[Detection of the viral load and its use as a virological marker in the follow-up of HIV-1-positive patients]. / Detección de la carga viral y su uso como marcador virológico en el seguimiento de pacientes HIV-1 positivos.

The evaluation of viral load as virological marker and its clinical and immunological correlation are presented. The first viral load studies were performed during 1996 at the National Reference Center for AIDS in Argentina in HIV-1 positive patients derived from different Hospitals in Buenos Aires. The study included 216 HIV-1 positive patients, 49 females and 167 males. Plasma was used for evaluating viral load and a second sample was obtained in 25 of the 216 patients for their monitoring. Viral load was performed using bDNA technique (Quantiplex HIV RNA assay 2.0, Chiron Corporation, USA). Other parameters such as CD4 count determined by flow cytometry and clinical stages according to CDC classification were obtained in order to correlate clinical and immunological status of the patients. When CD4 count was compared with viral load, the results showed a trend of viral RNA increase in plasma along with a decrease in CD4+ lymphocytes. This trend was also observed to correlate with the progression to AIDS disease. In all groups of patients, considering either CD4 counts or clinical status, ranges of viral load values were broad. Thus, as shown by percentiles 25 and 75, patients with CD4 counts < 200/ml, presented viral load values between 18,395 c/ml to 215,425 c/ml and patients with > 200/ml viral RNA showed values from < 10,000 to 35,180 c/ml. Patients with CDC's A and B stages presented values from < 10,000 to 45,160 c/ml and 87,000 c/ml respectively, while patients classified as C had 10,582 to 215,000 c/ml. Results of two consecutive samples in the 25 patients showed the usefulness of this technique for monitoring antiretroviral therapy. Nevertheless, despite the tendency of viral load to increase along with the progression of the disease, the broad range of values suggested the importance of using both virological and immunological parameters for the management of HIV infected patients.

[Clinical evaluation of fluoxetine]. / Ocena kliniczna fluoksetyny (wyniki badan wieloosrodkowych).

The multicenter trials were performed in a group of 86 depressive inpatients (among them 64 with endogenous depression) managed with fluoxetine (Prozac). It was established that the drug is most effective in managing psychogenic depressions and may also be of use in endogenous depressions, among them in drug resistant ones. Tolerance to the drug was satisfactory, 62% did not show any unwanted side-effects. The rest of the group displayed sleep disorders, increased anxiety, lost of appetite and nausea. Changes in the laboratory parameters and non-specific changes in the electrocardiogram were observed sporadically. Fluoxetine seemed not to have any direct cholinolytic effect.

[Drug resistance in endogenous depression Part II. Refractoriness to antidepressants in affective disorders]. / Lekoopornosc w depresjach endogennych Czesc II. Wystepowanie lekoopornosci w kolejnych nawrotach depresji.

Among 67 patients admitted for the first time to the hospital drug resistance was evaluated in the further course of disease for at least 3 consecutive depressive phases. It was established that drug resistance occurs (usually as a single episode) in 28% of patients with endogenous depression and it concerns 10% of all depressive phases. The drug resistance is more frequent after the 45th year of life. The incidence of therapeutic failures is 3% during the first depressive phase and goes up in the consecutive phases. The occurrence of drug resistance in the past has no prognostic value for the next phase. There is a certain subgroup of patients, characterized by repetitive drug resistance during several phases. This phenomenon needs further evaluation.

[Drug resistance in endogenous depression. Part I. Refractoriness to antidepressants in patients with depression admitted to a psychiatric clinic for the first time]. / Lekoopornosc w depresjach endogennych. Czesc I. Wystepowanie lekoopornosci u osób hospitalizowanych po raz pierwszy z powodu endogennego zespolu depresyjnego.

The efficacy of antidepressive treatment (mainly pharmacotherapy) was evaluated among 284 patients, admitted for the first time to the hospital with the diagnosis of endogenous depression. The first antidepressant therapy was found effective in 58% of the patients. Furthermore treatment with other antidepressants in the patients not responding to the initial therapy was successful in 57% of the cases. Drug resistance (defined as no therapeutical effect after 2 adequate courses of antidepressant treatment) was established in 7% of this sample. It was established that the drug resistance is more frequent after the 45th year of life. No relation between the drug resistance and sex, type of affective disorder, life events or somatic disorders were found.

[Treatment of depression with intravenous infusions of clomipramine and maprotiline]. / Leczenie depresji wlewami dozylnymi klomipraminy i maprotyliny.

