"Putting a face" on HIV infection/AIDS in older adults: a psychosocial context

Older HIV-1-seropositive individuals largely have not been investigated with respect to their psychosocial characteristics. In this article, the authors review research reported to date regarding the psychosocial context of this growing subgroup of HIV-1-infected individuals. Specifically, the authors consider the characteristics of mood state, life stressor burden, social support network, and coping strategies that individuals older than 50 years are more likely to adopt in adjusting to HIV-1 infection. The authors also separately consider issues of caregiving burden. Data supporting a theoretically based stressor-support-coping model are presented and related to targeting psychotherapeutic interventions for this age group.     

Histologic study of the tunica albuginea of the penis and mode of cavernosus muscles' insertion in it

The tunica albuginea (TA) is the outer covering of the corpora cavernosa (CCs) and corpus spongiosum (CS) of the penile shaft. The different histoanatomical patterns of the TA, as well as the mode of attachment of the ischio-/bulbo-cavernosus muscles (ICM, BCM) to the TA, were studied, aiming at elucidating their role in the mechanism of erection. Twenty-eight cadaveric specimens (18 adults, 10 neonatal deaths) were studied morphologically and histologically after staining with hematoxylin and eosin and Verhoeff-van Gieson stains. The TA consisted in 20 specimens of 2 layers: inner circular and outer longitudinal, in 6 specimens of 3 layers: inner circular, longitudinal and outer circular, and in 2 of only one longitudinal layer. The CS TA was formed of one layer of longitudinal fibers. The mode of cavernosus muscles insertion into the TA revealed 3 patterns. The conjoint BCM and ICM formed a fibrous belt over the CCs in 18 specimens, a muscular belt in 6 and no belt in 4. The functional role of the variations in the TA morphological structure is not exactly known. We hypothesize that the 3-layered TA gives more penile rigidity than the double and single layers. Considering the type of cavernosus muscles insertion into the TA, it appears that the fibrous belt exerts more CC compression than the other 2 types of insertion.     

Retrocaval ureter in a 10-year-old boy

Retrocaval ureter is an uncommon abnormality of the inferior vena cava, which is rarely detected in the child due to its non-specific symptomatology. Despite a varying state of severity, chronic ureteral obstruction generally leads to the deterioration of renal function during adulthood. Treatment depends on the symptomatology in question, and surgical management should be as conservative as possible.     

A Daily Process Investigation of Alcohol-involved Sexual Risk Behavior Among Economically Disadvantaged Problem Drinkers Living with HIV/AIDS

Alcohol use is believed to increase sexual risk behavior among people living with HIV/AIDS (PLWHA). As drinking and sexual risk acts often occur in the same social contexts, this association is difficult to confirm. In this study, electronic daily diaries were completed by 116 PLWHA over 5 weeks. This yielded a total of 1,464 records consisting of data pertaining to discrete occasions of anal and vaginal sex. Simultaneous within- and between-person multilevel analyses were conducted, including situational variables (partner type, partner serostatus, partner drinking) and individual difference variables (gender, level of alcohol dependence). The resulting model explains 27.5% of the variance and reveals that interactions among these situational and individual difference variables predict changes in the estimated rate of unprotected sex (US). Also, in defined contexts, the amount of alcohol consumed prior to sex significantly affects the rate of US among members of the sample. Implications are discussed.     

Symptoms in patients attending services for diagnosis of pulmonary tuberculosis in Sudan.

OBJECTIVE: To describe the variation in clinical features of individuals presenting to a health facility with chest symptoms according to their ultimate diagnosis. METHODS: Of 16735 patients (52.6% males and 47.4% females) presenting at respiratory centres in seven states in Sudan, 5338 patients were identified with respiratory tract symptoms: 2917 (54.6%) men and 2421 (45.4%) women, with a mean age of 32 years. Those who had cough for more than 3 weeks that was not responsive to a course of antibiotics were screened by microscopy of two or three sputum specimens and chest radiography. RESULTS: A total of 504 (9.44%) were smear-positive, 259 (4.85%) were smear-negative, and 166 (3.11%) had extra-pulmonary tuberculosis, of whom 59 (1.11%) had pleural involvement; the remaining 4409 suspects (82.6%) were non-tuberculous. CONCLUSION: Tuberculosis patients had a constellation of presenting symptoms, with the principal symptom being cough for more than 3 weeks. The accompanying symptoms with greatest predicted significance were weight loss, tiredness and night sweats.     

Impact of war, religiosity and ideology on PTSD and psychiatric disorders in adolescents from Gaza Strip and South Lebanon

This study investigated the extent to which differences in the types of war trauma, economic pressure, religiosity and ideology accounted for variation in PTSD and psychiatric disorders among adolescents from Gaza Strip and South Lebanon. Participants were 600 adolescents aged 12-16 years. They were selected from the public school system in the highly war exposed areas. Questionnaires were administered in an interview format with adolescents at school by two trained psychologists. Results indicated that the various types of trauma had differential effects on the psychological status of adolescents in both countries. Economic pressure was more predictive of PTSD and psychological distress in adolescents from Gaza. Differences in religiosity and ideology did not account for similar variation in stress response among adolescents from Gaza and South Lebanon. While higher levels of religiosity evidenced the greatest levels of depression and anxiety in adolescents from Gaza, religiosity had an attenuated effect on adolescents from South Lebanon. Ideology was negatively associated with depression and anxiety in Gaza strip adolescents, whereas it did not play a role for adolescents from South Lebanon. The clinical and research implications of these conclusions are discussed.     

Simultaneous Dual Vascular Access Site for the Treatment of Coronary Artery Bifurcation Lesions by Complex 2-Stent Technique

Objectives: To propose an original approach based on simultaneous dual vascular access site (DAS) using 2 small-size guiding catheters to easily perform complex 2-stent techniques for bifurcation coronary lesions (BL). Background: Simultaneous kissing stenting and classic crush technique require large 7 or 8Fr guiding catheters leading to large amounts of contrast medium, vascular access site complications, and sometimes frictions or criss-cross of the 2-stent delivery systems. Methods: DAS was used in 30 patients with BL (11 radio-radial, 16 radio-femoral, and 3 femoro-femoral). Among 60 guiding catheters, the size was 5Fr in 28, 6Fr in 30, and 7Fr in 2 cases of double adjacent BL. When 2 different size catheters were used, contrast medium injections were done using the smallest size catheter. DAS patients were compared with a group of 30 BL patients treated using a single femoral vascular access site (SAS) with 7 or 8Fr catheters. Results: Success rate was 100% in all patients. Contrast volume used was smaller in DAS than in SAS patients (277 ± 156 cc vs. 380 ± 165 cc,P = 0.01). No vascular access site complication occurred in the sub-group of the 11 DAS radio-radial patients. Postintervention hospitalization duration was shorter in DAS than in SAS (1.9 ± 2 vs. 2.8 ± 2 days,P = 0.048). Conclusion: DAS allows to successfully perform complex stenting technique of BL using small-size guiding catheters leading to decreased contrast medium volume, decreased vascular access site complications rates, and shortened hospitalization duration. (J Interven Cardiol 2012;25:439-446).