[Skin changes and anorexia nervosa]. / Hautveränderungen bei Anorexia nervosa.

Anorexia nervosa (AN) is one of the most dangerous psychiatric diseases; it bears a poor prognosis, marked addictive potential and a high risk of suicide. The earlier the eating disorder is diagnosed and treated, the better the prognosis of AN. A number of dermatological conditions may be associated with AN, although none are specific for AN. These findings include xerosis cutis, effluvium, gingivitis, cheilitis, acne and nail lesions. The cutaneous findings often observed in AN may be localized to the hands ("anorectic hand"), which should therefore always be examined if AN is suspected. The diagnosis of AN can thus be facilitated by knowledge of the cutaneous manifestations, which are generally plain to see. If AN is strongly suspected, the patient should be encouraged to consult a psychiatrist/psychotherapist.

Schizophrenic psychosis: a contraindication for treatment of hepatitis C with interferon alpha?

Depressive or psychotic symptoms are a well known side-effect of interferon alpha (INF-alpha). Therefore, the questions arises whether a chronic psychosis should be considered a contraindication for the treatment of active hepatitis C with INF-alpha. We report on a 38-year-old woman with a chronic schizophrenic psychosis, who acquired chronic aggressive hepatitis C. Considering the young age of the woman, the potential risk of developing a hepatocellular carcinoma and the result of the liver biopsy, treatment with interferon alpha 2 b (3x5 million IU/week) was started. The patient was seen three times a week, her psychiatric condition was monitored using the positive and negative symptoms score (PANSS). No signs of psychotic or depressive symptoms appeared during INF-alpha therapy. During the first 6 months the liver enzymes dropped slowly but the virus load was increasing. After adding ribavirin to the therapy, the liver enzymes dropped again, and the PCR carried out 9 months after initiation and 6 months after the end of the 12 months INF-alpha treatment did not detect any virus RNA. This positive result should encourage prospective studies including patients with these two diagnoses on whether patients benefit from INF-alpha.

A program of acquired immune deficiency syndrome education for nurses in Romania.

After the fall of the communist government in Romania, many children were found to be human immunodeficiency virus (HIV) infected. The majority of these children were abandoned and currently live in orphanages. The children have been cared for on a day-to-day basis by nurses with little general nursing education and even less HIV education. The Romanian-American Pediatric AIDS Education and Clinical Research Program was established at Texas Children's Hospital and Baylor College of Medicine in May, 1996 to aid in the education of Romanian nurses. Syllabi developed by the U.S. nursing team were initially piloted in three pediatric HIV centers in Romania in July, 1997. Since that time, two annual nursing symposia have been held offering topics on general pediatrics and HIV-related content. The purpose of this article is to describe a program of HIV education for nurses in Romania.

Symptomatic hypoglycemia secondary to a glipizide-trimethoprim/sulfamethoxazole drug interaction.

Sulfonamides have been reported to augment the hypoglycemic effects of chlorpropamide, glyburide, and tolbutamide. This case report is the first to describe a possible interaction with glipizide. An 83-year-old man receiving glipizide 10 mg bid developed symptomatic hypoglycemia within three days of adding trimethoprim/sulfamethoxazole (TMP/SMX) to his regimen. All other factors, including laboratory data, dietary intake, activity level, and concurrent use of other medications, were stable and noncontributory. This patient may have been at increased risk for this interaction secondary to his age and history of alcohol abuse. The mechanism of the interaction is probably inhibition of glipizide metabolism rather than protein-binding displacement. This case suggests that, when TMP/SMX is combined with glipizide, patients should be closely monitored, especially those at high risk for hypoglycemia.