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.

High prevalence of ST121 in community-associated methicillin-susceptible Staphylococcus aureus lineages responsible for skin and soft tissue infections in Portuguese children

In order to evaluate the incidence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in Portugal, we analyzed a collection of 38 S. aureus isolates recovered from 30 children attending the pediatric emergency department of a central hospital in Lisbon due to skin and soft tissue infections. Molecular characterization identified seven clonal lineages among the 35 methicillin-susceptible S. aureus (MSSA) isolates, of which the major lineage PFGE A/t159/ST121 included 63% of the isolates. The three MRSA isolates belonged to the Pediatric clone PFGE D/t535/ST5-IV (n = 2) and to the European CA-MRSA clone PFGE G/t044/ST80-IVc (n = 1). All isolates harbored several virulence factors, namely, leukocidins. Panton-Valentine leukocidin (PVL) was produced by isolates from five MSSA lineages and by the ST80 MRSA. Of interest, this is the first reported isolation of CA-MRSA ST80 in Portugal.

Reproductive biology of the crocodile shark Pseudocarcharias kamoharai

From February 2005 to September 2007, a total of 490 crocodile sharks Pseudocarcharias kamoharai, caught as by-catch in the swordfish and tuna longline fishery that operates in the tropical western Atlantic Ocean, was studied in regard to their reproductive biology. Maximum observed total lengths (L(T)) were 1220 and 1090 mm for females and males respectively, with a high proportion of the catch being composed of mature specimens. Sexual maturity was attained at 760-810 mm L(T) for males (L(T50) = 800 mm) and 870-980 mm L(T) for females (L(T50) = 916 mm). The size at birth was estimated at 415 mm L(T). Temporal variation in gonad morphology and mass suggests that in this region P. kamoharai, an aplacental viviparous species with oophagy, does not show a well-defined reproductive seasonality, with mating and parturition occurring possibly over an extended period of the year. Mean +/-S.D. fecundity was estimated to be 3.9 (+/- 0.6) pups per reproductive cycle.

Real-time data processing and magnetic field pitch angle estimation of the JET motional Stark effect diagnostic based on Kalman filtering

A novel technique for the real-time measurement of the magnetic field pitch angle in JET discharges using the motional Stark effect diagnostic is presented. Kalman filtering techniques are adopted to estimate the amplitude of the avalanche photodiode signals' harmonics that are relevant for the pitch angle calculation. The proposed technique {for extended technical details of the generic algorithm see [R. Coelho and D. Alves, IEEE Trans. Plasma Sci. 37, 164 (2009)]} is shown to be much more robust and provides less noisy estimates than an equivalent lock-in amplifier scheme, in particular when dealing with edge localized modes.

The Evaluation of Type d Personality, Depression and Quality of Life in Patients with Acute Coronary Syndromes

Background:

Acute coronary syndromes (ACS) are a major cause of morbidity and mortality in western industrialized countries and account for disability and loss of productivity. Type D personality and depression are established psychosocial factors with a negative impact on prognosis following acute events.

Methods:

We evaluated 65 patients admitted to a coronary unit with ACS regarding type D personality (DS-14), depression (BDI-II, HADS), anxiety (HADS), clinical depression (clinical interview following DSM-IV-TR criteria) and quality of life (SF-36). SPSS 12.0 was used for statistical analysis and significance considered for p< 0.05.

Results:

We found that 38.5% of patients had type D personality and divided the sample into two groups. No significant differences were found regarding social and demographic factors but differences were found regarding diagnosis on admission: type D patients had more AMI with ST elevation (p< 0.05). Type D patients had significantly higher scores in depression and anxiety scales of the HADS (p< 0.01) and worse quality of life in most SF-36 subscales (p< 0.01). There was a negative and significant correlation between the HADS and all the SF-36 subscales, strongest in the mental health subscale (p< 0.01).

Conclusions:

Type D patients have higher indices of anxiety and depression and worse quality of life when compared with other patients, and constitute a high risk group of worse prognosis. Our results also suggest differences between groups regarding the type of acute event but these results require further confirmation.

In my Breast… in Your Hands… Psychological Distress Among Women Submitted to Breast Histological Biopsy

It is almost consensual, the development of both anxiety and depression, among women diagnosed with breast cancer. Sometimes symptoms remain restricted to the time of diagnosis, but quite often they persist, and even increase after that. However, this same feature, among women with benign tumors, has not yet been well established.

Authors’ aim is to characterize the population of women attending a Breast Disease Diagnosis Unit, including: socio-demographic features, clinical conditions and screening for anxiety and depression. They also pretend to check out differences between the ones with benign and the others with malign disease.

For this purpose they evaluated 150 women, attending Breast Disease Diagnosis Unit of St. John Hospital (Oporto). All of them were first evaluated by a Psychologist, at the time of the histological diagnostic biopsy, and fulfilled a clinical specific protocol, as well as the Hospital Anxiety and Depression scale (HADS). Patients scoring for borderline (8-10) or pathological levels (» 11) were then reevaluated, after a three month period. Preliminary data shows that a high percentage of women with pathological levels of anxiety and depression symptoms (40%) were diagnosed with benign breast tumor.

First conclusion is about the need for a more attentive clinical behavior, also towards women with benign breast tumors. In fact it seems that they also have a high risk of developing both anxiety and depression.

This is an ongoing study, and the aim is to increase sample size and to better analyze and justify all possible variable correlations.

