Bone density and microarchitecture in hepatitis C and HIV-coinfected postmenopausal minority women

We found that HIV+/HCV+ women had 7-8% lower areal bone mineral density (aBMD) by dual-energy x-ray absorptiometry (DXA) at the spine, hip, and radius (p < 0.01) and 5-7% lower volumetric BMD (vBMD) by central quantitative computed tomography (cQCT) at the spine and hip (p < 0.05). These data suggest that true deficits in vBMD may contribute to bone fragility and excess fractures reported in HIV+/HCV+ women.

INTRODUCTION

aBMD by DXA is lower in persons coinfected with HIV and HCV (HIV+/HCV+) than with HIV monoinfection (HIV+). However, weight is often also lower with HCV infection, and measurement of aBMD by DXA can be confounded by adiposity; we aimed to determine whether true vBMD is also lower in HIV+/HCV+ coinfection.

METHODS

We measured aBMD of the lumbar spine (LS), total hip (TH), femoral neck (FN), and ultradistal radius (UDR) by DXA and vBMD of the spine and hip by cQCT and of the distal radius and tibia by high-resolution peripheral QCT (HRpQCT) in 37 HIV+/HCV+ and 119 HIV+ postmenopausal women. Groups were compared using Student's t tests with covariate adjustment by multiple regression analysis.

RESULTS

HIV+/HCV+ and HIV+ women were of similar age and race/ethnicity. HIV+/HCV+ women had lower body mass index (BMI) and trunk fat and were more likely to smoke and less likely to have a history of AIDS. In HIV+/HCV+ women, aBMD by DXA was 7-8% lower at the LS, TH, and UDR (p < 0.01). Similarly, vBMD by cQCT was 5-7% lower at the LS and TH (p < 0.05). Between-group differences in LS aBMD and vBMD remained significant after adjustment for BMI, smoking, and AIDS history. Tibial total vBMD by HRpQCT was 10% lower in HIV+/HCV+ women.

CONCLUSION

HIV+/HCV+ postmenopausal women had significantly lower spine aBMD and vBMD. These deficits in vBMD may contribute to bone fragility and excess fractures reported in HIV+/HCV+ women.

Vancomycin-resistant Enterococcus faecium meningitis successfully managed with linezolid: case report and review of the literature

Enterococci cause serious illness in immunocompromised patients and severely ill, hospitalized patients. Resistance to vancomycin has increased in frequency during the past few years. Limited therapeutic options are available for vancomycin-resistant enterococcal infections and the optimum therapy has not been established. We report a case of nosocomial vancomycin-resistant Enterococcus faecium meningitis in the setting of hyperinfection with Strongyloides stercoralis that was successfully treated with linezolid. We also review the previously reported cases of vancomycin-resistant E. faecium meningitis.

Magnesium orotate in myocardial and neuronal protection

The nervous tissue and the myocardium have in common many denominators, such as: the inability to renew to substitute the severely damaged or dead cells, the role of the membrane electric activity, the presence of similar systems for antioxidation protection, which are obviously involved in pathologic events a.s.o. Aggressive factors mainly act by free radicals injury and increase in cytosolic calcium level. Magnesium orotate molecule includes two synergic protective components: orotic acid and magnesium. Moreover, the orotic acid behaves as a transporter, carrying magnesium into the cells. The antioxidation protective effect of the orotic acid is mainly due to the pirimidinic bases that favor and increased synthesis of enzymes which act as free radical scavengers. The cell antioxidation protective system is dramatically impaired following heavy aggressions such as the ischemia-reperfusion process. Magnesium orotate improves the survival of cells situated within the perinecrotic areas as well as of the cells secondarily damaged during the so-called "second wind".

Hereditary angioedema due to deficit of C1 esterase inhibitor

A case of familial angioedema due to deficit of C1 esterase inhibitor is presented. The case had the following peculiarities: onset at a very early age (8 months); involvement, in some attacks, of the nasal mucosa with nasal obstruction and sinusitis manifestations; unusually long duration (as long as 9 days) of some of the localized edema. The absence of attacks during pregnancy was noted. The family study over 4 generations illustrated the dominant hereditary character of genetical transmission. Attention is drawn on two cases in the family in which the disease apparently skipped one generation from the point of view of clinical signs.

The biology of the myocardium in chronic hypoxia. Note I. Myocardial lesions in experimental chronic heart failure

The biology of the myocardium was studied in chronic heart failure, especially in the course of compensatory hypertrophy induced experimentally by partial stenosis of the aorta for 10 months and the administration of large isoproterenol doses for 7 months. In the stage of acute aggression, varied disseminated ultrastructural lesions are predominant, with the decrease of energy reserves, hydroelectrolytic and ECG perturbations. In the stage of ultrastructural compensatory hypertrophy, there is a prevalence of normal myocytes or others presenting regenerative aspects next to progressive fibrosis reflected biochemically by return to almost normal values, with certain oscillations due to the presence of some lesional foci, also recorded on the ECG tracings. The question of the pathogenesis and prognosis of these lesions is discussed.

Serum myoglobin in the diagnosis of acute myocardial infarction

Serum myoglobin (Mgl) level was studied by the method of passive hemagglutination inhibition in 128 patients of whom 65 with acute myocardial infarction, 27 with unstable angina and 36 with various diseases as well as in 197 apparently normal subjects. The immunologic determination of serum myoglobin by the passive hemagglutination inhibition reaction was proved useful in the diagnosis of acute myocardial infarction (AMI) since in 95.3% of the cases myoglobin was found present in the serum in concentrations of 100-4.800 ng/ml depending on the moment of blood collection and the severity of infarction. The passive hemagglutination inhibition reaction for the determination of serum Mgl is superior to the biochemical tests (transaminases) both by the proportion of positive results obtained (95.3% by the Mgl test as compared with 73.8% by the transaminase test) and by its precocity, Mgl appearing in the serum within the first 1-2 hrs after onset of infarction. In the cases of AMI with negative or uninterpretable biochemical tests and/or ECG, serum Mgl determination can be decisive for the diagnosis. The presence of serum Mgl in 37.5% of the cases with intermediary syndrome (unstable angina) suggests the existence of some microfoci of myocardial necrosis undetectable by the usual biochemical or electric methods. Serum Mgl determination by the passive hemagglutination inhibition reaction is a relatively simple method, rapid (the results are obtained 1-2 hrs after blood collection) and practical since it can be performed in any laboratory with the usual equipment.