Effect of ulcerative colitis treatment on transforming growth factor beta(1) in plasma and rectal mucosa

The aim of this study was to evaluate the effect of active ulcerative colitis (UC) treatment on transforming growth factor beta(1) (TGF-beta(1)) concentration in plasma and rectal mucosa measured in 28 patients. The highest plasma values were observed in patients with the severe course of the disease (74.2+/-14.0 ng/ml), and they were significantly higher than in the group with mild one (43.7+/-5.6 ng/ml). Mean TGF-beta(1) measured in mucosal samples from patients with severe UC (563+/-146 pg/mg protein) doubled values from patients with mild UC (286+/-65 pg/mg protein). Plasma and mucosal TGF-beta(1) correlated significantly with disease activity index (DAI) and clinical activity index (CAI). Plasma TGF-beta(1) correlated additionally with scored endoscopic degree of mucosal injury. Treatment caused significant decrease of plasma and mucosal TGF-beta(1) concentrations. Patients who responded completely had higher baseline plasma and mucosal TGF-beta(1) that decreased significantly after the treatment. These results show that plasma and mucosal concentrations of transforming growth factor beta(1) are strongly associated with ulcerative colitis activity, and successful treatment of the disease results with decrease of their levels. More effective response to the treatment can be achieved in patients with higher baseline concentrations of TGF-beta(1).

[Report of the first case in Poland of pregnancy after intrauterine insemination with semen of a HIV-1 seropositive partner and literature review]

HIV-1 serodiscordant couples are expressing increased interest in childbearing and many are seeking assisted reproduction. In 1992, Semprini et al. published a protocol for processing semen from HIV-1 seropositive men and reported the first births of healthy children after intrauterine insemination of the female partners with a fraction of motile spermatozoa. We described the first case in Poland of the intrauterine insemination of a female partner HIV(-) with the "washed" sperm of a 28-year old man infected with HIV. The woman gave birth to a healthy boy. Both mother and baby were tested for HIV-1 antibodies at the time of birth and 3 months later; both had negative results. Assisted reproduction techniques, although complicated and expensive are offered to serodiscordant couples as a preventive measure against infection that would result from unprotected intercourse.

Cerebral MR spectroscopy in neurologically asymptomatic HIV-infected patients

PURPOSE

To detect early metabolic changes in the brain of neurologically asymptomatic HIV-infected patients with normal MR imaging and to find the correlation between 1H MR results and immune status.

MATERIAL AND METHODS

Twenty neurologically asymptomatic HIV seropositive patients underwent MR imaging and single-voxel 1H MR spectroscopy (MRS) using a PRESS sequence. For all patients, the signals from N-acetyl-aspartate (NAA), choline-containing compounds (Cho), creatine-phosphocreatine (Cr) and myoinositol (mI) were compared with 32 healthy volunteers as metabolite ratios and metabolite areas to non-suppressed water area ratios.

RESULTS

In HIV patients, the NAA/Cho ratio was significantly lower ( p < 0.01), but there were no changes in NAA/Cr ratio. A statistically significant reduction in NAA/H2O and Cr/H2O (both p < 0.05) was observed. For the immune status there was a statistically significant correlation (r=0.47, p<0.05) between CD4 counts and NAA/H2O ratio. A significant increase in Cho/Cr ( p<0.001) and mI/Cr ( p<0.01) ratios in HIV patients was found, but Cho/H2O and mI/H2O concentrations were non-significantly increased.

CONCLUSION

These results indicate that neuronal loss and gliosis in HIV-infected patients may be associated with impairment of energy metabolism. The spectral changes found suggest that 1H MRS can be used for early detection of brain damage induced by HIV.

Cerebral MR spectroscopy in neurologically asymptomatic HIV-infected patients

PURPOSE

To detect early metabolic changes in the brain of neurologically asymptomatic HIV-infected patients with normal MR imaging and to find the correlation between 1H MR results and immune status.

MATERIAL AND METHODS

Twenty neurologically asymptomatic HIV seropositive patients underwent MR imaging and single-voxel 1H MR spectroscopy (MRS) using a PRESS sequence. For all patients, the signals from N-acetyl-aspartate (NAA), choline-containing compounds (Cho), creatine-phosphocreatine (Cr) and myoinositol (mI) were compared with 32 healthy volunteers as metabolite ratios and metabolite areas to non-suppressed water area ratios.

