Anxiety disorders and obesity

Anxiety disorders are the most prevalent mental disorders in developed countries. On the other hand, obesity is recognized to be one of the greatest public health problems worldwide.The connection between body weight and mental disorders remains an open issue. Low body weight has been studied enough (anorexia nervosa is a typical example) but high body weight has not been addressed sufficiently. It is known that obesity has been related with depression. Although moderate level of evidence exists for a positive association between obesity and anxiety disorders, the exact association between these two conditions is not clear yet.The studies about this subject are quite few and they follow different methodology. Furthermore,anxiety disorders share some common elements such as anxiety, avoidance and chronicity, but they also present a great deal of differences in phenomenology, neurobiology, treatment response and prognosis. This factor makes general conclusions difficult to be drawn. Obesity has been associated with anxiety disorders as following: most of the studies show a positive relationship with panic disorder, mainly in women, with specific phobia and social phobia. Some authors have found a relationship with generalised anxiety disorder but a negative relationship has been also reported.Only few studies have found association between obesity and agoraphobia, panic attacks and posttraumatic stress disorder. There has not been reported a relationship between obesity and obsessive-compulsive disorder. The causal relationship from obesity to anxiety disorders and vice versa is still under investigation. Pharmacological factors used for obesity treatment, such as rimonabant,were associated with depression and anxiety. Questions still remain regarding the role of obesity severity and subtypes of anxiety disorders. Besides, it is well known that in the morbidly obese patients before undergoing surgical treatment, unusual prevalence of psychopathology, namely depression and anxiety disorders, is observed. Anxiety is also a common trait in personality disorders.There is no single personality type characteristic of the morbidly obese, they differ from the general population as their self-esteem and impulse control is lower. Obese patients present with passive-dependent and passive-aggressive personality traits, as well as a trend for somatization and problem denial. Their thinking is usually dichotomous and catastrophic. Obese patients also show low cooperativeness and fail to see the self as autonomous and integrated. When trying to participate in society roles they are subject to prejudice and discrimination and should be treated with concern to help alleviate their feelings of rejection and guilt.

[A volumetric study of brain structures in subtypes of depression]

The aim of this study is to compare the volumes of hippocampus, amygdala and subgenual prefrontal cortex among patients with melancholic depression, patients with psychotic depression and normal controls. Thirty nine patients with a diagnosis of major depression (22 with melancholic and 17 with psychotic subtype) and 18 normal controls were included in the study. Hippocampal, amygdala, anterior and posterior subgenual cortex volumes were measured by manual tracings on magnetic resonance volumetric images and compared across the 3 groups. We identified larger amygdala volumes and smaller left anterior subgenual cortex volumes in both patient groups compared to controls. There were no differences in hippocampal, right anterior and posterior subgenual cortex volumes across the 3 groups. In conclusion, melancholic and psychotic depression were not differentiated regarding the volumes of the hippocampus, the amygdala, and anterior and posterior subgenual cortex, even though amygdala volumes and left anterior subgenual cortex volume of both patient groups were differentiated compared to controls.

Hospital anxiety and depression scale. A quantitative analysis in medical outpatients, psychiatric outpatients and normal subjects

Depressive and anxiety symptomatology represent the most common psychiatric manifestations that complicate the management and prognosis of patients with somatic disorders. The Hospital Anxiety and Depression Scale (HADS) is a reliable, valid andpractical screening tool for identifying and quantifying anxiety and/or depression in non-psychiatric out patients. The aim of the present study was to compare the psychometric properties of the HADS among internal medicine outpatients, psychiatric outpatients and the generalpopulation. The present study involved 264 subjects: 95 internal medicine outpatients, 79 psychiatric outpatients and 90 normal controls. Psychiatric outpatients were diagnosed according to DSMIV-TR and inclusion criteria required the absence of any psychotic or organic psychiatric disorder. Patients with depressive disorders were divided in 3 groups: major depression, dysthymic disorderand adjustment disorder with mixed anxiety and depressed mood. All patients were administered the following psychometric tools: HADS, BDI and STAI. Subjects of the control group were administeredonly HADS. In all psychometric scales the psychiatric group presented significantly greater values than the internal medicine and the control group. In turn, the internal medicine group scoredsignificantly higher than the control group. Within the psychiatric outpatient group significantly higher HADS and HADS-D scores were observed in the major depression group followed by the dysthymicdisorder and the adjustment disorder with mixed anxiety and depressed mood group. HADS may be capable of identifying anxiety and depressive symptoms between psychiatric outpatients, internal medicine outpatients and subjects in the general population. In addition, the HADS-D subscaledifferentiates the main depressive disorders.

