Do oral lesions associated with HIV affect quality of life?

OBJECTIVE: To assess the impact of oral lesions on quality of life (QOL) in HIV-positive (HIV+) individuals using the Oral Health Impact Profile (OHIP). STUDY DESIGN: This was a cross-sectional analytic study that compared 2 groups of HIV+ patients. Group 1 (n = 71) consisted of patients who presented with oral manifestations of HIV infection. Patients in group 2 (n = 79) were also HIV positive but had no oral lesions. The QOL measures were assessed by either simple frequency counts or the use of item weights. RESULTS: Oral candidiasis was the most common oral lesion diagnosed. Patients in group 1 reported significantly greater impacts (P < .05) for all 7 subscales in OHIP. CONCLUSIONS: Oral lesions associated with HIV infection negatively affect the oral health-related QOL in infected patients.

Sustained attention and executive functions in euthymic young people with bipolar disorder.

BACKGROUND: Persistent neuropsychological impairments have been reported in the euthymic phase of bipolar affective disorder. However, the findings have been confounded by multiple episodes, chronic illness and residual mood symptoms. AIMS: To assess sustained attention and executive functioning in euthymic young people with bipolar I disorder who had had no more than two affective episodes. METHOD: Thirty euthymic patients (with illness duration of less than 5 years and no more than two affective episodes) and 30 matched healthy individuals were assessed for sustained attention and executive functioning. RESULTS: The bipolar group (mean age 22.4 years, s.d.=2.52; duration of illness 20.87 months, s.d.=14.72), showed impairment on tasks of attention and executive functioning. Multivariate logistic regression analysis demonstrated that deficits in executive functioning differentiated cases from controls. There was no correlation between residual depressive symptoms and neuropsychological performance. CONCLUSIONS: Deficits in attention and executive functioning were present in young people who had experienced only a few episodes of bipolar disorder, suggesting that the deficits are possibly trait abnormalities. Whether these deficits worsen with progression of illness needs to be examined in longitudinal studies.

Practical and ethical issues with genetic screening.

Clinical hematologists are faced with a growing list of new genetic-based tools for identifying a patient's risk of disease. While many of the disease-specific tests are readily available, validation studies are required. Furthermore, genetic-based tests are being pushed to their technical limits, such as testing a single cell prior to embryo selection and transfer for couples at risk of genetic disease. As a result, misdiagnosis or misinterpretation of the data may result. As new genetic testing opportunities proliferate, the hematologist needs to be aware of the medical and legal issues surrounding their use. Furthermore, the hematologist needs to consider the psychological, ethical and social implications of this new field of genomic-based medicine.

Psychosocial responses of adolescent cystic fibrosis patients to lung transplantation.

What psychosocial issues do adolescent cystic fibrosis (CF) patients experience after undergoing lung transplantation (Tx)? The aim of this study was to determine, using an ethnographic study design, the common themes and emotional responses in post-lung transplant adolescent CF patients of the Cardiothoracic Transplant Clinic at the Childrens Hospital Los Angeles. Nineteen CF lung transplant recipients were studied (eight males, 11 females: mean age at time of transplant, 15.7 +/- 2.7 yr). The mean time interval from Tx to interview was 25.4 months (range 1-58 months). Sixteen patients had living donor lobar lung Tx while three patients received cadaveric lungs. A series of 25 questions was used to assess the psychosocial impact of Tx, and a semi-structured interview focused on the following five domains: lifestyle, family functioning, social functioning, body image, and psychological functioning. The major themes identified by patients included: a strong desire to set and attain meaningful long-range goals, the need to control as many aspects of their lives as possible while dealing with parental over-protectiveness, and the adjustment to a new lifestyle. Common emotional responses included manageable fear/anxiety of lung rejection and uncertainty of the future, impatience with disruptions of daily routines caused by post-transplant medical management and its effect on the attainment of set goals, and frustration with parental over-protectiveness. In general, patients reported a positive outlook on life, with greater emphasis on sought-after goals as well as inter-personal relationships. This study demonstrates that adolescent CF transplant recipients develop long-term goals and plans for independence. By identifying and anticipating the emotional needs of this population, health care providers can assist patients in improving the quality of their lives from a physiological, as well as a psychological, viewpoint.

Estimation of stress in child neglect from thymic involution.

It is difficult to evaluate the extent of stress in cases of suspected child abuse/neglect in a medico-legal autopsy. We have previously reported that stress due to abuse/neglect was found to have led to thymic involution. To elucidate the influence upon thymocytes differentiation, we compared the proportion of the thymocyte subpopulation in the thymus of a neglected child with one in an age-matched control obtained from cardiac surgery. We found that the relative number of CD4+ CD8+ double positive (DP) thymocytes decreased in the neglected child. It was presumed that the selective decrease in the number of the immature DP thymocytes with CD3- to low bcl-2low caused the thymic involution in the neglected child. It was suggested that an alteration in the proportion of thymocytes subpopulation might be used as an index of stress in cases of child abuse/neglect.

Splenomegaly and other hematological parameters in the socially dominant mouse.

Within a social dominance hierarchy, subordinate mice show hematological changes such as increased erythropoiesis and splenomegaly. The present experiment demonstrates similar findings for the unwounded dominant mouse. In addition, total serum protein, serum albumin and plasma fibrinogen were measured. Male DBA/2j mice were placed into social triads for three 24 hr periods. The resultant dominant and subordinate mice were compared with isolated control mice. Splenomegaly, thymus involution, decreased hematocrit, and increased fibrinogen levels were found in dominant mice. Subordinate mice demonstrated the same changes to a greater extent, as well as an increased reticulocyte count. Only dominant mice showed a reduction in total serum protein. Wounding-independent processes must be involved in these cellular and non-cellular hematological effects of psychosocial stress.