RESULTS

In HIV patients, the NAA/Cho ratio was significantly lower ( p < 0.01), but there were no changes in NAA/Cr ratio. A statistically significant reduction in NAA/H2O and Cr/H2O (both p < 0.05) was observed. For the immune status there was a statistically significant correlation (r=0.47, p<0.05) between CD4 counts and NAA/H2O ratio. A significant increase in Cho/Cr ( p<0.001) and mI/Cr ( p<0.01) ratios in HIV patients was found, but Cho/H2O and mI/H2O concentrations were non-significantly increased.

CONCLUSION

These results indicate that neuronal loss and gliosis in HIV-infected patients may be associated with impairment of energy metabolism. The spectral changes found suggest that 1H MRS can be used for early detection of brain damage induced by HIV.

The evaluation of dentition status in HIV-infected patients

PURPOSE

The aim of the study was the evaluation of dentition status in patients infected with HIV.

MATERIAL AND METHODS

We examined 30 HIV + patients, aged 20-46 and 30 non-infected subjects as the control group. Oral hygiene and dentition status were estimated. Oral hygiene status using simplified OHI-plague index according to Green and Vermilion. Dentition status was analysed using decay intensity index (DMF) as well as teeth loss index according to Rogowiec. The results were analysed in dependence on HIV infection with regard to infection time.

RESULTS

The results point to a high intensity of decay in HIV+ patients (23.66). There was a positive correlation between infection time and decay intensity and teeth loss evaluated using Rogowiec index. Unsatisfactory oral hygiene status (OHI > or = 1) was observed in 53.33% of infected patients. There is a relation between infection time and oral hygiene status. OHI-plague index increased in patients with infection time longer than 5 years up to 2.99 (patients with shorter than 5 years infection time--1.17 and the control group--0.57).

CONCLUSIONS

1. There is a positive correlation between HIV infection and dentition status and oral hygiene. 2. Infection time influences index values: decay intensity, teeth missing, and oral hygiene. 3. HIV+ subjects are patients of high necessity of therapy and because of their basic disease they should come within broadened health education and prophylactic activities.

[CNS changes in HIV-infected patients: magnetic resonance spectroscopy]

Changes that may appear in the central nervous system in the course of AIDS either result directly from HIV infection or--as is the case with opportunistic infections and some neoplasms--develop as a secondary consequence of general immunodeficiency. Neuroimaging techniques may be most useful in the differential diagnosis of these lesions. Basic principles of HIV encephalitis and progressive multifocal leukoencephalopathy differentiation in MRI scans are discussed in the paper, and diagnostic possibilities of MR imaging in some other infections (tuberculosis, toxoplasmosis, and cryptococcosis) are outlined. Special attention is paid, on the one hand, to difficulties in the differentiation between toxoplasmosis and lymphoma, and on the other hand--to the growing diagnostic utility of MR-spectroscopy in this respect.

[The central nervous system and HIV infection]

Human immunodeficiency virus (HIV) may be the cause of both primary and secondary brain diseases. In this review general features of HIV-associated neuropathology are discussed. Up to 90% of patients with AIDS have a variety of HIV-related brain diseases. Primary brain diseases including lymphocytic meningitis and HIV encephalitis are attributed directly to the effect of the virus on the brain. Secondary diseases including toxoplasmosis, cryptococcosis, primary leukoencephalopathies and lymphomas result from these patients' immunodeficiency status.

Plasma and mucosal prostaglandin E2 as a surrogate marker of ulcerative colitis activity

BACKGROUND

Enhanced production of prostaglandin E2 was observed in the course of inflammatory bowel diseases. The study was undertaken to determine whether mucosal and plasma concentrations of PGE2 can be considered as a surrogate marker of bowel inflammation activity in patients with ulcerative colitis.

METHODS

Prostaglandin E2 concentration was measured with an EIA in biopsies of rectal mucosa and plasma of 79 patients with ulcerative colitis and 12 controls. Endoscopic picture was scored and compared with plasma and mucosal PGE2, as well as with possible laboratory markers of the disease activity, including C-reactive protein, albumin, gamma-globulin, haemoglobin concentrations, and sedimentation rate, white blood count and platelets count.

RESULTS

Plasma and mucosal PGE2 demonstrated in ulcerative colitis exceeded control level over five and three fold respectively. They increased depending on the scored degree of mucosal injury, demonstrated through significant positive correlation (r = 0.437 and r = 0.525). Among other possible laboratory markers of the disease activity, only sedimentation rate revealed significant correlation (r = 0.288). CRP demonstrated weak association with the disease activity and there was almost lack of any association in respect to white blood count, and albumin or gamma-globulin concentrations.

CONCLUSION

These data confirm possible usefulness of plasma or mucosal PGE2 measurement in patients with ulcerative colitis as a possible marker of inflammation. Moreover, as a prognostic factor it can reduce the number of endoscopic procedures.

