Prevalence and correlates of depressive disorders in people with Type 2 diabetes: results from the International Prevalence and Treatment of Diabetes and Depression (INTERPRET-DD) study, a collaborative study carried out in 14 countries.

AIMS: To assess the prevalence and management of depressive disorders in people with Type 2 diabetes in different countries. METHODS: People with diabetes aged 18-65 years and treated in outpatient settings were recruited in 14 countries and underwent a psychiatric interview. Participants completed the Patient Health Questionnaire and the Problem Areas in Diabetes scale. Demographic and medical record data were collected. RESULTS: A total of 2783 people with Type 2 diabetes (45.3% men, mean duration of diabetes 8.8 years) participated. Overall, 10.6% were diagnosed with current major depressive disorder and 17.0% reported moderate to severe levels of depressive symptomatology (Patient Health Questionnaire scores >9). Multivariable analyses showed that, after controlling for country, current major depressive disorder was significantly associated with gender (women) (P<0.0001), a lower level of education (P<0.05), doing less exercise (P<0.01), higher levels of diabetes distress (P<0.0001) and a previous diagnosis of major depressive disorder (P<0.0001). The proportion of those with either current major depressive disorder or moderate to severe levels of depressive symptomatology who had a diagnosis or any treatment for their depression recorded in their medical records was extremely low and non-existent in many countries (0-29.6%). CONCLUSIONS: Our international study, the largest of this type ever undertaken, shows that people with diabetes frequently have depressive disorders and also significant levels of depressive symptoms. Our findings indicate that the identification and appropriate care for psychological and psychiatric problems is not the norm and suggest a lack of the comprehensive approach to diabetes management that is needed to improve clinical outcomes.

[FUNCTIONAL PARAMETERS OF BLOOD CIRCULATION IN FIRST THREE MONTHS AFTER RADIOFREQUENCY ABLATION OF ATRIAL FIBRILLATION AND FLUTTER].

The purpose of the study was to evaluate functional parameters of blood circulation in first 3 months after radiofrequency ablation of atrial fibrillation and atrial flutter. The study included 113 patients aged 59.3±10.1 years, after radiofrequency ablation (RFA) with pulmonary veins isolation (PVI) for atrial fibrillation (AF), RFA of cava-tricuspid isthmus (CTI) for atrial flutter (AFl), or combined RFA PVI and CTI. Presence of arrhythmia recurrence episodes, blood pressure (BP) levels, electrocardiographic and echocardiographic indices were assessed before RFA, in acute postoperative period (3-5 days) and 3 months after RFA in the groups of AF, AFl, and AF/AFl combination. In acute postoperative period, arrhythmia recurrence of was most often recorded in the AF/AFl group, less often in groups of isolated AF and AFl, 3 months later - the frequency of recurrence decreased in all groups, but the largest remained in group of combined AF/AFl. In first 3 months after RFA of AF a decreased heart rate (HR), right atrium (RA) and ventricle (RV) size, an increased QTc interval duration and BP; after RFA of AFl - a decreased HR, end-diastolic volume (EDV) and RA; and after RFA of AF/AFl - a decreased ejection fraction (EF), an increased BP, QTc interval duration, and the end-systolic volume (EDV) were recorded. The results showed that effectiveness of RFA of isolated AF and AFl is higher than RFA of combined AF/AFl in the first 3 months after the procedure. Isolated AF and AFl after RFA were associated with BP and QTc interval duration increase, HR, EDV, RA and RV decrease; combined RFA of AF and AFl - with BP, QTc interval duration and ESV increase and left ventricular EF decrease.

[Preclinical study of Reamberin and Remaxol safety].

Preclinical safety of reamberin, a preparation of succinic acid intended for the treatment of patients with shock conditions of different etiology, and remaxol a drug intended for the treatment of patients with liver dysfunction caused by acute intoxication was performed. Both medicines belong to the 5th class of practically non-toxic drugs. Their administration to experimental animals for 30 days did not cause toxic effects on the functional and morphological state of main systems and organs. Both medicines do not affect specific (humoral and cellular) and non-specific immune response and do not cause sensibilization, mutagenic, embryotoxic and teratogenic effects, and also do no alter parameters of reproductive functions of rats.

