Biomedical subjects
Publications and source records attributed to H Knobel.
The clinical observation of a 40 years old male presenting acquired immune deficiency syndrome and T-cell non Hodgkin's lymphoma is presented. The patient was treated with COMET-A regimen (cyclophosphamide, vincristine, methotrexate, etoposide and cytarabine) and a complete remission was obtained.
BACKGROUND: The aim of the present was to study the long term sequelae of osteoporotic fracture of the femur in a general hospital of 300 beds in Barcelona, analyzing 1) mortality; 2) degree of functional capacity; 3) care requirements; 4) familial repercussion, and 5) psychic repercussion. METHODS: Structured telephone interviews were carried out between 1990-1991 with the patients attended for osteoporotic fracture of the femur in our center from 1988-1989. Of a total of 145 patients, 12 died within 1 month. Among the remaining patients the interview was performed with 100 patients--25 of whom were males of 78 +/- 8 years of age and 75 females of 82 +/- 10 years of age. The degree of functional capacity was evaluated by the index of independence in daily activities (DA). RESULTS: Mortality within one month was 8.3%; at one year 30% and at 2 years 38%. Factors associated with the highest mortality were: age of over 80 years (p less than 0.004), deterioration of post fracture functional capacity (p less than 0.0004) and pre-fracture dementia (p less than 0.01). Important deterioration in post fracture functional capacity was seen in 45% of the cases. Seventeen percent of the patients required transfer to a center for chronic care and 34% resided in a center for chronic care prior to the fracture. Familial repercussion was observed in 43% of the cases and post fracture psychologic repercussion was seen in 28%. CONCLUSIONS: Osteoporotic fracture of the femur presents the following sequelae: mortality, intense deterioration of functional capacity and important health care requirements in addition to considerable familial and psychological repercussion.
Recognition of -24/-12-type promoters by RNA polymerase requires a special sigma factor, sigma 54 (RpoN NtrA GlnF). In the nitrogen-fixing soybean symbiont Bradyrhizobium japonicum, two functional, highly conserved rpoN genes (rpoN1 and rpoN2) were identified and sequenced. The two predicted B. japonicum RpoN protein sequences were 87% identical, and both showed different levels of homology to the RpoN proteins of other bacteria. Downstream of rpoN2 (but not of rpoN1), two additional open reading frames were identified that corresponded to open reading frames located at similar positions in Klebsiella pneumoniae and Pseudomonas putida. Both B. japonicum rpoN genes complemented the succinate- and nitrate-negative phenotypes of a Rhizobium meliloti rpoN mutant. B. japonicum strains carrying single or double rpoN mutations were still able to utilize C4-dicarboxylates as a carbon source and histidine, proline, or arginine as a nitrogen source, whereas the ability to assimilate nitrate required expression of at least one of the two rpN genes. In symbiosis both rpoN genes could replace each other functionally. The rpoN1/2 double mutant induced about twice as many nodules on soybeans as did the wild type, and these nodules lacked nitrogen fixation activity completely. Transcription of a nifH'-'lacZ fusion was not activated in the rpoN1/2 mutant background, whereas expression of a fixR'-'lacZ fusion in this mutant was affected only marginally. By using rpoN'-'lacZ fusions, rpoN1 expression was shown to be activated at least sevenfold in microaerobiosis as compared with that in aerobiosis, and this type of regulation involved fixLJ. Expression of rpoN2 was observed under all conditions tested and was increased fivefold in an rpoN2 mutant. The data suggested that the rpoN1 gene was regulated in response to oxygen, whereas the rpoN2 gene was negatively autoregulated.
