[Morbid obesity: surgical treatment (II). Current bariatric techniques, efficacy and legal implications].
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Biomedical subjects
Publications and source records attributed to M Foz.
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BACKGROUND: To evaluate the usefulness of serum immunoglobulin A (IgA) as a prognostic marker of human immunodeficiency virus type 1 (HIV-1) in parenteral drug abusers (PDA). METHODS: The serum IgA levels and HIV-1 antibodies were assessed in 374 PDAs admitted for infective diseases or for treatment of addiction. RESULTS: The prevalence of HIV infection was 70%; the frequency of serum IgA above the upper normal limit (440 mg/dl) was 8% in seronegative and 4% in seropositive subjects (NS). The IgA levels in the 274 seropositive subjects, classified for infective stages, were significantly higher in those fulfilling the criteria for acquired immunodeficiency syndrome (AIDS) or AIDS related complex (group IV) than in asymptomatic subjects (group II) or in those with generalized lymphadenopathy (group III) (p less than 0.01). CONCLUSIONS: Serum IgA levels in PDAs with HIV infection may be a useful marker of progression to AIDS.
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Patients with HIV infection were studied to assess the efficacy of octreotide, a somatostatin analogue, in the long-term management of refractory diarrhoea. Dosage of subcutaneous octreotide was increased progressively at 48 h intervals from 150 to 300, 750 and 1500 micrograms/day according to response. Twenty-nine patients, 21 with Cryptosporidium enteritis, one with Isospora belli enteritis and seven with no identifiable pathogen were selected for the study; four of these were excluded from the study because of death during the first month (two cases), abdominal pain and acute pancreatitis (one case each). Twenty-five patients were evaluable for response. Ten patients (four with Cryptosporidium enteritis, five without an identifiable pathogen and one with I. belli enteritis) achieved a complete response (40%) and nine cases (all with cryptosporidial enteritis) had a partial response (36%). Patients with higher weight and Karnofsky performance status and non-cryptosporidial enteritis had a better response to treatment. Mean durations of treatment and response were 4.2 +/- 4.2 and 4.4 +/- 4.5 months, respectively. In the absence of specific agents for cryptosporidial enteritis and HIV enteropathy, octreotide was found to be useful in the management of chronic diarrhoea in AIDS patients.
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OBJECTIVE: To determine the extent of transmission of hepatitis C virus in sexual partners of intravenous drug misusers and to examine the relation between the prevalences of HIV, hepatitis B virus, and hepatitis C virus infections in homosexual men and intravenous drug misusers and their sexual partners. DESIGN: Serum samples collected between 1984 and 1988 were tested for hepatitis B virus markers and antibodies against hepatitis C virus by enzyme linked immunosorbent assay (ELISA) and for HIV antibody by enzyme immune analysis and western blotting. SETTING: Large referral university hospital with an external AIDS clinic in the metropolitan area of Barcelona, Spain. SUBJECTS: 243 Intravenous drug misusers, 143 of their regular heterosexual partners, and 105 homosexual men. MAIN OUTCOME MEASURES: Prevalences of hepatitis C virus, hepatitis B virus, and HIV infections. RESULTS: In all, 178 of the 243 (73%) intravenous drug misusers, 16 out of 143 (11%) of their partners, and 17 of the 105 (16%) homosexual men had antibodies against hepatitis C virus. The presence of hepatitis C virus infection was unrelated to sex, age, the presence of HIV or hepatitis B virus infections, or the Centers for Disease Control stage of HIV. In sexual partners of intravenous drug misusers there were strong correlations between the presence of hepatitis C virus infection and that of HIV (p = 0.001) and hepatitis B virus (p = 0.013) infections. CONCLUSIONS: Intravenous drug misusers have a high risk of acquiring hepatitis C virus, hepatitis B virus, and HIV infections, but the presence of hepatitis C virus infection seems to be unrelated to the presence of the other two viruses. Homosexual men have a high prevalence of HIV and hepatitis B virus infections with a low prevalence of hepatitis C virus infection, the presence of which is not related to that of the other two infections. Conversely, heterosexual partners of intravenous drug misusers have low prevalences of the three virus infections, but the presence of hepatitis C virus infection correlates significantly with the presence of HIV and hepatitis B infections. The rate of sexual transmission of hepatitis C virus seems to be low, even in partners of people known to be seropositive for this virus.
Heterosexual couples of individuals infected by HIV represent a group of high risk of virus infection. We have investigated the presence of fragments of the HIV genome with a new nucleic acid amplification technique (PCR or polymerase chain reaction) in lymphocytes from 33 seronegative couples with anti-HIV antibodies, most of which were heroin addicts. 12 of the 33 couples (36%) had positive PCR for a gag HIV amplimer in the absence of antibodies. 4 of them (12%) also showed reactivity for sequences from an env amplimer. A control group of 7 patients with AIDS and 4 seropositive couples showed reactivity to gag and env in all. It is concluded that silent HIV infection may frequently develop in heterosexual couples of infected individuals.
