Chorea as a form of presentation of human immunodeficiency virus-associated dementia complex.
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Biomedical subjects
Publications and source records attributed to A Marcos.
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Eating disorders, such as anorexia nervosa and bulimia nervosa, are becoming more and more common in our society. Although they are psychiatric illnesses, there are many factors involved, including abnormal food behavior. Nutrients play an important role in the development and functionality of immunocompetent cells. An impaired immunocompetence has been shown to be an important causal factor in the increased susceptibility of malnourished individuals to infectious disease. Therefore, studies on the immune system are of great interest when assessing the extent to which the nutritional status of these patients could be affected. However, the literature in this field is controversial, and the mechanisms are not yet completely defined, although some hypotheses try to clarify the disturbances caused in the organism under these bizarre circumstances. In spite of the fact that the immune system is altered by distorted food behaviors, such as in eating disorders, the awareness of characteristics of other systems involved, and therefore altered, by these pathologies would be very helpful for understanding the mechanisms triggered in these syndromes. In fact, the interactions among the immune and other systems in eating disorders are beginning to be studied. Finally, the main goals are to limit the evolution of these illnesses through early diagnosis, and to devise a long-lasting, definitive cure for these patients through appropriate therapy.
Diets containing unheated casein (CD; control) or a casein-glucose mixture (CGD) previously heated at 140 degrees for 2 h were fed to two groups of young rats for 21 d. Differences in body weight, feed consumption, thymus, and spleen growth, protein metabolism and in vivo immune response were then determined. For this last experiment, animals were inoculated with sheep erythrocytes (SRBC) on day 15 to provide an immunological challenge. No changes were seen in body weight, feed consumption or feed conversion ratios. Neither were significant differences found in spleen weight, protein content, DNA content, DNase (EC 3.1.4.6) activity or lymphocyte count, suggesting that spleen cell growth remained similar in all the animals studied. The CGD induced marked increases in thymus DNA content whilst the protein:DNA ratio became lower. Spleen RNA content was similar in all rats, but thymus RNA content was 29% lower in the CGD group, although this difference did not reach statistical significance. This fact might be a consequence of the low RNase (EC 2.7.7.16) activity and RNase:RNA ratios in the thymus glands of CGD-fed animals. Further, the number of splenic plasma cells secreting anti-SRBC antibodies (direct plaque-forming cells) was significantly decreased in the same group. It might be concluded that both diets are adequate for rat growth and that the differences observed in the thymus of CGD-fed rats may be directed towards preserving tissue function. Nevertheless, the CGD did cause immunological disturbances affecting the humoral immune response.
Nutritional status and immunocompetence were evaluated in 15 patients suffering from anorexia nervosa in comparison with a control group (n = 15). After 1 y, data from six phases of the study were evaluated: immediately after admittance to the hospital (AN1), after 1 mo (AN2), after 2 mo (AN3), after 3 mo (AN4), after 6 mo (AN5), and after 1 y, (AN6). Patients recovered weight from AN4 until AN6 although, according to body mass index values, all patients had low weights during the 1-y follow-up. Likewise, leukocyte and lymphocyte values were borderline and lower in patients in all phases tested than in control subjects. All lymphocyte subpopulations were lower in AN1 and AN2 patients (inpatients) than in control subjects, except for CD19 cells, which remained unmodified. There seemed to be a recovery of lymphocyte subsets after hospitalization in AN3 and AN4 patients (outpatients), except for CD57, which remained below control values. However, there was a global decrease of the lymphocyte subsets in AN5 and AN6. Ratios of CD4 to CD8 cells were not altered but the ratio of CD2 to CD19 cells was lower in all phases except AN6. Moreover, cell-mediated immune function was impaired and none of the patients showed normal responses. Thus, despite the slight weight increase found in AN4, AN5, and AN6 and the apparent cell subset recovery after hospitalization, these results suggest a greatly depleted nutritional status that remained during the whole year in all patients.
