Serological response to syphilis treatment in HIV-positive and HIV-negative patients attending sexually transmitted diseases clinics.

BACKGROUND: HIV-positive patients treated for syphilis may be at increased risk for serological failure. OBJECTIVE: To compare follow-up serologies and serological responses to treatment between HIV-positive and HIV-negative patients attending two sexually transmitted disease (STD) clinics. STUDY DESIGN: Existing records were reviewed from HIV-positive patients who were diagnosed and treated for syphilis at the public STD clinics in Baltimore, Maryland, USA, between 1992 and 2000. Results of their serological follow-up were compared with those of HIV-negative clinic patients at the time of syphilis treatment. Failure was defined as lack of a fourfold drop in rapid plasma reagin (RPR) titre by 400 days after treatment or a fourfold increased titre between 30 and 400 days. RESULTS: Of the 450 HIV-positive patients with syphilis, 288 (64%) did not have documented follow-up serologies and 129 (28.5%) met the inclusion criteria; 168 (17%) of 1000 known HIV-negative patients were similarly eligible. There were 22 failures in the HIV-positive group and 5 in the HIV-negative group (p<0.001). The median times to successful serological responses in both groups were 278 (95% confidence interval (CI) 209 to 350) and 126 (95% CI 108 to 157) days, respectively (p<0.001). A multivariate Cox's proportional hazards model showed an increased risk of serological failure among the HIV-positive patients (hazards ratio 6.0, 95% CI 1.5 to 23.9; p = 0.01). CONCLUSION: HIV-positive patients treated for syphilis may be at higher risk of serological failure. Despite recommendations for more frequent serological follow-up, most patients did not have documentation of serological response after standard treatment for syphilis.

Image control and symptom expression in posttraumatic stress disorder.

Despite the devastating impact of affective dysregulation in posttraumatic stress disorder (PTSD), there has been little research on how trauma relates to affect regulation. This study examines the relationship between the cognitive capacity to control mental images and symptoms of individuals with (N = 23) and without (N = 23) PTSD after exposure to SCUD missile attacks during the Gulf War. The capacity to control mental images, symptoms of posttrauma, anxiety, and anger were assessed. PTSD subjects with a high image control reported a higher capacity to control anger, lower levels of anger state and expression, and lower levels of intrusive symptoms compared with PTSD subjects with low image control. In individuals without PTSD, results show that the better the image control, the lower the control of anger and the higher the expression of anger. Image control seems to play different functions in the emotional regulation of normal subjects (facilitatory) and PTSD patients (protective).

Image vividness as a psychophysiological regulator in Posttraumatic Stress Disorder.

This study examined the relationship between image vividness and psychophysiological responses to trauma-related stimuli in participants with Posttraumatic Stress Disorder (PTSD). An auditory stimulus related to a shared trauma was presented to participants with and without PTSD and physiological parameters (heart rate and blood pressure) were measured concurrently. A negative correlation was noted in the PTSD group between image vividness and the level of physiological response. When the PTSD group was divided into high and low vividness, the physiological response was higher than that of the non-PTSD controls only when image vividness was low. The results are discussed in the context of Lang' s theoretical model, emphasizing the role of image vividness in the mediation and regulation of psychophysiology.

Cytokine production in panic disorder patients.

Based on findings that stress and anxiety may modulate immune function, we compared the production of interleukin-2 (IL-2) and interleukin-3 (IL-3) by peripheral blood mononuclear cells between 24 patients with nonmajor depressed panic disorders, 9 with agoraphobia and 15 without, and 19 healthy volunteers. No differences in the production of these cytokines was noted between the patients with panic disorders and the volunteers or between the patients with and without agoraphobia. However, in the patients, a negative correlation was found for interleukin-3 production with severity of state anxiety, but not with trait anxiety or depression. This finding indicates that interleukin-3 levels may be sensitive to the presence of anxiety and stress.

The function of image control in the psychophysiology of posttraumatic stress disorder.

The physiological response to trauma-related stimuli of up to one third of participants with posttraumatic stress disorder (PTSD) cannot be discriminated from that of controls. Psychophysiological measures (heart rate and blood pressure) of 22 PTSD and 23 control civilian participants, all exposed to missile attacks during the Gulf War, were recorded while listening to five scripts. The physiological response of PTSD subjects with high image control (IC) was lower than that of PTSD participants with low IC and similar to that of non-PTSD subjects. The physiological response poorly discriminated high IC PTSD participants from controls, but was successful in discriminating low IC PTSD subjects from controls with 91% specificity and 92% sensitivity. Image control is proposed as a function influencing physiological response in PTSD.

Early transvaginal sonographic diagnosis of alobar holoprosencephaly.

Holoprosencephaly is a cerebral anomaly resulting from incomplete cleavage of the primitive prosencephalon or forebrain. Early detection of this anomaly is very important since the most severe form is incompatible with life. The diagnosis also signals the need for a chromosomal determination since chromosomal abnormalities have been associated with this anomaly. An early diagnosis of alobar holoprosencephaly at 14 weeks' gestation, employing transvaginal sonography, is reported. Our findings are compared with prenatal transabdominal sonographic findings of holoprosencephaly which have been reported during the last decade in the literature.

Effect of calcium channel blocker nifedipine on uterine artery flow velocity waveforms.

Calcium channel blockers have been used successfully in the treatment of pregnancy hypertension and premature labor. Only limited information related to their effect on uterine blood flow during pregnancy is available. In this study we measured the ratio between peak systolic to end-diastolic flow velocity (S/D ratio) in the ascending branch of the uterine artery in nine pregnant patients prior to and following a 10-mg dose of sublingual nifedipine. Another group of seven matched patients who received a placebo served as a control group. All studies were performed between 17 and 22 weeks gestation. The S/D ratio decreased shortly after sublingual nifedipine, but the change was not significant. It increased gradually afterward so that by 60 minutes it returned to the control value. The mean systolic blood pressure decreased by 8.6% to its lowest value after 25 minutes (P less than 0.01). The mean diastolic blood pressure decreased by 15.7% to its lowest value after 35 minutes (P less than 0.002). Maternal heart rate did not change significantly. No significant changes were observed in any of the measured variables in the placebo group. In conclusion, nifedipine does not induce significant changes in uterine arterial resistance in midtrimester and may be considered during pregnancy, providing that large fluctuations in maternal blood pressure are avoided.