Gouty arthritis in the acquired immunodeficiency syndrome

Patients with the acquired immunodeficiency syndrome (AIDS) are characteristically hypouricemic. Therefore, the occurrence of gouty arthritis in association with AIDS would be expected to be a rare phenomenon. We describe a patient with AIDS in whom gouty arthritis developed. Features of both diseases in relation to their coexistence in this patient are discussed.     

Does television induce suicidal contagion with adolescents?

In an attempt to assess what adolescents think they would do if they knew of previous adolescent suicides, 116 high school students viewed a videotaped vignette of a distressed high school student and were asked to imagine that they were she. They were then given an information sheet summarizing the vignette. One third of the information sheets contained an embedded sentence that two friends had recently committed suicide, another third a sentence that two friends had recently died in an airplane crash, and one third contained no embedded sentence. Subjects were then asked to rate the likelihood that they would engage in various behavioral alternatives (commit suicide, run away, abuse alcohol, drive recklessly, seek psychological help, try harder at school, adapt to the situation) and the degree to which they blamed the various situational factors described in the vignette (school, friends, alcohol, parents). Subjects also completed the Reasons fGr Living Inventory (RFL). The only significant difference across groups was the significantly higher score of the suicide group on the fear of social disapproval scale of the RFL. Adolescents may not be influenced by news about suicide or they may just deny such influence.     

Community attitudes toward childhood suicide and attempted suicide

To assess whether people's reactions to family members of child suicide attemptors were similar to reactions to family members of (a) actual suicides and (b) actual suicides that were preceded by a failed suicide attempt, 120 shoppers (60 men and 60 women) read and responded to one of five short newspaper articles about an incident of a 10-year-old child who either (a) attempted suicide, (b) committed suicide, (c) committed suicide after a previous suicide attempt, (d) died accidentally, or (e) died of a viral illness. Opinions about the psychological health of the victim and reactions to the surviving family varied depending on the nature of the incident. However, in many instances reactions to families of suicide attemptors could not be differentiated from reactions to families of actual suicides. Therefore, it is likely that the number of people affected by negative community reactions to suicidal behavior has been previously underestimated.     

Coronary calcification in hemodialysis patients: the contribution of traditional and uremia-related risk factors

BACKGROUND: Coronary artery calcification is a common feature of atherosclerosis, occurring in 90% of angiographically significant lesions. There is recent evidence that coronary artery calcification is frequent in hemodialysis patients and it has been suggested that this increased incidence may be associated to uremia-related factors. The development and progression of coronary artery calcification is similar to osteogenesis. The aim of this study was to evaluate the relationship between coronary artery calcification, uremia-related factors, and bone histomorphometry in hemodialysis patients. METHODS: A total of 101 hemodialysis patients were assessed for biochemical markers of inflammation, oxidative stress, and bone metabolism. Subsequently, they were submitted to multislice coronary tomography (MSCT) and transiliac bone biopsy. RESULTS: The median calcium score was 116.2 (range 0 to 5547). Fifty-two percent of the patients showed moderate and severe coronary artery calcification, 20% had calcium scores greater than 1000. In univariate analysis, age (r= 0.57, P < 0.000001), osteoprotegerin (OPG) (r= 0.44, P= 0.00002), and body mass index (BMI) (r= 0.24, P= 0.01) correlated positively with calcium score. Bone trabecular volume and trabecular thickness correlated negatively with calcium score (r=-0.24, P= 0.02; r=-0.22, P= 0.03). There was a correlation of borderline significance between calcium score and C-reactive protein (CRP) (r= 0.18, P= 0.062). The multiple linear regression analysis identified OPG as the only variable independently associated with coronary artery calcification. CONCLUSION: Coronary artery calcification is highly prevalent in the hemodialysis population and is associated with older age, higher BMI, inflammation and reduced trabecular bone volume. Higher OPG is independently associated with coronary artery calcification and may represent an incomplete self-defensive response to the progression of atherosclerosis in hemodialysis patients.     