PM2.5 and volatile organic compounds (VOCs) in ambient air: a focus on the effect of meteorology

PM(2.5) and VOCs (benzene, toluene, m-p-o-xylenes) concentrations were measured in an urban and a suburban site in Athens, Greece, during the period between April and November 2004. This period, which is considered to be the warmer period in Greece, is characterized by the development of sea-breeze over the Attica Basin. Additionally strong Northern, North-eastern winds called "The Etesians", predominate during the summer months (July-August), acting positively to the dispersion of pollutants. In this campaign, 24 days with sea-breeze development were observed, 15 days with northern winds, 6 days with southern winds while the rest of the days presented no specific wind profile. Maximum concentrations of PM(2.5), VOCs and nitrogen oxides, were detected during the days with sea-breeze, while minimum concentrations during the days with northern winds. Ozone was the only pollutant that appeared to have higher concentrations in the background site and not in the city centre, where benzene presented strong negative correlation with ozone, indicating the photochemical reaction of hydrocarbons that lead to the ozone formation. The BTX ratios were similar for both sites and wind profiles, indicating common sources for those pollutants. T/B ratio ranged in low levels, between 3-5 for site A and 2-5 for site B, suggesting vehicles emissions as the main sources of volatile compounds. Finally, the strong correlations of PM(2.5) and benzene concentrations, between the two sampling sites, indicate that both the city centre and the background site, are affected by the same sources, under common meteorological conditions (sea-breeze, northern winds).

Ions species size distribution in particulate matter associated with VOCs and meteorological conditions over an urban region

Airborne particulate matter (PM10, PM2.5, PM1) and volatile organic compounds (benzene, toluene, m,p-xylene, o-xylene) samples were collected during winter and summer seasons of 2005 at two sites, representing an urban and a suburban region of the Greater Athens Area. Urban site traffic emissions were the major contributor to the concentration of PM2.5, PM10, toluene, and xylenes, while benzene and PM1 concentrations were presented in significant spatial variations. K+, Na+, Mg2+, Ca2+, NO3-, Cl- and SO42- ions were analyzed for the chemical characterization of the collected PM samples. The results showed that Na+ cations and SO42- anions were the dominant species, during winter and summer, respectively, in both sites. The analysis of the synoptic scale and mesoscale atmospheric circulation during the experimental periods demonstrated that the meteorological conditions play a key role, not only in the variation but also in the distribution of the ionic concentrations at the three fractions of particulates and the dominant character (alkaline/acidic/neutral) of the particulates at the two sampling sites.

Gas-particle concentration and characterization of sources of PAHs in the atmosphere of a suburban area in Athens, Greece

Atmospheric polycyclic aromatic hydrocarbons (PAH) were determined in two places in a suburban area of Athens greater area (AGA) during June and November 2003. Fourteen PAHs were quantified in the collected samples. The total concentration in the gas phase ranged between 6.89 and 124ngm(-3), while in the particulate phase between 0.44 and 13.2ngm(-3). Maximum concentrations of the total PAHs (gas and particulate phase) were observed during the cold period with an average of 40.7ngm(-3). PAHs were correlated with NO, NO(2) and O(3), wind speed, wind direction and temperature. Positive correlation was observed between PAHs and NO, NO(2), while negative correlation was detected between PAHs and O(3). The most abundant members were phenanthrene, anthracene, fluorene, fluoranthene and pyrene. Potential sources of PAHs in aerosols were investigated using molecular diagnostic ratios, which reflect sources such as diesel and gasoline engines, although other sources such as coal combustion and liquefied petroleum gas also contributed.