The nutritional status of 21 patients suffering from bulimia nervosa was evaluated by anthropometric and immunologic indexes in comparison with a control group (n = 15). In addition, the influence of body mass index (BMI; in kg/m2) values and vomiting episodes on the nutritional status of bulimic patients was assessed. Anthropometry showed no signs of malnutrition in either group, except for those patients with low weights (BMI < 19). Bulimic patients had lower lymphocyte counts than did control subjects, except for those without vomiting (NVBN). All T lymphocyte subsets tested as well as CD57 cells were lower (22% and 55%, respectively) in bulimic patients than in control subjects, but the CD19 cell subset remained unmodified. The low-weight bulimic group (LWBN) had lower CD4 cell counts than did the normal-weight (BMI > 19) bulimic group. The NVBN group had lymphocyte subpopulations similar to those in the control group, except for CD57, which was lower. The bulimic patients with vomiting had the lowest cell subset values. These results suggest a depleted nutritional status in all bulimic patients studied, even those with normal weights. The LWBN group had the most depleted nutritional status and the NVBN group was least affected at a subclinical level. CD57 can be considered a good marker of nutritional status in this syndrome because it was the only subpopulation altered in all groups.
To clarify the interrelations among drug abuse, malnutrition, and immunosuppression, the effects of human immunodeficiency virus (HIV) infection on the nutritional status of 17 noninfected and 19 HIV-infected asymptomatic female drug addicts undergoing detoxification were evaluated by measuring anthropometric and immunologic indexes. Anthropometric measurements were normal in both groups as a result of weight gain (approximately 10 kg) in every patient after the detoxification period. Leukocyte and lymphocyte values and CD2 lymphocyte subset counts were also similar in both groups. CD4 counts (P = 0.04) and the ratio of CD4 to CD8 cells (P = 0.6 x 10(-4)) were lower whereas CD8 counts (P = 0.003) were higher in the HIV-infected than in the noninfected group. Responses to a delayed-hypersensitivity skin test were below normal in both groups but significantly more so in the HIV-positive group (P = 0.05). CD19 counts were lower (P = 0.02) and values for serum immunoglobulins G and M were higher (51% and 37%, respectively) in the HIV-infected females than in the noninfected women. These results may suggest that despite anthropometric recovery, the HIV-infected women had depleted immune function, resulting not only from HIV infection but also from the subclinical malnutrition triggered by previous drug addiction.
Anthropometric measurements and dietary intakes of male drug addicts (n = 62), infected (n = 23) or not infected (n = 39) with human immunodeficiency virus (HIV), who underwent two phases of detoxification (P1:15 d to 1 mo and P2: 5-6 mo) were assessed. Body weight, weight gain during detoxification, height, body mass index, and ideal body weight were measured. A prospective food-record questionnaire was compiled and energy and nutrient contents of ingested food were determined. Food intakes were compared with dietary recommendations for the Spanish population. At the time of the study, all patients had substantial weight gains, mostly in P1. Nutrient consumption was lower in P2 (energy, protein, and lipids) and in groups not infected with HIV. In P2, lipid intake was higher in the HIV-positive than in the HIV-negative group (P < 0.05, Student's t test). Moreover, an interactive effect of HIV by phase was shown for lipid intake (P = 0.04, two-way analysis of variance). Magnesium, folate, and vitamin E intakes were lower than recommended in nearly all patients. Energy, zinc, riboflavin, and vitamin B-6 intakes were lower than recommended or were borderline. HIV infection did not have a negative effect on anthropometric measurements or on nutrient intakes. The anthropometric assessment may suggest an adequate recovery of the indexes measured in all patients, which principally took place during P1. Measurement of nutrient intakes showed certain imbalances and deficits that should be corrected.
