Differences in coping strategies in adult patients with bipolar disorder and their first-degree relatives in comparison to healthy controls

INTRODUCTION

The objective of this study was to compare patients with bipolar disorder (BD), their first-degree relatives and a group of healthy controls in terms of use of adaptive and maladaptive coping strategies, exploring differences between specific types of strategies and their correlations with clinical variables.

METHODS

This was a cross-sectional study enrolling 36 euthymic patients with BD, 39 of their first-degree relatives and 44 controls. Coping strategies were assessed using the Brief COPE scale.

RESULTS

Significant differences were detected in the use of adaptive and maladaptive strategies by patients, their first-degree relatives and controls. Patients used adaptive strategies less often than the patients' relatives (p<0.001) and controls (p = 0.003). There was no significant difference between first-degree relatives and controls (p=0.707). In contrast, patients (p<0.001) and their relatives (p=0.004) both exhibited higher scores for maladaptive coping than controls. There was no significant difference regarding the use of maladaptive strategies between patients and their relatives (p=0.517).

CONCLUSIONS

First-degree relatives were at an intermediate level between patients with BD and controls regarding the use of coping skills. This finding supports the development of psychosocial interventions to encourage use of adaptive strategies rather than maladaptive strategies in this population.

Fusarium tricinctum Associated with Head Blight on Wheat in Argentina

Wheat (Triticum aestivum L.), the most widely grown winter cereal crop in Argentina, is grown on 5 million ha. Fusarium species affect yield and grain quality because of mycotoxins. In December 2009, a screen of fungal species in wheat seeds from a field in Azul, Buenos Aires, Argentina was conducted. Four hundred seeds were surface sterilized by dipping successively into 70% ethanol for 2 min, 5% sodium hypochlorite for 2 min, and finally rinsing twice in fresh sterilized distilled water. The seeds were plated on potato dextrose agar (PDA), pH 6, and incubated at 24 ± 2°C with exposure to 12-h alternate cycles of darkness and light. Eight isolates morphologically similar to Fusarium species were observed after 6 days of incubation. For identification, monosporic isolates were transferred onto PDA and carnation leaf agar (CLA) to grow at the conditions described above (1). One isolate, when grown on PDA, rapidly produced abundant, dense, white, aerial mycelium that became pink with age and formed red pigments in the medium. On CLA, macroconidia were abundant, relatively slender, curved to lunate, and three to five septate. Microconidia were abundant, napiform, oval or pyriform, zero to one septate, and commonly clustered in false heads. Chlamydospores were absent. The fungus was identified as Fusarium tricinctum (Corda) Saccardo on the basis of fungal morphology (1). To complete Koch's postulates, the pathogenicity of the fungus was tested by spraying five healthy inflorescences (on average 16 spikelets per spike) of wheat with a 5-ml suspension (2 × 10⁵ conidia per ml). Another two healthy inflorescences were sprayed with sterile distilled water. Plants were placed in a growth chamber with a 12-h photoperiod at 22 ± 2°C, covered with polyethylene bags that were removed after 3 days, and then moved to a glasshouse. The same procedure was repeated. While control inflorescences were asymptomatic, inoculated inflorescences showed a mean of five bleached spikelets per spike. By using the methodology described above, the fungus was reisolated from all infected grains of inoculated plants but not from the controls. To confirm the morphological diagnosis, the genomic DNA of the isolate was extracted (3) and the internal transcribed spacer (ITS) and the translation elongation factor (TEF) regions were PCR-amplified using primer pairs ITS3/ITS4 (4) and EF-1/EF-2 (2), respectively. The sequences were compared with those in GenBank. The ITS sequence (Accession No. HM635739) showed 100% similarity with several F. tricinctum sequences (e.g., Accession Nos. HM068317, FN598932, and EF589873) but also with other Fusarium species such as F. acuminatum. The TEF sequence (Accession No. HQ214681) showed 99 to 100% similarity with Accession Nos. HM068307, EU744838, and EU744837 of F. tricinctum. To our knowledge, this is the first report of F. tricinctum on wheat in Argentina. This species is known to produce fusarin C, enniatins, and moniliformin toxins. Since F. tricinctum can infect different cereal grains, a large-scale survey of cereals from fields throughout Argentina is in progress. References: (1) J. F. Leslie and B. A. Summerell. The Fusarium Laboratory Manual. Blackwell Publishing, Oxford, UK. 2006. (2) K. O'Donell et al. Proc. Nat. Acad. Sci. USA 95:2044, 1998. (3) S. A. Stenglein and P. A. Balatti. Physiol. Mol. Plant Pathol. 68:158, 2006. (4) T. J. White et al. Page 315 in: PCR Protocols: A Guide to Methods and Applications. Academic Press, San Diego, 1990.

