Infections and exposure to anti-infective agents and the risk of severe mental disorders: a nationwide study

OBJECTIVE

Severe infections are associated with increased risks of mental disorders; however, this is the first large-scale study investigating whether infections treated with anti-infective agents in the primary care setting increase the risks of schizophrenia and affective disorders.

METHOD

We identified all individuals born in Denmark 1985-2002 (N = 1 015 447) and studied the association between infections treated with anti-infective agents and the subsequent risk of schizophrenia and affective disorders during 1995-2013. Cox regression analyses were adjusted for important confounders.

RESULTS

Infections treated with anti-infective agents were associated with increased risks of schizophrenia by a hazard rate ratio (HRR) of 1.37 (95%-CI = 1.20-1.57) and affective disorders by a HRR of 1.64 (95%-CI = 1.48-1.82), fitting a dose-response and temporal relationship (P < 0.001). The excess risk was primarily driven by infections treated with antibiotics, whereas infections treated with antivirals, antimycotics, and antiparasitic agents were not significant after mutual adjustment. Individuals with infections requiring hospitalization had the highest risks for schizophrenia (HRR = 2.05; 95%-CI = 1.77-2.38) and affective disorders (HRR = 2.59; 95%-CI = 2.31-2.89).

CONCLUSION

Infections treated with anti-infective agents and particularly infections requiring hospitalizations were associated with increased risks of schizophrenia and affective disorders, which may be mediated by effects of infections/inflammation on the brain, alterations of the microbiome, genetics, or other environmental factors.

[Fluorescence cystoscopy using 5-aminolevulinic acid]

BACKGROUND

Fluorescence diagnosis has an increasing importance in different medical fields. In the presented paper, comparison of cystoscopy in white light with fluorescence cystoscopy after intravesical administration of 1 g of 5-aminolevulinic acid is presented.

METHODS AND RESULTS

From the group of 63 persons examined, no difference between findings in white and blue light was found in 39 cases. In 21 patients more pathological spots were found in blue light (10 cases) or, in agreement with histology, pathology was detected in the blue light only (11 cases).

CONCLUSIONS

The intravesical administration of 5-aminolevulinic acid had no side effects. Our study has definitely proved the advantages of fluorescence cystoscopy.

Convergent strategies for the attachment of fluorescing reporter groups to peptide nucleic acids in solution and on solid phase

The site-selective conjugation of peptide nucleic acids (PNA) with fluorescent reporter groups is essential for the construction of hybridisation probes that can report the presence of a particular DNA sequence. This paper describes convergent methods for the solution- and solid-phase synthesis of multiply labelled PNA oligomers. The solid-phase synthesis of protected PNA enabled the selective attachment of fluorescent labels at the C-terminal end (3' in DNA) which demonstrated that further manipulations on protected PNA fragments are feasible. For the conjugation to internal sites, a method is introduced that allows for the on-resin assembly of modified monomers thereby omitting the need to synthesise an entire monomer in solution. Furthermore, it is shown that the application of a highly orthogonal protecting group strategy in combination with chemoselective conjugation reactions provides access to a rapid and automatable solid-phase synthesis of dual labelled PNA probes. Real-time measurements of nucleic acid hybridisation were possible by taking advantage of the fluorescence resonance energy transfer (FRET) between suitably appended fluorophoric groups. Analogously to DNA-based molecular beacons, the dual labelled PNA probes were only weakly fluorescing in the single-stranded state. Hybridisation to a complementary oligonucleotide, however, induced a structural reorganisation and conferred a vivid fluorescence enhancement.

[Percutaneous antegrade endopyelotomy]

Between 1987 and 1996 forty eight endypyelotomies (EPT) were performed in our institute on account of ureteropelvic junction (UPJ) obstruction. Forty three obstructions were primary, five secondary. Three EPT were made under fluoroscopic control but with poor results. Twenty one EPT were antegrade, percutaneous and 24 EPT were retrograde, ureteroscopic. The criteria of EPT as successful were improvement of radiological parameters, patient symptomatology and urinary bacteriology. The overall success rate of antegrade EPT was 81%. The results of retrograde EPT are similar as the antegrade ones, but follow up is too short to evaluate them. The results support the view, that EPT should be considered as first choice therapy for most UPJ obstructions.

