Seguimiento del duelo en un CSMA / Out-patient follow-up of bereavement

El objetivo del trabajo fue evaluar qué sucede con las personas que han sufrido una pérdida y su duelo ha sido tan intenso que les ha llevado a consultar en el CSMA. Utilizando los criterios diagnósticos del DSM IV se recogieron durante el período comprendido entre 1990 y 1999, un total de 37 historias con el diagnóstico en el Eje 1 de Duelo V62.82. Se analizaron las siguientes variables: edad, tipo de pérdida, familiar perdido y evolución, dentro de esta última se observó que habían abandonado el CSMA por lo que se contactó con ellos telefónicamente a fin de evaluar las causas que motivaron el abandono. Resultados: La edad media fue de 44 años con un intervalo entre 19 y 67 años. El tipo de pérdida fue: enfermedad (n = 17); accidente (n = 11 ); suicidio (n = 9). El familiar perdido fue: hijo (n = 14); esposo (n = 12); padres (n = = 4); novio (n = 4); hermano (n = 2); amigo (n = l). Respecto a la evolución por orden de frecuencia las causas fueron: abandono (n = 18); continúan (n = = 11); alta (n = 8). En cuanto al abandono se consiguió localizar a 13 pacientes (72 por ciento) quienes alegaron distintos motivos para el mismo (encontrarse mejor, no verse aliviado, angustiarse más...).Conclusiones: 1. El duelo no es exclusivo de un género pero en nuestra muestra es mayor la consulta femenina (34 mujeres frente a 3 hombres). 2. No hay duelos de esposas, los 12 duelos de cónyuge son de maridos. 3. La evolución del duelo no tiene que ver con edad ni tipo de pérdida (50 por ciento abandono y 50 por ciento altas y seguimiento). 4. La frustración de no encontrar lo que se busca suele ser la causa más frecuente de abandono junto a la sustitución de la pérdida por otras actividades (AU)

[Are enteroviruses the causal agents of acute enteritis in humans?]. / Jsou enteroviry puvodci akutních enteritid lidí?

Based on assembled data from the literature and oral communications as well as findings in the laboratory, the author concludes that an enteroviral aetiology of diarrhoeal diseases can be taken for granted in many instances. Enteroviral gastritis is not frequent nor serious and is usually not encountered in winter but rather in summer under conditions with a higher standard of hygiene. The ratio of enteroviruses in epidemics of gastroenteritis and in the aetiology of enteritis within the framework of epidemics with other manifestations of enteroviral disease is very variable and there is no generally valid frequency which could serve for orientation. Virological and serological diagnosis of enteroviral diarrhoea would not be expedient in winter, it is, however, useful in summer and in epidemics affecting neonates and young children. In general, less attention is paid to an enteroviral aetiology or diarrhoea, as compared with thorough assessment of an enteroviral aetiology in severe forms of the disease. Attention is drawn to the usefulness of a more detailed investigation of properties of strains of polioviruses isolated from patients with diarrhoea.

[Acute hemorrhagic viral conjunctivitis]. / Akutní hemorrhagická virová konjunktivitida.

Two cases of acute hemorrhagic conjunctivitis are described, in which the enterovirus Coxsackie 24 was found by serological examination to be the etiological agent. The virus was important from Nigeria. The patients suffered by the acute hemorrhagic keratoconjuntivitis with transient iritic irritation without the systemic symptoms. Since now this disease with serological verification was not diagnosed in our country. The question of the viral hemorrhagic conjunctivitis and their treatment is discussed. The necessity of virological investigation in inflammations of the anterior segment is stressed.

[Prevalence of hantavirus infection in small mammals in the South Moravian Region]. / Prevalence nákaz drobných savcu hantaviry v Jihomoravském kraji.

In 1987 to 1990 in the South Moravian region 1094 lungs of small terrestrial mammals were examined for hantavirus antigen and sera of 525 rodents and 93 hares for antibodies against these viruses. In the majority the materials were not from the same individual. Lungs were examined by the ELISA method, antibodies were assessed by the indirect immunofluorescence reaction. An antigen resembling the western subtype (Puumala) was found in 65 animals (5.9%) of two rodent species (Microtus arvalis--63 times and Apodemus flavicollis--twice) in 20 localities. Antibodies against this subtype were detected in 25 examined individuals (4.0%) of four species (Microtus arvalis, Apodemus flavicollis, Pitymys subterraneus and Lepus europaeus) from eight localities. A marked predominance of positive findings was obtained from Microtus arvalis which under conditions of the South Moravian region can be considered the main host of hantaviruses of the western subtype. Only in one specimen of Clethrionomys glareolus from Hrbov antibodies against the eastern subtype were detected (Hantaan). Hantaviruses form in Southern Moravia natural foci of the avector type, in particular in perennial fodder crops, most frequently with a mesophil character of the site. The foci were found most frequently at sites of assumed borderlines of natural meadow forests of the Alno-Padion type and woods of the Carpinion betuli, Quercion robori-petreae and Fagion silvaticae type.

