations of a bleached Kraft pulp mill (BKPM) effluent. Somatic indices such as HSI (hepatosomatic index) and GSI (gonadosomatic index) were calculated and a significant reduction was found in males GSI. A significant increase of HSI was recorded for both sexes exposed to 50% BKPM effluent. Exposure to BKPM effluent induced CYP1A synthesis in both sexes and decreased VTG synthesis in females according to the different effluent concentrations suggesting that the secondary treated effluent contained compounds that affect fish negatively. The results suggest that BKPM effluent can cause sex-related biochemical changes in xenobiotic metabolism.

[Factors influencing the distribution of nests of the Argentine ant Linepithema humile Mayr (hymenoptera: formicidae), in a foothills ecosystem of the central zone of Chile]

The purpose of this research was to demonstrate the dependant relationship between the Argentine ant Linepithema humile Mayr, plant coverage, and human settlements. A method was designed in order to sample the presence of the Argentine ant and other ant species that may had influenced L. humile distribution, under different types of vegetation and percentages of plant coverage, taking in consideration the distance from human settlements. Eight sample stations were established. Four of these stations were found on a dwelling home and the other four were found on similar areas, but far from human settlements. Three transects were established from the center of each sampling station (Tt1, shrublike vegetation, Tt2, herblike vegetation and Tt3, no vegetation). Transects were compound by 10 m side quadrants. A negative correlation was found between nest number of L. humile and human settlement distance, therefore nests were not found at distances higher than 80 m, in all studied areas. There was a positive and significant correlation between nest number of L. humile and plant coverage percentage, regardless the type of vegetation found. The same trend was found for other ant species studied in the area. Finally, it was proved that the distribution of L. humile nests is not influenced by other ant species.

[Cavernous malformation of the pineal region. Case report and review of the literature]

Cavernous malformations rarely occur in the pineal region with only 21 reported to date. Although its diagnosis is not easy because of the extreme rareness of this condition, the presence of this lesion can be suspected based on its typical radiological findings. We report the case of a 57-year-old woman presented with desorientation, somnolence and diplopy. The CT-scan showed an acute hemorrhage in the pineal region and triventricular hydrocephalus. An MRI suggested a cavernous malformation. The patient was operated with total en-bloc removal of the lesion. We conclude that surgical exploration and total resection is the treatment of choice when the diagnosis of cavernous angioma is suspected of the basis of neuroimaging.

Variant Creutzfeldt-Jakob disease: the first confirmed case from Portugal shows early onset, long duration and unusual pathology

We present clinical and autopsy findings in the first case of variant Creutzfeldt-Jakob disease diagnosed and confirmed in Portugal. Onset was at 11 years, the earliest onset reported, and the course (32 months) relatively long. Western blot showed protease resistant prion protein, mainly of type 4 (2B) isoform. The cerebral cortex revealed severe spongiform change with numerous amyloid plaques, which did not fit the definition of florid plaques. In the striatum, spongiform change was limited but the extracellular space was dilated. Other reports have found marked spongiform change in the striatum and little in the cortex. Massive neuronal loss, in excess of what has been described, was found in the thalamus and pontine grey. The cerebellum showed, as expected, severe loss of granule cells, moderate loss of Purkinje cells and marked immunopositivity for the prion protein. Differences between our findings and previous ones probably result from the patient's long survival.