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We report 7 individuals in whom HIV seroconversion developed, in 6 associated with symptoms and in one without any symptom at all. The most florid and sustained symptoms appeared in the oldest patients: a female and her heterosexual partner, who was a promiscuous male with recent seroconversion. A heroin abuser had oral muguet, and another had esophageal candidiasis. Rash was absent in all cases. Antigenemia was demonstrated in 6 of the 7 patients. In one case, a third generation ELISA was more sensitive than Western blot for the identification of seroconversion.
HTLV-1 was the first human retrovirus to be isolated. It has been shown that it is the causative agent of T cell leukemia in the adult and some types of subacute myelopathies. The virus is transmitted by similar routes as the AIDS virus. HTLV-1 infection is endemic in South Japan, the Caribbean countries and some African areas. The prevalence of HTLV-1 infection in our country is unknown in the general population and in the groups at high risk. We report the preliminary results of a study of 1279 serum samples from high risk individuals from the Barcelona area. ELISA and Western blotting were used to detect antibodies. We found evidence of anti-HTLV-1 only in 4 of 905 (0.44%) parenteral drug abusers and in 1 of 102 western Africans. Anti-HTLV-1 were not found in the remaining sera from 62 homosexuals, 53 patients with leukemia and/or lymphoma, 3 with idiopathic spastic paraparesis and 154 with multiple blood transfusions. These results suggest that HTLV-1 has a very low diffusion in our area. The 4 positive heroin addicts are the first reported in our country with evidence of HIV and HTLV-1 coinfection.
The progress of 298 heroin addicts treated for different reasons in a general hospital from 1984 to 1987 is followed, in order to know the remission degree of parenteral drug use and mortality rates in heroin abusers, after being treated for organic diseases or undergoing quick detoxification treatment. After an average of 25 months since their first visit or admission, information was obtained in 90% of the cases, and of these, it was confirmed that 4% (11/266) had died and that 6% (15/255) were in prison. Of the remainder, reliable information was obtained from 66% (158/240), of whom 40% were no longer endovenous drug users, while 54% were still addicted to parenteral drugs. The results showed a higher percentage of remission in patients that had been admitted for organic diseases (39/65; 60%) than in those that had been treated for detoxification (30/93; 35%) (p less than 0.05).
Forty-eight children, referred for evaluation of short stature, underwent 24-hour spontaneous growth hormone (GH) secretion studies. The GH level in pooled sera was assessed for each child, using up to 11 commercial immunoassays. In a group of 15 children, the mean GH values obtained by nine of the assays were compared with the mean value given by a polyclonal radioimmunoassay (RIA) from Sorin: four gave higher results (p less than 0.0001), three gave comparable results and two gave lower results (p less than 0.001). The assay yielding the highest results (Nichols: 5.9 +/- 2.3 ng/ml, mean +/- SD) gave values that were approximately triple those obtained by the assay yielding the lowest results (Hybritech: 1.8 +/- 0.8 ng/ml; p less than 0.0001); both of these are monoclonal immunoradiometric assays (IRMAs). The GH concentrations measured in 24-hour pools from 32 children using a monoclonal IRMA from Biomérieux were similar to those obtained using a polyclonal RIA from Farmos (2.8 +/- 1.1 ng/ml and 2.9 +/- 1.4 ng/ml, respectively) but significantly lower than those measured by another polyclonal RIA from Sorin (3.5 +/- 1.5 ng/ml). Two polyclonal assays (Biomérieux and Sorin) were then used to measure the GH levels in all of the 30-minute samples and in the day, night and 24-hour pools from the secretion studies of 22 children. The ratio of the results of the two assays remained fairly constant for a given child (although the GH levels in different 30-minute samples differed considerably). However, the ratios between different children showed quite wide variation (from 2.03 to 1.04).(ABSTRACT TRUNCATED AT 250 WORDS)
Eleven prepubertal children with short stature were treated with clonidine (0.15 mg/m2 daily) for a period of 1 year. The effect of this drug was evaluated on both clinical (growth velocity, height standard deviation scores for chronological age and bone age) and hormonal (urinary growth hormone excretion and insulin-like growth factor I) parameters. Our study shows that long-term clonidine administration in children with short stature did not result in significant differences in growth velocity, height standard deviation scores for chronological age and bone age, insulin-like growth factor I or in urinary growth hormone excretion.
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The presence of antibodies against human immunodeficiency virus type 2 (HIV-2) was retrospectively investigated in serum samples from 433 parenteral drug abusers from Barcelona. A third generation ELISA was used for the initial screening of sera, and a specific western blot technique for the definitive confirmation of the results. The presence of anti-HIV-2 was demonstrated in 9 samples (prevalence 2.1%). All of them belonged to patients also infected with HIV-1. The 9 cases reported here are the first seropositive patients for HIV-2 described in native individuals from this country.