Digoxin is a widely used drug. Previous studies suggest a high prevalence of inadequate use, subtherapeutic levels and high toxicity rates. The aim of the present study was to evaluation the use of digoxin in our area. 50 consecutive patients who attended our emergency service and who were receiving digoxin on a chronic basis were prospectively evaluated. There were 37 females and males, with age 78.1 +/- 8.6 years. We found that digoxin was not indicated in 12% of cases. Only 48% had digoxin plasma levels within the therapeutic range. When plasma levels were considered in association with clinical and electrocardiographic findings, 12% of patients were undertreated and 6% had digitalis toxicity. There was no relation between the digoxin plasma level and the dosage schedule, the ECG findings, the renal function, the use of other drugs or the anthropometric data. Emphasis is made on the need to individualize digoxin therapy and to measure plasma levels in particular cases.
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Of 2,115 persons who were submitted to a voluntary check-up, we found 10.6% suffering from hypertension and 16.2% with borderline hypertension, the latter group having been followed and the condition subsequently confirmed in 45.9% of the case. The prevalence increases with age. There were no prevailing differences found between rural and city populations. The prevalence is greater in self-employed persons that in salary workers and we would bring to the fore the higher prevalence in housewives (p less than 0.0005). 74.8% of the hypertensive patients knew of their situation but only 15.6% of them showed normal blood pressure at the following-up. Rarely 0.85% had severe hypertension and 3% had moderate hypertension.
The reversal of acute alcohol intoxication by naloxone is controversial. Naloxone increases cortisol secretion but there are no reports of this effect during acute alcohol intoxication. This study examines the effect of 20 mg naloxone on alcohol-induced intoxication using a balanced placebo design to investigate the role of cortisol, participant expectancy of treatment, and possible pharmacokinetic interactions during intoxication. Our results show differences in the time course of subjective self-evaluation of drunkenness in the presence of naloxone. Also, changes are observed in naloxone pharmacokinetic parameters with the ingestion of alcohol, specifically a decrease in plasma clearance. Whereas the cortisol response induced by naloxone was greater in the subgroup of participants with positive expectancy, in the presence of alcohol the naloxone effect on cortisol response was not observed. These observations may help explain the observed reversal of alcohol-induced coma by naloxone in a subgroup of patients.
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We investigated the distribution and excretion of 8-14C-caffeine as well as the effects of caffeine on bile secretion in the unanaesthetized piglet after intravenous and intraduodenal application. The findings confirm a) data known from other species concerning the intestinal absorption, distribution and excretion of 8-14C-caffeine, b) the delayed plasma disappearance of 8-14C-caffeine known in the pig following an initial rapid disappearance rate and c) a hydrocholeresis, so far only known from rats. However, the increase in bile flow accompanied by an increase of urine flow was noticed not before 3--4 h after caffeine application. Therefore the question arises whether this increase is caused by caffeine itself or by its metabolites. On the basis of our results and those of the literature it is attempted to answer this question.
We report 8 patients with the acquired immunodeficiency syndrome (AIDS) and intracerebral haemorrhage. There were 7 men and 1 woman (mean age 37.2 years) with a mean CD4 count of 81.2/mm3. Alcohol abuse was recorded in 7 patients, intravenous drug use in 4, homosexual activity in 2, thrombocytopaenia in 1 and severe hypertension in 1. There were 5 lobar and 3 deep haemorrhages. Potential aetiologies of intracerebral haemorrhage included cerebral toxoplasmosis (n = 2), thrombocytopenia (n = 2), hypertension (n = 1) and cerebral tuberculosis (n = 1). Data of these patients were compared with those of 30 AIDS inpatients without brain haemorrhage matched by age and sex and no statistically significant differences in risk factors for AIDS except for alcohol abuse (> 80 g/day) (p = 0.045) were found. Causes of brain haemorrhage in AIDS patients are heterogeneous. The relationship between both conditions may be explained by the effect of several predisposing factors to stroke in association with AIDS-related complications. Intracerebral haemorrhage is a late and serious complication of AIDS (mortality 62.5%). The frequency of intracerebral haemorrhage in AIDS (1.0%) is higher than that expected in a general population of young adults.