HIV-related cases among 2,094 admissions to a psychiatric hospital

OBJECTIVE

Admissions to an acute care psychiatric hospital were studied to determine what proportion of admissions were for HIV-related psychiatric disturbances, what evidence exists that the HIV-related admissions constitute a new population of psychiatric inpatients, and whether any psychiatric variables distinguish patients with HIV-related disorders from patients without such disorders.

METHODS

Charts for 2,094 consecutive admissions to the hospital in a three-year period were reviewed. Chi square analyses and t tests were used to compare various groups of HIV-related admissions and non-HIV-related admissions on sociodemographic characteristics, length of stay, history of psychiatric hospitalization, and other clinical measures.

RESULTS

One-hundred and sixty-three admissions (7.8 percent of the total admissions) were judged to be HIV related. The largest category of HIV-related admissions, nearly half, were patients experiencing functional or psychological complications of HIV infection or risk. AIDS-phobic patients, who expressed irrational concerns about infection, accounted for 20.2 percent, and patients with organic manifestations for 18.4 percent. If the AIDS-phobic, HIV-bereaved, and factitious HIV-positive admissions were excluded, the rate of HIV-related admissions was 5.2 percent.

CONCLUSIONS

Psychiatric hospitals can expect a significant but not overwhelming number of HIV-related admissions.

Helicobacter pylori induced interleukin-8 expression in gastric epithelial cells is associated with CagA positive phenotype

AIMS

To use a range of natural phenotypically variant strains of Helicobacter pylori with disparate CagA and VacA (vacuolating cytotoxin) expression to determine which bacterial factors are more closely associated with epithelial interleukin-8 (IL-8) induction.

METHODS

Gastric epithelial cells (AGS and KATO-3) were co-cultured with five H pylori strains which were variously shown to express the cagA gene/CagA protein, VacA and/or to exhibit biological cytotoxicity. Secreted IL-8 was assayed by enzyme leaked immunosorbent assay (ELISA) and IL-8 messenger RNA (mRNA) was assayed using a reverse transcription polymerase chain reaction based technique (RT-PCR).

RESULTS

Strains expressing CagA, including a variant strain (D931) which is non-cytotoxic and does not express the VacA protein, were found to upregulate epithelial IL-8 secretion and gene expression. In contrast, strains with no CagA expression, even in the presence of VacA and/or biological cytotoxicity, (G104, BA142), failed to induce IL-8 protein or mRNA above control values.

CONCLUSIONS

These results strongly support a role for H pylori CagA or coexpressed factors other than the cytotoxin in upregulation of gastric epithelial IL-8. Increased epithelial IL-8 secretion and concomitant neutrophil chemotaxis and activation in addition to direct cytotoxicity may be an important factor in tissue damage and ulceration.

THE EFFECTS OF BRANCHIAL CHLORIDE CELL PROLIFERATION ON RESPIRATORY FUNCTION IN THE RAINBOW TROUT ONCORHYNCHUS MYKISS

The objectives of this study were to induce chloride cell (CC) proliferation on the gill lamellae of rainbow trout Oncorhynchus mykiss and to evaluate the consequences for respiratory function. Chronic elevation of hormone levels was used to induce CC proliferation; fish were injected with a combination of cortisol (8 mg kg-1 intramuscularly every day for 10 days) and ovine growth hormone (2 mg kg-1 intraperitoneally every second day for 10 days). The extent of CC proliferation was quantified using scanning electron microscopy and a two-dimensional analysis. An extracorporeal preparation in combination with environmental hypoxia was used to assess the effects of CC proliferation on respiratory function. Arterial blood was routed from the coeliac artery through an external circuit in which pH (pHa), partial pressure of oxygen (PaO2) and partial pressure of carbon dioxide (PaCO2) were monitored continuously. Environmental hypoxia was imposed by gassing a water equilibration column supplying the experimental chamber with N2. The hormone treatment increased the average CC surface area by 2.7-fold and CC density by 2.2-fold; the combined effect was a fivefold increase in CC fractional area. While the PaO2 values of hormone-treated and control fish were similar at PwO2>12.0 kPa, the arterial O2 tensions of treated fish were significantly lower than those of the control group for PwO2¾12.0 kPa. In comparison with control fish at all environmental O2 tensions, the hormone-treated fish exhibited elevated PaCO2 values and a significant acidosis. The effects of CC proliferation on blood gas variables in hormone-treated fish were accompanied by a significantly elevated ventilation amplitude and a lowered ventilation frequency. The results of this study demonstrated (i) that impairment of respiratory gas transfer coincides with CC proliferation, (ii) that O2 and CO2 transfer are influenced differently and (iii) that partial compensation is achieved through physiological adjustments.