[Serological verification of the role of enteroviruses in the etiology of polyradiculoneuritis and aseptic meningoencephalitis]. / Sérologický prukaz podílu enteroviru na etiologii polyradikuloneuritidy a aseptické meningoencefalitidy.

In a group of 38 patients with the Guillain-Barré syndrome (SGB) and a group of 38 patients selected at random who suffered from meningoencephalitis the authors compared the characteristics by age, sex, onset of the disease (month of the year) and intervals between the onset of the disease and collection of serum samples. Using the neutralization microtest, the sera were examined for antibodies against 23 serotypes of enteroviruses incl. polioviruses. The groups differed significantly in the following indicators: the SGP group had a non-seasonal annual distribution, it included different age groups, there were longer intervals of sample collection. There were fewer cases with an assessed enteroviral aetiology, no case with a polioviral aetiology. More detailed analysis of serological results revealed, that the group does not differ fundamentally as regards the immunological experience of individuals with enteroviruses before the disease. The authors discuss the need of more detailed examinations of the enteroviral aetiology in all cases of SGB.

[Laboratory-confirmed cases of hemorrhagic fever with renal syndrome which occurred in Breclav 1989-1990]. / Laboratorne potvrzené prípady hemoragické horecky s ledvinovým syndromem v letech 1989-1990 na Breclavsku.

The authors describe the first three cases with a serologically confirmed hantaviral aetiology in the Czech Republic. It is the causal agent of haemorrhagic fever with renal syndrome, western type (strain CG 18-20, identical with the Puumala prototype). All patients come from a locality where since 1984 very actively a natural focus of hantaviral infection was investigated in small mammals, and where formerly groups of farmers were found with a high herd immunity with hantavirus. The disease was present in a mild to medium severe form with some sequelae. In the discussion the authors draw attention to the necessity of wider use of aetiological diagnosis in suspect diseases.

[Antibodies against Hantaviruses in game and domestic oxen in the Czech Republic]. / Protilátky proti hantavirum u lovné zvere a turu domácího v Ceské republice.

Using the test of indirect immunofluorescence, the authors examined sera of animals for antibodies against the strain CG 18-20 of Hantavirus (identical with strain Puumala) and against the Hantaan strain. As a control and supplement of the examination the authors used cells containing the TBE virus, strain Hypr. In a group of 260 hares (Lepus europaeus) in 3.5% antibodies were present against Hantavirus CG 18-20. Of 41 deer (Capreolus capreolus) they were present in 14.1%. Of 11 fallow-deers none had antibodies against hantaviruses. Among 145 specimens of Bos taurus antibodies were present in two incl. one against the strain Hantaan. The findings are discussed in relation to previous research of natural foci of hantavirus infections and infections with the TBE virus in Bohemia and Moravia. The paper reveals hitherto unknown localities of foci and hitherto not studied participants of the circulation of hantaviruses.

Qualification of long-stored samples of serum banks for seroepidemiological studies.

Serum samples were tested for antibodies against polio virus and measles virus from two serum banks after having been stored under different conditions for several years. The results are compared with those ones obtained immediately after sampling. Despite of small increases of antibody-negative samples and of small decreases of the titres the suitability of the samples stored could be shown. Special attention should be given to the establishment, e.g. in the framework of Expanded Programme on Immunization of the World Health Organization and in order to study new pathogens unknown to date, and the technical preconditions for that should be planed.

Anti-hantavirus antibodies in human sera in Czechoslovakia.

By indirect immunofluorescence using antigens of hantavirus Hantaan and CG 18-20 on Vero E6 cells were examined 5,827 samples of sera from 5,299 probands of Czechoslovakia. In 49 persons (0.94%) were found antibodies of titres 1:32 and higher. Two groups of elderly farm workers showed a cluster of positive individuals amounting to 9.9% and 29.4% respectively. The ratio of positivities in some other, randomly and specifically selected groups was deep below 1%. The partial results for the group of farmers were confirmed by RIA test. Occasionally antibodies only to one of the hantavirus serotypes, at other time, to both were found. The authors discuss the findings of antibodies of the two serotypes in humans as related to the evidenced existence of two hantavirus antigen serotypes in animals.