28 patients aged from 31 to 69 years with endogenous depression were studied. All cases were drug-resistant i.e. they did not improve after a treatment with tricyclic antidepressants and in four cases also after electroconvulsive therapy. The group were managed with intravenous infusions of clomipramine or maprotiline followed by oral administration of the drug. Clomipramine was given i.v. at doses 75-300 mg daily for 7 to 16 days and maprotiline at 75-200 mg daily for 6 to 20 days. Remission of depressive symptoms was observed in 43% of cases and the first signs of improvement were observed on tenth day of the treatment. Tolerance to both drugs given parenterally in majority of cases was satisfactory. Half of the group did not show any untoward events. The rest of the group displayed local tissue reactions, both increased and decreased blood pressure, weakness, drowsiness, anxiety, vertigo, hyperpyretic reactions. Four patients had the treatment discontinued because of local tissue reactions or increased blood pressure or hyperpyretic reactions.

[The course of bipolar disorder before the manifestation of the first manic stage]. / Przebieg choroby afektywnej dwubiegunowej do wystapienia pierwszej fazy maniakalnej.

The study aimed to establish prognostic considerations for the course of bipolar affective disorder from its onset till first manic phase in persons in whom depression was that first clinical phase of the disorder. Studied group comprised of 80 patients (34 males and 46 females) with the disorder lasting for 11 to 50 years. Within the evaluated period as positive prognostic factors were identified an early onset of the disorder (before 30 years of age), a short (lasting less than 3 months) first depressed phase and a long (above 5 years) first remission. In women and in persons who had lost their parents before 14 years of age the course of disorder was more severe as indicated by duration and frequency of depressed phases. The time of duration of the disorder until the first manic phase was not influenced by pharmacotherapy. Both, treated and untreated depressions more frequently ended with remission (77% of episodes) than switch to mania (23% of episodes). Perris' criterion for diagnosis of unipolar affective disorder has rather limited value since in almost half of the studied individuals a risk of occurrence of a manic phase following three successive depressed phases still existed and diagnosis was still an open question.

[Reaction to sleep deprivation as a prognostic factor in the treatment of endogenous depression]. / Reakcja na bezsenna noc jako czynnik prognostyczny w leczeniu depresji endogennej.

Studies conducted on a group of 38 patients with endogenous depression demonstrated that a reaction to sleep-deprivation presenting as improved well-being has a significant predictive potential for treatment with imipramine. Patients who displayed the reaction also significantly more frequently displayed improvement of clinical course (remission; good response). Risk of switching from depression to mania also increased among these patients. Patients responding to sleep-deprivation with improved well-being belonged mainly to the bipolar affective disorder. Neither clinical manifestations of depression, nor the number of relapses, nor the duration period of the disorder, nor basic demographic patterns did show distinct features; nor did they differ significantly from patients who did not respond to sleep-deprivation with improved well-being.

Evaluación del uso de los antibióticos en el Hospital de Clínicas "José de San Martín" / Evaluation of antibiotics use at the Hospital of Clinical José de San Martín

El 18 de junio de 1986 se efectuó en el Hospital de Clínicas José de San Martín un estudio para evaluar el uso de los antibióticos en pacientes internados y los gastos que surgen de su empleo inadecuado. El 28% de los internados recibían antibióticos, el 69% de las indicaciones con finalidad terapéutica y el 35% de las profilaxisis fueron correctas. El error más frecuente en el tratamiento fue el uso del antibiótico no electivo y en la profilaxis, la utilización innecesaria. El gasto por uso inadecuado fue de u$s 494.17 en un día, u$s 14.825 en un mes y u$s 180.372 por año (AU)

Evaluación del uso de los antibióticos en el Hospital de Clínicas "José de San Martín" / Evaluation of antibiotics use at the Hospital of Clinical José de San Martín

El 18 de junio de 1986 se efectuó en el Hospital de Clínicas José de San Martín un estudio para evaluar el uso de los antibióticos en pacientes internados y los gastos que surgen de su empleo inadecuado. El 28% de los internados recibían antibióticos, el 69% de las indicaciones con finalidad terapéutica y el 35% de las profilaxisis fueron correctas. El error más frecuente en el tratamiento fue el uso del antibiótico no electivo y en la profilaxis, la utilización innecesaria. El gasto por uso inadecuado fue de u$s 494.17 en un día, u$s 14.825 en un mes y u$s 180.372 por año