Suboptimal lopinavir exposure in infants on rifampicin treatment receiving double-dosed or semi-superboosted lopinavir/ritonavir: time for a change

BACKGROUND

While super-boosted lopinavir/ritonavir (LPV/r; ratio 4:4 instead of 4:1) is recommended for infants living with HIV and receiving concomitant rifampicin, in clinical practice many different LPV/r dosing strategies are applied due to poor availability of paediatric separate ritonavir formulations needed to super-boost. We evaluated LPV pharmacokinetics in infants with HIV receiving LPV/r dosed according to local guidelines in various sub-Saharan African countries with or without rifampicin-based tuberculosis (TB)-treatment.

METHODS

This was a 2-arm pharmacokinetic sub-study nested within the EMPIRICAL trial (#NCT03915366). Infants aged 1-12 months recruited into the main study were administered LPV/r according to local guidelines and drug availability either with or without rifampicin-based TB-treatment; during rifampicin co-treatment they received double-dosed (ratio 8:2) or semi-superboosted LPV/r (adding a ritonavir 100mg crushed tablet to the evening LPV/r dose). Six blood samples were taken over 12 hours after intake of LPV/r.

RESULTS

In total, 14/16 included infants had evaluable pharmacokinetic curves; 9/14 had rifampicin co-treatment (5 received double-dosed and 4 semi-superboosted LPV/r). The median (IQR) age was 6.4 months (5.4-9.8), weight 6.0kg (5.2-6.8) and 10/14 were male. Of those receiving rifampicin, 6/9 (67%) infants had LPV C trough <1.0mg/L compared to 1/5 (20%) in the control arm. LPV apparent oral clearance was 3.3-fold higher for infants receiving rifampicin.

CONCLUSION

Double-dosed or semi-superboosted LPV/r for infants aged 1-12 months receiving rifampicin resulted in substantial proportions of subtherapeutic LPV levels. There is an urgent need for data on alternative antiretroviral regimens in infants with HIV/TB co-infection, including twice-daily dolutegravir.

Approaches in Sustainable, Biobased Multilayer Packaging Solutions

The depletion of fossil resources and the growing demand for plastic waste reduction has put industries and academic researchers under pressure to develop increasingly sustainable packaging solutions that are both functional and circularly designed. In this review, we provide an overview of the fundamentals and recent advances in biobased packaging materials, including new materials and techniques for their modification as well as their end-of-life scenarios. We also discuss the composition and modification of biobased films and multilayer structures, with particular attention to readily available drop-in solutions, as well as coating techniques. Moreover, we discuss end-of-life factors, including sorting systems, detection methods, composting options, and recycling and upcycling possibilities. Finally, regulatory aspects are pointed out for each application scenario and end-of-life option. Moreover, we discuss the human factor in terms of consumer perception and acceptance of upcycling.

Neurocognitive correlates of the varied domains of outcomes at 20 year follow-up of first-episode psychosis

Little is known about long-term outcomes of the first episode of psychosis (FEP) other than in the symptomatic domain. We hypothesised that cognitive impairment is associated with poorer multi-domain outcomes at a long-term follow-up of FEP patients. We followed-up 172 FEP patients for a mean of 20.3 years. Ten outcome dimensions were assessed (symptomatic, functional and personal recovery, social disadvantage, physical health, suicide attempts, number of episodes, current drug use, chlorpromazine equivalent doses (CPZ), and schizophrenia/schizoaffective disorder final diagnosis). Cognition was assessed at follow-up. Processing speed and verbal memory deficits showed significant associations with poor outcomes on symptomatic, social functioning, social disadvantage, higher number of episodes, and higher CPZ. Significant associations were found between visual memory impairments were significantly associated with low symptomatic and functional recovery, between attentional deficits and a final diagnosis of schizophrenia/schizoaffective disorder, and between social cognition deficits and poor personal recovery.Lower cognitive global scores were significantly associated with all outcome dimensions except for drug abuse and physical status. Using multiple outcome dimensions allowed for the inclusion of the patients' perspective and other commonly neglected outcome measures. Taken together, cognitive impairment in FEP patients is strongly related to poor performance on several outcome dimensions beyond symptomatic remission.