Estimation of selected heavy metals and arsenic in PM10 aerosols in the ambient air of the Greater Athens Area, Greece

Aerosol samples of PM(10) were collected during summer and winter 2003 at two different sites in the Messogia Basin northeast of Athens, to demonstrate the variations of heavy metals in PM(10) and examine their relationship with both gaseous pollutants and meteorological parameters. Estimated heavy metals during the experimental campaign were mercury (Hg), cadmium (Cd), lead (Pb), nickel (Ni) and arsenic (As). The average heavy metal concentrations for the first site (Spata) constituted 0.66-14.7ng/m(3) for the summer period and 0.14-19.5ng/m(3) for the winter period. At the second site (Koropi), the corresponding values varied between 0.89 and 13.3ng/m(3) and 0.16 and 24.7ng/m(3), respectively. PM(10) Hg, PM(10) Cd and PM(10) Ni contents showed regular daily variations, with higher mass percentages during the summer, indicating differences in local PM(10) sources for each season. On the contrary, PM(10) Pb presented higher mass percentages during the winter. Examination of the relationship between heavy metals and meteorological parameters indicated a higher correlation with temperature and relative humidity, especially for Pb. In addition, most of the heavy metals (apart from Hg) presented an expected correlation with nitrate oxides (NO(x)), PM(10) and ozone (O(3)). Higher correlations with both meteorological parameters and gaseous pollutants were observed during the winter experimental campaign. Maximum heavy metal concentrations at both sites were observed during days with NE or NNE prevailing winds during the summer campaign, while the winter period was characterized with maximums during days with W or WNW prevailing winds.

Temporal variations of PM2.5 in the ambient air of a suburban site in Athens, Greece

Twenty-three hour measurements of PM(2.5) particulate matter have been carried out during the period between the 1st April and the 13th November 2003 in a suburban area of Athens. The monitoring site was located in the National Research Center "DEMOKRITOS", on the foot of Hemittos Mountain and about 12 km away from the center of Athens. The site covers an area of 600 acres in a forest of pine trees close enough to the newly constructed Hemittos Mountain peripheral highway. PM(2.5) samples were collected on 47 mm filters, with the use of low volume gravimetric samplers while a meteorological station recorded meteorological data 6 m above the ground, nearby the sampling instrumentation. The daily average PM(2.5) concentration reached 21.1 microg m(-3) and all measurements were below U.S. Environmental Pollution Agency daily limit (65 microg m(-3)). A regression analysis was used to investigate the relationship among PM(2.5) concentrations and meteorological parameters. Additionally, PM(2.5) mass concentrations were correlated with other inorganic gaseous pollutants (O(3), NO, NO(2), SO(2)) while weekly and seasonal PM(2.5) variations were also investigated.

