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.

[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.

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.

The impact of multiple biopsies on outcomes of nerve-sparing robotic-assisted radical prostatectomy.

Active surveillance of prostate cancer patients involves subjecting them to multiple prostate biopsies, and we sought to investigate the effects of this on functional outcomes after robotic-assisted radical prostatectomy (RARP). Between May 2009 and December 2009, 367 patients who consecutively underwent RARP by a single surgeon were divided into two groups, one that had single prostate biopsy and another multiple biopsies before RARP. The groups were matched for significant clinicopathologic preoperative variables, and only premorbidly potent low-risk cases that underwent nerve sparing were included. This left 50 and 23 patients for analysis in the single and multiple biopsy groups, respectively. The primary endpoint was potency and continence at 3 and 6 months after surgery. We found continence rates of 84% (83%) and 94% (96%) for single (multiple) biopsy groups at 3 and 6 months, respectively (P=0.88, P=0.77). Multiple biopsy patients had worse postoperative erectile function at 6 months (57% versus 80%, P=0.03). Men subject to multiple preoperative biopsies are more likely to become impotent postoperatively than those who undergo surgery after a single biopsy. This should be borne in mind when counseling men regarding repeat biopsy as part of an active surveillance strategy.

[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.

Experimental study of biological activity of angiogen in experimental cardiovascular and hemostasis pathology.

Positive effects of angiogen, a preparation containing succinic and acetylsalicylic acids, on ECG, blood clotting, and lipid metabolism were demonstrated on animals with experimental cardiovascular disease induced by repeated injections of norepinephrine.

Detection of chlamydial antigenic material in ovarian, prostatic, ectopic pregnancy and semen samples of culture-negative subjects.

PROBLEM: The pathogenesis of long-term sequelae in Chlamydia trachomatis infection is poorly understood. While serology indicates previous chlamydial infection, culture studies are frequently negative. We wanted to know whether in chronic cases the bacterium is absent or persists in a dormant state where it evades detection. METHODS OF STUDY: Using immunoperoxidase (IP) staining and in situ hybridization (ISH), we examined tissues of culture-negative subjects. Ovarian biopsy specimens from 19 culture-negative women with pelvic adhesions and/or tubal infertility were analyzed by both methods. Samples of prostates from 10 culture-negative men undergoing prostatectomy for benign hypertrophy, two sets of semen samples from culture-negative sexual partners of 28 women with PID and/or bacterial vaginosis (BV), and ten endometrium-tube sample-pairs from ectopic pregnancies (EPs) were examined by IP only. RESULTS: Seven of the nineteen ovarian specimens tested positive for Chlamydia antigen or deoxyribonucleic acid (DNA) (36%). Of the 10 hypertrophic prostates examined, 4 (40%) were positive. Of the 28 semen samples examined, 10 (35%) tested positive. Tissue samples of 3 cases of EP were positive by IP. CONCLUSIONS: 1. C. trachomatis antigen and nucleic acid can be frequently demonstrated in asymptomatic, culture-negative men and women with chronic infection. 2. Chlamydia antigens may have an etiologic role in benign prostate hypertrophy and EP. 3. Antigenic material may be sexually transmissible. 4. IP and ISH identify temporarily inactive bacteria that may continue to act as immunostimulants and potentially reactivate as Chlamydia infection.

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.

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.

bcl-2 and p53 in endometrial adenocarcinoma.

bcl-2 protein is expressed in normal endometrium and seems to be under hormonal control. Its role in endometrial carcinoma (EC) is largely unknown. EC can serve as a good model to investigate the role of bcl-2 in hormone-dependent neoplasia, because EC shows a spectrum of hormonally induced changes in which bcl-2 might have a potential role. p53, a tumor suppressor gene, is the most commonly mutated gene in human cancer and is a frequent abnormality in advanced EC. There is interaction between p53 and bcl-2 proteins in the regulation of physiological programmed cell death and in malignant processes. In this study, we performed immunohistochemical investigations of the expression of bcl-2 and p53 in 57 ECs, along with estrogen and progesterone receptors (ERs, PRs), to correlate the expression patterns of bcl-2 and p53 in different grades of EC with relation to clinicopathologic parameters. The average age of the patients was 61 years. Among 57 ECs, there were 13 noninvasive ECs and 44 ECs with various depths of invasion. p53 was positive in 21 of 57 cases, and bcl-2 was positive in 42 of 57. ER and PR were positive in 24 of 57 cases; PR and ER alone were positive in 15 and 2 cases, respectively. bcl-2 expression is present in ECs, and its expression is related to grade and stage. bcl-2 expression is strongly associated with PR, whereas p53 is associated with higher grade and is inversely related to PR positivity.