Hantaviruses in small wild living mammals in Czechoslovakia. Results of a 1983-1989 study.

During a 7- year period were hunted small wild living mammals and examined by ELISA and RIA techniques for the presence of hantavirus antigen and/or antibodies by MFA. In total 3,050 animals of 16 species caught in 9 out of 10 regions of Czechoslovakia, were examined. The proportion of positive animals was 4.4%. To the positive ones with the serotype 2 (Western type) belonged the following: M. arvalis, C. glareolus, P. subterraneus, A. sylvaticus, A. flavicollis. To the Eastern serotype: A. agrarius in eastern Slovakia, A. flavicollis in North of Bohemia and A. sylvaticus in South of Moravia. The repeatedly examined localities were found to be either repeatedly positive or repeatedly negative. The antigen titres in the lungs of M. arvalis were constant irrespective of sex and season of capture. They were, however, much higher in young animals, whereas the proportion of positivities was higher in adults ones. The titres of antigen in the lungs of C. glareolus never exceeded those of M. arvalis.

[Sexual development in obese women]. / Sexuální vývoj obézních zen.

By means of an interview and the questionnaire "Heterosexual Development of Women" [HDW] the authors subjected to sexuological examination 129 obese women aged 20-50 years with a body mass index above 25. As regards the time when overweight developed 29 women developed obesity during the prepubertal period and in 100 of the women obesity developed during adolescence and later. It was revealed that the sexual development of obese women was normal. The mean values in the HDW questionnaire in both subgroups with a different period of development of overweight were all within the normal range.

[Neurotic symptoms in obese women]. / Neurotické príznaky u obézních zen.

In a group of 129 obese women with a body mass index (BMI) above 25 by means of questionnaire N5 the frequency and intensity of neurotic symptoms was examined. It was revealed that in the sub-group of 61 probands with pathological obesity (BMI above 30) both values were highly significantly higher (p less than 0.01) than in 68 women with simple obesity (BMI 25-30). Among ten most frequent neurotic symptoms in obese women above all depressive and vegetative symptoms predominated.

[Sexual development and life of obese women]. / Sexuální vývoj a zivot obézních zen.

The authors examined by means of a structured interview and four questionnaires (heterosexual development of women, sexual activity of women, sexual function of women and N5 assessing the incidence and intensity of neurotic symptoms 100 obese women, mostly aged 21-40 years, who had a regular sex life. 73 of them had BMI values of 22 to 30. In the remaining 27 morbid obesity was involved with BMI values above 30. In the group as a whole the course of sexual development and life did not differ markedly from that of average women. A retarding trend with lower values in questionnaires on sexual activity and sexual function was found in women with primary and morbid obesity. In these sub-groups the number and intensity of neurotic symptoms was elevated. Their intensity in the group as a whole was significantly higher than in the ordinary population.

Using different sorbents for the concentration of enteroviruses.

Comparative investigations were carried out to evaluate the efficiency of concentration (EC) of enteroviruses (poliovirus type 1 and simian rotavirus SA-11) using macroporous glass (brands MPG-1000 VGKh, USSR, and SO1, Czechoslovakia) and membrane filters (MF): (nitrocellulose PNTs 0.45, USSR, Millipore HAWP 0.45, USA, Synpor 0.45, Czechoslovakia as well as polycapromide MF Pall 0.2, FRG, and FMPA 0.55, USSR). To assess the sorption properties of filters, poliovirus preparations and rabbit serum gamma-globulin were labelled with radioactive isotopes. Nitrocellulose filters (Millipore and PNTs) proved to be superior in providing for 64-90% virus sorption and 20-24% protein sorption. Elution experiments using solutions of different chemical nature--protein solutions (triptosophosphate broth and beef extract), amino acid mixture (glycine + arginine), chaotropic salt (sodium trichloroacetate mixed with lysine)--showed that protein solutions better eluted rotavirus SA-11 from nitrocellulose filters and macroporous glass (MPG). The utilization of nitrocellulose filters and MPG as sorbents enables a 10-40-fold concentration of enteroviruses depending on the chosen eluent. Comparisons of EC values for rotavirus SA-11 obtained using porous glass MPS-1000 VGKh and SO1 indicated that MPS-1000 VGKh was superior both with respect to recovery efficiency (R) and concentration factor (CF).