Factors associated with the onset of major depressive disorder in adults with type 2 diabetes living in 12 different countries: results from the INTERPRET-DD prospective study.

AIMS: To examine the factors that are associated with changes in depression in people with type 2 diabetes living in 12 different countries. METHODS: People with type 2 diabetes treated in out-patient settings aged 18-65 years underwent a psychiatric assessment to diagnose major depressive disorder (MDD) at baseline and follow-up. At both time points, participants completed the Patient Health Questionnaire (PHQ-9), the WHO five-item Well-being scale (WHO-5) and the Problem Areas in Diabetes (PAID) scale which measures diabetes-related distress. A composite stress score (CSS) (the occurrence of stressful life events and their reported degree of 'upset') between baseline and follow-up was calculated. Demographic data and medical record information were collected. Separate regression analyses were conducted with MDD and PHQ-9 scores as the dependent variables. RESULTS: In total, there were 7.4% (120) incident cases of MDD with 81.5% (1317) continuing to remain free of a diagnosis of MDD. Univariate analyses demonstrated that those with MDD were more likely to be female, less likely to be physically active, more likely to have diabetes complications at baseline and have higher CSS. Mean scores for the WHO-5, PAID and PHQ-9 were poorer in those with incident MDD compared with those who had never had a diagnosis of MDD. Regression analyses demonstrated that higher PHQ-9, lower WHO-5 scores and greater CSS were significant predictors of incident MDD. Significant predictors of PHQ-9 were baseline PHQ-9 score, WHO-5, PAID and CSS. CONCLUSION: This study demonstrates the importance of psychosocial factors in addition to physiological variables in the development of depressive symptoms and incident MDD in people with type 2 diabetes. Stressful life events, depressive symptoms and diabetes-related distress all play a significant role which has implications for practice. A more holistic approach to care, which recognises the interplay of these psychosocial factors, may help to mitigate their impact on diabetes self-management as well as MDD, thus early screening and treatment for symptoms is recommended.

Muscle phosphofructokinase deficiency: abnormal polysaccharide in a case of late-onset myopathy.

A 61-year-old woman with muscle phosphofructokinase (PFK) deficiency had mild limb weakness all her life but no cramps or myoglobinuria. For 5 years the limb weakness progressed. In muscle, PFK activity was 1% of normal and glycogen concentration was elevated (2.13%). By light microscopy, a minor component of the accumulated glycogen appeared as PAS-positive, diastase-resistant inclusions in 10% of muscle fibers. The inclusions had a filamentous fine structure that resembled the abnormal long-chain glycogen of brancher enzyme deficiency. Iodine absorption spectra of both the inclusions and a diastase-resistant fraction of isolated glycogen resembled amylopectin. The abnormal polysaccharide in PFK deficiency may be related to greatly elevated concentration of muscle glucose-6-phosphate, an activator of the chain-elongating enzyme glycogen synthase.

HIV in testis: quantitative histology and HIV localization in germ cells.

The testes of AIDS patients invariably show decreased spermatogenesis and are atrophic. These testicular changes can be grouped into three categories: (1) spermatogenesis present, but decreased; (2) spermatogenic arrest at primary spermatocyte stage; and (3) Sertoli only (or almost Sertoli only). The purpose of this study is 2-fold: firstly, to quantitate the numbers and types of germ cells in these three groups as compared with normals. In addition the presence of HIV-1 DNA positive germ cells was quantitated by PCR in situ hybridization. HIV-1 was identified in 14 of 15 testes from HIV infected adults, and was present in 25-33% of residual germ cells. There was an average of 18.9 HIV infected germs cells/tubule in the spermatogenesis group, 6.3 HIV infected germs cells in the spermatogenic arrest group, and 0.25 HIV infected germ cells in the almost Sertoli only group. HIV-1 DNA was absent in three of the three preadolescent boys testes (HIV acquired in utero). This study quantitates the degree of germ cell loss in AIDS patients and quantitates the degree of HIV positivity of the residual germ cells, thus shedding more light on the testicular HIV burden, with its possible repercussions for sexual transmission of HIV.