Effect of ulcerative colitis activity on plasma concentration of transforming growth factor beta1

Enhanced expression of transforming growth factor-beta1 (TGF-beta1) demonstrated in human colonic mucosa of patients with ulcerative colitis (UC), indicates its possible significance in the pathogenesis of this disease. The aim of this study was to evaluate plasma TGF-beta1 concentration in patients with different degrees of colonic mucosal injury, as a possible indicator of ulcerative colitis activity. TGF-beta1 concentration was measured with an enzyme immunoassay (EIA) in plasma of 45 patients with endoscopically confirmed UC. Values observed in UC patients (40.5+/-15.9 ng/ml) were significantly higher than in healthy people (18.3+/-11.6 ng/ml) and higher than in patients with irritable colon syndrome (ICS), (20.5+/-13.6 ng/ml). The highest plasma TGF-beta1 (58.6+/-112.1 ng/ml) was in patients with the severe UC course. TGF-beta1 level analysed in all UC patients revealed significant positive correlation with scored degree of mucosal injury (r=0.396;P<0.01). Among other possible laboratory markers of the disease activity, only C-reactive protein concentration demonstrated significant correlation. Enhanced production of TGF-beta1 can be related to inflammation activity. Measurement of plasma TGF-beta1 may be considered as a biomarker of the disease activity.

[Transforming growth factor beta in pathogenesis of liver diseases]

Transforming growth factor (TGF-beta) is the protein playing a principal role in the intracellular signalling. The most important function is ability to stimulate synthesis of extracellular matrix proteins, what is responsible for wound formation and tissue reconstruction. The damage of hepatocytes is a signal for macrophages and platelets activation, resulting in release of TGF-beta and over-expression of genes responsible for morphologic and functional changes in Ito cells. They undergo transformation into myofibroblasts and become the source of extracellular matrix proteins, such as: collagens, fibronectin, laminin, entactin, tenascin, undulin. The consequence of their accumulation in the space of Disse and inside hepatic lobuli is fibrosis, which is the form of tissue healing in the place of necrosis. However continuous action of damaging agent leads to massive fibrosis and reconstruction of liver, what is clinically manifested as cirrhosis. The role of transforming growth factor beta in the pathogenesis of liver diseases and its possible use as an indicator of disease progression were discussed in this paper.

[The role of transforming growth factors beta in pathogenesis of ulcerative colitis]

Transforming growth factor beta is the protein playing a principal role in the intercellular signalling. The most important functions are: control of cellular growth, differentiation and migration. Moreover it stimulates synthesis of extracellular matrix proteins, modulates immune response and is responsible for angiogenesis, wound formation and tissue reconstruction. All these activities are involved in the development or healing of inflammatory bowel diseases. The role of transforming growth factors beta in the pathogenesis of ulcerative colitis are discussed in this paper.

[Magnetic resonance imaging and spectroscopic metabolites assessment in brain cryptococcosis]

Cryptococcus neoformans is the causative agent of cryptococcosis and cryptococcal meningitis, which are serious pathological conditions affecting up to 10% of patients with AIDS. In this paper we present results magnetic resonance imaging and spectroscopic metabolites (1H MR) in brain cryptococcosis. In 1 HMR spectroscopy we find decreased metabolic ratios to nonsaturated water (H2O) signal N-acetylaspartate (NA/H2O, creatine (Cr/H20), choline (Cho/H2O). We show increased mioinositol to H2O ratio. Spectroscopy results suggest about massive neuronal injury and accompanying gliosis in brain cryptococcosis.

[Antibodies against M2-antigen in differential diagnosis of primary biliary cirrhosis]

Measurement of antimitochondrial antibodies is established as a sensitive indicator for primary biliary cirrhosis, which has unfortunately limited diagnostic specificity. M2-antigen complex, consisted of four proteins of the inner mitochondrial membrane, has been found to be strongly associated with PBC. Clinical value of anti-M2 antibodies quantitative measurement with ELISA was analysed in 107 patients with carefully diagnosed liver diseases: acute viral hepatitis A, B, C (VHA, VHB, VHC; n = 41), chronic viral hepatitis B, C (CHB, CHC; n = 23), autoimmune hepatitis (AH; n = 6), liver cirrhosis (LC; n = 20), extrahepatic cholestasis (EC; n = 2) and primary biliary cirrhosis (PBC; n = 15). The highest values were found in PBC patients and varied from 92 to 167 U/l and dramatically exceeded normal range recommended by manufacturer (5 U/l). Mean value in this group (119.5 +/- 8.4 U/l) was significantly (p < 5 x 10(-8)) higher than in others, that varied from 1.3 +/- 0.2 up to 2.8 +/- 1.7 U/l in VHA and CHC groups respectively. Only two among 92 non-PBC patients have values over 10 U/l, but they reached only 15.8 (CHB) and 16.5 (CHC). Anti-M2 level in PBC patients demonstrated a significant positive correlation (r = 0.857) with the degree of liver insufficiency measured trough Child-Pugh score. From these data we can conclude, that quantitative measurement of anti-M2 antibodies with ELISA can serve as a very good screening for PBC, with 100% diagnostic sensitivity and specificity, if concentration of 20 U/l will be established as a pathognomic level.

