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Biomedical subjects

M Arias

Publications and source records attributed to M Arias.

At least 235 records · Page 13Linked to original sources
PubMedDate not supplied

Tuberculin skin test and CD4+/CD8+ T cell counts in adults infected with the human immunodeficiency virus in Medellín, Colombia.

To evaluate the effect of BCG vaccination and T lymphocyte subpopulations on the reactivity to the tuberculin skin test, 113 asymptomatic HIV+ individuals were tuberculin tested by intradermal injection of 5TU of purified protein derivative and the levels of circulating lymphocyte (CD3, CD4 and CD8) subpopulations determined by indirect immunofluorescence. Ninety-two percent of the subjects included in the study were males. The mean age of the group was 32.1 +/- 7.4 years. Sixty-two percent presented a BCG scar. However, only 22% exhibited positive tuberculin reactions (> or = 5 mm) irrespective of the presence of the BCG scar. Tuberculin positive individuals exhibited higher CD4+ cell counts (p = 0.004) and CD4+/CD8+ ratios (p = 0.006) than tuberculin negative (< 5 mm) HIV+ individuals. The number of individuals with positive tuberculin reactions was significantly higher in subjects with more than 500 CD4+ lymphocytes/microliter (p = 0.02) or CD4+/CD8+ ratios > or = 1.12 (p = 0.002). These results suggest that a prior BCG vaccination does not influence the reactivity to the tuberculin skin test in HIV+ asymptomatic individuals and that the number of CD4+ lymphocytes and the CD4+/ CD8+ ratio positively correlate with the tuberculin reactivity.

Adolescent↗
PubMedDate not supplied

[Coma associated with migraine].

INTRODUCTION: Basilar migraine is a particular form of migraine with an aura in which crises of headache are accompanied by symptoms of dysfunction in the vertebro-basilar territory, including alteration of consciousness in the form of stupor or coma. CLINICAL CASES: We report four patients, three men of 14, 17 and 83 years of age and one woman of 21. All had previous histories of migraine and presented with transitory episodes of coma. During the coma, the woman woke up spontaneously with intense bulimia. In the three men, it was seen, on injecting flumazenil, that the state of consciousness and the EEG returned to normal transiently. Neuroimaging studies (CT and MR) were normal in all patients. CONCLUSIONS: Migraine-coma is an exceptional, emergency condition in which structural, infectious, toxic and metabolic pathology of the Central Nervous System should be ruled out. As well as in patients with basilar migraine, the association of migraine and coma may also be seen in patients with familial hemiplegic migraine and CADASIL and MELAS syndromes. It may be that gabaergic mechanisms are involved in the theoretical dysfunction of the ascending reticular activating system causing alteration of consciousness, since in the three patients in whom flumazenil was injected, there was a response.

Adolescent↗
PubMedDate not supplied

[Isolated hemi-ataxia as a sign of mesencephalic lacunar infarction].

INTRODUCTION: Lesions of the dento-rubro-thalamo-cortical pathway may cause homolateral or contralateral hemiataxia, depending on whether they are found above or below the decussation which occurs at the level of the inferior colliculus. Most mesencephalic infarctions causing hemiataxia also show oculomotor involvement with nuclear or fascicular lesions of the third cranial nerves. This was not seen in the case we report. CLINICAL CASE: We describe the case of a diabetic patient with a permanent right appendicular hemiataxia, without oculomotor involvement, caused by a lacunar infarct shown on MR imaging which was situated in the antero-external part of the left superior mesencephalum. CONCLUSIONS: This case helps to clarify the topography of the thalamic radiations of the mesencephalic calotte, including the decussated superior dento-rubro-thalamic pathway to the red nucleus. Involvement of this, situated in the mesencephalic lateral vascular territory causes contralateral hemiataxia.

Aged↗
PubMedDate not supplied

[Pseudomigraine as a symptom of carbon monoxide intoxication].