Particle release from refit operations in shipyards: Exposure, toxicity and environmental implications

European harbours are known to contribute to air quality degradation. While most of the literature focuses on emissions from stacks or logistics operations, ship refit and repair activities are also relevant aerosol sources in EU harbour areas. Main activities include abrasive removal of filler and spray painting with antifouling coatings/primers/topcoats. This work aimed to assess ultrafine particle (UFP) emissions from ship maintenance activities and their links with exposure, toxicity and health risks for humans and the aquatic environment. Aerosol emissions were monitored during mechanical abrasion of surface coatings under real-world operating conditions in two scenarios in the Mallorca harbour (Spain). Different types of UFPs were observed: (1) highly regular (triangular, hexagonal) engineered nanoparticles (Ti-, Zr-, Fe-based), embedded as nano-additives in the coatings, and (2) irregular, incidental particles emitted directly or formed during abrasion. Particle number concentrations monitored were in the range of industrial activities such as drilling or welding (up to 5 ∗ 10⁵/cm³, mean diameters <30 nm). The chemical composition of PM₄ aerosols was dominated by metallic tracers in the coatings (Ti, Al, Ba, Zn). In vitro toxicity of PM₂ aerosols evidenced reduced cell viability and a moderate potential for cytotoxic effects. While best practices (exhaust ventilation, personal protective equipment, dust removal) were in place, it is unlikely that exposures and environmental release can be fully avoided at all times. Thus, it is advisable that health and safety protocols should be comprehensive to minimise exposures in all types of locations (near- and far-field) and periods (activity and non-activity). Potential release to coastal surface waters of metallic engineered and incidental nanomaterials, as well as fine and coarse particles (in the case of settled dust), should be assessed and avoided.

P–563 Assessing ovarian age: Could we use leukocyte telomere length as a surrogate marker of cumulus cells telomere content?

Study question

Is leukocyte telomere length (LTL) correlated with cumulus cells telomere length (CCTL) in an age-heterogeneous women population?

Summary answer

LTL showed a positive correlation with CCTL in the studied population. Hence, its potential value as indicator of ovarian age would deserve further evaluation.

What is known already

Progressive telomere shortening has been related to ovarian aging and genomic instability during early development. A positive correlation between short telomere length of the first polar body and aneuploidy rate has been reported. CCTL has shown to be a biomarker of oocyte and embryo quality, but its assessment is impractical. LTL has been proposed as a surrogate of TL of follicular cells, but telomere lengthening through folliculogenesis could be controlled by different mechanisms. Thus, we aimed to determine if LTL in an age-heterogeneous population is correlated with CCTL and therefore considered an accurate surrogate for telomere length in the ovary.

Study design, size, duration

In this prospective non-interventional cohort study, 35 egg donors and 17 women undergoing Preimplantation Genetic Testing for Aneuploidy (PGT-A) treatment were included during sixteen months. Following controlled ovarian stimulation determined by treating physicians, oocyte retrieval was performed 36 hours after final maturation induction. Cumulus cells (CC) for telomere length (TL) measurement were obtained after the pick-up and oocyte stripping. A blood sample was collected through peripheral venous access for LTL measurement.

Participants/materials, setting, methods

Genomic DNA of CC and leukocytes from the 52 subjects was isolated. Average delta cycle threshold (ΔCt) was determined using a SYBR green quantitative real-time PCR protocol for relative TL. For normalization of measurements, a Taqman assay for the multicopy gene Alu was performed. ΔCtL and ΔCtCC were compared by a paired t-test analysis and the fold change was calculated. Additionally, the association between them and patient age was analyzed by a Pearson correlation test.

Main results and the role of chance

Mean participant’s age was 29.94 ± 7.55 years and mean values for ΔCtL and ΔCtCC were 7.99 ± 0.53 and 7.46 ± 0.75, respectively. A positive significant correlation was found between age and ΔCt (ΔCtL: R2=0.71, p-value=5.18e–09; ΔCtCC: R2=0.47, p-value=0.00049). Since ΔCt values are inversely proportional to the amount of nucleic acids amplified and, therefore, to the telomere length, this correlation means that TL in both cell types decreases as women age. Additionally, ΔCtL was significantly higher than ΔCtCC (ΔCt fold change: 0.93, p-value=9e–07), meaning that CC showed significantly longer telomeres than leukocytes, thus supporting our previous published results in young egg donors. When analyzing the ΔCtL and ΔCtCC in these age-heterogeneous sample, a positive moderate and significant correlation was observed (R2=0.42, p-value=0.002). Thus, LTL could be suggested as a potential indicator of CCTL and therefore as a candidate for a biological marker of ovarian aging.