[Results of surgical treatment of benign prostatic hyperplasia]

The authors have evaluated the results of the BPH surgery in the computer study on 669 patients (out of them 181 after TVPE and 488 after TURP) operated on at the department of Urology, FN Motol during 1988-1992. The average age of the patients was 70.6 years. The occult cancer was found in 6.7%. The incidence of bladder stones rose with the age (in the 8th decade at the quarter of patients). The average weight of the resected tissue was 63.7 gms in TVPE and 16.7 gms in TURP and it rose with the age. The average surgery time 47.1 mins at TVPE and 50.8 mins at TURP did not change statistically. The average demand on the blood transfusion was higher at TVPE (440.1 mls) than at TURP (95.5 mls) and rose with the resected tissue. The death rate was 0.5% among all the patients included (TVPE 0, TURP 0.6%). All three patients after TURP died from myocardial infarction. In this thesis is evaluated the number of early and late complications (incl. the transient incontinence), which have occurred in five consecutive years. The total morbidity was 27.2% and the further surgery was necessary in 2.8% after TVPE and 5.7% after TURP respectively. The pre-surgery performance status was aggravated in 79.4% of patients. In spinal anesthesia was operated on in 84.2% (subarachnoidal 56.5% and epidural 27.7%) and in general anesthesia in only 15.8% of patients. The pre-surgery urinary infection was found in 38.7% and after operation in 29.3%. Out of the latter, 30% were nosocomials. This was in accordance with the higher rate of late complications after both types of operations.

[Subjective symptoms before and after prostate surgery. The International Symptom Scoring System, I-PSS]

In this thesis are evaluated the questionnaires of the I-PSS retrieved from 415 patients (TVPE 104, TURP 272, TUIP + PRP 25 and TUIP 14) operated on the BPH at the department of Urology, FN Motol, during 1988-1993. The average value of S in the whole group of patients was 18.9 in the pre-surgery period and 6.9 after surgery. Before the surgery, the prominent difficulties were recorded in 50.8% of patients (S = 20-35) and after surgery this number fell down to 7%. Without any major difficulties (S = 0-7) were 66.3% of patients after the surgery. The average value of L before and after surgery was 4.2 and 1.6 respectively. The quality of life after the surgery was perceived by the patients more convenient than should correspond to the symptom scoring value. The best results (both the average S and L) were recorded in patients after TVPE (S 5.1 and L 1.1), followed by TURP (S 7.4 and L 1.7), than TUIP + PRP (S 8.4 and L 2.1) and only TUIP alone closed scale (S 8.9 and L 2.4). The differences of postsurgery S and L are statistically significant (p < 0.05). The comparison between the subjective better performance and the quality of life, when taken from TVPE resp. TURP point of view, does not prove to be the statistical difference. The comparison between S changes after the standard operation (TVPE and TURP) and minor prostatic surgery (TUIP + PRP and TUIP) also does not occur as statistically significant. Only the quality of life (L changes) is recorded by the patients as significantly worse after the minor prostatic surgery (p < 0.05). The pre-surgery worst perceived symptoms are: weak stream, nycturia and polakisuria (questions Nr. 5.7 and 2). After the surgery, nycturia is the leading worst symptom.