Safety and pharmacokinetics of repeat-dose micafungin in young infants

Given the risk of central nervous system infection, relatively high weight-based echinocandin dosages may be required for the successful treatment of invasive candidiasis and candidemia in young infants. This open-label study assessed the safety and pharmacokinetics (PK) of micafungin in 13 young infants (>48 h and <120 days of life) with suspected candidemia or invasive candidiasis. Infants of body weight > or =1,000 and <1,000 g received 7 and 10 mg/kg/day, respectively, for a minimum of 4-5 days. In the 7-mg/kg/day group, the mean baseline weight and gestational age were 2,101 g and 30 weeks, respectively; in the 10-mg/kg/day group, they were 688 g and 25 weeks, respectively. The median pharmacokinetic values for the 7- and 10-mg/kg/day groups, respectively, were as follows: area under the concentration-time curve from 0 to 24 h (AUC(0-24)), 258.1 and 291.2 microg x h/ml; clearance at steady state adjusted for body weight, 0.45 and 0.57 ml/min/kg; maximum plasma concentration, 23.3 and 24.9 micro g/ml; and volume of distribution at steady state adjusted for body weight, 341.4 and 542.8 ml/kg. No deaths or discontinuations from treatment occurred. These data suggest that micafungin dosages of 7 and 10 mg/kg/day are well tolerated and provide exposure levels that have been shown (in animal models) to be adequate for central nervous system coverage.

Effects of ECF-Kraft pulp mill effluent treated with fungi (Rhizopus oryzae) on reproductive steroids and liver CYP1A of exposed goldfish (Carassius auratus)

The toxicity of bleached Kraft pulp mill effluents (BKME) is usually attributed to chemical compounds which are produced and released throughout various stages of pulp and paper production. The main objective of the present work was to detect sub-lethal responses of goldfish (Carassius auratus) to secondary treated BKME which was treated with Rhizopus oryzae. A total of 96 carps (C. auratus; 11 +/- 3 g) were exposed to different concentrations of the post-treated effluent (0, 1, 10, 25, 50, and 100%), in 28 days semi-static tests. Several biomarkers were then evaluated to assess the toxicological effects: induction of CYP1A (metabolic processes of organic compounds in liver), change in steroid profiles (11-Ketotestosterone, 17beta-estradiol), histopathology of liver and gonads and somatic indices (GSI, HSI) for endocrine disruption and other physiological disturbances. The most significant results show an induction of CYP1A in both sexes and a decrease of 17beta-estradiol concentrations in females. Histopathological changes such as liver tissue degeneration were observed in fish exposed to 50 and 100% of the BKME. Although the BKME was biologically treated there are some chemical compounds in the effluent that are capable to affect fish physiology, however, a clear evidence for endocrine disruption was not found.

Biological treatment of the effluent from a bleached kraft pulp mill using basidiomycete and zygomycete fungi

Three white-rot fungi (Pleurotus sajor caju, Trametes versicolor and Phanerochaete chrysosporium) and one soft-rot fungi (Rhizopus oryzae) species confirmed their potential for future applications in the biological treatment of effluents derived from the secondary treatment of a bleached kraft pulp mill processing Eucalyptus globulus. Among the four species P. sajor caju and R. oryzae were the most effective in the biodegradation of organic compounds present in the effluent, being responsible for the reduction of relative absorbance (25-46% at 250 nm and 72-74% at 465 nm) and of chemical oxygen demand levels (74 to 81%) after 10 days of incubation. Laccase (Lac), lignin (Lip) and manganese peroxidases (MnP) expression varied among fungal species, where Lac and LiP activities were correlated with the degradation of organic compounds in the effluent treated with P. sajor caju. The first two axes of a principal component analysis explained 88.9% of the total variation among sub-samples treated with the four fungus species, after different incubation periods. All the variables measured contributed positively to the first component except for the MnP enzyme activity which was the only variable contributing negatively to the first component. Absorbances at 465 nm, LiP and Lac enzyme activities were the variables with more weight on the second component. P. sajor caju revealed to be the only species able to perform the biological treatment without promoting an increment in the toxicity of the effluent to the Vibrio fischeri, as it was assessed by the Microtox assay. The opposite was recorded for the treatments with the other three species of fungus. EC(50-5 min) values ranging between 28 and 57% (effluent concentrations) were recorded even after 10 to 13 days of treatment with P. chrysosporium, R. oryzae or with T. versicolor.