National multicenter study of HIV testing and HIV seropositivity in patients with chronic hepatitis C virus infection

BACKGROUND: Although HIV testing is recommended for persons with hepatitis C virus (HCV) infection who are at risk for HIV, little is known about HIV testing in this population. METHODS: Data were prospectively collected in 4364 HCV-infected patients at 24 Veterans Affairs medical centers across the United States, including demographics, risk factors for HIV infection, and self-reported information on HIV testing. RESULTS: Overall, 76.8% had been tested for HIV at least once, 14.8% were never tested, 6.6% did not know if they were tested, and 1.8% declined to answer. Multivariable analysis identified injection drug use, needlestick injury, sex with a same-sex partner, a greater number of lifetime sexual partners, and sex with an injection drug user as factors that were independently associated with HIV testing. At least one risk factor for HIV infection was present in 84.5% of the 646 patients who were never HIV tested. Among the 3350 subjects who were tested for HIV, 8.4% were positive, 88.3% were negative, 2.4% did not know the results of their test, and 0.9% declined to answer. Multivariable analysis identified African American and Hispanic race/ethnicity, income < or = 10,000 dollars, sex with a same-sex partner, and sex with an injection drug user as the only variables that were independently associated with HIV seropositivity. CONCLUSIONS: Although a substantial proportion of HCV-infected patients have been tested for HIV, missed opportunities for early diagnosis of HIV infection exist. Public health strategies to improve HIV testing among patients with chronic HCV infection are needed.     

Naltrexone and disulfiram in patients with alcohol dependence and current depression

OBJECTIVE: Although disulfiram and naltrexone have been approved by the Food and Drug Administration for the treatment of alcoholism, no medications have been approved for individuals with alcohol dependence and comorbid psychiatric disorders. In particular, the effect of these medications on alcohol use outcomes and on specific psychiatric symptoms is still unknown in patients with the most common co-occurring disorder, major depression. METHOD: Two hundred fifty-four patients with a major Axis I psychiatric disorder and comorbid alcohol dependence were treated for 12 weeks in an outpatient medication study conducted at 3 Veterans Administration outpatient clinics. Randomization included (1) open randomization to disulfiram or no disulfiram, and (2) double-blind randomization to naltrexone or placebo. This resulted in 4 groups: (1) naltrexone alone, (2) placebo alone, (3) disulfiram and naltrexone, and (4) disulfiram and placebo. Primary outcomes were measures of alcohol use. Secondary outcomes included psychiatric symptoms assessed by the Hamilton Depression Rating Scale, alcohol craving, gamma-glutamyltransferase levels, and adverse events. RESULTS: One hundred thirty-nine subjects (54.7%) met the current Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for major depression. There was no relationship between the diagnosis of depression and medication treatment on alcohol use outcomes, psychiatric symptoms, or the reporting of side effects for these medications. There was a significant interaction between diagnosis, medication group, and craving, where subjects with depression on disulfram reported lower craving over time than subjects with depression on naltrexone. CONCLUSIONS: The results suggest that disulfiram and naltrexone are safe pharmacotherapeutic agents for dually diagnosed individuals with depression for the treatment of alcohol use disorders.     

NH-1,2,3-Triazole Inhibitors of the VIM-2 Metallo-β-Lactamase

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Transcutaneous dilation tracheostomy in the acute period in patients with penetrating craniofacial injury complicated by intracranial hypertension

Early tracheotomy is well founded in severe brain injury involving the facial skeleton and skull case. Intracranial hypertension interferes with the safe performance of an operation. The authors developed a procedure for safe paracentetic dilatation tracheostomy (PDT) in the acute phase of severe brain injury. The study covered 15 patients with severe brain craniofacial injury. Surgery was made under intravenous anesthesia (with hypnotics, myorelaxants, narcotic analgesics, and cholinolytic agents). PDT was performed by the combined procedure developed by Sigley and Griegse ("Portex and COOK") under endoscopic guidance (Karl Storz 11001 BN1), by displaying the images. The patient is put to bed, without placing a bolster under the shoulders, the bed head end being elevated at an angle of 30 degrees. Bronchoscopic monitoring was made discretely (20-60 sec) under artificial ventilation through a special connector. There were 3-6 sessions of bronchoscopies. Tracheostomy lasted as long as 24 hours in 5 patients, 48 hours in 12 patients; surgery was made in 7 patients on day 3 after injury. Prior to tracheostomy, a horizontalization test was conducted, which revealed an elevation of intracranial pressure (> or = 20 mm Hg). There were no episodes of intracranial hypertension during tracheostomy. PDT can be safely made in patients with intracranial hypertension when they are put to bed, without placing a bolster under the shoulder, the bed head end being elevated at an angle of 30 degrees under discrete bronchoscopic guidance.     

Transcutaneous dilation tracheostomy in children

The paper presents the experience of transcutaneous dilatation tracheostomy (TDT) in 16 children. Up to date, childhood has been a contraindication for TDT. The experience gained at the Department of Resuscitation, Institute of Neurosurgery, in performing TDT in more than 300 adult patients has permitted this procedure to be also used in childhood. Based on the analysis of the outcome of 16 TDTs, the authors have posed indications for TDT, its performance modification, approaches to preventing perioperative complications, by taking into account the anatomic and physiological characteristics of childhood.     

Correlation between brain electrical responses and lipid peroxidation during pathological aging

All-Union Mental Health Research Center, Academy of Sciences of the USSR, Moscow. (Presented by Academician of the Academy of Medical Sciences of the USSR, O. S. Adrianov.) Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 107, No. 6, pp. 682–684, June, 1989.     

A randomised control trial of the effectiveness of personalised letters sent subsequent to school dental inspections in increasing registration in unregistered children

Background

The Child Perceptions Questionnaires (CPQ_8–10 and CPQ_11–14) are indicators of child oral health-related quality of life. The aim of this study was to assess the validity and reliability of the self-applied CPQ_8–10 and CPQ_11–14 in Brazilian children, after translations and cultural adaptations in the Brazilian Portuguese language.

Methods

Schoolchildren were recruited from general populations for pre-testing (n = 80), validity (n = 210), and test-retest reliability (n = 50) studies. They were also examined for dental caries, gingivitis, fluorosis, and malocclusion.

Results

Children with greater dental caries experience in primary dentition had higher impacts on CPQ domains. Girls had higher scores for CPQ_8–10 domains than boys. Mean CPQ_11–14 scores were highest for 11-year-old children and lowest for 14-year-old children. Construct validity was supported by significant associations between the CPQ_8–10 and CPQ_11–14 scores and the global rating of oral health (r = 0.38, r = 0.43) and overall well-being (r = 0.39, r = 0.60), respectively. The Cronbach's alpha was 0.95 for both questionnaires. The test-retest reliabilities of the overall CPQ_8–10 and CPQ_11–14 scores were both excellent (ICC = 0.96, ICC = 0.92).

Conclusion

The Brazilian Portuguese version of CPQ_8–10 and CPQ_11–14 was valuable and reliable for use in the Brazilian child population, although discriminant validity was sporadic due to the fact that impacts are mediated by others factors, such personal, social, and environmental variables.