[Sexual consequences of benign prostatic hyperplasia]

In this thesis are evaluated the sexual questionnaires retrieved from 412 patients (TVPE 101, TURP 272, TUIP + PRP 25, TUIP 14), who had been operated on during 1988-1993 for the BPH at the department of Urology, FN Motol. Before the surgery, 69.7% of patients were sexually active yet (28.6% regularly, 41% irregularly). Without sexual intercourse were 29.9% in the time of surgery and 2 patients (0.5% did not respond the questions. The sexual activity was rapidly declining in the 7th decade, in the 8th decade still 41% of the patient argued sexual activity prior to surgery. The libido remained unchanged in 62.9%, worsened in 24.3% and improved in 10.7%. The changes in libido was neither parallel to the aging nor the type of prostatic surgery. After the surgery, the intercourse was admitted only by 49.3% of patients. Without any intercourse remained 50%. The difference compared to the pre-surgery responds is statistically proved (p < 0.01). The erectile dysfunction seemed to be the main cause of sexual intercourse decline. The impotence margin after TVPE or TURP is not statistically significant. On the other hand, the reawakening of the sexual activity at the patients, who had already not experienced intercourse preoperatively, was recorded only in 6 cases (1.5%). The unchanged ejaculation after surgery argued 13.1% of patients, the weaker ejaculation was recorded in 21.6% of patients and ejaculation was completely absent in 62.4% (retrograde ejaculation). Between TVPE and TURP was no significant margin found. The ejaculation damage after minimal prostatic surgery (TUIP + PRP and TUIP alone) is significantly minor (p < 0.01) than after the standard prostatectomy (TVPE and TURP).

[Percutaneous nephrolithotomy]

Within eight years, since October 1985 till June 1993, we had been operating on 409 patients, who had been subjected to 500 percutaneous nephrolithotomies. In 30% per cent of all the operations we had used mechanical, electrohydraulic or ultrasound lithotripsy. Out of the total number of the patients, 7 per cent had been discharged with the residual stones, but in 5.6 per cent the ESWL or spontaneous exodus had been presumed. Serious complications we had registered at 10 patients (e.g. 2 per cent of all operations). None of them however had required an emergency nephrectomy. The authors discuss the today's position of the PNL among the other operative methods of treatment of urolithiasis.

[Personal experience with uretero-renoscopy]

The authors submit evaluation of 188 patients operated on during five years (1989-1993). Using the ureterorenoscopic technique (URS), 207 operations have been performed. The average age in the group of patients was 56.1 years. In general anesthesia 151 operations were completed, in spinal anesthesia 54, in neuroleptanalgesia 1 and without any anesthesia 1. The postoperative ureteric intubation was accomplished 128 times (61.8%). The moderate dilatation of the hollow system of the kidney was proved ultrasonographically in only 7 cases. The average postoperative hospitalization reached 5.8 days. Out of 207 operations, we have reached successful result 177 times (85.5%) and 30 times (14.5%) we were not able to accomplish the operation only by means of the URS. 184 operations were performed because of urolithiasis (88.9%) and 23 (11.1%) for other reasons. Out of 184 URS for urolithiasis, 156 (84.8%) were successful and there was no difference found between pelvic (85.4%) and lumbal (83.6%) localization of urolithiasis in the view of success rate. The authors summarize the causes of mishaps and following solutions. The biochemical analyses of 153 concrements are added.

[Generalized melanoblastoma of the lower urinary tract]

The primary metastatic melanoblastoma presented with macroscopic haematuria as a first sign is described. So far it is our first experience with such a type of tumor in lower urinary tract in ageing man. The references in literature are scarce on this subject.

[Gluconeogenesis in perfused rat liver following preservation in various temperature ranges]

Experiments with perfused rat livers have shown that rates of various metabolic processes are influenced by changes in temperature in different ways. Cytosolic processes exhibit a linear temperature dependence when plotted in an Arrhenius-diagram in the range between 37 degrees and 1 degree C. In contrast, processes which are bound to mitochondrial membranes show phase changes at 22 degrees C. Furthermore, with gluconeogenesis another phase was observed at 11 degrees C. After 24 hour of perfusion at 11 degrees C the livers produced more glucose from gluconeogenic precursors when perfused at 37 degrees C than after perfusion at 4 degrees C. The importance of the balance of metabolism during hypothermia is discussed by comparison with metabolism of poikilothermic animals.