[Prevalence of antibodies against HIV in drug addicts and convicts]

The presence of anti-HIV (human immunodeficiency virus) antibodies was determined in 325 subjects. The samples were taken from 138 convicts from Carabanchel and Ocaña I jail, 162 parenteral drug addicts (PDA) from a center for rehabilitation of drug addicts (CR), and from 14 family members and 11 stable couples of these PDAs. There was a global seroprevalence of 61.23%, 56.9% in Carabanchel, 68.7% in Ocaña I and 68.5% in the CR. When the results from the jailed convicts were analyzed according to risk factors, it was discovered that drug addiction was the most relevant since there was only a 29.4% of seropositivity in non PDAs with a statistically significant difference (p less than 0.01). This value was also higher than the seroprevalence found in the CR with a statistically significant difference (p less than 0.01). None of the family members of the CR were HIV-positive. Two stable couples were positive in this sexual contact group. This article makes clear the important role of drug addiction in the dispersion of HIV infection in our midst.

Kinetic evidence for thermally induced conformational change of butyrylcholinesterase

The effect of temperature on the kinetics of human plasma butyrylcholinesterase-catalyzed reactions was studied. The Arrhenius plot of o-nitrophenylbutyrate hydrolysis presents a break at 21 degrees C. However, nucleophilic competition data indicate that there is no change in the rate-limiting step of the overall reaction. In addition, the temperature dependence of the bimolecular rate constant of enzyme carbamylation shows a break at 18 degrees C. These results argue for the existence of thermally induced conformational active states of the enzyme tetramer. It is suggested that the effects of this transition on kinetics arise at the acylation step.

Parenteral nutrition of injured patients: Effect of manipulation of aminoacid infusion (increasing branched chain while decreasing aromatic and sulphurated aminoacids)

Sixteen critically ill injured patients received parenteral nutrition providing nitrogen (0.34 g kg(-1) day(-1)) and glucose (32 kcal kg(-1) day(-1)) for 5 days. They were randomly divided into two groups with respect to aminoacid supply: an essential aminoacid solution vs the same solution enriched in branched chain amino acid (BCAA) content and decreased in phenylalanine and methionine content (mean BCAA intake, 0.55 vs 0.69 g kg(-1) day(-1)). Basal values of nitrogen metabolism without treatment showed no difference between the two groups. Nitrogen losses and 3 methylhistidine (3-MEH) excretion were elevated; the plasma aminoacid pattern was altered by the trauma and except for phenylalanine, aspartate and glutamate, plasma aminoacid concentrations were decreased below normal values. Net muscular aminoacid output was demonstrated by femoral arterio-venous (av) differences that were all negative except for glutamate and citrulline TPN with both solutions improved the nitrogen balance and reduced the negative aminoacid balance across the leg. Adjusting a TPN regimen to increase the BCAA content without altering the total nitrogen infused, had no effect on overall nitrogen balance, but exerted a beneficial effect on body protein catabolism, as assessed by the urinary 3-MEH excretion rate, and a transient improvement in the aminoacid balance across the leg at the peak of the infusion. The short-lived effect of BCAA suggest a metabolic effect of these aminoacids which deserves further study.

Influence of total parenteral nutrition on protein metabolism following acute injury: assessment by urinary 3-methylhistidine excretion and nitrogen balance

The use of total parenteral nutrition after acute injury, either surgical or accidental, is widely accepted for its important benefits, although it is not yet completely understood whether a reduction of body protein catabolism can be effectively achieved. We applied total parenteral nutrition to 14 critically ill patients after either trauma or major surgery. Their daily nitrogen balance, urinary 3-methylhistidine and creatinine excretion, and molar 3-methylhistidine/creatinine ratio, during initial 24-hr fasting period, were respectively -0.19 +/- 0.01 (SEM) g kg-1, 5.46 +/- 0.47 mumol kg-1, 27 +/- 4 mg kg-1, and 0.030 +/- 0.005. Daily nonprotein calorie intake of 31.11 +/- 0.58 kcal kg-1, as glucose, and administration of nitrogen 0.350 +/- 0.004 g kg-1, as 10% crystalline L-aminoacids solution, and insulin 1 IU every 5.03 +/- 0.14 g of glucose, resulted in progressive decline of urinary 3-methylhistidine (4.21 +/- 0.43 mumol kg-1, p less than 0.001), creatinine (22 +/- 2 mg kg-1, NS), and their molar ratio (0.022 +/- 0.002, NS). Mean nitrogen balance resulted in 0.032 +/- 0.008 g kg-1. Since urinary 3-methylhistidine role as a marker of protein catabolism is well established, its decrease under total parenteral nutrition together with greatly improved nitrogen balance, demonstrates that our treatment can effectively quench protein catabolism, meanwhile enhancing protein synthesis.

