Unique Aspects of the Care of HIV-Positive Latino Patients Living in the United States

Latinos are disproportionately affected by HIV, with a higher risk of infection and a delayed presentation to care as compared to non-Hispanic whites. Over the last decade many Latinos, especially foreign-born migrants, have settled in regions of the country with historically low Latino representation. Therefore, clinicians who care for HIV-infected patients are likely to encounter Latino patients, regardless of their practice location. Providing optimal care to this population may be especially challenging for clinicians practicing in areas of newer Latino expansion, where culturally appropriate services may be sparse. In this article, we argue that an understanding of the HIV epidemic among Latinos requires an appreciation of the diversity and heterogeneity of the Latino population in the United States. We also review unique clinical aspects of HIV care among Latinos, including manifestation of co-infections with pathogens endemic in Latin America but rare in the United States.     

Quality of sleep, fatigue and daytime sleepiness in migraine— a controlled study

The objective of this study was to evaluate whether the quality of sleep and the degree of fatigue and daytime sleepiness are related to migraine. We investigated 489 subjects comprising 97 patients with eight or more, 77 patients with five to seven and 196 patients with one to four migraine days per month, and 119 migraine-free controls with fewer than six headache days per year. The patients were recruited via articles in newspapers not stressing the subject of the study. All participants underwent a semistructured interview and completed the Pittsburgh Sleep Quality Index (PSQI), the Fatigue Severity Scale (FSS), the Epworth Sleepiness Scale (ESS) and the Self-rating Depression Scale and the Self-rating Anxiety Scale. For statistical analysis we used two way manova s, post hoc univariate two-way anova s and Hochberg's GT2 tests as well as three-way mixed design anova s. The PSQI total score was highest in patients with frequent migraine (5.9 ± 4.3) and lowest in controls (4.3 ± 2.5, P  = 0.04). Four subscores of the PSQI showed similar statistically significant differences. The FSS and ESS scores did not differ in the four study groups. Analysing depression and anxiety revealed a significant impact on PSQI, FSS and ESS, but did not demonstrate interactions with migraine, thus suggesting that the impact of migraine is similar in patients without and with psychiatric comorbidity. In conclusion, the quality of sleep is decreased in patients with migraine, whereas fatigue and daytime sleepiness do not differ from healthy controls. The decreased quality of sleep in migraineurs is also a consequence of migraine itself and cannot be explained exclusively by comorbidity with depression or anxiety.     

Biofeedback improves postural control recovery from multi-axis discrete perturbations

ABSTRACT: BACKGROUND: Multi-axis vibrotactile feedback has been shown to significantly reduce the root-mean-square (RMS) sway, elliptical fits to sway trajectory area, and the time spent outside of the no feedback zone in individuals with vestibular deficits during continuous multidirectional support surface perturbations. The purpose of this study was to examine the effect of multidirectional vibrotactile biofeedback on postural stability during discrete multidirectional support surface perturbations. METHODS: The vibrotactile biofeedback device mapped tilt estimates onto the torso using a 3-row by 16- column tactor array. The number of columns displayed was varied to determine the effect of spatial resolution upon subject response. Torso kinematics and center of pressure data were measured in six subjects with vestibular deficits. Transient and steady state postural responses with and without feedback were characterized in response to eight perturbation directions. Four feedback conditions in addition to the tactors off (no feedback) configuration were evaluated. Postural response data captured by both a force plate and an inertial measurement unit worn on the torso were partitioned into three distinct phases: ballistic, recovery, and steady state. RESULTS: The results suggest that feedback has minimal effects during the ballistic phase (body's outbound trajectory in response to the perturbation), and the greatest effects during the recovery (return toward baseline) and steady state (post-recovery) phases. Specifically, feedback significantly decreases the time required for the body tilt to return to baseline values and significantly increases the velocity of the body's return to baseline values. Furthermore, feedback significantly decreases root mean square roll and pitch sway and significantly increases the amount of time spent in the no feedback zone. All four feedback conditions produced comparable performance improvements. Incidences of delayed and uncontrolled responses were significantly reduced with feedback while erroneous (sham) feedback resulted in poorer performance when compared with the no feedback condition. CONCLUSIONS: The results show that among the displays evaluated in this study, no one tactor column configuration was optimal for standing tasks involving discrete surface perturbations. Feedback produced larger effects on body tilt versus center of pressure parameters. Furthermore, the subjects' performance worsened when erroneous feedback was provided, suggesting that vibrotactile stimulation applied to the torso is actively processed and acted upon rather than being responsible for simply triggering a stiffening response.     

Photographic protocol for image acquisition in craniofacial microsomia

Craniofacial microsomia (CFM) is a congenital condition associated with orbital, mandibular, ear, nerve, and soft tissue anomalies. We present a standardized, two-dimensional, digital photographic protocol designed to capture the common craniofacial features associated with CFM.     

Responsiveness of the reproductive axis to a single missed evening meal in young adult males

Objectives: The male reproductive axis is responsive to energetic deficits, including multiday fasts, but little is known about brief periods of fasting (<24 hours). Reduced testosterone in low‐energy balance situations is hypothesized to reflect redirection of resources from reproduction to survival. This study tests the hypothesis that testosterone levels decrease during a minor caloric deficiency by assessing the effects of a single missed (evening) meal on morning testosterone in 23 healthy male participants, age 19–36. Methods: Participants provided daily saliva and urine samples for two baseline days and the morning following an evening fast (water only after 4 PM). Testosterone, cortisol, and luteinizing hormone were measured with enzyme immunoassays. Results: Fasting specimens had significantly lower overnight urinary luteinizing hormone (P = 0.045) and morning salivary testosterone than baseline (P = 0.037). In contrast to morning salivary testosterone, there was a significant increase in overnight urinary testosterone (P = 0.000) following the evening fast, suggesting an increase in urinary clearance rates. There was a marginal increase in overnight urinary cortisol (P = 0.100), but not morning salivary cortisol (P = 0.589). Conclusion: These results suggest the male reproductive axis may react more quickly to energetic imbalances than has been previously appreciated. Am. J. Hum. Biol., 2010. © 2010 Wiley‐Liss, Inc.     

Development of a guinea pig cutaneous radiation injury model using low penetrating X-rays

Purpose: A guinea pig skin model was developed to determine the dose-dependent response to soft X-ray radiation into the dermis.

Materials and methods: X-ray exposure (50 kVp) was defined to a 4.0?×?4.0?cm area on the lateral surface of a guinea pig using lead shielding. Guinea pigs were exposed to a single fraction of X-ray irradiation ranging from 25–79?Gy via an XRAD320ix Biological Irradiator with the collimator removed. Gross skin changes were measured using clinical assessments defined by the Kumar scale. Skin contracture was assessed, as well as histological evaluations.

Results: Loss of dermal integrity was shown after a single dose of soft X-ray radiation at or above 32?Gy with the central 2.0?×?2.0?cm of the exposed site being the most affected. Hallmarks of the skin injury included moist desquamation, ulceration and wound contracture, as well as alterations in epithelium, dermis, muscle and adipose. Changes in the skin were time- and radiation dose-dependent. Full-thickness injury occurred without animal mortality or gross changes in the underlying organs.

Conclusions: The guinea pig is an appropriate small animal model for the short-term screening of countermeasures for cutaneous radiation injury (CRI).