Public reactions to child suicide: Effects of child's age and method used

In two separate experiments, a total of 180 citizens at a suburban shopping mall responded to questionnaires about a fictitious newspaper article describing a male child's suicidal death. In Experiment I (90 subjects), the child's age was reported as either 10, 13½, or 17. In Experiment II, an additional 90 subjects responded to a fictitious newspaper article describing a 10-year-old boy's suicidal death by gunshot, hanging, or drug overdose. Seventeen-year-olds who committed suicide were rated more psychologically disturbed than 13½- or 10-year-olds. Parents of 17-year-old suicides were liked more than parents of younger children. In the case of the 17-year-olds, respondents were more likely to say that they felt that the cause of death should not be publicly reported. Across all ages, fathers were perceived as significantly more psychologically disturbed by female than by male respondents. Children who shot themselves were rated more psychologically disturbed than children who overdosed, but parents were rated about the same regardless of the child's method of suicide.     

Differential effects on naloxone on the release of neurohypophysial hormones in normotensive and spontaneously hypertensive rats

The hypothalamo-neurohypophysial system is altered in the spontaneously hypertensive rat (SHR). We hypothesized that an aberrant regulation of vasopressin (VP) and oxytocin (OT) release by endogenous opiod peptides alters this neuroendocrine system in the SHR. Concentrations of the neurohypophysial hormones in plasma and the pituitary were measured in 17-week-old SHRs and two strains of normotensive controls, Wistar Kyoto (WKY) and Sprague-Dawley rats. Animals were decapitated 20 min after s.c. injection of saline (1 ml/kg) or naloxone hydrochloride (1 or 10 mg/kg). In addition, neurohypophysial hormones excreted during the day (08.00–17.30 h) and night (17.30–08.00 h) were determined in urine from 16-week-old animals kept in metabolic cages for 5 days. VP at extrahypothalamic sites was also measured as [VP] in acid extracts of the subfornical organ area, hippocampal commissure-fornix and choriod plexus. Hormones were quantified by radioimmunoassay. The pituitary content, plasma concentration, and urinary excretion of OT were reduced (P < 0.05) in SHRs, whereas VP content was increased (P < 0.05) in the pituitary and plasma, but unchanged in urine, of hypertensive animals. In extrahypothalamic tissues, [VP] in the hippocampal commissure-fornix was increased in the SHR. Naloxone elevated (P < 0.05) the plasma concentration of OT in WKY animals and VP in SHRs. Neither [VP] nor [OT] in plasma was changed by naloxone in Sprague-Dawley rats. Pituitary stores of the neurohypophysial hormones were not altered by naloxone in either hypertensive or normotensive rats. In conclusion, endogenous opioid peptides tonically inhibit OT release in WKY rats, whereas VP releas is decreased by opioid peptides in SHRs, 16–17 weeks of age. The neuromodulatory role of opioid peptides in the release of neurohypophysial hormones appears to be altered in the SHR such that VP release is suppressed and OT release is augmented.     

Isolated systolic hypertension,obesity, and hyperkinetic hemodynamic states in children

OBJECTIVE: To determine the factors that contribute to the pathogenesis of isolated systolic hypertension in children. METHODS: School-based measurement was performed of blood pressure (BP), heart rate, weight, and height in 2460 students (49% Hispanic, 31% black, 13% white) 12 to 16 years of age in 8 urban public schools. An independent group of 71 untreated children underwent 24-hour ambulatory BP monitoring (ABPM) to confirm clinic hypertension and assess circadian BP patterns. RESULTS: Hypertension and obesity were found in 17% and 23% of students, respectively. Among hypertensive students, 88% (363/413) had isolated systolic hypertension. Hypertension was more prevalent in obese than nonobese students (33% vs 11%, P <.0001). Obese hypertensive students had higher resting heart rate than nonobese normotensive patients (85.9 vs 79.6 beats/min, P <.001). Among patients who underwent ABPM, isolated systolic hypertension was found in 51% (36/71) by clinic BP and in 62% (18/29) with confirmed hypertension by ABPM. Blood pressure variability during daytime and sleep periods was higher in obese than nonobese patients for systolic BP (P <.01) and diastolic BP (P <.05). CONCLUSIONS: The findings of increased heart rate and BP variability in obese children with isolated systolic hypertension suggest that sympathetic nervous system hyperactivity may contribute to its pathogenesis.