Risk factors of osteopenia in HIV-infected women: no role of antiretroviral therapy.

OBJECTIVES: Osteopenia and osteoporosis are more frequent in HIV-infected patients. Whether antiretroviral therapy induces a bone mineral density (BMD) loss remains controversial and few data are available in women. This cross-sectional study of 89 pre-menopausal HIV-infected women evaluates the relationship between BMD and antiretroviral treatment. METHODS: Three groups of women were compared: women never treated (n=37), women treated with nucleoside reverse transcriptase inhibitors and non-nucleoside reverse transcriptase inhibitors and never treated with protease inhibitor (PI) (n=25) and women treated with a PI-containing regimen (n=27). Their lumbar spine and hip BMD was measured by dual-energy X-ray absorptiometry. We assessed also demographic parameters, body mass index (BMI), habits, history of HIV infection and treatment, lipodystrophy and metabolic and hormonal parameters. RESULTS: 83% were African women. Mean age was 37 years. Median duration of HIV treatment was 3.5 years. The overall prevalence of osteopenia/porosis was 31.5%. No difference was found between the three groups. Using logistic regression, low BMI was the only factor associated with osteopenia/porosis. CONCLUSION: Osteopenia/porosis was highly prevalent among these HIV-infected pre-menopausal women, mainly of African origin. BMD loss was not associated with antiretroviral therapy (containing PI or not) but was associated with a low BMI.

[Difficult weaning due to tracheal compression by an esophageal bezoar]. / Difficulté de sevrage par compression trachéale due à un bézoard.

INTRODUCTION: Bezoars result from the aggregation of ingested materials (food, drugs, hair) that accumulate at a certain anatomic level in the gastrointestinal tract. It is a rare condition, which is favoured by a reduction in intestinal motility, or by a primary abnormality reducing the patency of gastrointestinal tract. CASE REPORT: We present a case when acute respiratory symptoms revealed an oesophageal bezoar. The patient presented with compression of the posterior tracheal wall by an oesophageal bezoar. The diagnosis was confirmed by oesophageal endoscopy. Treatment consisted in endoscopy-guided fragmentation and removal of the bezoar followed by topical lavage. CONCLUSION: Oesophageal bezoars may account for compression of the posterior tracheal wall causing acute respiratory failure or difficult weaning from the ventilator. The close anatomic proximity between the gastrointestinal and respiratory tract may explain the impact of oesophageal bezoars on the respiratory tract.

Hepatotoxicity observed in clinical trials of aplaviroc (GW873140).

Aplaviroc (APL) was a new CCR5 antagonist that was investigated in two dose-ranging studies with antiretroviral therapy-naïve, human immunodeficiency virus-infected adults: ASCENT, in which 147 subjects were randomized 2:2:1 to receive zidovudine-lamivudine (ZDV-3TC) plus APL 600 mg twice a day (BID), APL 800 mg BID, or efavirenz (EFV), respectively, and EPIC, in which 195 subjects were randomized 2:2:2:1 to receive lopinavir-ritonavir (LPV-RTV) plus APL 200 mg BID, APL 400 mg BID, APL 800 mg once a day, or ZDV-3TC BID, respectively. Both studies (and, ultimately, the clinical development of APL) were discontinued after a mean of 14 weeks of therapy because of higher than anticipated severe liver toxicity; grade 2 or higher treatment-emergent elevations in alanine aminotransferase (ALT) levels were observed in 17/281 (6.0%) APL recipients but only 2/55 (3.6%) control recipients, while grade 2 or higher elevations in total bilirubin levels occurred in 29/281 (10.3%) APL recipients but only 4/55 (7.3%) controls. Two APL recipients developed grade 3 or higher treatment-emergent elevations in both ALT and total bilirubin levels, and one of these individuals had a severe case of hepatic cytolysis that was attributed to APL. Despite the high intersubject variability in APL plasma exposures, a Pearson correlation analysis of the combined study data did not reveal any significant associations between plasma concentrations and the liver enzyme elevations observed during the study. The mechanism for the idiosyncratic hepatotoxicity observed in the clinical trials of APL is unknown but is likely intrinsic to the molecule rather than its novel mechanism of action.

Glutamine is involved in the dependency of brain neuron survival on cell plating density in culture.

The mechanism by which neuronal cell viability in culture is dependent on cell plating density is unclear. To address this question, dissociated cells from the neonatal rat cortex were cultured in a chemically defined medium. Medium conditioned with cortical cells plated at high density (2000 cells/mm2) promoted the survival of neurons grown at low cell density (100 cells/mm2) in a dose-dependent manner. Data obtained from molecular sieving suggested that the molecule(s) promoting the survival of neurons was smaller than 1000 Da. Amino acid analysis of the conditioned medium revealed the release of a mass of glutamine from cortical cells in culture. L-Glutamine mimicked the conditioned medium in action promoting the viability of neurons. These findings suggest that the effect of plating density on neuronal cell viability is mediated at least in part by glutamine released from cultured cells.

Prostaglandin-D-synthase (beta-trace protein) levels in rat cerebrospinal fluid.

The precise role of prostaglandin-D-synthase (beta-trace protein), the major constituent of cerebrospinal fluid, is unclear. In the present study, a sensitive and highly specific fluoroimmunoassay was developed. The measurement of the enzyme levels in rat CSF revealed a developmental change in the CSF levels with the highest value of 66 +/- 8 microg/ml at 7 days after birth. No significant difference in the levels was seen between different times of day. Subcutaneous injections of all-trans retinoic acid caused a dramatic decrease in the protein levels in a dose- and time-dependent manner. These findings may raise the possibility that prostaglandin-D-synthase in CSF is involved in retinoic acid action on the brain.