Treatment of recurrent genital herpes with interferon alpha-2alpha

The purpose of the present study was to evaluate the efficacy and safety of parenteral administration of interferon alpha-2alpha in the treatment of recurrent herpes genitalis. A total of 97 patients (66 males, 31 females, mean age 34.86 +/-16.74 years), who had at least five recurrences of genital herpes during the previous 12 months, participated in a prospective open study on the effects of treatment with interferon alpha-2alpha (Roferon-A; Roche). The patients were treated with interferon alpha-2alpha (3 x 10(6) IU) by subcutaneous injection, three times weekly for 4 weeks, and the same schedule was repeated after 3 and 6 months. All patients were asymptomatic at the start of the study. After initiation of treatment, all patients reported to the clinic every 3 months for 2 years (the males were submitted to peoscopy and the females to Pap test and colposcopy) at the time of their recurrences. Comparison was made of the number of recurrences, duration of lesions, duration and severity of pain, and itching and burning. Prophylactic administration of interferon alpha-2alpha prevented recurrences of genital herpes virus infection in 51 patients (20 males and 31 females). Interferon administration shortened the healing time from 8.5 days before treatment to 2.5 days after treatment (p < 0.001). There was a significant reduction in the number of recurrences during the study period, from 7.46 before treatment to 2.64 after treatment (p < 0.001). On the basis of the overall efficacy and adverse effects, this regimen may be of value in the routine treatment of recurrent herpes.

Treatment of penile intraepithelial neoplasia (PIN) with interferon alpha-2a, CO2 laser (vaporization) and 5-fluorouracil 5% (5-FU)

This study was undertaken to assess the effectiveness of CO2 laser (vaporization), 5-FU topical application and Interferon (IFN alpha-2a) parenterally in the therapy of penile intraepithelial neoplasia (PIN). From March 1986 to September 1991, 1,372 men, sexual partners of women with condylomata accuminata or flat or cervical intraepithelial neoplasia (CIN), were submitted to peoscopy, of 1,019 men who presented with various lesions caused by human papillomavirus (HPV)-confirmed histologically-208 were treated for PIN. The best treatment modalities irrespective of grade of lesion were found to be the combination of 5-FU plus CO2 laser vaporisation plus IFN alpha-2a (high dose) (96.15%), the combination of 5-FU plus CO2 laser vaporization (87.09%) and the combination of CO2 laser vaporization plus IFN alpha-2a (high dose) (80%). It is concluded that IFN alpha-2a (low dose) can be used as first line treatment in combination with 5-FU in patients with PIN II and as an adjuvant treatment (high dose) in patients with recurrent PIN I and PIN III.

Peoscopic diagnosis of flat condyloma and penile intraepithelial neoplasia. Clinical manifestation

Peoscopy was performed in order to assess penile lesions in the male sexual partners of 326 women with cervical intraepithelial neoplasia (CIN) or flat condyloma (FC). Each patient was submitted to a careful naked-eye inspection, peoscopy and biopsy of any suspicious lesion which was confirmed histologically and immunohistochemically. A brush cytologic examination of the distal portion of the urethra was also performed. The distribution of penile lesions was as follows: (1) 8 patients with herpes virus infection; (2) 37 patients with condyloma accuminata (CA); (3) 89 patients with FC; (4) 51 patients with FC and CA; (5) 18 patients with penile intraepithelial neoplasia grade 1 (PIN-I); (6) 2 patients with PIN-II; (7) 17 patients with PIN-III; (8) 92 patients with no penile lesions; (9) 7 patients with human papilloma virus infection of papillae coronae glandis, and (10) 5 patients with FC of the distal portion of the urethra. Naked-eye inspection revealed the presence of penile lesions in 39 of 233 patients (16.73%). Peoscopic examination revealed the presence of penile lesions in 233 of 326 patients (71.48%). In 135 of 155 patients the peoscopic findings were in accordance with the histologic diagnosis (87.09%). Immunohistochemical (by indirect peroxidase-antiperoxidase method) detection of virus antigens was positive in 16 of 34 patients (47.03%). It is concluded that peoscopy of the male sexual partners of women with CIN or FC should be performed to better assess the treatment used in the couple.