Fusarium proliferatum, a New Pathogen Causing Head Blight on Oat in Argentina

Oat (Avena sativa L.) is widely grown (~200,000 ha) for livestock feed in Argentina. Fusarium spp. affect yield and commercial quality and can cause indirect losses because some Fusarium spp. produce mycotoxins. In December 2008, a study of oat seeds (cv. Graciela INTA) from Trenque Lauquen, Buenos Aires, Argentina was conducted. Seeds (400) were surface sterilized by dipping successively into 70% ethanol for 2 min, 5% sodium hypochlorite for 2 min, rinsed twice in fresh sterilized distilled water, plated on 2% potato dextrose agar (PDA) pH 6, and incubated at 24 ± 2°C with 12-h photoperiods. Six isolates morphologically similar to Fusarium spp. were observed after 6 days of incubation. For identification, monosporic isolates were transferred onto 2% PDA and carnation leaf agar (CLA) to grow with the conditions described above. Two isolates produced abundant, white, aerial mycelium and violet-to-dark (with age) pigments in the PDA. On CLA, macroconidia were abundant, slender, almost straight, thin walled, and usually three to five septate. Microconidia were abundant, usually single celled, oval or club-shaped in chains (less commonly in false heads) on monophialides and polyphialides. Chlamydospores were absent. The fungus was identified as Fusarium proliferatum (Matsushima) Nirenberg on the basis of fungal morphology (1). To complete Koch's postulates, the pathogenicity of the fungus was tested by spraying five healthy inflorescences of oat (cv. Graciela INTA) with a 5-ml suspension (2 × 10⁵ conidia/ml). Another two healthy inflorescences were sprayed with sterile distilled water. Plants were placed in a growth chamber with a 12-h photoperiod at 22 ± 2°C and covered with polyethylene bags that were removed after 3 days and plants were moved to a glasshouse. This procedure was repeated. While control inflorescences were asymptomatic, inoculated inflorescences showed bleaching glumes that sometimes became necrotic with some grains that presented pale brown discoloration and necrotic areas. The fungus was reisolated from glumes and grains of inoculated plants and not from controls using the methodology described above. To confirm the morphological diagnosis, the genomic DNA of the isolates was extracted (3) and a PCR reaction with specific primers 5'-CTTTCCGCCAAGTTTCTTC-3'-forward and 5'-TGTCAGTAACTCGACGTTGTTG-3'-reverse was chosen (2) using the following cycling protocol: initial denaturation step at 95°C for 2 min; 30 cycles at 95°C for 30 s, 55°C for 30 s, 72°C for 45 s; final extension at 72°C for 2 min. Successful amplifications were confirmed by gel electrophoresis. Size of the DNA fragment was estimated using a 100-bp DNA ladder. The reaction was repeated three times. The expected size product (585 bp) was obtained, confirming the identification (2). To our knowledge, this is the first report of F. proliferatum on oat in Argentina. This species is known to produce fumonisins, beauvericin, fusaric acid, fusarins, and moniliformin toxins, among others. Since F. proliferatum can infect different cereal grains, a large-scale survey in the same and different fields is in progress. A voucher culture has been deposited in the LPSC (Culture Collection of the La Plata Spegazzini Institute) No. 1058. References: (1) J. F. Leslie and B. A. Summerell. The Fusarium Laboratory Manual. Blackwell Publishing, Oxford, UK. 2006. (2) G. Mule et al. Eur. J. Plant Pathol. 110:495, 2004. (3) S. A. Stenglein and P. A. Balatti, Physiol. Mol. Plant Pathol. 68:158, 2006.