Detection of HIV-related protein in testes and prostates of patients with AIDS.

The testes and prostates of 14 patients with acquired immune deficiency syndrome (AIDS) for whom autopsies were performed were examined for the presence of human immunodeficiency virus (HIV) and the pathologic alterations seen in AIDS. Histologically, the testes contained peritubular fibrosis and variable spermatogenic arrest, which were inconsistent with the young age of these patients. There were also numerous foci of germ cell degeneration and occasional germ cell loss. The Leydig cells were atrophic and decreased in number. The prostates contained increased numbers of concretions. Sections of testis and prostate were stained with an anti-HIV P17 monoclonal antibody with the use of the avidin-biotin technique. Small scattered foci of positive staining were identified in 8 of 14 testes (57%). They were located over one or several degenerating germ cells and the surrounding Sertoli cells. In addition, in 9 of 14 prostates (64%) there were a few minute foci of positive staining in several adjacent glandular epithelial cells. In one case the testis was positive and the prostate was negative, whereas in two cases the testes were negative and the prostate positive. In contrast, 22 testes and 22 prostates of control non-AIDS patients, read double-blind, were negative. The positive controls were HIV-infected tissue culture HUT 78 lymphoma cells in which there were many scattered positive cells. The results indicate the presence of focal HIV-associated protein in the testes and prostates of patients with AIDS, particularly within the foci of germ cell degeneration. The present observations are in accordance with previous research demonstrating the presence of HIV in the seminal fluid of patients with AIDS and appears to indicate the presence of an infection of the male genital tract by the HIV virus.

Normal-sized ovary carcinoma syndrome.

A clinical situation occasionally presents in which diffuse metastatic disease of the peritoneal cavity is noted, but the ovaries are of normal size, with or without a fine granularity on their external surface. We term this clinical phenomenon the "normal-sized ovary carcinoma syndrome." In an effort to study this dilemma, the clinical records and pathology slides were reviewed for 11 cases identified from 1976-1987. Four diagnostic groups were identified: mesothelioma (four patients), "extragonadal müllerian" tumors (two patients), metastatic tumors of unknown origin (four patients), and ovarian carcinoma (one patient). The survival for each of the first three groups is usually less than 1 year. Improved survival for mesotheliomas may be achieved with a combination of radiotherapy, an adriamycin-based chemotherapy regimen, and debulking surgery. A successful treatment strategy for serous surface papillary carcinoma has not been identified. Patients with metastatic tumors of unknown origin should either be treated with 5-fluorouracil or should not be treated at all. In order to discern the site of origin, satisfactory perioperative radiologic assessment, fastidious surgical exploration, and adequate communication between the surgeon and the pathologist are necessary.

Predictive accuracy of transrectal ultrasound-guided prostate biopsy: correlations to matched prostatectomy specimens.