Seminal volume and total sperm number trends in men attending subfertility clinics in the greater Athens area during the period 1977-1993

The trends for such important parameters of male fertility as seminal volume and total sperm number were assessed in men living permanently in the Greater Athens area over a prolonged period of time. To this end, the records of three andrological laboratories employing the same method for semen evaluation were analysed retrospectively. Out of 23,850 men examined from 1977 to 1993 (17 years) for couple subfertility, a total of 2385 (10%) were selected for evaluation by a randomization procedure. Analysis of the data included (i) estimation of mean seminal volume and total sperm number per year, (ii) assessment of percentage frequency distribution of each seminal parameter and (iii) evaluation of seminal volume and total sperm number changes in relation to the year of observation and age of the subjects. A significant decrease (P < 0.01) of total sperm number was observed over the years with a mean (+/-SEM) of 154.3 +/- 19.2 x 10(6) at the beginning (1977), dropping to 130.1 +/- 13.3 x 10(6) in the final year (1993). Mean seminal volume was lower in the final year of observation, but its difference from the initial year value was not significant. Frequency distribution analysis showed a marked decline in the 240-400 x 10(6) sub-set of the range of sperm number values from 16.9 +/- 4.5% (1977) to 10.6 +/- 1.6% in the final year (P < 0.01). Multiple regression analysis of seminal volume, total sperm number, age and year of assessment revealed a significant decline of the two seminal parameters along the years of observation (P < 0.05 and P < 0.0001 respectively). Over the same period, a marked deterioration of some air pollution indices was observed in that area. It is concluded that in this racially and ethnically homogeneous sample of men, living under the same environmental conditions, a significant decline in seminal volume and total sperm number occurred over the 17 years of observation.

Comparative study of systemic interferon alfa-2a plus isotretinoin versus isotretinoin in the treatment of recurrent condyloma acuminatum in men

OBJECTIVES

Purpose of the present study was to evaluate the effectiveness of isotretinoin versus interferon alfa-2a plus isotretinoin in the treatment of recurrent condyloma acuminatum in 86 men.

METHODS

Men were randomly assigned to group A (n = 42) who received isotretinoin 1 mg/kg orally daily until remission was achieved, but not more than 3 months, or to group B (n = 44) who received interferon alfa-2a 3 x 10(5) IU subcutaneously three times weekly until remission was achieved, but not more than 8 weeks, plus isotretinoin in the same dosage as in group A.

RESULTS

The reduced duration of treatment to achieve remission was statistically significant in group B (2.18 versus 2.5 months; P < 0.01) and the recurrence rate was less in group B (4 of 44 versus 16 of 42; P < 0.01).

CONCLUSIONS

The results of this study are encouraging and demonstrated that the combination of isotretinoin plus interferon alfa-2a achieves higher remission rates and a shorter duration of treatment than isotretinoin alone.

Tamoxifen treatment in male infertility. I. Effect on spermatozoa

OBJECTIVE

To evaluate the effects of tamoxifen treatment on sperm density, motility, vitality, and morphology.

DESIGN

Placebo-controlled, randomized study.

SETTING

Outpatient department.

INTERVENTIONS

Patients were assigned to two comparable groups: group A (n = 122) was treated with 10 mg tamoxifen twice daily for a period of 3 months and group B (n = 117) was given placebo for the same period of time, following a previously randomized design.

MAIN OUTCOME MEASURES

In every patient sperm density, motility, viability, and morphology were evaluated 3 months after cessation of treatment.

RESULTS

Mean sperm density in group A improved significantly with a more pronounced improvement in severe oligozoospermic men. Sperm density was found significantly improved compared with group B. Dead spermatozoa in group A significantly decreased after tamoxifen treatment and were also found significantly decreased compared with group B.

CONCLUSION

It is concluded that tamoxifen exerts a beneficial effect on sperm density and number of live spermatozoa but it has no substantial effect in sperm motility and morphology.

Optically exact equations of caustics for slant cracks biaxially loaded

The equations of caustics have been derived based on the exact theory of geometrical optics, and they have been adapted to the problem of a slanting internal crack in a disk under biaxial loading. A comparison of the exact caustics with those derived from the far-field theory used in the past in the applications showed negligible difference between the two theories. Thus, it is shown that the approximate theory of caustics used before for determining singular fields in mechanics is sufficiently accurate for engineering applications.