Monitorización de las concentraciones plasmáticas de vancomicina en pacientes en hemodiálisis

OBJECTIVE

The aim of this study was to confirm whether patients undergoing dialysis and treated with vancomycin 1 g/week or 500 mg/48 hours reach optimum plasma levels (10-25 mcg/ml).

METHOD

Thirty two patients were included with a total number of 34 infectious events. The most commonly used dose was 1 g/week (67.6% of infectious events), versus 500 mg/48 hours (32.4%). Low ultrafiltration membranes were used more frequently (64.7%) than high ultrafiltration membranes (35.3%).Vancomycin was infused over an one-hour period during the last hour of the hemodialysis session and plasma samples were drawn prior to the beginning of the session. Samples were analyzed using fluorescent polarization immunoassays.

RESULTS

Mean concentration results for the total population did not reach optimum values (10-25 mg/ml). In the group receiving 500 mg/48 hours, optimum mean values were not reached in any of the determinations, whereas in the group receiving 1 g/week, optimum values were reached in the fourth determination. Mean plasma levels of the antibiotic were below optimum values, regardless the type of membrane used, either low or high ultrafiltration.

CONCLUSIONS

Based on the above results, we recommend titration of the vancomycin dose in this group of patients and the administration of a loading dose of 20 mg/kg during the last hour of the hemodialysis session, followed by a maintenance dose of 7 mg/kg after each session, as well as the monitoring of the drug levels in this group of patients.

[Acute myeloid leukemia in those over 70 years of age. Experience using low-dose ara-C treatment]

PURPOSE

The treatment of elderly patients with acute myeloid leukaemia (AML) remains controversial. We present the results of the treatment of a group of patients aged above 70 years with AML diagnosed in our Hospital since 1990.

PATIENTS AND METHODS

We have studied retrospectively the cases of AML in patients older than 70 years diagnosed in our Service since January 1990 to June 1996. Induction treatment was performed, in all cases but one, with two cycles of Ara-C 10 mg/m2/12 h s.c. for 21 days and after haematological recuperation, if complete remission had been achieved, monthly maintenance treatment with Ara-C (25 mg/m2/12 h oral x 5 days), prednisone (40 mg/m2/day x 5 days) y vincristine (1 mg/m2 i.v. x 1 day) was begun.

RESULTS

During the period of study 48 patients with AML have been diagnosed in our Service, among them 22 (45.8%) were older than 70 years. One of them could not be considered for the study as not all data from him could be compiled. Among the other 21 patients 5 presented previous haematological processes (4 myelodysplastic syndrome and 1 Waldenström's macroglobulinemia). Initial diagnosis according to FAB classification for AML was as follows: 7 M1, 6 M2, 4 M4, 2 M5 and 2 M6. From these 21 patients 2 received no treatment due to rapid progression and death, among the other 19, one was directly treated with a modification of the maintenance treatment with vincristine and prednisone without response (survival 2 months). The other 18 patients were treated with low-dose Ara-C (described above), among them 3 (16.7%) were not evaluable as they did not finish the first cycle of induction treatment; 8 (44.4%) showed no response; 2 (11.1%) achieved partial remission and 5 (27.8%) complete remission. One patient did not show any response after two cycles of low-dose Ara-C but she obtained complete remission when treated with Ara-C and idaurubicin. Overall mean survival was 5.7 months (median 2; 95% confidence interval 1.6-9.8 months). In the group of patients treated with low-dose Ara-C mean survival was 6.6 months (median 3.5; 95% confidence interval 1.9-11.2 months).