UREA TRANSPORT BY HEPATOCYTES AND RED BLOOD CELLS OF SELECTED ELASMOBRANCH AND TELEOST FISHES

Although urea transport is receiving increased attention in mammalian systems, very little is known about urea transport in fish tissues. This study examined mechanisms of urea transport in red blood cells and hepatocytes from the lesser spotted dogfish (Scyliorhinus canicula), Atlantic stingray (Dasyatis sabina), turbot (Scopthalmus maximus), redfish (Scianops ocellatus), gulf toadfish (Opsanus beta) and oyster toadfish (Opsanus tau). Urea appeared to be passively distributed in both tissues (i.e. there was no difference between plasma and tissue urea concentrations). Additionally, a number of in vitro experiments examining [14C]urea flux were performed. In red blood cells from all species except redfish, urea transport occurred via simple passive diffusion, but redfish red blood cells showed a small (25 %) phloretin-sensitive uptake component. In hepatocytes of the two elasmobranch species (dogfish and stingray), urea efflux was also by simple passive diffusion. However, urea efflux in toadfish (both O. beta and O. tau) hepatocytes exhibited a marked phloretin-sensitivity, and O. beta hepatocytes were used in further experiments with other inhibitors and treatments. Urea transport in O. beta had a relatively high specificity for urea compared with the urea analogues acetamide, thiourea and N-methylurea, was unaffected by phloridzin and extracellular Na+ removal, and was not inhibited by physiological levels of glucose (0.5­10 mmol l-1). A phloretin-sensitive glucose transport, that was not inhibited by physiological levels of urea, was discovered in O. beta hepatocytes. The results are discussed in terms of patterns of species distribution and similarities between urea and glucose transport.

THE EFFECTS OF HYPOXIA, HYPEROXIA OR HYPERCAPNIA ON THE ACID-BASE DISEQUILIBRIUM IN THE ARTERIAL BLOOD OF RAINBOW TROUT

An extracorporeal circulation in combination with a stop­flow technique was used to characterize the acid­base disequilibrium in the arterial blood of rainbow trout Oncorhynchus mykiss during environmental hypoxia, hyperoxia or hypercapnia. Arterial blood was routed from the coeliac artery through an external circuit in which pH (pHa), partial pressure of oxygen (PaO2) and partial pressure of carbon dioxide (PaCO2) were monitored continuously. The stop­flow condition was imposed by turning off the pump which drove the external loop. Water PO2 or PCO2 was adjusted to give the experimental conditions by bubbling N2, O2 or CO2 through a water equilibration column supplying the fish. During normoxia, the arterial blood exhibited a positive acid­base disequilibrium of approximately 0.04 pH units; that is, pH increased over the stop­flow period by 0.04 units. The extent of the imbalance was increased significantly by hypoxia (final PaO2=2.7­3.7 kPa; deltapH=0.05 units). In fish exposed to hyperoxia (final PaO2=47­67 kPa), the direction of the disequilibrium was reversed; pHa declined by 0.03 units. During hyperoxia, CO2 excretion was impaired by 63 % and the PCO2 of postbranchial blood was higher than that of prebranchial blood. It is therefore conceivable that a reversal of the normal, outwardly directed, diffusion gradient for CO2 accounted for the negative disequilibrium; CO2 uptake at the gills would drive plasma CO2/HCO3-/H+ reactions towards CO2 hydration and H+ formation. During hypercapnia, fish exhibited a twofold increase in the positive pH disequilibrium (deltapH=0.06 units). The results of this study confirmed the existence of an acid­base disequilibrium in the arterial blood of rainbow trout and clearly demonstrated that the extent and/or direction of the disequilibrium are influenced by the respiratory status of the fish.

Estrogen mediates the pregnancy-enhanced cardiotoxicity of cocaine in the isolated perfused rat heart

OBJECTIVE

To determine whether pregnancy enhances cocaine toxicity in the isolated perfused whole rat heart model and whether this enhanced toxicity can be simulated by pre-treatment with either estrogen or progesterone.