Accidental transmission of HCV and treatment with interferon.

Accidental transmission of contagious pathogens, especially hepatitis C virus (HCV), by needlestick or other means as an occupational hazard for medical staff is of concern. We retrospectively analysed cases of work-related accidental injury with pathogens such as hepatitis B virus (HBV), HCV, syphilis and human immunodeficiency virus (HIV) reported to the centres for disease control at 15 hospitals (total 5776 beds) in the Gunma prefecture, Japan, from December 1990 to August 1993 (24.7 months). There were 416 such cases (16.8 cases/month), with an incidence of 0.2-3.5 accidents per month per hospital. Such accidents occurred in 297 (71.2%) nurses, 98 (23.5%) medical doctors, 13 (3%) laboratory technicians, four (1.0%) hospital maintenance workers, one (0.2%) assistant nurse, one secretary and two others. There were 323 (77.6%) injuries caused by needlestick, 42 (10.1%) from suture needles or surgical knife cuts, 17 (4.1%) from blood splatters from patients into the eyes or mouth, 10 (2.4%) from contact with injured skin and 24 (5.8%) simple skin contacts. Of the pathogens, 60.3% were HCV, 22.6% HBV, 5.8% syphilis, 0.7% HIV and 10.6% were of unknown origin. Four cases (1.6%) of HCV infection were found and treated with one or two courses of interferon therapy, and HCV was subsequently cleared. All four patients were cured with interferon therapy. None of the HBV-injured cases resulted in infection, possibly because of prophylaxis with HB immunoglobulin and HB vaccine. No HIV or syphilis infection was contracted. In summary, chronic HCV infection acquired as an occupational hazard can be cured by appropriate treatment, such as with interferon, after early detection of the infection.

Changes in distribution of cystatin C, apolipoprotein E and ferritin in rat hypothalamus after hypophysectomy.

To clarify the mechanism underlying the process of degeneration of injured CNS neurons, we have immunohistochemically examined the distribution of cystatin C, apolipoprotein E, IgG, transferrin and ferritin in the hypophysectomized rat hypothalamus. Stainings for ferritin revealed that reactive microglial cells massed in the paraventricular and supraoptic nuclei 14 days after hypophysectomy, when the degeneration of vasopressin neuronal cell bodies was apparent. Cystatin C-positive magnocellular neurons first appeared at 4 days and the number of intensely-stained cells increased rapidly up to the 7th day of hypophysectomy, followed by a decrease thereafter. Most of such cystatin C-positive neurons were simultaneously stained with anti-vasopressin serum. Accumulation of apolipoprotein E in extracellular spaces was obvious in the both hypothalamic magnocellular nuclei at 7 days. Several apolipoprotein E-positive cells were localized in the supraoptic nucleus, although the number of apolipoprotein E-positive cells was much smaller than that of cystatin C-positive cells. The experiments performed with the transferrin and IgG antibodies showed undetectable levels of such molecules in and around the degenerating magnocellular neurons during whole experimental periods. These findings suggest the importance of cystatin C and apolipoprotein E in the process of degeneration and/or regeneration of magnocellular neurons after hypophysectomy.

Appearance of beta-2-microglobulin in rat hypothalamic magnocellular neurons after hypophysectomy.

To clarify the relationship between neuronal cell degeneration and MHC class-I complex expression, we have immunohistochemically examined the distribution of beta(2)-microglobulin in the hypophysectomized rat hypothalamus. In the sham-operated control rats, positive stainings were distributed only in blood vessels in the hypothalamic areas where magnocellular neurons were localized. Three days after hypophysectomy, positive stainings appeared in a large number of magnocellular neurons in the paraventricular and supraoptic nuclei. Most of such beta(2)-microglobulin-positive cells were simultaneously stained with antivasopressin serum. The pattern of distribution of positive cells and the intensity of the stainings remained unchanged at least until the 14th day. These morphological findings suggest that the process of degeneration of hypothalamic magnocellular neurons after hypophysectomy is a useful model to investigate the role of MHC class I complex in the brain.

Meninges play a neurotrophic role in the regeneration of vasopressin nerves after hypophysectomy.

Following hypophysectomy the regenerating fibers of magnocellular neurons are known to establish new neurohemal connections with reorganized vasculatures in the median eminence, which lead to establishment of a posterior pituitary-like structure. In order to examine the role of the meninges (the pia mater and the arachnoid) in this regeneration process, we implanted the meningeal tissues obtained from neonatal rat pups into the third ventricle of the adult rats, and then hypophysectomized the host animals. Ten days after hypophysectomy, the meningeal tissue grafts were found to be densely innervated by regenerating vasopressin-immunoreactive fibers. Such fibers had dots and frequently formed large punctuations. On the contrary, few vasopressin fibers were found within the cortical tissue grafts. Further, the exposure of primary hypothalamic cell cultures to the medium conditioned by meningeal cell cultures promoted not only the survival of vasopressin-immunoreactive neurons but also the outgrowth and aborization of the neurites. The survivals of cortical and cerebellum neurons in culture were also promoted by the conditioned medium. These findings raise the possibility that the meninges play an important role in the axonal regeneration process after hypophysectomy.

[Assessment of a chloroquine-spiramycin combination in the treatment of malaria in an area of moderate resistance]. / Appréciation d'une association chloroquine-spiramycine dans le traitement du paludisme en zone de chloroquinorésistance modérée.

The authors treated two groups of children in Zaire with two different regimens: chloroquine vs chloroquine-spiramycin. Chloroquine alone was successful in 83% of cases and chloroquine-spiramycin in 95% of cases (statistically significant). The tolerance of both regimens was excellent.