Real-time estimation of the poloidal wavenumber of ISTTOK tokamak magnetic fluctuations

The successful control of a fusion plasma discharge relies on the continuous improvement of existing diagnostics and on the development of new ones based on innovative concepts. It is equally important to provide efficient numerical tools capable of extracting, in real time, the most important physical quantities emerging from the collected data. This encompasses, for instance, the determination of the wavenumber and amplitude tracking of plasma instabilities, a necessary ingredient for establishing in real time the type of feedback control stabilization scheme to be used. In this paper, the characterization of the wavenumber spectra of unstable modes observed in ISTTOK plasma discharges is addressed using a set of two poloidal arrays of magnetic coils (Mirnov coils). In particular, the prospect for the estimation of the poloidal wavenumber in real time using recursive filtering techniques is investigated. It is shown that, in contrast with typical cross-spectrum analysis, where a large dataset is required to estimate the wavenumbers, with this innovative technique, the wavenumber spectra may be obtained in faster time scales.

Real-time plasma control based on the ISTTOK tomography diagnostic

The presently available processing power in generic processing units (GPUs) combined with state-of-the-art programmable logic devices benefits the implementation of complex, real-time driven, data processing algorithms for plasma diagnostics. A tomographic reconstruction diagnostic has been developed for the ISTTOK tokamak, based on three linear pinhole cameras each with ten lines of sight. The plasma emissivity in a poloidal cross section is computed locally on a submillisecond time scale, using a Fourier-Bessel algorithm, allowing the use of the output signals for active plasma position control. The data acquisition and reconstruction (DAR) system is based on ATCA technology and consists of one acquisition board with integrated field programmable gate array (FPGA) capabilities and a dual-core Pentium module running real-time application interface (RTAI) Linux. In this paper, the DAR real-time firmware/software implementation is presented, based on (i) front-end digital processing in the FPGA; (ii) a device driver specially developed for the board which enables streaming data acquisition to the host GPU; and (iii) a fast reconstruction algorithm running in Linux RTAI. This system behaves as a module of the central ISTTOK control and data acquisition system (FIRESIGNAL). Preliminary results of the above experimental setup are presented and a performance benchmarking against the magnetic coil diagnostic is shown.

Observation of plasma density fluctuations by a heavy ion beam probe diagnostic with multiple cell array detector on the tokamak ISTTOK

The heavy ion beam probe (HIBP) diagnostic permits the measurements of electron density and plasma potential as well as their fluctuations. The use of a multiple cell array detector (MCAD) spreads the HIBP capabilities to make simultaneous measurements across the plasma column. Two sets of current-to-voltage converters with respective bandwidths of 400 kHz and 4 MHz have been tested. This upgrade of the MCAD electronics has allowed the observation of quasicoherent fluctuations in bulk plasma at frequencies between 100 and 200 kHz. The localization and frequency of bulk plasma fluctuations correlate with the magnetohydranamic activity of the plasma.

Right ventricular diastolic function after repair of tetralogy of Fallot

The objective of this study was quantitate diastolic dysfunction in the postoperative phase of tetralogy of Fallot (TOF) and to correlate it with the type of surgical procedure and clinical parameters. Fifty consecutive patients (mean age, 5.0 years; mean weight, 13.5 kg), operated for TOF during the period November 2004 to May 2005, were prospectively studied [infundibular resection, 23; infundibular resection and transannular patch (TAP), 19; right ventricle --> pulmonary artery conduit, 8). Detailed echocardiography was done on postoperative days 3 and 9 with a focus on Doppler indices of right ventricular (RV) function, Antegrade late diastolic flow in the right ventricular outflow tract (RVOT) was taken as the marker of restrictive RV physiology. The previous parameters were correlated to the type of surgery and clinical indices of RV dysfunction. There was no mortality. Twenty-four patients showed restrictive RV physiology. This finding correlated with lower values of E/A ratio (0.98 +/- 0.17 vs 1.33 +/- 0.49, p < 0.002), tricuspid valve E-wave deceleration time (86.9 +/- 21.7 vs 151.4 +/- 152 msec, p < 0.05), index of myocardial performance (0.15 +/- 0.06 vs 0.26 +/- 0.09, p < 0.001), isovolumic relaxation time (19.4 +/- 17 vs 39+/-30 msec, p < 0.009), and a higher central venous pressure (15.1 +/- 1.5 vs 12.7 +/- 1.9, p < 0.001). Restrictive RV physiology correlated with prolonged intensive case unit (ICU) stay (5.1 +/- 3.7 vs 2.8 +/- 2 days, p < 0.015), longer duration of inotropic support (108.3 +/- 56.2 vs 55.5 +/- 28.3 hours, p < 0.02), and higher dosage of diuretics. RV diastolic dysfunction is demonstrable by Doppler echocardiography in the first week following surgery for TOF and tends to be worse with TAP. Restrictive physiology demonstrated by RVOT pulse Doppler predicts longer duration of inotropic support, prolonged ICU stay, and higher dosage of diuretics.

Thrombolysis with percutaneous transluminal balloon angioplasty of a blocked modified Blalock-Taussig shunt

Transcatheter balloon recanalization of occluded Blalock-Taussig shunts in the early post-operative period has been reported in the past but there are issues regarding the role of thrombolysis in this situation. We present our experience with such a procedure in an infant with blocked modified Blalock-Taussig shunt.