Analysis of serious non-AIDS events among HIV-infected adults at Latin American sites

OBJECTIVE

Acquired immune deficiency appears to be associated with serious non-AIDS (SNA)-defining conditions such as cardiovascular disease, liver and renal insufficiency and non-AIDS-related malignancies. We analysed the incidence of, and factors associated with, several SNA events in the LATINA retrospective cohort.

MATERIALS AND METHODS

Cases of SNA events were recorded among cohort patients. Three controls were selected for each case from cohort members at risk. Conditional logistic models were fitted to estimate the effect of traditional risk factors as well as HIV-associated factors on non-AIDS-defining conditions.

RESULTS

Among 6007 patients in follow-up, 130 had an SNA event (0.86 events/100 person-years of follow-up) and were defined as cases (40 with cardiovascular events, 54 with serious liver failure, 35 with non-AIDS-defining malignancies and two with renal insufficiency). Risk factors such as diabetes, hepatitis B and C virus coinfections and alcohol abuse showed an association with events, as expected. The last recorded CD4 T-cell count prior to index date (P = 0.0056, with an average difference of more than 100 cells/μL) and area under the CD4 cell curve in the year previous to index date (P = 0.0081) were significantly lower in cases than in controls. CD4 cell count at index date was significantly associated with the outcome after adjusting for risk factors.

CONCLUSIONS

The incidence and type of SNA events found in this Latin American cohort are similar to those reported in other regions. We found a significant association between immune deficiency and the risk of SNA events, even in patients under antiretroviral treatment.

[Prognostic estimation in critical patients. Validation of a new and very simple system of prognostic estimation of survival in an intensive care unit]

OBJECTIVE

To make the validation of a new system of prognostic estimation of survival in critical patients (EPEC) seen in a multidisciplinar Intensive care unit (ICU).

DESIGN AND SCOPE

Prospective analysis of a patient cohort seen in the ICU of a multidisciplinar Intensive Medicine Service of a reference teaching hospital with 19 beds.

PATIENTS AND METHOD

Four hundred eighty four patients admitted consecutively over 6 months in 2003. Data collection of a basic minimum data set that includes patient identification data (gender, age), reason for admission and their origin, prognostic estimation of survival by EPEC, MPM II 0 and SAPS II (the latter two considered as gold standard). Mortality was evaluated on hospital discharge. EPEC validation was done with analysis of its discriminating capacity (ROC curve), calibration of its prognostic capacity (Hosmer Lemeshow C test), resolution of the 2 x 2 Contingency tables around different probability values (20, 50, 70 and mean value of prognostic estimation). The standardized mortality rate (SMR) for each one of the methods was calculated. Linear regression of the EPEC regarding the MPM II 0 and SAPS II was established and concordance analyses were done (Bland-Altman test) of the prediction of mortality by the three systems.

RESULTS

In spite of an apparently good linear correlation, similar accuracy of prediction and discrimination capacity, EPEC is not well-calibrated (no likelihood of death greater than 50%) and the concordance analyses show that more than 10% of the pairs were outside the 95% confidence interval.

CONCLUSION

In spite of its ease of application and calculation and of incorporating delay of admission in ICU as a variable, EPEC does not offer any predictive advantage on MPM II 0 or SAPS II, and its predictions adapt to reality worse.

Intellect, perceptual characteristics, and weight gain in anorexia nervosa

Studied weight gain in a group of primary anorexics by examining two popular psychodiagnostic measures, the Wechsler and Rorschach, for indices that may predict improvement. Twenty-seven successively admitted anorexics to a behavior modification weight gain program at NIMH were studied. Using weight gain as a continuous criterion, multiple regression analyses indicated that perceptual-personality variables did not have any predictive power. Cognitive focusing skills, as measured by the Arithmetic and Digit Span subtests of the Wechsler, were found to account for roughly half of the variance and to be good predictors of weight gain.

A comparative analysis of primary anorexics and schizophrenics on the MMPI

Although only a very small number of studies have described personality testing in primary anorexia nervosa (patients), they seem to suggest a deeper personality disturbance than commonly suggested by psychiatric interview. These results represent an attempt to define the contribution of psychological test data to differential diagnosis and personality organization in primary anorexia nervosa. Fourteen female schizophrenic and 14 female anorexic patients were compared on the MMPI. No significant differences were found on any of the validity or clinical scales. A product-moment correlation between the two profiles, obtained via a measure of distance between profiles, revealed remarkable similarities in their overall profiles (D2 = .83). The Depression, Psychopathic Deviate, Psychasthenia, Paranoia and Schizophrenia scales occupied the first five rankings for both groups (although in a different order) and were elevated over a T-score of 70 (for the anorexics, the Psychopathic Deviate scale score approached 70). The results are consistent with the few studies that utilized psychodiagnostic tests with anorexics and that point to extremely poor personality integration and to a more serious disorder than a neurotic disturbance.