Limitations, reasons for caution

The sample size of this study was moderate and perhaps increasing the number of subjects might give additional strength to our findings. In addition, although relative telomere length allowed for adequate comparison between subjects, this method did not allow for absolute TL measurement.

Wider implications of the findings: While reproductive implications of LTL measurement need to be further studied, our results support the potential usefulness of LTL measurement as an indicator of CCTL and ovarian aging when analyzing an age-heterogeneous population. Further, our findings suggest that CC could possess different mechanisms to cope against telomere length shortening.

Trial registration number

Not applicable

P–478 Quality of life assessment in women undergoing assisted reproduction. A study of FertiQol and HADS

Study question

The present study aims to explore infertility-related psychosocial outcomes, including fertility quality of life (QoL), as well as anxiety and depression levels, in women diagnosed with infertility.

Summary answer

Differences on fertility-related QoL appeared when comparing treatment types (gamete donation vs own gamete). Furthermore, statistically significant associations were found between QoL and anxious-depressive symptomatology.

What is known already

Those who wish to have children and do not achieve their objective just like other peers can see their goals and expectations with pessimism, generating concern and a series of negative emotions. Several psychological implications of infertility have been described, such as increased levels of stress, anxiety, depression, decreased self-esteem, mood and hope, or poor relationship adjustment. The emotional impact of infertility in people’s life cycle can be so strong that reducing it only to biological aspects would lead to a dangerous situation of neglect. For this reason, QoL assessment in ART becomes an important need.

Study design, size, duration

FertiQol stands as the most widely used tool to assess infertility-related QoL, overcoming the limitations of other instruments that only target specific medical conditions. The present is a multi-site cross-sectional study over patients with infertility (n = 104), aiming to explore their fertility-QoL, as well as their anxiety and depression levels, which are symptoms that have been previously associated.Questionnaire administration, and sociodemographic and medical data gathering took place between January 2019 and December 2020.

Participants/materials, setting, methods

Participants were 104 female patients (M.age= 39.8) undergoing or expecting a fertility treatment. The FertiQol Spanish version was administered through mobile app, and its paper version distributed at medical/psychological appointments. QoL was self-reported through FertiQol, assessing the influence of infertility problems in various areas (e.g. impact on self-esteem, emotions, general health, family, partners, social relationships, work, life projects...). Additionally, HADS (Hospital Anxiety and Depression Scale) was provided as a measurement of anxiety and depression levels.

Main results and the role of chance

Regarding treatments, 50.6% of participants were currently undergoing gamete donation while 44.3% were undergoing treatments that involved using their own gametes. After comparing QoL between these treatment types, results showed that patients who underwent egg donation, compared to those who used their own eggs, reported statistically significantly lower scores of QoL in the Social Subscale (p = .03), but not in the other psychological outcomes. Also, statistically significant negative correlations were found between HADS and all core FertiQol subscales (p&lt; .05). Results are consistent with previous studies showing similar associations between fertility QoL and anxiety and depression, as well as with increased psychological negative implications of gamete donation. The majority of participants reported non-pathological scores of anxiety and depression when considering the cut off value of 8 for HADS, thus suggesting the presence of a relatively healthy sample. The number of treatments that patients had previously taken and the years of infertility were not associated with any of the psychological variables.

Limitations, reasons for caution

Some limitations to consider are presence of co-morbid diagnosis, differences in medication, or patient’s cultural backgrounds.Also, conclusions should be interpreted cautiously since the design doesn’t allow causal inferences. Further investigations should consider a continuous assessment to explore changes in psychological well-being at different points of intervention, specially with gamete donation.

Wider implications of the findings: The great advantage we’ve seen so far when using FertiQol is the possibility to identify more accurately the true impact on other aspects of patient’s well-being besides the emotional area.ART professionals, including psychologists and counselors,will have more information within a small amount of time about QoL when using this tool.

Trial registration number

1503-BCN–019-DG

Empirical validation of the wcst network structure in patients

Introduction

Cognitive impairment is a core feature of schizophrenia and other psychotic disorders and executive deficits are within the most impaired cognitive functions The Wisconsin Card Sorting test (WCST) has been extensively used in literature on schizophrenia and psychosis. The underlying structure of executive impairment may have important implications for our understanding of the complex connections between executive dysfunction and the psychopathology and neurofunctional basis of psychosis.