Immunogenicity of oral poliomyelitis vaccine (OPV) against variants of wild poliovirus type 3.

Serological investigations of three groups of children from the German Democratic Republic (GDR) and from Czechoslovakia who had different immunization histories against poliomyelitis indicated that the immunity induced by oral poliovaccine (OPV) is effective against both the wild poliovirus Saukett strain and a new wild variant of poliovirus type 3 that was isolated during an outbreak of poliomyelitis in Finland in 1984. There is therefore no obvious risk that individuals in the GDR or Czechoslovakia, most of whom have been immunized with OPV, are threatened by new wild poliovirus variants. These findings are of importance, especially in connection with WHO's initiative for the global eradication of poliomyelitis by the year 2000.

[The clinical picture and etiology of meningoencephalitis in hospitalized patients in 1986]. / Klinický obraz a etiologie meningoencefalitid u hospitalizovaných pacientu v roce 1986.

In 1986 in the CSR 978 cases of acute meningoencephalitis were notified, incl. 184 in the capital. In a group of 129 patients aged 1 to 63 years hospitalized at the First Clinic for Infectious Diseases in Prague-Bulovka (Paediatric Faculty Charles University) in 1986 the authors investigated the clinical course of acute meningoencephalitis in relation to the causal agent of the disease. The aetiological agent was assessed by isolation from cerebrospinal fluid or by isolation from faeces with the corresponding antibody response, or by serological examination only. In children under 15 years of age the etiological agent was assessed in 36%, in adults in 65%. In the investigated group, contrary to previous years (3), tick-borne encephalitis was involved which accounted for the majority of severe cases of the disease. The severe clinical course, manifested at first by symptoms of cerebral oedema with impaired consciousness, is more frequent with advancing age. In adults tick-borne encephalitis had a severe course in one third of the patients. In the other age groups the development was favourable, in particular in the group of children aged 4-10 years. As compared with previous years, there was no fatal case, no permanent paresis as a complication of the disease (2).

[Virologic and morphologic study in sudden and unexpected death in children]. / Virologická a morfologická studie u náhle a neocekávane zemrelých detí.

The authors examined a group of 47 children who died at the age of 1-9 months, incl. 19 female and 28 male children. In 23 the death was described as sudden and in 24 as unexpected. From 19 dead children a virus was isolated: in 14 one or two serotypes of enterovirus were found, in two the virus of parainfluenza 3 in two adenoviruses (type 2, 7). A total of 46 viral strains were isolated. By immunofluorescence in tissues antigens of the parainfluenza virus 3 and adenovirus were detected. Immune complexes were not detected in tissues. The distribution of vaccination polioviruses in organs and tissues after a known interval following vaccination was recognized. In some of the infants a possible causal relationship between the virological and morphological findings was found and the authors discuss the possible pathogenetic role of the revealed changes in sudden death.

Complement-fixing antibodies against rotaviruses in healthy children in the Czech Socialist Republic and People's Democratic Republic of Yemen.

Levels of complement-fixing antibodies against rotaviruses were evaluated in the sera of 900 healthy children aged 1-9 years 300 sera were collected in the People's Democratic Republic of Yemen in September-October 1985, 300 sera were obtained in the Czech Socialist Republic in the same period and another 300 also in the Czech Socialist Republic in September-October 1986. The latter two groups were investigated in the framework of immunological surveys. A complement-fixation antigen was prepared from a simian strain of the rotavirus type SA-11 in a tissue cell line MA-104. The sera from Yemen featured lower mean titres in the age groups and thus the lowest overall titre. As the antibody titre increased, the portion of seropositive sera from Yemen declined by far more rapidly than in the Czech children, where it remained virtually the same. The sera from Yemen showed the lowest negative rate and lowest ratio of high titres. The antibody titre of 1:64 and higher was not detected in children from Yemen, while they occurred in the two groups of Czech children. There was no correlation between antibody titres and probands' sex, nor was there linear dependence of titre magnitude on age. The mean positivity rate in each group as assessed by the antibody titres was the lowest in the sera from Yemen. The percentage of positive sera in all age groups was higher in the Czech children with the exception of children from Yemen aged 6 and 9 years. The aim of the present study was to evaluate the antibody status in infant populations and thus expand knowledge of rotavirus epidemiology.