Toward a comprehensive care of HIV patients: finding a strategy to detect depression in a Spanish HIV cohort

Depression is a common but frequently undiagnosed feature in individuals with HIV infection. To find a strategy to detect depression in a non-specialized clinical setting, the overall performance of the Hospital Anxiety and Depression Scale (HADS) and the depression identification questions proposed by the European AIDS Clinical Society (EACS) guidelines were assessed in a descriptive cross-sectional study of 113 patients with HIV infection. The clinician asked the two screening questions that were proposed under the EACS guidelines and requested patients to complete the HADS. A psychiatrist or psychologist administered semi-structured clinical interviews to yield psychiatric diagnoses of depression (gold standard). A receiver operating characteristic (ROC) analysis for the HADS-Depression (HADS-D) subscale indicated that the best sensitivity and specificity were obtained between the cut-off points of 5 and 8, and the ROC curve for the HADS-Total (HADS-T) indicated that the best cut-off points were between 12 and 14. There were no statistically significant differences in the correlations of the EACS (considering positive responses to one [A] or both questions [B]), the HADS-D ≥ 8 or the HADS-T ≥ 12 with the gold standard. The study concludes that both approaches (the two EACS questions and the HADS-D subscale) are appropriate depression-screening methods in HIV population. We believe that using the EACS-B and the HADS-D subscale in a two-step approach allows for rapid, assumable and accurate clinical diagnosis in non-psychiatric hospital settings.

The General Criteria for Personality Disorders Assessed by Interview: Do They Still Have a Role to Play?

On the path to developing dimensional models of personality disorder (PD), we are at risk of leaving key diagnostic aspects behind. The general criteria for PD may be important ones because they reflect the defining aspects of personality pathology: long duration, independence from psychopathological states, and harmfulness. We assessed these criteria by interview in a sample of 362 psychiatric outpatients after administering the Personality Diagnostic Questionnaire-4+. The result was a 42.5% fall in self-reported endorsements, due to misinterpretations (11.5%), short duration of traits or contamination by state psychopathology (9.8%), and traits being non-harmful (21.2%). However, not all personality traits and disorders underwent correction to the same extent, and ultimately, the interview did not improve the prediction of clinical variables. These findings raise doubts about the practical relevance of the general criteria for PD and support the role of self-report questionnaires for diagnostic purposes.

[Spanish scientific production in antimicrobial agents and susceptibility procedures during period 1990-2002]

The aim of this study was to analyze the scientific production of Spanish authors on antimicrobial agents and susceptibility tests during the period 1990-2002. Articles from Spanish scientific institutions of microbiology, bacteriology, mycology and parasitology published and recorded in the MEDLINE database (WEBSPIRS version 4.2) during the period 1990-2002 were selected. Only articles about antimicrobial agents and susceptibility procedures were reviewed. A total of 5,259 documents were analyzed, of which 1,041 (19.8%) were about antimicrobal agents. The annual number of documents increased by two-fold (from 48 in 1990 to 101 in 2002). The journal that published most documents was Antimicrobial Agents and Chemotherapy, with 183 (17.1%). The main field of interest of the documents was antimicrobial agents and susceptibility tests (765; 73.5%) and in vitro resistance analyses (265; 25.5%). The highest number of contributions came from hospitals (571; 54.9%), followed by universities (351; 33.7%). The institutions with most documents published were the Ramón y Cajal Hospital (8.6%), and Seville University Faculty of Medicine (6%). The most productive autonomous communities were Madrid (43.4%), Catalonia (16.4%) and Andalusia (4.7%). A total of 787 documents (75.6%) were published in journals with impact factors and the mean expected impact factor was 2.390 +/- 1.546. It was concluded that the scientific production of Spanish researchers in antimicrobial agents had increased during the period 1990-2002, and that hospitals were the most productive institutions in this area of microbiology, with the main areas of interest being antimicrobial agents and susceptibility tests.