Objectives

The objective was to empirically validate the dimensions of the WCST network structure of patients regarding antecedent, concurrent and outcome variables.

Methods

Subjects were 298 patients with a DSM 5 diagnosis of psychotic disorder. To assess the empirical validation of network structure of the WCST antecedent, concurrent and outcome variables were selected from the CASH interview and other scales of patients.

Results

Pearson coefficient correlations between the 4 network loadings (NL) of WCST, namely perseveration, inefficient sorting, failure to maintain the set and learning, and antecedent, concurrent and outcome validators are shown in the table. PER and IS showed common and strong associations with antecedent, concurrent and outcome validators. LNG dimension was also moderately associated and FMS did not show significant associations.

Conclusions

‘Perseveration’ and ‘Inefficient sorting’ dimensions achieve and share common antecedent, concurrent and outcome validators. While ‘Learning’ dimension achieves partial validation in terms of antecedent and outcome validators and ‘Failure to maintain the set’ dimension was not associated with external validators. These four underlying dysfunctions might help to disentangle the neurofunctional basis of executive deficits in psychosis.

Development of Generalized QSAR Models for Predicting Cytotoxicity and Genotoxicity of Metal Oxides Nanoparticles

In recent years, nanomaterials have gained tremendous attention due to their wide variety of industrial applications including food packaging, consumer products, nanomedicines, etc. The fascinating properties of nanoparticles which are responsible for creating several exciting opportunities, however, are also accountable for growing concerns of their toxic effects on humans as well as the environment. Thus, in the present study, the authors have developed generalized models for predicting the cytotoxicity and genotoxicity of seven metal oxide nanoparticles. The models not only take into account the structural features, but also the diverse experimental conditions under which the toxicity of nanoparticles was determined. The diverse experimental conditions were captured in the generalized models using the Box-Jenkins moving average approach. Here, two machine learning techniques, namely, linear discriminant analysis and random forest were utilized to build the final models. Importantly, the validation metrics showed that the developed models have significant discriminatory power.

Selincro use in a patient diagnosed with dependence to stimulants, alcohol abuse and hyper-sexuality

Introduction

Hyper-sexuality is an increased sexual activity that causes stress the individual at social levels. There are studies that support the theory that neurophysiological abnormalities of individuals appear in this disorder and do not overlap with the alterations found in substance addictions. However, it is doubtful whether addiction to other substances can trigger behavior in the sexual sphere.

Objective

To report a case of abuse of alcohol as a trigger relapse in terms of sexual alterations in a patient diagnosed with alcohol abuse, stimulants dependence and hyper-sexuality.

Case description

Here we report a married gentleman in the fourth decade of his life that presents behavior and sexual activity level compatible with a case of hyper-sexuality. After conducting motivational interviews with the psychologist to aim a sustained abstinence of amphetamines and a lack of alterations on the sexual sphere, the patient achieved clinical stability over several years. However, it is referred for psychiatric consultation as he presented recently abusive alcohol consumption associated with Speed. He relapsed in the sexual sphere by increasing sexual desire and impulsiveness. It was decided to prescribe oral nalmefene (1 tablet daily) for two months and then stop treatment regularly (taken PRN in case of high risk situations). As a result, he has had sustained remission for over 6 months.

Conclusion

Although, there are studies suggesting that neurobiological changes among the pathologies described are different, the treatment of alcohol abuse can be beneficial in other diseases such as hyper-sexuality as disinhibition associated with alcohol intoxication.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Breast cancer PAM50 signature: correlation and concordance between RNA-Seq and digital multiplexed gene expression technologies in a triple negative breast cancer series

Background

Full RNA-Seq is a fundamental research tool for whole transcriptome analysis. However, it is too costly and time consuming to be used in routine clinical practice. We evaluated the transcript quantification agreement between RNA-Seq and a digital multiplexed gene expression platform, and the subtype call after running the PAM50 assay in a series of breast cancer patients classified as triple negative by IHC/FISH. The goal of this study is to analyze the concordance between both expression platforms overall, and for calling PAM50 triple negative breast cancer intrinsic subtypes in particular.