The main determinants of nitrogen balance during total parenteral nutrition in critically ill injured patients

Factors influencing nitrogen balance during total parenteral nutrition have been investigated in 34 critically ill injured patients studied during the first 6 days after trauma. Basal nitrogen balance was severely negative (-0.26 +/- 0.12 (SD) g X kg-1), but improved consistently during treatment. Nitrogen intake proved to be the major determinant of a positive, or less negative, nitrogen balance, only secondarily followed by total energy intake corrected to predicted basal energy expenditure, according to multiple regression analysis. The amount of non-protein calories and the non-protein calorie to nitrogen ratio appeared to have little significance on nitrogen balance, when corrected for the two former variables.

A critical approach to prophylactic use of lithium in therapy for manic-depressive patients

During a follow-up study of 120 cases of recurrent affective disorders treated prophylactically with lithium, the authors considered certain aspects of this treatment from a psychologic point of view. In particular, they examined the problems connected with prolonged administration of the drug, the relationship between drug therapy and psychotherapy, and the significance of pharmacologic prevention of the crisis by modifying the underlying individual, familial, and social conditions that the crisis manifests.

HLA-B27 antigen in diagnosis of atypical seronegative inflammatory arthropathy

Eighteen patients with an inflammatory pauciarticular peripheral arthropathy not typical of any known entity showed an asymmetrical pattern of disease, with a predilection for the lower extremities. Destructive joint changes and deformities were absent (mean follow-up 10 years). Although spondylitis and sacroiliitis were absent on x-rays, HLA-B27 antigen was found in 8 patients (44%). This antigen and similar joint symptoms are also found in other forms of arthritis.

[Remarks on the nervous disturbances observed during an occupational medicine survey in workmen employed in a metal container manufacturing plant (author's transl)]

The authors report the results of a survey carried out in order to investigate psychic disturbances in subjects working in a metal container manufacturing industry. The manufacturing process is described and an attempt made to analyse the relationships among its evolution, work organisation--mainly referring to working group composition--and work division levels reached. The possible influences of noxious environmental factors on the onset of the psychic disturbances observed are examined. The obtained data are analysed and the psychic disturbances classified as: 1) anxious, 2) depressive, and 3) psychosomatic in nature; hypotheses are formulated in order to explain the higher frequency of almost all reported disturbances in female compared to male workers. Data are reported concerning psychotropic drug treatment as well as psychiatric hospitalization in the examined subjects; and their higher prevalence in comparison with the mean general population data is underlined. Finally, some remarks are made on methodology problems, and a correct setting up of the technician/homogeneous working group relationship is said to be the fundamental support for a profitable survey such as the one performed by the authors.

[Arrhythmia in the course of myocardial infarct. Our year's experience in a coronary unit]

Personal experience with arrythmia in 57 out of 132 cases of myocardial infarct treated over a period of one yr. in a coronary unit. The ECG and biohumoral enzyme pictures gave clear indications of infarct in all 132 cases. The various types of primary stimulus formation or conduction arrhythmia observed in these 57 patients are examined in relation to the site and extent of infarct. The treatment modalities are described. Mortality was less than 10 per cent in the entire series, with 3 per cent deaths due to serious rhythm disturbances. It is concluded that the introduction of coronary units has primarily contributed to the reduction of infarct deaths by their effective treatment of arrhythmia. Earlier admission to such units would lead to further reductions in mortality.