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D Costagliola

Publications and source records attributed to D Costagliola.

At least 19 recordsLinked to original sources
PubMed1997

Effect of interferon alpha on high serum androgen concentrations in HIV positive men with Kaposi's sarcoma.

AIM: To measure serum androgen concentrations in men with HIV related Kaposi's sarcoma (KS) who had been treated with recombinant interferon (IFN) alpha-2a to determine the role of androgens on the development of KS lesions. METHODS: 32 men with HIV related KS who had been treated with IFN were studied: 24 men in complete KS remission and eight not in remission. Serum androgen concentrations were determined before, during, and after IFN treatment and correlated with clinical remission. RESULTS: All patients in complete KS remission had lower serum androgen concentrations following IFN treatment: -51% for dehydroepiandrosterone (DHEA) (p < 0.0001); -38% for DHEA sulphate (p < 0.002);-39% for androstenedione (p < 0.002); and -44% for testosterone (p < 0.007). These decreases brought the serum concentrations to about normal levels. However, IFN had varying effects on serum androgen concentrations in the men not in remission: a small decrease, a large increase in one androgen, or no change in serum androgens. CONCLUSIONS: The association between serum androgen levels and the progression or remission of HIV associated KS suggests that androgens affect the development of KS lesions. A clear understanding of the changes in the androgen environment may provide a sound basis for the development of new therapeutic strategies.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Arterial hypertension in the adult population of Guadeloupe, and associated factors in subjects of African origin.

This study was designed to estimate the prevalence of hypertension in Guadeloupe, the French West Indies, and to evaluate the risk factors associated with hypertension in the largest ethnic group, that of African origin. Households were randomly selected using a two-stage systematic sample of districts and then of houses; all adults aged 18 years in the household were included. In total, 1043 men and women were studied. Blood pressure, plasma glucose concentrations and gamma-glutamyl transferase activity were measured, hypertensive treatment and lifestyle factors recorded. The prevalence of hypertension, age-standardized to the Guadeloupe population was 21% and 26% in men and women of African origin, 28% and 22% in those of Indian-origin and 18% and 16% for other origins. The vast majority of subjects were unaware of their hypertension (90% of men, 74% of women). After adjustment for age, factors associated with high blood pressure in the 826 adults of African origin were: obesity, hyperglycemia, low educational level and family history of hypertension and of stroke. Additional factors in women were alcohol consumption, gamma-glutamyl transferase activity, physical inactivity, occupational category and a retired status, even after adjustment for age. Measures must be taken to diagnose hypertension early, particularly in individuals of African and Indian origin. An effective education program is needed, with an emphasis on life-style factors associated with obesity: diet and physical activity.

Adolescent↗
PubMed1995

Estimated timing of mother-to-child human immunodeficiency virus type 1 (HIV-1) transmission by use of a Markov model. The HIV Infection in Newborns French Collaborative Study Group.

It has been shown that mother-to-child human immunodeficiency virus type 1 (HIV-1) transmission can occur both during pregnancy and at delivery, but the respective frequencies in these periods are unknown. Moreover, it is difficult to determine the timing of mother-to-child HIV-1 transmission by direct sampling. The use of an elaborate statistical method is therefore necessary. The authors studied 495 consecutive infants born between May 1988 and August 1991 who were included, at birth, in the French Prospective Study on Pediatric HIV Infection. At least one blood sample was obtained from every infant during the first 14 days of life. All samples obtained within 3 months of birth were tested by at least two of the following methods: viral culture, polymerase chain reaction (PCR), and antigenemia, as well as by Western blot test. Data for the 95 infected infants (those seropositive at 18 months and those who died of HIV disease before this age), and who were exclusively bottle-fed, were analyzed in a Markov model to estimate the timing of viral transmission, the time from birth to the emergence of detectable virus, and the time from birth to seroconversion. The model indicated that one-third of the infants were infected in utero, less than 2 months before delivery (95th percentile). In the remaining 65% of cases (95% confidence interval (CI) 22-92), the date of infection was estimated as the day of birth. The estimated median period between birth and the emergence of viral markers was 10 days (95% CI 6-14) and the 95th percentile was estimated at 56 days. These results support the view that HIV infection can be diagnosed during the first 3 months of life. The authors conclude that mother-to-child HIV-1 transmission appears to occur late in pregnancy or at delivery.