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.

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.

[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.

P53 expression in adenomyosis in endometrial carcinoma patients.

Histopathologic changes ranging from simple cystic hyperplasia to carcinoma in situ may be observed in adenomyotic foci in patients with endometrial carcinoma. These changes can be an area of concern and physicians should be aware of their clinicopathologic significance. We studied a total of 94 patients, including endometrial carcinoma with (28 patients) and without adenomyosis (56 patients), and control group of adenomyosis cases (10 patients) without endometrial carcinoma. The histopathological changes in adenomyosis in patients with endometrial carcinoma varied from endometrial glands resembling the basal endometrium (13 of 28) through simple hyperplasia (8 of 28) to complex atypical hyperplasia, resembling carcinoma in situ (7 of 28). Formalinfixed paraffin-embedded tissues from 55 patients (45 endometrial carcinomas and 10 control adenomyosis) were stained with monoclonal antibodies against P53. P53 positivity was not detected in adenomyosis cases without endometrial carcinoma but was present in 7 of the endometrial carcinoma-related cases. P53 positivity was found in 14 of 45 endometrial carcinomas studied. In all of the adenomyosis-positive cases, the endometrium was also positive. In conclusion, adenomyosis with a range of hyperplastic to atypical changes is not uncommon in adenocarcinoma patients. Our findings regarding P53 positivity in adenomyosis are consistent with the hypothesis that hyperplastic and atypical changes in adenomyosis might be due to a carcinogenic field effect in the vicinity of endometrial carcinoma rather than by direct invasion.

Fulminant, systemic strongyloidiasis in AIDS.

The 15th known case of systemic Strongyloidiasis in an AIDS patient is recorded, with emphasis on the fulminant clinical cause and diffuse organ involvement.

[Use of unified methods in microbiologic monitoring of penicillin resistance in Pneumococcus]. / Primenenie unifitsirovannykh metodov pri mikrobiologicheskom monitoringe penitsillinorezistentnosti pnevmokokkov.

The microbiological surveillance of pneumococci according to the Protocols for the International Surveillance of Pneumococci Resistant to Penicillin and Other Antimicrobial Agents developed by Prof. M. Jacobs (USA) and Prof. P. Appelbaum (USA) made it possible for the first time in Russia to detect the strains with moderate resistance to penicillin. It is necessary to revise the current Russian recommendations for the laboratory diagnosis of pneumococcal infection and the determination of antibiotic susceptibility so as to participate in the united programme of the International Surveillance of Penicillin Resistance in Streptococcus pneumoniae.

HIV-1 nucleic acids localize to the spermatogonia and their progeny. A study by polymerase chain reaction in situ hybridization.

The purpose of this study was to determine the histological distribution of in situ polymerase chain reaction (PCR)-amplified HIV-1 nucleic acids in the male genital tract to elucidate the mechanism of sexual transmission of AIDS. Viral DNA was detected in the testicular tissue of 11 of 12 men with HIV-1 infection using the PCR in situ hybridization technique. The amplified viral DNA localized to many spermatogonia, spermatocytes, and rare spermatids. Relatively few viral infected macrophages were noted, mostly in the prostate. The viral infection was activated given the presence of cDNA sequences consistent with genomic and multiple spliced transcripts as determined by reverse transcription in situ PCR. PCR-amplified viral nucleic acids were not detected in the epithelial of the prostate, epididymis, seminal vesicles, or penis in men with AIDS nor in any genital tract tissues from three boys who died of AIDS acquired in utero. The demonstration that HIV-1 selectively infects the spermatogonia and their progeny suggests that this may serve as a primary source of venereal spread of the virus. Concomitant destruction of these cells by HIV-1 may also explain the marked inhibition of spermatogenesis and severe atrophy that characterizes the testes in AIDS.

[Tactics of the treatment of acute pancreatitis]. / Taktika lecheniia ostrogo pankreatita.

During the period of 6 years 176 patients with an acute pancreatitis were treated in the clinic, 17 (9,1%) of whom with destructive forms of disease. Tactics of treatment was developed on the grounds of ultrasonographic scanning of pancreas data, laparoscopy and enzymologic investigation results. Twenty two (12,5%) of patients were operated on. Postoperative lethality was 22,7%. Erosive hemorrhage was the cause of death in 2 patients and septic-purulent complications--in 3.