[Vaccination against influenza and Guillain-Barre syndrome: are there any relations?]

Influenza, a disease known for centuries, continues to be a major medical problem throughout the world with substantial economical and health impact. The risk of death related to influenza is higher among individuals over 65 years of age and those with chronic diseases. Vaccination against influenza was successfully applied in massive prophylaxis of the disease in different countries for many years. Although there are some well known and monitored adverse reactions to influenza vaccines, the evidence whether influenza vaccination might be causally associated with higher risk of Guillain-Barré syndrome is not clear. In this paper the available literature data concerning this problem were reviewed. Own experiences on influenza vaccination and plasmapheresis treatment of Guillain-Barré syndrome were presented.

Beta 2-microglobulin and neopterin in patients with giardiasis

The aim of the study was to evaluate serum beta 2-microglobulin (beta-2m) and neopterin (NPT) in in patients with giardiasis. Twenty-two patients with giardiasis were examined and compared with twelve healthy subjects as a control group. Serum beta-2m and NPT concentration were determined twice: at the moment of diagnosis of giardiasis and six months after antiparasitic treatment with metronidazole. It was shown that serum beta-2m concentration in patients with giardiasis was remarkably elevated. It decreased significantly, but six months after treatment it was still higher as compared to the control group. However, serum NPT before anti-parasitic treatment was slightly lower than in the control group, but after elimination of Giardia an increase of NPT concentration above control values was observed. It is concluded that Giardia infection leads to long-lasting disturbances in the immunological status of the host and may influence macrophage function and downregulate their parasiticidal effects.

[Rubella: the problem of women in procreative age]

The only effective method of preventing rubella virus infection is by vaccinating women who lack the antibodies IgG-RUB, which have been proven to prevent rubella. In these study we analyze the natural seroconversion against rubella virus among women in the procreative ages of 23-30 with ELFA assay (enzymimmunofluorescence assay), using a mini-VIDAS instrument. 7.8% of 148 women tested lacked IgG-RUB. Such seronegative women should be vaccinated before pregnancy.

Effects of ulcerative colitis activity on plasma and mucosal prostaglandin E2 concentration

The aim of this study was to determine effects of changes in ulcerative colitis activity on mucosal and plasma PGE2 concentrations measured with an EIA in 49 patients who underwent sigmoidoscopy. The disease was diagnosed in 37 patients. Twelve patients with normal colonic mucosa served as controls. Patients were divided into three groups depending on the changes of endoscopic picture during a three-month follow-up. Some laboratory markers of the disease activity, such as C-reactive protein, albumin, gamma-globulin and hemoglobin concentrations, sedimentation rate, and white blood and platelets counts, were also evaluated. Initial examination revealed a significant, positive correlation of mucosal and plasma PGE2 concentration with endoscopic score. Follow-up of patients without significant progression of mucosal changes revealed constant and close to normal concentration of mucosal PGE2. Plasma PGE2 was higher at the second examination, yet without significant difference. Improvement of endoscopic picture resulted in significant decrease of plasma and mucosal PGE2 concentrations. Worsening of mucosal changes reflected endoscopically was associated with significant increase of PGE2. There were no remarkable changes in the values of analyzed laboratory markers of the disease activity. These results indicate the usefulness of mucosal or plasma PGE2 measurement as a possible prognostic marker in patients with ulcerative colitis.

[Toxoplasmosis of the brain as an example of the opportunistic invasion of the women HIV positive]

Most toxoplasmosis infections occur in the brain. Cerebral toxoplasmosis is a specially serious complication in patients with AIDS. Similarly to other opportunistic pathogens, Toxoplasma gondii causes rapidly progressive, and often fatal disease in immunosuppressed patients. The diagnosis is difficult, since no sensitive and specific non-invasive diagnostic tests exist. The subject of our study is a 27-old female initially diagnosed with metastasis in central nervous system.