Adult↗
PubMed1995

Hemodynamic criteria for diagnosis of right ventricular ischemia associated with inferior wall left ventricular acute myocardial infarction.

To test the diagnostic value of different hemodynamic indexes for the diagnosis of acute right ventricular (RV) ischemic dysfunction, we studied 2 groups of consecutive patients admitted for an acute left ventricular inferior wall myocardial infarction: 51 patients with (group 1) and 32 patients without (group 2) RV ischemia as determined by coronary angiography. In both groups, we analyzed by right-sided cardiac catheterization right-sided heart pressures, pulmonary capillary wedge pressure, and cardiac index. We also calculated pressure ratios (mean right atrial pressure or RV end-diastolic over pulmonary capillary wedge pressures), pulmonary vascular resistance, and RV stroke work index. We found significant differences (p < 0.01) between the 2 groups when comparing mean right atrial pressure, RV end-diastolic pressure, ratio of these 2 pressures over pulmonary capillary wedge pressure, RV stroke work index, and right atrial and RV pressure waveforms. The best combined sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were found for the right atrial M or W waveform pattern, isolated or combined with a disproportionate elevation of RV end-diastolic over pulmonary capillary wedge pressures (respectively, 92%, 94%, 90%, 87%, and 89%). Volume loading was performed in 27 patients (18 with and 9 without RV ischemia). Right heart pressures and RV stroke work index increased significantly and similarly in both groups. Cardiac index increased significantly only in patients without RV ischemia (p = 0.02). However, volume loading did not significantly modify the diagnostic value of the different hemodynamic criteria studied.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Relations between Doppler tracings of pulmonary regurgitation and invasive hemodynamics in acute right ventricular infarction complicating inferior wall left ventricular infarction.

To test the hypothesis that flow characteristics from pulmonary regurgitation (PR) can predict right ventricular (RV) involvement in patients with inferior wall acute myocardial infarction, we prospectively recorded continuous-wave Doppler tracings and right-sided cardiac hemodynamics in 48 consecutive patients with inferior wall acute myocardial infarction and PR. Right heart hemodynamics enabled the identification of 29 patients with (group 1) and 19 without (group 2) RV involvement. In patients with RV involvement, the pulmonary regurgitant flow pattern was characterized by a rapid rise in flow velocity to a peak level followed by an abrupt deceleration in mid-diastole, whereas in patients without RV involvement, the deceleration in mid-diastole was gradual. The pressure half-time of PR (PHTPR) and the lowest mid-diastolic to peak early diastolic velocity ratio were significantly lower in group 1 than in group 2 (91 +/- 31 vs 214 +/- 57 ms [p < 0.001], 0.35 +/- 0.08 vs 0.59 +/- 0.13 [p < 0.001], respectively). The best diagnostic accuracy (95%) was obtained with cut-off values of PHTPR < or = 150 ms and the lowest mid-diastolic to peak early diastolic velocity ratio < or = 0.5: sensitivity 100%, specificity 89%, positive predictive value 94%, and negative predictive value 100%. Using multiple logistic regression analysis, we found that PHTPR was the strongest predictor of RV involvement. Thus, these parameters, derived from pulmonary regurgitant tracings, are useful in the noninvasive bedside diagnosis of RV infarction.

Aged↗
PubMed1995

How much would the safety of blood transfusion be improved by including p24 antigen in the battery of tests?