OBJECTIVES: To characterize observed differences in Gleason score between prostate biopsy and corresponding radical retropubic prostatectomy (RRP) specimens. METHODS: One hundred consecutive clinically localized prostate cancers diagnosed by transrectal ultrasound-guided biopsy (TRUS-Bx) and treated with RRP were reviewed. All specimens were evaluated in blinded review by a single expert uropathologist and contrasted with the initial histologic analysis, performed by multiple pathologists. RESULTS: Mean Gleason score of TRUS-Bx specimens for blinded review and at initial evaluation were 6.6 +/- 0.1 and 6.0 +/- 0.1 (P < 0.001). Corresponding RRP values were 6.8 +/- 0.1 and 6.5 +/- 0.1 (P < 0.03). Differences in Gleason score between TRUS-Bx and RRP at initial evaluation were significant (P < 0.02), but not in blinded review (P = NS). In blinded review, TRUS-Bx correctly predicted RRP histology for 88% of men with lesions scored as Gleason 5 to 7 and 41% of men with well-(Gleason score of 2 to 4) or poorly differentiated (Gleason score of 8 to 10) lesions (P < 0.01). CONCLUSIONS: TRUS-Bx does not accurately reflect RRP histology when predicting well- or poorly differentiated lesions. Prostate cancer treatment algorithms should not be predicated upon biopsy histology alone. Histologic interpretation is more accurate and precise when performed by a single experienced uropathologist.

Changing testicular histology in AIDS: its implication for sexual transmission of HIV.

OBJECTIVES: The understanding of testicular histology in acquired immunodeficiency syndrome (AIDS) is essential, because the sexual route is one of the main means of transmission of the human immunodeficiency virus, which is localized primarily in the germ cells of the testes. It is important to determine whether any changes have occurred in the testicular histologic patterns in the course of the AIDS epidemic. METHODS: One hundred forty testicular specimens were available from AIDS autopsies during the AIDS epidemic (1981 to 1998). The epidemic was divided into pre-zidovudine (pre-AZT) therapy (1981 to 1987) and antiviral therapy (1988 to 1998) periods; the latter period was further subdivided on the basis of the particular treatment used. Testicular histology was evaluated and correlated with patient age, CD4 T-cell counts, and pathologic findings in other parts of the body. RESULTS: Testicular histologic findings were categorized into three groups: hypospermatogenesis (group S), spermatogenic arrest (group A), and Sertoli cell only (group O). The percentage of AIDS patients with group S histologic findings remained constant throughout the study period: 26% in the pre-AZT and 28% in the antiviral therapy periods. However, there was a reversal in the percentages of patients in groups A and O: group A decreased from 48% (pre-AZT) to 28% (antiviral) and group O increased from 26% (pre-AZT) to 44% (antiviral). There was no correlation between testicular histologic results and patient age or CD4 count. Opportunistic infections and testicular neoplasms were also identified. CONCLUSIONS: This study demonstrates that current therapy and prolongation of survival in AIDS patients are associated with a shift in the histologic findings of testes toward a more pronounced loss of germ cells. However, 28% of patients still show significant spermatogenesis at the time of death from AIDS and this subgroup cannot be identified by age or CD4 T-cell counts. The presence of large numbers of residual germ cells in these patients suggests that they may continue to be infectious throughout their disease course.

Metastatic breast carcinoma presenting as endometrial cancer. A case report.

BACKGROUND: Breast cancer is the most common cancer in women in the United States and second leading cause of cancer death in women. Primary breast carcinoma frequently metastasizes to the pelvic organs. CASE: A 63-year-old, post-menopausal woman with a history of breast carcinoma presented with post-menopausal vaginal bleeding. Diagnostic studies were consistent with a fibroid uterus and notably normal ovaries bilaterally. Dilatation and curettage revealed poorly differentiated adenocarcinoma thought to be primary endometrial cancer. A total abdominal hysterectomy and bilateral salpingooophorectomy were performed, and final pathology revealed metastatic breast carcinoma. Neoplastic cells were strongly positive for both carcinoembryonic antigen and gross cystic disease fluid protein, a marker of breast carcinoma. CONCLUSION: Breast carcinoma may metastasize to unusual sites, such as the endometrium and uterine leiomyomata, and mimic primary uterine malignancies. Immunohistochemistry is useful in reaching the diagnosis in difficult cases when a patient has a history of breast carcinoma.

[The microbial colonization of the skin of newborn infants rooming in with the mother in maternity homes]. / Mikrobnaia kolonizatsiia kozhi novorozhdennykh detei pri sovmestnom prebyvanii s mater'iu v rodil'nykh domakh.