Psoriatic arthritis: clinical response and side effects to methotrexate therapy

In the last decade, methotrexate (MTX) has emerged as a useful second line agent for a variety of arthritides. However, there still exists some reluctance for its wider use mainly because of concerns about its liver side effects. We describe our clinical experience with this drug in psoriatic arthritis (PsA). The study group included 24 men and 16 women, with a mean age of 47 years (16-75), with oligoarticular (13) or polyarticular (27) involvement, with a mean disease duration of 12 years (1-36). Patients received a mean dose of 11.2 mg of MTX orally/week during a mean period of 34 months (6-132). Seven had been previously treated with other second line agents. Thirty-eight patients had an excellent or good response. In them, the erythrocyte sedimentation rate dropped in a mean of 38 mm/h. Only 2 patients had a rather poor response. Two patients discontinued the medication because of side effects: leukopenia in one and stomatitis in the other. Eleven patients presented with liver test abnormalities: 3 mild, 6 moderate and 2 severe. Seven patients had 11 liver biopsies. Except for one, none had evidence of cirrhosis or inflammation. Indeed, no changes were observed in the histopathology in those with repeated biopsies. The case reported as cirrhosis occurred very early in the course of MTX therapy. He continued taking MTX treatment without further deterioration of liver chemistry and/or histology. It is concluded that MTX is an effective and safe agent in PsA. Results also indicate that it is not necessary to perform liver biopsies on a routine basis.

[Identification of sentinel lymph node with patent blue V in patients with cutaneous melanoma]

Regional lymphadenectomy in patients with cutaneous malignant melanoma in stages I-U AJC/UICC has not demonstrated improvement either in loco-regional control or in survival. The results of the lymphatic mapping technique have demonstrated that on identifying the sentinel node, the group of patients with microscopic nodal metastases can be selected for regional treatment. We performed the intraoperative lymphatic mapping technique with 1 ml of blue patent V by intradermal injection just around the primary melanoma; after injecting the dye we incised the nodal skin region, identifying the sentinel node by its blue color. The histologic examination, by frozen section of this node, determines whether or not to proceed with a formal lymphadenectomy. We calculated the sensitivity of the dye for the identification of the sentinel node and the Pearson's test was performed between the intraoperative histologic study and the definite pathological result. Thirty one lymphatic mappings were performed in 29 patients with stages I-II malignant cutaneous melanoma. The sentinel node was found in 26/31 explored lymphatic zones, and in 5, it was not found, sensitivity of 84%; 23/26 sentinel nodes were negative and only 3/26 were metastatic in frozen section. The Pearson's test result was 0.78 with a predictive value of 92%. The blue patent V intraoperative lymphatic mapping technique in patients with malignant cutaneous melanoma provided a great sensitivity to identify the sentinel node and allows the identification of patients with high risk of microscopic nodal metastases.

Differentiating Abnormal, Normal, and Ideal Personality Profiles in Multidimensional Spaces

Abstract: Current dimensional taxonomies of personality disorder (PD) establish that intense traits do not suffice to diagnose a disorder, and additional constructs reflecting dysfunction are required. However, traits appear able to predict maladaptation by themselves, which might avoid duplications and simplify diagnosis. On the other hand, if trait-based diagnoses are feasible, it is the whole personality profile that should be considered, rather than individual traits. This takes us into multidimensional spaces, which have their own particular – but poorly understood – logic. The present study examines how profile-level differences between normal and disordered subjects can be used for diagnosis. The Dimensional Assessment of Personality Pathology – Basic Questionnaire (DAPP-BQ) and the Personality Inventory for DSM-5 (PID-5) were administered to a community and a clinical sample each (total n = 1,925 and 3,543 respectively). Intense traits proved to be common in the general population, so empirically-based thresholds are indispensable not to take as abnormal what is at most unideal. Profile-level parameters such as Euclidean and Mahalanobis distances outperformed individual traits in predicting mental problems and equaled the performance of published measures of dysfunction or severity. Personality profiles can play a more central role in identifying disorders than is currently acknowledged, provided that adequate metrics are used.