BACKGROUND: Because p24 antigen may be detectable during seroconversion, before antibodies, some of the infected blood undetected by antibody screening could be identified through antigen screening. STUDY DESIGN AND METHODS: The potential benefit of antigen screening was evaluated in a simulation model incorporating present knowledge of the time sequence from antigen exposure to antibody development during seroconversion and the incidence of seroconversion among repeat donors. The model was designed so that the results were consistent with the observed rate of antibody-positive blood donations and the CIs of surveys that did not find any antibody-negative/antigen-positive donated blood. RESULTS: In the United States in 1990, the number of expected, undetected, contaminated blood components was estimated at 68; of these 8 to 17 could have been identified by antigen screening, depending on the hypothesis explored. (In 1992, 20 undetected, contaminated blood components were expected according to this model, of which 2 to 5 could have been identified by antigen screening.) In France, the comparable figures were 1 to 4 of 13 in 1990 and 1 to 2 of 7 in 1992. CONCLUSION: The projected benefit must be weighted against possible negative consequences, including 1) an increase in recently infected persons seeking p24 antigen screening at blood banks (assuming this test is not incorporated into screening in non-blood bank settings) and 2) the need for additional quality assurance procedures to avoid operational flaws associated with the increase in the donor screening test battery. In any case, the best way of increasing the safety of blood is improvement in the selection of donors, which can diminish the residual risk of transmission of any viruses.

Biomarkers↗
PubMed1995

Estimation of the size of the HIV/AIDS epidemic due to blood transfusion in France.

BACKGROUND: This study presents estimates of the number of individuals contaminated by human immunodeficiency virus (HIV) via a blood transfusion received in France before the end of 1991 and those who have developed or will develop AIDS. METHODS: The computer simulation model takes into account several possible hypotheses concerning the annual number of infected blood donations collected before the introduction of HIV screening in August 1985, those collected between August 1985 and December 1991 not excluded by the testing procedure due to the seroconversion period, the number of labile blood components elaborated from one donation, the 5-year mortality rate of blood recipients, and the incubation delay. RESULTS: Results reproducing the evolution of the reported annual number of transfusion-associated AIDS cases were selected which enabled the estimation of the number of recipients infected (between 3300 and 4300) and of the number of transfusion-associated AIDS cases (between 1600 and 1800) compared with 1300 transfusion-associated AIDS cases reported by June 1993. CONCLUSION: This methodology could be used for other countries provided information required by the model is available.

Blood Donors↗
PubMed1995

Differences in androgens of HIV positive patients with and without Kaposi sarcoma.

AIM: Since most forms of Kaposi sarcoma are much more common in men than in women, the aim of this study was to examine serum concentrations of sex steroids in HIV positive men with and without Kaposi sarcoma. METHODS: Blood samples from 34 HIV positive men without Kaposi sarcoma (KS-) and 28 with Kaposi sarcoma (KS+) and from 35 HIV negative men (controls) were analysed for adrenal and gonadal steroids. Further analysis was done in subgroups classified by CD4 lymphocyte counts. RESULTS: KS+ patients had significantly higher serum dehydroepiandrosterone (DHEA) and testosterone concentrations than the KS- patients, and their DHEA, DHEA sulphate, testosterone, and androstenedione values were higher than in the controls. The KS+ patients with more than 500 CD4 lymphocytes per mm3 had significantly higher serum DHEA, DHEA sulphate, and testosterone than the KS- patients with the same CD4 counts; those with 500-200 CD4 cells/mm3 had higher serum DHEA and testosterone than the equivalent KS- men; and those with < 200 CD4 cells/mm3 had raised DHEA only compared with KS- men. Both KS+ and KS- men had higher serum progesterone and oestradiol than the controls. Glucocorticoids were not significantly altered. CONCLUSIONS: The high androgen levels in KS+ patients, particularly in the early stages of the disease (> 500 CD4 cells/mm3), may affect the immune system by inducing an abnormal cytokine profile, or by increasing T8 proliferation and activation, or both. This raises the question of the relationship between androgens and Kaposi sarcoma.

Adult↗
PubMed1995

[The epidemiology of cerebral lymphoma in AIDS].