Results

The analyses were performed in paraffin-embedded tissues from 96 patients recruited in a multicenter, prospective, non-randomized neoadjuvant triple negative breast cancer trial (NCT01560663). Pre-treatment core biopsies were obtained following clinical practice guidelines and conserved as FFPE for further RNA extraction. PAM50 was performed on both digital multiplexed gene expression and RNA-Seq platforms. Subtype assignment was based on the nearest centroid classification following this procedure for both platforms and it was concordant on 96% of the cases (N = 96). In four cases, digital multiplexed gene expression analysis and RNA-Seq were discordant. The Spearman correlation to each of the centroids and the risk of recurrence were above 0.89 in both platforms while the agreement on Proliferation Score reached up to 0.97. In addition, 82% of the individual PAM50 genes showed a correlation coefficient > 0.80.

Conclusions

In our analysis, the subtype calling in most of the samples was concordant in both platforms and the potential discordances had reduced clinical implications in terms of prognosis. If speed and cost are the main driving forces then the preferred technique is the digital multiplexed platform, while if whole genome patterns and subtype are the driving forces, then RNA-Seq is the preferred method.

Electronic supplementary material

The online version of this article (10.1186/s12864-019-5849-0) contains supplementary material, which is available to authorized users.

High sperm DNA fragmentation delays human embryo kinetics when oocytes from young and healthy donors are microinjected

BACKGROUND

Time-lapse monitoring (TLM) technology has been implemented in the clinical setting for the culture and selection of human embryos. Many studies have assessed the association between sperm DNA fragmentation (sDNAf) and clinical outcomes after ART, but little is known about the influence of sDNA on embryo morphokinetics.

OBJECTIVES

The objective of this retrospective study, which includes 971 embryos from 135 consecutive ICSI cycles (56 cases with own oocytes, 79 with oocytes from young and healthy donors), was to assess if sDNAf has an impact on embryo morphokinetics.

MATERIALS AND METHODS

Samples used to perform ICSI were analyzed by the flow cytometry TUNEL assay, and embryo development was assessed through an EmbyoScope^® system. The association between sDNAf and the timings of cell cleavage was analyzed by categorizing the first variable into quartiles: ≤6.50%; 6.51-10.70%; 10.71-20.15%; >20.15%.

RESULTS

In cases where sDNAf was above 20.15% (the upper quartile), embryos derived from donated oocytes (n = 644) showed significantly slower divisions. Such association was not observed in embryos obtained from the patients' own oocytes (n = 327). The embryo cleavage pattern (either normal, direct from 1 to 3 blastomeres, direct from 1 to 4 blastomeres, incomplete, reversed or asynchronous) was independent of the sDNAf level. Blastocyst arrival rate was 63.0% and the rate of good quality embryos (transferred and frozen embryos divided by the number of zygotes) was 45.49%. Neither parameter was related to the levels of sDNAf.

DISCUSSION

According to our results, the association between high sDNAf and donated oocytes led to delayed cell division. To our knowledge, this is the first study suggesting that sDNAf can delay human embryo cleavage timings when oocytes from donors are inseminated.

CONCLUSIONS

This finding may indicate that, in the presence of increased DNA damage, time is needed before the first embryonic cell division for the activation of the optimal DNA repairing machinery in higher quality oocytes.

SSRIs and QT interval prolongation management. A review

Introduction

In 2011, the FDA issued an alert recommending not to prescribe citalopram high doses, due to QT prolongation risk. We explored the clinical background of QT interval prolongation related to serotonin selective reuptake inhibitors (SSRI) use and the clinical implications of safety issues.

Methodology

A review was conducted to clarify the mechanisms associated with the occurrence of TdP when using SSRI and investigating therapeutic measures to avoid/minimize these effects. The literature search was conducted in PubMed data reviewing articles between 2001 and 2016.

Results

(1) Related to risk factors/intraclass differences: risk factors are increase in QTc interval ≥60 ms from the pretreatment value, advanced age, female sex, acute myocardial infarction and electrolytic abnormalities among others. Citalopram appears more likely than others to induce this phenomenon but its importance is under current debate. (2) Related to dose: drug-induced QTc interval prolongation and TdP was associated to citalopram in doses > 40 mg/day. However, psychotropic drug-induced sudden cardiac death may be an outlier in the absence of identified risk factors for QTc interval prolongation and TdP. (3) Related to poly-pharmacy/management: there is an additive effect when using SSRI and antipsychotics (EKG control is recommended in those cases). Cross-sectional studies showed that SSRI use was not associated with QT interval prolongation. This could be explained by the EKG intra-intersubject variability.