[Characterization fo mycelial mutants of Mucor rouxii]

The consequences of two different mutations induced with N-methyl-N-nitrosoguanidine (Strain G1) and Trifluoperazine resistance (Strain G5) in Mucor rouxii, were studied. Mutants were stable and exhibited mycelial morphology in aerobiosis. Mutants cells exhibit phenotypic characteristics of slow-growing. The mutants G1 and G5 cultures showed 16.8% and 35.3% of reduction of the growth relative to parental strain. Morphologically mycelia of mutants cell were indistinguishable from wild-type cells, except from reduction in extension and branching of hyphal that has the mutant G5. Calcofluor and FITC-Concanavalin A were used to study the distribution of new cell-wall polymers i.e. Chitin, glucans. The two G1 and G5 strains showed a uniform distribution of fluorescence over the cell surface, indicating that active deposition of new-wall material has occurred. Cellular proteins of mutants and parental strains were labeled with 14C-aminoacid mixture. The proteins pattern revealed that the majority of polypeptides synthesized by parental strain were also synthesized by mutants. It is evident the synthesis preferential of peptides with apparent M(r) > 92K, 60K, 50K, 43K, 38K and 25K. These results indicated that the primary defect of the mutation was not on cellular differentiation. It discuss phenotypic and biochemistry characteristics from mutants.

[A genetic-behavioral alternative to the personality disorders: the Livesley dimensional model]

In the personality disorder section of the DSM-V research agenda, the authors stress the need for studies on the relevance of a change from diagnostic categorical models to dimensional ones. These studies should identify the underlying genetic and neurobiologic mechanisms and appropriate representation on the dimensions of clinical criteria as cognitive disturbances, identity conflicts and attachment. Livesley's behavioral-genetic model represents an interesting dimensional paradigm of personality pathology. It was elaborated deductively from the consensus and statistical refinement of data collected by a large number of clinicians from different psychopathological tendencies. The traits are made operative in the "Dimensional Assessment of Personality Pathology-Basic Questionnaire" (DAPP-BQ) tool with 18 dimensions (that became 30) and 4 higher rank factors (adapted to Spanish by Gutiérrez- Zotes et al, 2008). The model has shown an appropriate relationship with important personality paradigms and good predictive power for personality disorders. The authors incorporate methods of variance breakdown for statistical processing of the genetic-environmental mechanism underlying each personality disorder dimension. Homologation of DSM-IV-TR criteria for personality disorders is proposed so that the model's dimensions capture and represent the clinical complexity of the symptoms in a convenient manner for the new location in DSM-V.

Asparaginase activity monitoring in pediatric acute lymphoblastic leukemia: A cross-sectional nationwide study in Spain

BACKGROUND

A cross-sectional nationwide study was designed to assess national compliance with international consensus/guidelines of monitoring asparaginase levels in children with acute lymphoblastic leukemia (ALL) treated with asparaginase in routine clinical practice.

METHODS

An ad hoc questionnaire was designed and completed by staff physicians from Hemato-Oncology Units throughout Spain.

RESULTS

A total of 39 physicians (64% pediatricians) with a mean (SD) age 43.5 (7.9) years and 15.3 (17.6) years of professional activity participated in the study. They accounted for 90% of hospitals in which children with ALL are treated in Spain. A total of 19 participants (48.7%) reported that asparaginase levels were routinely monitored (own center in 2 cases [10.5%], another hospital in 17 cases [89.5%]). Asparaginase was not monitored in 51.3% of the cases, mostly (80%) because unavailability of testing. When asparaginase was monitored, 68% of participants reported that this was done in all asparaginase-treated patients and 84% in all phases of the disease (induction, consolidation, re-induction, maintenance) with a time interval of 7 days for the pegylated form, 48 h for Erwinia asparaginase and 14 days for maintenance with the pegylated form. All participants reported that they modified treatment according to results of testing, with a limit of total depletion of ≥100 IU/L. Levels <100 or 20 IU/L were considered indicative of hypersensitivity by 46% of physicians.

CONCLUSION

There is still a gap between what is recommended and what is done in clinical practice, with more than 50% of centers not monitoring the level of asparaginase activity in pediatric ALL. Protocols for asparaginase testing in daily practice should be implemented.