Alpha-fetoprotein serum concentration in different stages of liver cirrhosis

Serum alpha-fetoprotein (AFP) concentration was measured in 41 patients with different stages of liver cirrhosis demonstrated through scored Child-Pugh classification. Mean value was elevated up to 65.9 21.9 U/l, butstatistically significant difference in comparison with control group was observed only in patients classified as Child-Pugh C. AFP concentration revealed significant positive correlation with score values. Dynamics of AFP during one-year follow up demonstrated three-fold and statistically significant increase of its concentration, that was accompanied by elevation of mean score values.

[Candida humicola infection of the central nervous system in an HIV-infected patient: a case report]

HIV infection and parenteral drug abuse are at increased risk of developing Candida infection. Central nervous system (CNS) infection is an exceptional finding. We present fatal CNS infection by Candida humicola in drug abuser at late stage of HIV disease. In MEDLINE we have found only 3 reports about pathogenicity Candida humicola in humans (ophthalmopathy, conjunctivitis, melanonychia). Our case report suggests, that spectrum of pathogens dangerous to persons with AIDS increases.

[What motivates people to get tested for HIV antibodies?]

The aim of the study was to evaluate reasons for anti-HIV testing among persons admitted to Outpatient Counseling Unit. Serum examination for antibodies against HIV were performed in 389 persons during 8 years of the Unit activity. The most frequently it was analysed in intravenous drug users. However there are still many persons who are urged for this analysis before invasive medical procedures. Knowledge on HIV/AIDS in Poland seems to remain on the very low level in public as well as in medical staff.

[Prophylaxis after occupational exposure to human immunodeficiency virus (HIV)]

Reasons for seeking consultation among health care workers due to potential or supposed risk of HIV infection were analyzed. From August 1990 till July 1996 41 health care providers were consulted including: 22 nurses, 1 student of nursing college, 3 midwives, 4 laboratory workers and 7 physicians (surgeons and gynaecologist). Type of exposure to HIV and applying of safety precautions were evaluated in each case. In 10 cases the offer of postexposure prophylaxis with zidovudine was accepted (6 nurses, 1 student of nursing college, 3 surgeons). Exposure to HIV was described as: needlestick immediately after it was used in a HIV/AIDS patient, injury with a surgical needle while operating on an HIV infected blood. In the remaining cases the fear of HIV infection was due to work without protective gloves (nurses, laboratory workers), performing surgery on HIV (+) patient, (surgeons, nurses) or short-time contact of HIV infected blood with undamaged skin (nurses). Following conclusions can be drawn from our study: 1. Health care workers undertake safety precautions only when they are informed about HIV seropositivity of the patient. 2. Patients whose HIV serologic status is not known are considered not to create health risk for medical staff. 3. The level of knowledge of health care workers about risk of acquiring HIV infection, lack of risk and ways of diminishing the risk is poor. 4. None of followed health care workers was HIV-seropositive after occupational exposure to HIV.

Clinical picture of tick-borne encephalitis among patients hospitalized in 1994 in the Department of Infectious Diseases Medical School Białystok

In 1994 20 patients of the Department of Infectious Diseases, Medical School Białystok were diagnosed to have tick-borne encephalitis. The etiologic agent was identified by serologic studies of the serum and cerebrospinal fluid (FSME IgM ELISA Immuno Austria). 12 patients (60%) reported a tick bite preceding the disease. Following clinical manifestations were found in the analyzed groups of patients: fever > 37.5 degrees C-20 patients (100%), headache--20 patients(100%), nuchal rigidity-14 patients (70%), abdominal pain -3 patients (15%), arthralgia and myalgia-3 patients (15%), drowsiness and mental confusion -3 patients(15%). Total cell count in CSF ranged from 18 to 348 cells (mean-175). Lymphocytes predominated in 13 cases (68%). The FSME-IgM antibodies were present in serum of 19 patients (95%) and in CSF of only 4 patients (20%). The hospitalization lasted 12-58 days (mean 24 days). In one case the disease was complicated by acute psychosis requiring psychiatric treatment. Severe neurologic complications have been not observed. The prognosis in all cases was good. Our study confirms that tick-borne encephalitis is a current problem in north-eastern Poland. Noteworthy is the fact that only a part of patients give the history of tick bite.

Delayed-type hypersensitivity skin reaction estimated with Multitest CMI in human giardiasis

Delayed-type hypersensitivity skin reaction performed with Multitest CMI as an indicator of cell-mediated immunity, has been evaluated among 20 adults with giardiasis. There were no correlation found between Multitest CMI score and clinical course of the disease, but significant correlation was observed in relation to CD4/CD8 ratio, an another indicator of cell-mediated immunity. Multitest CMI score revealed lower values in giardiasis patients than in controls, and it was associated with significantly higher frequency of hypoergic reactions among subjects.