METHODS

Hearts excised from 65 female Sprague-Dawley rats were attached to a Langendorff apparatus for measurement of left ventricular systolic pressure, heart rate, and contractility. Before excision, the animals were assigned to one of five groups: 1) nonpregnant, 2) pregnant, 3) nonpregnant pretreated with progesterone, 4) nonpregnant pretreated with estrogen, and 5) nonpregnant pretreated with estrogen and progesterone. Each group was exposed serially to the following cocaine concentrations: 5 x 10(-6), 1 x 10(-5), and 6 x 10(-5) mol/L.

RESULTS

Heart rate declined at all doses of cocaine (9.2, 6.9, and 31.0%, respectively). The lowest dose of cocaine had positive inotropic effects, with a 23.2% increase in left ventricular pressure and a 15.3% increase in contractility. Exposure to the two higher doses resulted in negative inotropic effects (a 24.8% decrease in left ventricular pressure and a 39.7% decrease in contractility for the highest dose). Although pre-treatment with estrogen, alone or with progesterone, resulted in responses similar to those seen in pregnant animals, progesterone pre-treatment alone failed to do so.

CONCLUSIONS

Cocaine displayed cardiotoxicity in isolated rat hearts similar to that in other animal models. This toxicity was enhanced by pregnancy. We were able to simulate changes by pretreating the animals with estrogen. Perhaps the enhanced cardiotoxicity of cocaine in pregnancy is partially mediated by estrogen.

Undetected HIV infection among patients admitted to an alcohol rehabilitation unit

Of 300 patients admitted to an alcohol rehabilitation unit, serological testing of discarded admission blood samples revealed that 31 (10.3%) had HIV infection. Chart records indicated that four patients were known to be HIV infected on admission, and HIV infection was detected in another three patients during hospitalization; however, 24 (77.4%) of the HIV-positive patients were discharged with their HIV infection still undetected.

Characterization of infectious molecular clones of equine infectious anaemia virus

We have recovered five infectious molecular clones of the lentivirus equine infectious anaemia virus (EIAV). The clones were recovered from fetal equine kidney (FEK) cells infected with a virulent, cell culture-adapted virus stock (designated PV) and have been characterized at a molecular level. Each clone has unique envelope and long terminal repeat (LTR) sequences. We further investigated LTR sequence variation in the PV stock using PCR amplification to obtain additional LTR clones from infected FEK cells and from peripheral blood mononuclear cells (PBMCs) from animals experimentally infected with PV. Sequence analysis of resulting clones indicates a selection for different LTR populations in pony PBMCs compared to FEK cells. Finally, we observed that the cloned EIAV proviruses did not remain infectious when maintained in a derivative of pBR322. However, two proviruses have been stably maintained in a low copy number vector (pLG338-SPORT).

Quality of sexually transmitted disease services in Jamaica: evaluation of a clinic-based approach. Collaborative Working Group on Indicators of STD Case Management

As part of a larger strategy to develop global indicators of HIV (human immunodeficiency virus) infection prevention programmes, a clinic-based method for the assessment of sexually transmitted disease (STD) service quality was developed and field tested by trained observers who visited a random sample of public-sector clinics in Jamaica in October 1991. The assessment included an inventory of equipment and drugs, interviews with clinic staff, and observations of 27 health workers in 15 clinics as they provided services to 115 patients presenting for STD care. This observation-based method provided Jamaican programme managers with descriptive data on STD case management in public clinics within a one-month study period at an approximate local cost of US+ 5000. Based on weighted estimates, 91% of public-sector STD patients in Jamaica were seen in clinics whose staff had received some training in STD case management during the preceding 12 months. The correct treatment rate was estimated to be 82% for those diagnosed with gonorrhoea, and 70% for those diagnosed with syphilis. Based on 98 observed encounters for first-time-for-episode patients, counselling included sex partner referral (57%), partner reduction (48%), and condom use (59%). Although 61% of STD patients were seen in clinics with condoms in stock on the day of the assessment, only 23% were offered condoms during their visit. The clinic-based assessment method can be adapted to the programme management and reporting needs of countries at all stages of STD service development, and can provide data needed to improve programme operations and meet international reporting standards.