Peroxisomal proliferation induced by treatment with clofibrate in a patient with a peroxisomal disease

The induction of peroxisomal proliferation in liver parenchymal cells of rats fed a diet containing clofibrate, a hypolipidemic drug, is a well-established event. However, the available data on human hepatocytes in vivo and in vitro indicate that agents that induce peroxisomal proliferation in rats and mice have no effect on human liver cells. The authors are reporting the case of a patient with clinical and laboratory diagnosis of X-linked-adrenoleukodystrophy. In an initial liver biopsy, a reduced volume fraction of peroxisomes was found (Vv. = .012) after a morphometric analysis, initiating treatment with clofibrate at a dose of 1.5 g/d. The administration of clofibrate was maintained for 7 yr. Liver biopsies were taken after 2, 4, and 7 yr, to follow the peroxisomal response. Results demonstrated a 500% increase in peroxisomal Vv. (.060) after 2 yr of treatment, compared with the pretreatment Vv. In subsequent biopsies, the peroxisomal Vv. value was maintained at 225 and 183% increases above the pretreatment biopsy (.027 and .022, respectively).

Relationship between foreign H-2-like antigens on MCG4 sarcoma and the in vivo rejection of this tumor by syngeneic and semisyngeneic mice

MCG4, a BALB/c sarcoma (H-2d), that abnormally expresses H-2k and h-2b-like antigens, regressed spontaneously when inoculated in BALB/c and in BALB/c hybrids F1. A relationship was found between the anti-H-2k and/or anti-H-2b activity detected in the sera and spleen cells of the regressor mice and their capacity to reject the tumor.

Dimensional Personality Assessment among a Chronic Fatigue Syndrome (CFS) sample with Personality Inventory for DSM-5 (PID-5)

INTRODUCTION

Personality Disorders (PD) are highly prevalent among Chronic Fatigue Syndrome (CFS) patients, but studies based on the DSM-5 are still scarce. Validated instruments have not yet been specifically used in CFS patients. Therefore, our aim was to analyze the differences in personality facets and domains profiles among CFS patients with and without a PD using the Personality Inventory for DSM-5 (PID-5). Additionally, we analyzed the ability of this instrument to predict PD in a sample of CFS patients. This instrument is validated for PDs, but not for CFS.

METHODS

All of the 84 CFS patients were evaluated through a clinical interview and underwent psychopathological evaluation with the SCID I and SCID II. Dimensional personality facets and domains were evaluated with the PID-5, according to DSM-5.

RESULTS

In our sample, 54 (64%) of the patients fulfilled the criteria of a PD. The most significant facets in CFS with PD in comparison to those patients without a PD were Separation Insecurity, Perseveration, Withdrawal, Depressivity, Rigid Perfectionism, Unusual Beliefs and Experiences. Negative Affectivity and Detachment were the two significant domains in CFS-PD patients. In the regression analyses, only Detachment and Rigid Perfectionism constituted a prognostic factor leading to high probability of an endorsed PD. Conclussion. According to these results, the PID-5 domains and facets could be adequate and useful to differentiate between PD and non-PD patients in clinical samples and suggest a more frequent dimensional personality profile in CFS patients.

Chlamydia-induced reactive arthritis

Chlamydia trachomatis infection is now recognized as the most prevalent veneral disease in the Western World. The majority of cases of Reiter's syndrome, one type of reactive arthritis, are secondary to sexually transmitted infections. Evidence of urogenital C. trachomatis infection is found in 36% to 61% of cases of Reiter's syndrome. We investigated the prevalence of infection by this organism in a group of patients with spondyloarthropathies. Positive cultures were obtained in 39.4% of patients with Reiter's syndrome, as well as in 22.2% of patients with psoriatic arthritis and in 20% of patients with ankylosing spondylitis. An important percentage of patients also had positive serum antibodies against C. trachomatis (62.1% of patients with Reiter's syndrome), suggesting presence of infection at some point during the course of the disease. Our findings and those from other authors support the use of long-term antibiotic therapy in patients with reactive arthritis, mainly in those in whom positive culture for C. trachomatis has been obtained as well as in their sex partners.