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The gyrA gene mutations associated with quinolone resistance were determined in 21 epidemiologically unrelated clinical isolates of Acinetobacter baumannii. Our studies highlight the conserved sequences in the quinolone resistance-determining region of the gyrA gene from A. baumannii and other bacteria. All 15 isolates for which the MIC of ciprofloxacin is > or = 4 micrograms/ml showed a change at Ser-83 to Leu. Six strains for which the MIC of ciprofloxacin is 1 microgram/ml did not show any change at Ser-83, although a strain for which the MIC of ciprofloxacin is 1 microgram/ml exhibited a change at Gly-81 to Val. Although it is possible that mutations in other locations of the gyrA gene, the gyrB gene, or in other genes may also contribute to the modulation of the MIC level, our results suggest that a gyrA mutation at Ser-83 is associated with quinolone resistance in A. baumannii.
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Arbitrarily primed polymerase chain reaction (AP-PCR) and ribotyping were compared in an investigation of an outbreak of Acinetobacter baumannii infections. Twenty-five clinical isolates shown previously by other criteria to belong to two different groups, and nine randomly selected A. baumannii clinical isolates from other hospitals were investigated. Among the strains analysed, nine different EcoRI rRNA gene restriction pattern fingerprints were observed. While similarity was detected between strains of the same group, these fingerprints differed clearly between the two A. baumannii groups defined in the outbreak. Two of the nine strains selected randomly had the same ribotype as those strains involved in the outbreak, whereas the remaining seven strains each had a different ribotype. When the strains were tested by AP-PCR with 0.25, 0.5 or 1 microM of M13 forward primer, 10 different profiles were obtained. However, 11 profiles were observed if two different primer concentrations (0.25 and 1 microM) were used. It was concluded that ribotyping and AP-PCR exhibited a similar discriminatory power, although AP-PCR had the additional advantages of speed and simplicity.
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Nutritional status of patients suffering from bulimia nervosa was evaluated by anthropometric, hematological, and immunological parameters in comparison with a healthy control group. Anthropometry showed no signs of malnutrition in either group. Bulimic patients showed a significant decrease in most of the routine clinical indexes related to red blood cells. Lymphocyte subsets CD2 and CD4 in bulimic patients were lower than in controls, whereas CD8 remained unmodified, leading to a lower CD4:CD8 in bulimic patients. The decreases in CD2 and CD4 numbers might be linked to an impaired cell-mediated immune function, as evaluated by the response to skin tests. The B lymphocyte subset was increased in the bulimic group. Innate immunity was impaired in the bulimic patients. Although anthropometric and most of the routine clinical parameters were within the normal range, these results might suggest that the depleted immune function accounts for a subclinical malnutrition status in bulimic patients.
Antimicrobial susceptibility testing was performed on 54 epidemiologically unrelated clinical isolates of Acinetobacter baumannii by using a standard agar dilution technique. On the basis of the in vitro activities, imipenem and doxycycline were the most active agents, whereas amikacin, isepamicin, and the new fluorquinolones ciprofloxacin and ofloxacin presented moderate activity. Cephalosporinase activity was found in 98% of the strains, whereas lactamases of TEM type 1 and one with a pI of 7 to 7.5 were present in 16 and 11% of the strains, respectively. Resistance to aminoglycosides was explained by the production of the three classes of aminoglycoside-modifying enzymes, with predominance of aminoglycoside-3'-phosphotransferase VI in 28% of the strains.
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Nutritional status and immunocompetence were evaluated in 26 patients suffering from anorexia nervosa (AN) (n = 16) or bulimia nervosa (BN) (n = 10) in comparison with a control group (n = 22). Body mass index (BMI) was lower in all patients than in controls, AN patients having the lowest values. Slight leukopenia together with relative lymphocytosis was shown in both AN and BN. The CD4/CD8 ratio was low in all patients, but more so for BN patients, although cell-mediated immune function was impaired to the same extent for both eating disorders. The complement system appeared to be damaged in all the patients in comparison with controls. These results may mean that the nutritional status of both syndromes was different. Although anthropometric measurements in the BN group may suggest a more acceptable nutritional status, immunological parameters were shown to be depleted at the same level as the AN group and even more impaired when judged by the lower CD4/CD8 values.