Cerebral lymphomas are one of the complications of AIDS. Their increasing frequency, especially in the last decade, has to be correlated with the incidence of systemic lymphomas and especially central nervous system (CNS) lymphomas in non immuno-compromised patients. CNS involvement is found in 40% of systemic lymphomas. Primary lymphomas have an incidence of 0.4-0.56% in epidemiological studies and 7.6% in post-mortem series. Primary lymphomas are noted in all patients, homosexuals, drug-addicts, children, with a lower rate in the haemophiliacs. Known risk factors are HIV itself Epstein-Barr virus almost constantly demonstrated in tumour cells. Epidemiological studies on cerebral lymphomas must still be completed as, until recently, they were included in the group entitled lymphomas, and risk factors have to be specified with more accuracy.

Brain Neoplasms↗
PubMed1995

A prospective evaluation of clinical criteria and polymerase chain reaction assay of cerebrospinal fluid for the diagnosis of cytomegalovirus-related neurological diseases during AIDS.

OBJECTIVE: To study the predictive value of clinical criteria and polymerase chain reaction (PCR) assay of cerebrospinal fluid (CSF) for the diagnosis of cytomegalovirus (CMV)-related neurological disorders during AIDS. SETTING: Four infectious diseases departments in two tertiary referral teaching hospitals in Paris, France. DESIGN AND PARTICIPANTS: One-year prospective study involving 164 consecutive immunosuppressed HIV-seropositive patients undergoing lumbar puncture (LP). METHODS: A tentative diagnostic classification, based on strict operational criteria and PCR assay of CSF, was performed at the time of LP. At the end of the study, tentative diagnoses and PCR results were blindly and independently compared with the firm diagnoses, based on central nervous system histology, clinical outcome and/or viral culture of CSF. RESULTS: The tentative diagnosis showed CMV-related neurological disease in 38 patients, and CMV DNA was detected in 42. Among the 88 patients for whom a firm diagnosis was possible, 26 had a diagnosis of CMV-related neurological disease. The concordance between the tentative and firm diagnoses was 61%, with a kappa index of 0.40. In contrast, the sensitivity and specificity of PCR were respectively 92 and 94%, with positive and negative predictive values of 86 and 97%. The presence of CMV DNA in CSF was associated with an increased risk of death (P < 0.0001). CONCLUSIONS: Unlike clinical criteria, PCR detection of viral DNA in CSF can be used reliably for antemortem diagnosis of CMV-related neurological disease, a frequent complication of AIDS in this study. This rapid method should make a major impact on the management of these patients.

AIDS-Related Opportunistic Infections↗
PubMed1995

Prevalence of non-insulin dependent diabetes as perceived by general practitioners in France.

A representative, random sample of French general practitioners, reported the number of diabetic patients they treated in their practices. The resulting NIDDM prevalence rate for France was 1.71% (SE +/- 0.03), compatible with the rates found in other studies. Prevalence rates for NIDDM were also calculated by region and a multivariate covariance model was used to correlate the prevalence with known risk factors. The three significant factors were: the quantity of wine consumed, the female/male sex ratio of people over 45 years of age, both positively correlated, and the consumption of animal fats, which was negatively correlated with NIDDM prevalence.

Aged↗
PubMed1994

[Risk of the appearance of inhibitors linked to the administration of factors VIII and IX. Review of the literature].

Factors VIII and IX administration exposes haemophiliac patients to the risk of inhibitor development which reduces treatment efficacy. Methods and results of 17 studies (transversal and longitudinal) and of one clinical trial dealing with haemophilia A and of 3 studies dealing with haemophilia B were reviewed. Besides differences in study design, lack of method standardisation complicates comparison between studies. In patients with haemophilia A, prevalence of inhibitors ranges from 4 to 18% (5 studies), and incidence between 3 and 39/1,000 person-years (7 studies). Cumulative age incidence is above or equal to 20% after 6 years of age (4 studies). Cumulative incidence by exposure days is estimated at 22% at 100 exposure days in a retrospective cohort observed between 1975 and 1992, and above or equal to 36% at 25 exposure days in two prospective cohorts of patients receiving recombinant factor VIII products. The new European regulation dealing with stable blood products will make the evaluation of new products by clinical trials mandatory. With The National therapeutic Follow up of Haemophiliacs which begun in October 1994, following a decision by the French Minister of Health, the adverse effects in patients receiving factor VIII and IX which have been approved for sales will be evaluated.

Adolescent↗