The formation of skin biocenosis in children under the conditions of a maternity hospital with the joint care of mother and child was studied with the use of commercial bacteriological imprints manufactured in the USSR. The colonization of newborn infants in maternity hospitals with opportunistic, saprophytic and normal microflora was established. In newborn infants aged up to 5 years low skin resistance to colonization and, as a consequence, frequent colonization of the skin with opportunistic and saprophytic microflora was observed.

[Use of a coagglutination reaction based on a Soviet staphylococcal reagent for serogrouping Streptococcus group B and meningococci]. / Ispol'zovanie reaktsii koaggliutinatsii na osnove otechestvennogo stafilokokkovogo reagenta dlia serogruppirovaniia streptokokkov gruppy B i meningokokkov.

The coagglutination (COA) test is used for the serogrouping of streptococci, group B, and meningococci. The trial of a Soviet commercial preparation (staphylococcal reagent) has shown good prospects for its use in the COA test and high specificity of this test method. The availability of highly specific immune sera permits making standard kits for the identification of different infective agents in the COA test.

[Ecology of serogroup B streptococci in maternity hospitals (preliminary report)]. / Ekologiia streptokokkov serogruppy B v rodospomogatel'nykh uchrezhdeniiakh (predvaritel'noe soobshchenie).

Materials on the study of the colonization of newborns, their mothers and the medical staff of a maternity hospital by group B streptococci are presented. These streptococci were isolated from 26.3% of newborns, 19.6% of puerperae and 14.7% of the staff members. Group B streptococci were found to colonize different loci in newborns (the fauces, the nose, the umbilical cord, the ears, feces) and their mothers (the fauces, the vagina, the perianal fold, milk, the skin around the nipples, amniotic fluid, the umbilical cord). The serological typing of streptococci, isolated simultaneously from newborns and their mothers, suggested the presence of two possibilities of infecting the newborns with these microorganisms: (1) from their mothers and (2) from other newborns or members of the hospital staff during the stay in the maternity hospital.

[Choice of nutrient media for the laboratory diagnosis of Streptococcus group B]. / Podbor pitatel'nykh sred dlia laboratornoi diagnostiki streptokokkov gruppy B.

The comparative study of a large assortment of liquid and solid culture media used for the cultivation of streptococci in laboratory practice in the USSR and abroad was carried out with the aim of selecting the optimal media for the laboratory diagnosis of group B. streptococci. Liquid media were tested with the use of 7 streptococcal reference strains, and some of these media, found to yield the best results, were selected for tests on clinical material. The use of liquid accumulation media was shown to permit the isolation of group B. streptococcal strains which could not be detected by the direct inoculation of clinical material into dishes with blood agar. The character of hemolysis induced by group B. streptococci in solid media with 5% of blood added was found to depend on the composition of the medium and the conditions of cultivation.

[Ecologic and epidemiologic features of the circulation of streptococcus group B at a maternity clinic]. / Ekologicheskie i épidemiologicheskie osobennosti tsirkuliatsii streptokokkov gruppy B v rodil'nom dome.

In a maternity clinic the circulation of group B streptococci among the newborns, their mothers and the personnel was established during the period of 1982-1985. Group B streptococci were detected at different biotypes of newborns (the pharynx, the imbilical stump, external suditory meatus, nasal and oral mucosa, eyes and feces), their mothers (the vagina, the perianal area, breast milk, the pharynx, urine, the umbilical cord, amniotic fluid) and in the pharynx of the personnel. In this maternity clinic 15 combinations of type antigens were detected, two combinations (1a/c and 1 b/c) prevailing among them. These results confirmed earlier data concerning two possible ways of transferring infection to newborn infants: vertical, i.e. from the mother to the child during parturition, and nosocomial, i.e. from contaminated newborns or members of the personnel.