Conclusions

There is little evidence that drug-associated QTc interval prolongation by itself is sufficient to predict TdP. Future research needs to improve its precision to better understand the factors that facilitate/attenuate that progression. Clarifying this may lead to a safer SSRI use.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Clinical case: Gynecological side effects caused by methylphenidate

Introduction

Methylphenidate drugs is prescribed in attention deficit disorder and hyperactivity. Among its rare side effects, include alterations in the gynecological. We report a clinical case and review current evidence regarding the tolerability this drug in this area.

Methods

We performed a PubMed search of articles published in English of different types (case reports or case/controls studies). We collected the clinical practice guidelines conclusions regarding adverse drug reactions.

Case presentation

Our patient is a 14-year-old male diagnosed of ADHD treated with methylphenidate (0.8–1 mg\kg). He developed bilateral and asymmetric gynecomastia under this treatment plan so a referral was made to rule out other causes of this event. After performing several work up tests, it was concluded that this clinical presentation was caused by methylphenidate. Hence, we initiated crossed titration swapping this drug to atomoxetine. Four months later, he was mentally stable and he experimented a volumetric decrease as concerns his gynecomastia.

As regards methylphenidate, in 2009 a couple of cases in which alterations in the sexual sphere presented with the oros presentation were reported. There are series of reported pharmacological side effects (gynecomastia) and also denoted an improvement of the same months after drug discontinuation.

Conclusions

Gynecological clinic secondary to the use of psychotropic drugs in ADHD is uncommon. In line with our case, the current evidence suggests a drug suspension as adverse effects are usually reversible (although it may take several months to complete recovery). Further studies are needed to understand the mechanisms underlying these tolerability issues.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Clinical case: Phelan–McDermid and pharmacological management

Introduction

The Phelan–McDermid syndrome is a chromosomal disorder consisting of a selection on chromosome 22q13.3 associated psychiatric and emotional level, behavioral and traits of autism spectrum disorders. During the neurodevelopmental such chromosomal deletion, which associated with haplo insufficiency Shank 3 causes alterations in the synaptogenesis altering the balance of activating and inhibitory transmission. Throughout the various studies, it is considered that this syndrome has a psychiatric disorder bipolar like.

Case presentation

Here, we present s 13-year-old female diagnosed with autism spectrum disorders in childhood and presented regression with catatonia features and behavioral disorders. Interestingly, she presented mutation/microdeletion of the SHANK3 gene, inducing a premature stop codon in exon 21. Different pharmacological treatments (antipsychotics at high doses and benzodiazepines) failed to improve clinical symptoms and lead to multiple adverse events. In contrast, lithium therapy reversed clinical regression, stabilized behavioral symptoms and allowed patients to recover their pre-catatonia level of functioning. After the first menstruation there was a cycling psychiatric worsening with a similar clinical pattern so risperidone as adjunctive therapy. As a result of this, this patient recovered clinical and socio-functional stability.

Conclusions

They are previous cases where there affective and behavioral improvement after use of mood stabilizer molecules such as valproate or lithium. There is also evidence of the benefit of risperidone low to have a beneficial effect on the balance of activatory and inhibitory transmission level doses of NMDA receptors.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

A Case of Catatonia, Klebsiella Pneumoniae Lung Infection and Intellectual Disability: Differential Diagnosis

Introduction

In DSM-V, catatonia is individualized as a disease of its own. The priority is to look first for organic causes like intoxication. We present a clinical case diagnosed with intellectual disability (ID) and catatonia.

Objective

To study a case of catatonia which underwent testing using Bush-Francis Catatonia rating scale (BFCRS) prior/after clinical intervention. We therefore study catatonia's etiology in ID population.

Aims

To study the etiology of catatonia (and its clinical complications) in ID.

Method

Our patient is 48-year-old female with DI. Considering her clinical features of catatonia (using BFCRS) and clinical examination (fever and hypoxia), the case orientated towards a secondary diagnosis. Work-up tests revealed pneumonia in the lower lobe of the right lung (chest radiography showed opacities and blood tests showed Leuokocytosis with a left shift). The case further received a course oral levofloxacin (500 mg/day) and haloperidol was stopped. Valproic acid was also added to a dose of 600 mg/day, which led to clinical improvement. Remaining psychotropic treatment (duloxetine 60 mg/day, lorazepam 15 mg/day, diazepam 35 mg/day) was not modified.