CONCLUSION

We consider that the treatment with low-dose Ara-C is a valid option in the treatment of elderly patients (aged 70 or above) with AML because 28% complete remissions can be achieved, specially in those ones in which other more aggressive treatments are not possible.

[Kikuchi-Fujimoto disease associated with acute infection by herpesvirus 6]

The histiocytic necrotizing lymphadenitis or Kikuchi-Fujimoto disease is a very rare entity in Spain. We present a 34-year-old arabic male admitted to hospital because one-month story of asthenia, anorexia, weight loss, fever and lymphadenopathies in all palpable sites. Analytic studies were all within normal limits except LDH levels and globular sedimentation rate, both raised. After cervical lymph node biopsy performance high grade Non-Hodgkin lymphoma was initially diagnosed. During admission he complained from pain in both shoulders and an erythematous desquamative eruption in trunk appeared. Some days later, a second lymph node biopsy was performed and Kikuchi-Fujimoto disease was diagnosed. Serologic tests for human herpes virus 6 were positive demonstrating active associated infection. He begun treatment with indomethicin, fever and general symptoms disappeared one week later discontinuing treatment. Two months after discharge, all lymphadenopathies had disappeared. A review on epidemiological, clinical, pathological and differential diagnosis issues is made.

[Usefulness of bone marrow examination in patients with advanced HIV infection]

A bone marrow investigation is a common examination in HIV infected patients for the study of cytopenia, febrile syndromes of unknown origin and extension of neoplastic disorders. A study was made of bone marrow specimens from 35 patients with advanced HIV infection (stage IC or C, CDC, Atlanta) for morphologic and culture investigations (aerobes, anaerobes, fungi, and mycobacteria). In nine patients cytopenia accounted for the investigation of bone marrow specimens (9 aspirates and 3 biopsies); in only two cases did the investigation orientate towards a possible etiology: in the first patient a parvovirus B19 infection and in the second patient a hemophagocytic syndrome. In twenty-five patients the bone marrow specimen was studied because of fever of unknown origin (23 aspirates and 10 biopsies) and only in one case was the identification of Mycobacterium tuberculosis obtained. The other patient was studied for lymphoma staging and aspirate and biopsy examinations were normal. A high percentage of patients had eosinophilia, plasmacytosis, increased iron reserves, fibrosis, and changes consistent with myelodysplasia. In conclusion, in our experience the investigation of bone marrow specimen was of little help to clarify the possible etiology of cytopenia and febrile syndromes of unknown origin in patients with advanced HIV infection.

[Comparative study of the stability of oral anticoagulant treatments (warfarin vs acenocoumarol)]

PURPOSE

To compare the stability of the effect of two oral anticoagulants, one of them (acenocoumarol) with a short half life and the other one with a long half life (warfarin) in patients in the stable phase of treatment (at least 2 months with treatment before entering the study).

PATIENTS AND METHODS

During a year period (January-December 1993) a comparative study of two groups of 53 patients each was performed: group 1 patients were treated with warfarin and group 2 with acenocoumarol. Both groups were paired with respect to age, sex, diagnosis for anticoagulant therapy and desired therapeutic range (INR 3-4.5). The mean value of controls per patient, the dosage changes, the evolutive controls and the incidence of haemorrhagic and thromboembolic episodes were studied.

RESULTS

The controls performed in group 1 were 728 in total with a mean value of 13.74 per patient and 800 in group 2 with a mean value of 15.09 per patient. A change in the dosage was performed in 214 controls in patients of group 1 and in 269 of group 2. Seventeen patients had 38 haemorrhagic episodes (2 major and 36 minor) in group 1, and 6 of group 2 had 20 episodes (2 major and 18 minor). Significant differences were observed in the mean value of controls (p = 0.04), the evolutive controls (p < 0.001), the global incidence of haemorrhages (p = 0.008) and incidence of minor ones (p = 0.006). No significant differences in dosage were observed. In both groups no thromboembolic episodes during the period of study were reported.