THE EFFECTS OF ACCLIMATION TEMPERATURE ON THE DYNAMICS OF CATECHOLAMINE RELEASE DURING ACUTE HYPOXIA IN THE RAINBOW TROUT ONCORHYNCHUS MYKISS

The response of cannulated rainbow trout (Oncorhynchus mykiss) to acute hypoxia was studied in fish acclimated to two temperatures (5 and 15 °C). Blood/water respiratory variables and plasma catecholamine levels were measured before and 15 min after exposure to hypoxic water varying between 4.0 and 10.7 kPa (30–80 mmHg) oxygen partial pressure (PwO2). Arterial blood PO2 (PaO2) and oxygen content (CaO2) fell during hypoxia in a similar manner at both temperatures, although the changes in CaO2 were often more pronounced in the fish acclimated to 15 °C. Regardless of acclimation temperature, plasma catecholamine levels were consistently elevated at PwO2 values below 8.0 kPa (60 mmHg); the largest increases in plasma catecholamine levels occurred below PwO2=5.3 kPa (40 mmHg). Adrenaline was the predominant catecholamine released into the circulation. Adrenaline was released at PwO2 values of 8.0 kPa or below, whereas noradrenaline was released at PwO2 values of 6.7 kPa or below. The construction of in vivo oxygen dissociation curves demonstrated an obvious effect of acclimation temperature on haemoglobin (Hb) oxygen-affinity; the P50 values at 15 °C and 5 °C were 3.6 kPa (26.7 mmHg) and 1.9 kPa (14.0 mmHg), respectively. At 15 °C, catecholamines were released into the circulation abruptly at a PaO2 threshold of 4.6 kPa (34.5 mmHg) while at 5 °C the catecholamine release threshold was lowered to 3.3 kPa (24.5 mmHg). The difference in the PaO2 catecholamine release thresholds was roughly equivalent to the difference in the P50 values at the two distinct temperatures. Catecholamine release thresholds, calculated on the basis of arterial blood oxygen-saturation (expressed as CaO2/[Hb]), were similar at both temperatures and were approximately equal to 53–55 % Hb O2-saturation. The results support the contention that the lowering of blood oxygen content/saturation rather than PO2 per se is the proximate stimulus/signal causing catecholamine release in rainbow trout during acute hypoxia.

Severity of psychiatric symptoms after HIV testing

OBJECTIVE

The authors were interested in the psychiatric effects of serological testing for HIV and what information feasibly available at intake might predict more severe psychiatric symptoms 1 year later.

METHOD

HIV testing in a private office setting was offered to adults at perceived risk for HIV infection but without AIDS. At entry, then 6 and 12 months later, subjects were counseled by psychiatric nurses and assessed by the Hamilton Rating Scale for Depression, Beck Depression Inventory, Spielberger State-Trait Anxiety Inventory, and Brief Symptom Inventory.

RESULTS

Mean scores on all measures of psychiatric symptoms were lower at follow-up among both 106 HIV-positive and 222 HIV-negative adults. One year after HIV testing, 121 (37%) of the 328 subjects had scores associated with psychopathology. These elevated scores were not predicted by serostatus but by initial psychopathological scores (N = 150), annual income less than +15,000 (N = 114), being female (N = 46), and history of injection drug use (N = 32) and heterosexual risk factors (N = 60) as compared to males having sex with males (N = 236).

CONCLUSIONS

Before the development of more severe physical symptoms, on average, knowledge of HIV infection does not increase psychiatric morbidity; however, regardless of serostatus, a notable percentage of at-risk adults have sustained high levels of psychiatric symptoms. Counseling during the HIV testing process provides an opportunity to identify these individuals for closer study and indicated psychiatric treatment.

Comparison of acellular (B type) and whole-cell pertussis-component diphtheria-tetanus-pertussis vaccines as the first booster immunization in 15- to 24-month-old children

We compared an acellular (B type) pertussis-component diphtheria-tetanus-pertussis (DTP-Ac) vaccine containing equal amounts of filamentous hemagglutinin and lymphocytosis-promoting factor with a conventional whole-cell vaccine as the first booster immunization in 162 healthy children 15 to 24 months of age. Fewer local reactions (e.g., erythema, swelling, and tenderness at the injection site) were seen in DTP-Ac vaccine recipients during the first 48 hours of observation. This group also had fewer episodes of fever (> or = 38 degrees C) and other systemic reactions (e.g., irritability, drowsiness, and anorexia). Overall, 57% of the DTP-Ac vaccine recipients had no obvious adverse reactions, in contrast to 5% in the comparison group. At 4 to 8 weeks after vaccination, serum antibody responses to filamentous hemagglutinin and lymphocytosis-promoting factor were greater in recipients of the acellular vaccine as determined by an enzyme-linked immunosorbent assay. We conclude that this B-type acellular vaccine is both immunogenic and much less likely to cause an adverse reaction than a currently licensed whole-cell vaccine, and is suitable for routine booster immunizing doses to protect against pertussis.