[Streptococcus group B in a maternity home with a decentralized system of newborn infant care (of the mother-child type)]. / Streptokokki gruppy B v rodil'nom dome s detsentralizovannoi sistemoi obsluzhivaniia novorozhdennykh (po tipu mat'--ditia).

In a maternity hospital with the decentralized system of infant care the presence of the group B streptococcal colonization of puerperants (13.0 +/- 4.5%), newborn infants (25.0 +/- 4.4%) and medical staff (16.9 +/- 3.2%) was established. The strains isolated in this hospital belonged to 13 different serotypes and antigenic combinations with type 1 a/c dominating among them (28.7 +/- 4.8%). Group B streptococci were found to be transmitted by the vertical way in one out of two colonized mother-child pairs, in all other cases the nosocomial spread of streptococci occurred.

[Microbial colonization and succession on the faucial mucosa in newborn infants rooming in with their mothers in a maternity hospital]. / Mikrobnaia kolonizatsiia i suktsessiia na slizistoi obolochke zeva u novorozhdennykh detei pri sovmestnom s mater'iu prebyvanii v akusherskom statsionare.

The formation of microflora on the laryngeal mucosa in newborn infants during the first 5 days of their life was studied in one of the maternity hospitals of Moscow. In this work modern methods of the isolation and identification of aerobic and anaerobic microorganisms were used, and the results thus obtained were computer-processed. In the maternity hospital of the "mother-child" type the microbial colonization of the laryngeal mucosa by normal and opportunistic microorganisms was noted in newborn infants. A wave-like course of the formation of laryngeal microflora, indicative of microbial succession occurring in the child, was revealed. The attempt to establish the cases of microbial interference between the species colonizing the laryngeal mucosa revealed that it was very rarely observed in 5-day-old newborns. This feature was seemingly the cause of low resistance of the larynx to colonization in newborn infants, which determined frequent colonization of their laryngeal mucosa with Staphylococcus aureus and Klebsiella.

[An experimental model of benzodiazepine intoxication]. / Eksperimental'naia model' otravleniia benzodiazepinami.

It has been demonstrated in rat experiments that intraperitoneal injection of 100 mg/kg phenazepam immobilizes the animals for one hour, causes long-term diminution of the muscular tonus and disturbed coordination of movements, tachycardia, hypotension, hyperthermia, depression of orientation and exploration motor activity, and disturbance of conditioned reflexes of active and passive avoidance. It is concluded that the changes in the above-indicated parameters of autonomic and behavioral status of rats under the effect of a 100 mg/kg dose of phenazepam are clearly expressed for a long period of time, are specific to the effect of benzodiazepines and may therefore serve as a model of severe BD intoxication for evaluating the efficacy of their antidotes. This has been confirmed in experiments with the well-known BD antagonist phlumazelin.

[The sensitivity to 12 antibiotics of 125 strains of Streptococcus group B isolated in a maternity home]. / Izuchenie chuvstvitel'nosti k 12 antibiotikam 125 shtammov streptokokkov gruppy B, vydelennykh v rodil'nom dome.

Sensitivity of 125 strains of group B streptococci isolated from newborns, their mothers and personnel in a maternity home was studied with respect to 12 antibiotics: benzylpenicillin, ampicillin, methicillin, cephalotin, erythromycin, lincomycin, levomycetin (chloramphenicol), oxacillin, tetracycline, streptomycin, gentamicin and ristomycin. The method of serial dilutions in a solid medium was applied. All the strains were sensitive to ristomycin and erythromycin. The predominating number of the strains were sensitive to lincomycin, levomycetin and the beta-lactam antibiotics. Strains resistant or moderately resistant to benzylpenicillin, ampicillin, oxacillin, methicillin and cephalotin were detected. The majority of the strains were resistant to streptomycin, tetracycline and gentamicin. Multiple antibiotic resistance with 2-7 determinants was revealed in 11.2 per cent of the strains. The antibiotic sensitivity of the strains isolated from the newborns, their mothers and the personnel in the maternity home was on the whole similar or insignificantly differed.