INTRODUCTION: Carbon monoxide poisoning (CO) is a common intoxication. Diagnosis is sometimes difficult since the symptoms may be very varied. We report a case of repeated intoxication which led to several consultations and admission to hospital, since there were headaches and loss of consciousness suggesting basilar migraine. CASE REPORT: A 30 year old woman consulted for repeated headaches over the previous six months, normally occurring in the morning, accompanied by vertigo, nausea and vomiting and loss of consciousness on two occasions. Clinical examination and the complementary tests done (laboratory analysis, cerebral MR, ECG, ECG Holter, EEG) were normal. Finally CO intoxication was diagnosed when levels of carboxyhemaglobin of over 30% were found in both the patient and her sister. The cause was a faulty water heater, confirmed on technical inspection. CONCLUSIONS: CO intoxication may present as repeated headaches, with or without alteration in consciousness. Finding similar symptoms in other people living in the same place should increase suspicion. In certain case, anamnesis should include details regarding apparatus used for heating, cooking and bathrooms. More carboxyhaemaglobin estimations should be done in Emergency Departments.

Adult↗
PubMedDate not supplied

[Effect of recipient age on the clinical course of renal transplantation].

Since the immune response in older recipients has been described as weaker they may have a lower risk of rejection of a transplanted organ. Therefore a less aggressive immunosuppressive regimen should be the best option. The aim of our study was to evaluate the incidence and severity of acute rejection (AR) episodes on graft survival of older patients (> or = 60 years) and to compare them with the younger ones (< 60 years). A total of 439 kidney transplants were performed between 1/94 and 12/99 at our Transplant Unit. Clinical and immunological data, incidence and severity of AR and cause of graft loss were recorded. Patients were divided into two groups, according to age at transplantation [A (< 60, n = 342/77.9%) and B (> or = 60, n = 97/22.1%)]. The percentage of aging recipients and mean age of both donors and recipients increased through the period of study. Although the incidence of acute tubular necrosis was higher in the older group (31% vs 22.8%, pNS), the incidence of AR was also similar (31.6% vs 29.8%, pNS). The number of AR episodes per patient was 0.44 and 0.41 respectively. The incidence of AR was higher in those patients who had ATN (50% vs 19.6%), p < 0.01). The severity of AR was: Banff grade I: A (40.3%)/B (45.7%) pNS; grade II: A (44.1%)/B (48.5%) pNS; grade III: A (15.6%)/B (5.8%) pNS. One-year patient survival was 96%/91% (p < 0.001) and graft survival was 81%/78% (pNS) respectively. The age of recipient does not seem to have a significant influence on the incidence and severity of AR or on graft survival. So immunosuppression should be individualized for each patient.

Acute Disease↗
PubMedDate not supplied

[Kleine-Levin syndrome: contribution of brain SPECT in diagnosis].

INTRODUCTION: Kleine Levin syndrome is an infrequent disorder of uncertain aetiopathogenesis that usually affects adolescent males, producing drowsiness and alterations in behaviour, appetite and sexuality. We report a clinically typical case in which the brain SPECT showed right frontal hypoperfusion. CASE REPORT: Male aged 17, right handed, who presented drowsiness, apathy, alterations in his sexual behaviour (masturbations in public and attempted assault of women) and hyperphagia, which coincided with his undergoing an emotionally stressful period in his life. Brain SPECT revealed reduced flow in the right frontal lobe, although MRI and CSF study were normal. The polysomnographic study revealed a destructured pattern of sleep, with a reduction in phases III and IV and in REM sleep. He was treated with lithium and evolved favourably without any relapses during the 18 month follow up. CONCLUSIONS: Cases of Kleine Levin syndrome with structural lesions have been reported, but most of them are idiopathic. A disorder in the hypothalamus and the limbic system is suggested. In our case, the findings from the brain SPECT confirmed a non dominant hypoperfusion of the frontal lobe, which could result from a phenomenon of diaschisis brought about by a diencephalic dysfunction.

Adolescent↗