Research in the clinical radiology department

Researchers often feel tangled in a web of bureaucracy when attempting to conduct their research. However, it is vital that researchers get involved and develop review processes such as those described above, which facilitate animal research yet address the important ethical, legal, and other related issues raised by hospital administrators and the public. As we do so, it is vital that we communicate directly with the public. Without this participation, we will find more and more hospital radiology departments closing their doors to animal-based research.

Experimental aspects of cerebrospinal hemodynamics: the relationship between blood flow velocity waveform and cerebral autoregulation

The dynamic relationships among mean flow velocity, its pulsatile amplitude (FVa), cortical cerebral blood flow (CBF), and cerebral perfusion pressure (CPP) were studied in normal rabbits and rabbits with subarachnoid hemorrhage using 8-MHz pulsed transcranial Doppler ultrasound and hydrogen clearance under conditions of systemic hypotension and intracranial hypertension. A two-slope relationship was observed between FVa and CPP with a break point that correlated closely with the lower limit of CBF autoregulation in each animal. Below this CPP break point, FVa varied directly with CPP, and above the break point FVa varied inversely with CPP. In this experimental model, an inverse correlation between FVa and CPP indicates intact CBF autoregulation, whereas loss of that correlation implies exhaustion of autoregulatory reserve. Simultaneous recording and computation of FVa, CPP, and the correlation coefficient between FVa and CPP may be a means of monitoring CBF autoregulation in clinical practice.

Predictors of posttraumatic stress disorder after burn injury

OBJECTIVE

The authors' goal was to examine subjective and objective predictors of posttraumatic stress disorder (PTSD).

METHOD

Hospitalized burn patients were assessed 1 week after injury with both objective predictors (percent of burned area and facial disfigurement) and subjective predictors (emotional distress and perceived social support). The patients were then assessed 2, 6, and 12 months later for development of PTSD.

RESULTS

Among 51 patients, 18 (35.3%) met PTSD criteria at 2 months. High rates of PTSD were also found at 6 months (N = 16, 40.0% of the 40 available patients) and 12 months (N = 14, 45.2% of the 31 available patients). PTSD was predicted by subjective variables assessed at baseline, but patients with more severe burns were not more likely to develop PTSD.

CONCLUSIONS

The DSM-III-R diagnosis of PTSD relies on an objective evaluation of the stressor's severity. The prospective data in this study support those who argue that evaluations of the severity of the stressor might also take into account subjective factors.

Relationships over 1 year between lymphocyte subsets and psychosocial variables among adults with infection by human immunodeficiency virus

To examine relationships between immune and psychosocial variables among adults infected with human immunodeficiency virus type 1, 221 subjects without acquired immunodeficiency syndrome were assessed for degree of depression, anxiety, psychiatric symptoms, social support, stressful life events, hardiness, hopelessness, bereavement, and intrusive and avoidant thoughts about acquired immunodeficiency syndrome. At entry, none of 22 psychosocial variables significantly correlated with lymphocyte subsets. Among subjects seen 6 and 12 months later, severity of physical symptoms was associated with greater emotional distress, but the CD4 cell count was predicted by neither clinical ratings of psychopathology and global functioning nor by standardized self-report measures of constructs used in psychoimmune research. We conclude that among our sample, physical symptoms contributed to emotional distress, but emotional distress did not contribute to the CD4 cell count, a marker of disease progression.

Undetected HIV infection among acutely ill psychiatric inpatients

Serological testing of waste bloods revealed that 25 (7%) of 350 acutely ill psychiatric inpatients had HIV infection. Eight of the 10 HIV-positive patients whose serological status was not recorded on admission were discharged with their status still unrecorded and presumably undetected. Thirty-nine (51%) of the 77 inpatients with HIV-related risk behaviors identified on admission were discharged with no record of their having been serologically tested before or during hospitalization.