CONCLUSIONS

Anticoagulant treatment with warfarin is more stable than with acenocoumarol. The total controls and the mean value of controls per patient are decreased. Nevertheless with warfarin we have observed a greater incidence of haemorrhagic episodes.

[Primary testicular lymphoma. Report of two cases]

Primary testicular lymphoma (PTL) is the most frequently diagnosed testicular tumor in men over 60 years, in spite of this circumstance it is a rare process. Two cases of PTL are reported, the first one in a child and the second in an adult. Both cases were intermediate grade lymphoma and had low stage (IEA), presenting initially as an enlargement of the testicle as the only symptom, the second case presented involvement by contiguity of the abdominal muscles. Immunohistological markers showed T nature in the first case, and B in the second. The treatment applied in both cases was orchiectomy and systemic chemotherapy using COP-BLAM/IMVP-16, in the child prophylaxis of the central nervous system using methotrexate was made. Response to treatment was good, the first patient achieved complete remission and his survival at present is 24 months, the second patient died 5 month after diagnosis due to stroke without having completed chemotherapy but with an important reduction of the tumoral mass. A review of the literature on clinical, diagnostic and therapeutic issues is made.

Melkersson-Rosenthal syndrome

The Melkersson-Rosenthal Syndrome consists of recurrent edema of the lips, intermittent facial edema and a furrowed tongue. This is the classic triad which defines the syndrome, although it is accepted that the presence of two manifestations is sufficient to make the diagnosis. Distribution is universal although the majority of the cases are described in the European literature. The case of a 37 year-old female is presented. She came to consult for persistent edema of the upper lip, of a three-year duration, which started abruptly without any clear etiologic correlation with acute episodes that disappear spontaneously or with corticoid treatment. Associated symptoms included migraine headaches which started years earlier. The complimentary examinations were normal except for a mild elevation of the sedimentary rate, and the biopsy was compatible with granulomatous cheilitis. In conclusion, MRS has to be considered as a diagnostic possibility in a patient who consulted for recurrent edema associated with other dermatologic and neurologic manifestations, although not necessarily having the complete triad.

Contribution to the etiopathogenesis of urticaria in children

For hundreds of years urticaria has been an intriguing problem for researchers. Together with angioedema it constitutes a common condition that affects 20% of the general population. The etiologic diagnosis is obtained in a variable percentage of cases, according to the different studies published. The clinical course and the association with angioedema are also variables in the different works. It was the diversity of results that led us to undertake the present study. We selected 161 histories of children who came to our department of allergology; these children whose ages ranged from 1-12 years were diagnosed of urticaria and/or angio edema. The number of males was slightly higher than females and the most affected age group was that between 7-12 years. The acute and acute intermittent forms predominated especially in atopic children, highly associated with angioedema; chronic urticaria was less frequent. Within the etiologic factors, food allergy played an important role, followed by drug allergy. It was not possible to reach an etiologic diagnosis in 39.13% of cases.

The protective effect of ketotifen in exercise-induced bronchospasm

The present study evaluates the protective action of ketotifen on exercise-induced bronchospasm in patients diagnosed with bronchial asthma of different aetiologies. The patients were classified in 2 groups. The first group with seasonal asthma was made up of patients with pollen hypersensitivity, while the second group with perennial asthma was made up of patients with bacterial aetiology or sensitivity to the Dermatophagoides mite. Spirometry and airway resistance measurements (in basal conditions, 5 to 10 minutes after a resistance test which consisted of 6 minutes' free running on a treadmill) was performed on each patient. Those patients in which significant spirometry or Raw alterations were detected received a 15-day treatment of ketotifen (a dose of 1 mg every 12 hours); after this time, the tests mentioned before were repeated. We found that in the seasonal asthma group, ketotifen was effective in protecting against exercise. However, we did not observe the same effect in the perennial asthma group. In the light of these results, we propose the possible existence of different mechanisms in triggering off exercise-induced bronchospasm, according to their aetiologies.