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Indirect mechanisms are implicated in the pathogenesis of the dementia associated with human immunodeficiency virus-type 1 (HIV-1) infection. Proinflammatory molecules such as tumor necrosis factor alpha and eicosanoids are elevated in the central nervous system of patients with HIV-1-related dementia. Nitric oxide (NO) is a potential mediator of neuronal injury, because cytokines may activate the immunologic (type II) isoform of NO synthase (iNOS). The levels of iNOS in severe HIV-1-associated dementia coincided with increased expression of the HIV-1 coat protein gp41. Furthermore, gp41 induced iNOS in primary cultures of mixed rat neuronal and glial cells and killed neurons through a NO-dependent mechanism. Thus, gp41-induced NO formation may contribute to the severe cognitive dysfunction associated with HIV-1 infection.

The first educational course for 30 medical doctors and 16 nurses, engaged in outpatient diabetes care in Bulgaria, was carried out with the aim of assessing the existing level of knowledge of diabetes, to implement a training programme matching the assessed needs, and to evaluate the efficiency of the education delivered. The initial level of knowledge was assessed by an anonymous pre-test questionnaire on general issues of diabetes care. After 5 days of training, a post-test questionnaire was administered which included more specific questions on matters that had been taught during the course. The results of the pre-test showed that, on average, 60.3 +/- 20.6 (SD) % of the doctors and 50.5 +/- 25.0% of the nurses gave correct answers. The results of the post-test were significantly improved (73.5 +/- 20.6% for the doctor and 70.8 +/- 23.5% for the nurses), although the post-test questionnaire had been expertly evaluated as more complex and specific. The analysis of the results allowed us to draw general conclusions regarding the educational needs, the optimal structure, and implementation of such training courses in the specific conditions of Bulgaria. Some of the results and conclusions might be useful for other countries from Central and Eastern Europe in their efforts to promote successful diabetes education programmes.