Results

After 1 month, the patient improved according to BFCSR score.

Conclusions

We presented a case of presence of catatonia in other psychiatric conditions and undiagnosed general medical conditions. Haloperidol is contraindicated those circumstances and it may have worsened her clinical state (it should be used cautiously in DI). Other medications (gabaergic drugs) should be considered in such settings and rare causes related to hypoxia cannot be ruled out (Table 1).

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Atypical antipsychotic switching versus atypical antipsychotic combination in schizoaffective disorder – A clinical case

Introduction

Recent studies suggest that aripiprazole (ARP) shows a better profile in terms of mental state and extrapyramidal symptoms (EPS) in psychosis. However, other studies consider that a combination of atypical antipsychotics (AAP) may also be an option for some refractory patients. We present a case of a schizoaffective disorder, manic type (SAFM) (F25.0, ICD-10 criteria) that improved in terms of EPS adverse effects after switching from long-term fluphenazine (LTF) to Long-acting injectable aripiprazole (LAIA) but showed relapse symptoms.

Objective

We present a clinical case of SAFM that improved clinically in our outpatient clinic after 1 month of bi-therapy with low doses of oral risperidone and standard dose of LAIA. We study oral AAP-LAIA drug combination utility in this clinical setting.

Aims

To study “oral AAP-LAIA combo” benefits in refractory SAFM cases.

Methods

Our patient is a 68-year-old female diagnosed of SAFM clinically stable with a combination of lithium and LTF. She presented severe cogwheel stiffness in the upper limbs and postural tremor. We switched from long-term fluphenazine to LAIA and 4 weeks later, she showed discrete cogwheel stiffness but also persecutory delusions and dysphoria.

Results

We maintained LAIA (400 mg/28 days) and lithium (800 mg/day) doses and added-on risperidone 1 mg/day. She presented clinical relapse 1 month later. She kept her better EPS tolerance as she only had discrete cogwheel in upper limbs only by using attention distraction techniques.

Conclusions

Oral risperidone-LAIA drug combination appears as an effective and well-tolerated treatment in refractory SAFM cases.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Prediction of delayed graft function by means of a novel web-based calculator: a single-center experience

Renal failure persisting after renal transplant is known as delayed graft function (DGF). DGF predisposes the graft to acute rejection and increases the risk of graft loss. In 2010, Irish et al. developed a new model designed to predict DGF risk. This model was used to program a web-based DGF risk calculator, which can be accessed via http://www.transplantcalculator.com . The predictive performance of this score has not been tested in a different population. We analyzed 342 deceased-donor adult renal transplants performed in our hospital. Individual and population DGF risk was assessed using the web-based calculator. The area under the ROC curve to predict DGF was 0.710 (95% CI 0.653-0.767, p < 0.001). The "goodness-of-fit" test demonstrates that the DGF risk was well calibrated (p = 0.309). Graft survival was significantly better for patients with a lower DGF risk (5-year survival 71.1% vs. 60.1%, log rank p = 0.036). The model performed well with good discrimination ability and good calibration to predict DGF in a single transplant center. Using the web-based DGF calculator, we can predict the risk of developing DGF with a moderate to high degree of certainty only by using information available at the time of transplantation.

Characteristics of research-related HIV testing programmes contribute to detection of more HIV infections

HIV prevalence estimates from bathhouse testing programmes differ widely, ranging from 3% to 11%. The observed difference may be a consequence of whether the programme was part of a research project or a community-based programme. A research-funded testing programme was offered at a bathhouse between May 2001 and December 2002. A local community-based organization began a testing programme in July 2006 at the same bathhouse; the data for this analysis cover the period July 2006 through December 2007. County-wide HIV prevalence estimates were available across the two time periods (i.e. 2001-2002 and 2006-2007). The research-funded testing programme recruited fewer men but identified more positive individuals (10.7% of those testing in the research programme) than were identified among men who tested in the area clinics (3.8% of those men who have sex with men [MSM] testing throughout the county in the same time period). However, the community-based testing programme identified about the same proportion of positive MSM (2.6%) as county clinics (2.7%) in the same time period. In conclusion, results confirmed that even in the same venue, a community-based HIV testing programme identified a similar proportion of positive MSM as the area clinics; however, the research-funded programme identified appreciably more. Incentives may contribute to the difference.