Daniele Scevola

Effect of exercise and strength training on cardiovascular status in HIV-infected patients receiving highly active antiretroviral therapy

A routine evaluation of lipid metabolism and body fat distribution along with a careful cardiovascular risk stratification according to international guidelines are required for HIV-infected patients receiving highly active antiretroviral therapy. Intervention includes evaluation of patients for both epidemiological and clinical factors, and for anthropometric and biochemical parameters. Diet counseling, prescription of antihyperlipidemic drugs and exercise training are the cornerstones of programs devoted to protecting patients from side effects of therapies that compromise quality of life and the functions of organs like the pancreas and heart that are involved in lipid disorders.

Sulphuric acid burned women in Bangladesh: a social and medical problem

In August-September 1998 an Italian medical team, composed of a plastic surgeon, an anaesthesiologist, an infectious diseases specialist and a psychologist, assisted by a local non-government organization (Narripokkho), studied a cohort of Bangladeshi women injured by sulphuric acid. The goals of the mission were: (1) recognition of the magnitude of the phenomenon of acid being intentionally thrown at women; (2) evaluation of the type and severity of burns; (3) preparation of a tentative schedule of surgical treatment of the lesions; (4) organization of local facilities; (5) training of doctors and nurses.

Non‑pathogenic microflora of a spring water with regenerative properties

The Comano spring water (Comano, Italy) has been demonstrated to improve skin regeneration, not only by increasing keratinocyte proliferation and migration, but also by modulating the regenerated collagen and elastic fibers in the dermis. However, such biological properties may not be entirely explained by its mineral composition only. As the non-pathogenic bacterial populations have demonstrated an active role in different biological processes, the potential presence of non-pathogenic bacterial species within the Comano spring water was investigated in order to identify any possible correlation between these bacterial populations and the demonstrated biological properties of this water. The water was collected at the spring using an aseptic procedure and multiple cultures were carried out. A total of 9 different strains were isolated, which were Aeromonas hydrophila, Brevundimonas vesicularis, Chromobacterium violaceum, Citrobacter youngae, Empedobacter brevis, Pantoea agglomerans, Pseudomonas putida, Pseudomonas stutzeri and Streptococcus mitis. All the isolated bacterial strains, although showing a rare potential virulence, demonstrated peculiar and favorable metabolic attitudes in controlling environmental pollution. The therapeutical effects of certain spring waters are currently being proven as correlated not only to their peculiar mineral composition, but also to the complex activity of their resident non-pathogenic bacterial populations. Although the present study provided only preliminary data, some of the non-pathogenic bacterial populations that were identified in the Comano spring water are likely to produce molecular mediators with a role in the wound healing process that, thus far, remain unknown. Numerous other unknown bacterial species, comprehensively termed DNA-rich ‘dark matter’, are likely to contribute to the Comano water regenerative properties as well. Therefore, the non-pathogenic bacterial populations of the Comano spring water are possibly credited for its demonstrated regenerative properties.

Virologic and immunologic activity of PegIntron in HIV disease.

Objective:The primary objectives of this study were to evaluate the safety, tolerability, and antiviral activity of pegylated interferon-α (PegIntron) in HIV-1 treatment-experienced patients failing their current antiretroviral regimen. Design:This was a phase II, multicenter, randomized, double-blind, placebo-controlled study. Methods:Patients were randomized to receive either weekly subcutaneous PegIntron 0.5, 1.0, 1.5, or 3 μg/kg or placebo added to their failing antiretroviral regimen for the first 4 weeks of study. Individuals who achieved more than 0.5 log10 reduction in HIV RNA at week 4 were allowed to continue study medication with optimization of their antiretroviral therapy for an additional 24 weeks. Results:In the 259 patients included in the intent-to-treat analysis, changes in plasma HIV RNA from baseline to week 4 were −0.25 (P > 0.5), −0.46 (P = 0.024), −0.39 (P = 0.008), −0.53 (P < 0.001), and −0.17 (P > 0.5) log10 copies/ml in the 0.5, 1.0, 1.5, and 3.0 μg/kg and placebo arms, respectively. No significant changes were seen in CD4 T-cell parameters in any of the treatment or control arms. Adverse events (most commonly fever, flu-like symptoms, other constitutional symptoms, and psychiatric symptoms) resulted in discontinuation of study medication in 13, 17, 16, 28, and 2% of patients in the 0.5, 1.0, 1.5, 3.0 μg/kg, and placebo group, respectively. Conclusion:The demonstration of significant antiviral activity in a heavily pretreated patient population with acceptable toxicity and only weekly dosing makes PegIntron a potentially valuable therapy for patients with HIV infection that warrants further investigation in a broader population of patients.

HIV Infection-Related Cachexia and Lipodystrophy

Protein energy malnutrition (PEM) is, alone or associated with other diseases, the first step in the development of cachexia [1] [3]. An insufficient amount of food is the leading cause of malnutrition and infectious diseases are the second. In developing countries, 20% of the population — more than 800 million people — eats a quantity of food only sufficient to supply energy for a sedentary life, i.e. 1.2–1.4 times the resting energy expenditure (REE).More than 192 million children suffer from PEM and 2 billion people lack different micronutrients (vitamins, minerals, essential fatty and amino-acids) [4] [7]. Even in Western countries, where an enormous surplus of food is produced, many groups of people, especially the poor, the elderly, drug addicts, pregnant women, patients with liver, kidney and gastro-intestinal (GI)-tract diseases, cancer, AIDS, show nutritional defects. In general, 60% of the world’s population (41% in developing countries) consumes less than 2600 Kcal/person/day, an amount of energy considered barely sufficient for limited activity.

Nutritional Status Assessment

Malnutrition is not invariably diagnosed by physical findings of nutritional deficits. Malnutrition is a deviation (in excess or defect) from a complex of ideal scores. Paradoxically, a plump, flourishing patient may be affected by malnutrition if he or she exceeds this ideal score.

Starvation: Social, Voluntary, and Involuntary Causes of Weight Loss

Under physiological conditions, body weight remains remarkably stable because of the importance of maintaining energy stores. A complex network of neural and hormonal factors regulates appetite and metabolism. A fundamental role is played by hypothalamic centres of feeding and satiety. Neuropeptides induce anorexia by acting on the satiety centre; gastrointestinal peptides, such as glucagon, somatostatin, and cholecystokinin, induce anorexia by vagal signalling; hypoglycaemia inhibits satiety centre. Leptin, produced by adipose tissue, acts on the hypothalamus to decrease food intake and increase energy expenditure, thus achieving long-term weight homoeostasis [1].

Treatment of AIDS Anorexia-Cachexia Syndrome and Lipodystrophy

Anorexia-cachexia syndrome [1] and lipodystrophy [2] [6] are two conditions frequently associated with the course of HIV infection. Under many circumstances, they can be included as components of a single disease, multifactorial in origin, leading to alterations of energetic metabolism and to body fat tissue modifications. The risk for the clinician is of only partially considering the two diseases, for which, until recently, a true definition [3] was lacking. The approach to therapy, due to the multifactorial origin, must be multidisciplinary, involving experts in nutrition, infectious diseases, physiology, gastroenterology, etc.