Donald B. Louria

The Major Medical Complications of Heroin Addiction

Excerpt An estimated 60,000 to 120,000 persons in the United States are addicted or habituated to opiates, the former defined as physical dependence on the drugs, the latter as chronic use without ...

Effect of alcohol and various diseases on leukocyte mobilization, phagocytosis and intracellular bacterial killing.

Abstract Alcoholics are more susceptible than the general population to pneumonia, apparently in some cases because of nutritional deficiencies. Ethyl alcohol produced a profound depression in the rate of leukocyte mobilization into traumatized skin of nutritionally normal people, and was comparable to that observed in terminal phases of medical shock. Diabetic patients showed a less marked decrease in mobilization. No significant depression of polymorphonuclear-leukocyte mobilization was found in patients with cirrhosis or uremia, in coma or undergoing prolonged general Anesthesia for major surgery. Human polymorphonuclear leukocytes, obtained after alcohol was given, or leukocytes exposed to alcohol in vitro showed no decrease in ability to ingest or kill ingested bacteria. Diminished leukocyte mobilization may contribute substantially to the increased susceptibility to infection in the lung parenchyma noted in alcoholics and in diabetic patients or those with severe prolonged shock.

Fungal and Yeast Infections of the Central Nervous System: A Clinical Review

In the past 20 years, there has been a marked increase in the number of reported cases of meningitis and brain abscess due to fungi and yeasts. This increase is due in part to better diagnostic techniques and greater awareness of the possibility of fungal invasion of the nervous system; but the increase can also be attributed to a growing pool of severely compromised hosts, many of whom are undergoing treatment with adrenal glucocorticoids or immunosuppressive agents. The diagnosis and treatment of aspergillosis, blastomycosis, candidiasis, coccidioidomycosis, cryptococcosis, infections caused by dematiaceous fungi, histoplasmosis, paracoccidioidomycosis, petriellidosis, and sporotrichosis, as well as relatively rare infections of the central nervous system caused by other fungi, are discussed. The efficacy of amphotericin B and 5-fluorocytosine in the treatment of CNS fungal and yeast infections is also evaluated.

Micronutrient status and human immunodeficiency virus (HIV) infection

This study surveyed serum concentrations of vitamins, electrolytes, and trace elements in subjects seropositive for HIV-1 by ELISA and confirmatory Western blot. Thirty subjects (26 males, 4 females) were recruited at a hospital clinic. Seventeen were classified as having mild or severe ARC (AIDS-related complex), 7 had AIDS, and 6 were asymptomatic. Eight had experienced weight loss of 10 pounds or more in the past 6 months. Most (93%) were anergic to skin test antigens. Percentages of subjects with below normal plasma concentrations include: zinc-30%, calcium-27%, magnesium-30%, carotenes-31%, total choline-50%, and ascorbate-27%. Eighty-seven percent of the subjects had at least one abnormally low value. Percentages with above normal values include: folate-37% and carnitine-37%. Some subjects with above normal values for plasma vitamins reported self-supplementation, usually with large doses. The results suggest that one or more abnormally low concentrations of the plasma micronutrients studied here are likely to be present in the majority of HIV seropositive patients.

Vitamin profiles in elderly persons living at home or in nursing homes, versus profile in healthy young subjects.

ABSTRACT: The vitamin profile of 473 elderly persons was compared with that of 204 healthy volunteers (controls). Of the 473 elderly, 327 (mean age 87) lived in nursing homes, and 146 (mean age 77) lived at home. The 204 controls were in the 20–50 year age group. The circulating levels of biotin, pantothenate, riboflavin, vitamins A, B6, B12, C, E, folate, thiamine, nicotinate, and carotenes were determined in all groups. Hypovitaminemia was not obvious for biotin, pantothenate, riboflavin, vitamins A, E, and carotenes in either the institutional or non‐institutional elderly. Thiamine, vitamin C and vitamin B12 levels were strikingly depressed in the non‐institutional elderly as compared with the institutional population or the controls. Over 30 percent of the institutional elderly had vitamin B6 and nicotinate hypovitaminemia compared to the controls. Both the institutional and the non‐institutional elderly showed depressed levels of folate and vitamin B12. Vitamin supplementation reduced the percentage of folate and B12 deficits. The marked vitamin deficits in the institutional population, in descending order of incidence were: vitamin B6, nicotinate, vitamin B12, folate, thiamine, and ascorbate, whereas the pattern for the non‐institutional elderly was: vitamin B12, thiamine, ascorbate, vitamin B6, nicotinate, and folate. In the 473 elderly studied, vitamin B6, nicotinate, and vitamin B12, in that order, were the most common deficits; folate, thiamine and ascorbate deficits comprised a lesser percentage. The role of vitamin deficits and the effects upon the aging population are discussed.

Micronutrient profiles in HIV-1-infected heterosexual adults.

There is compelling evidence that micronutrients can profoundly affect immunity. We surveyed vitamin supplement use and circulating concentrations of 22 nutrients and glutathione in 64 HIV-1 seropositive men and women and 33 seronegative controls participating in a study of heterosexual HIV-1 transmission. We assayed antioxidants (vitamins A, C, and E; total carotenes), vitamins B6 and B12, folate, thiamin, niacin, biotin, riboflavin, pantothenic acid, free and total choline and carnitine, biopterin, inositol, copper, zinc, selenium, and magnesium. HIV-infected patients had lower mean circulating concentrations of magnesium (p < 0.0001), total carotenes (p = 0.009), total choline (p = 0.002), and glutathione (p = 0.045), and higher concentrations of niacin (p < 0.0001) than controls. Fifty-nine percent of HIV+ patients had low concentrations of magnesium, compared with 9% of controls (p < 0.0001). These abnormal concentrations were unrelated to stage of disease. Participants who took vitamin supplements had consistently fewer low concentrations of antioxidants, across HIV infection status and disease stage strata (p = 0.0006). Nevertheless, 29% of the HIV+ patients taking supplemental vitamins had subnormal levels of one or more antioxidants. The frequent occurrence of abnormal micronutrient nutriture, as found in these HIV+ subjects, may contribute to disease pathogenesis. The low magnesium concentrations may be particularly relevant to HIV-related symptoms of fatigue, lethargy, and impaired mentation.

Psychological distress, drug and alcohol use as correlates of condom use in HIV-serodiscordant heterosexual couples.

ObjectiveTo investigate the relationship between psychological distress, alcohol, drug and condom use in HIV-serodiscordant heterosexual couples. MethodsStructured interviews were conducted to collect demographic information, detailed data on psychological distress, drug and alcohol use and sexual behavior. ResultsAnalyses were based on 106 pairs of sexually active discordant couples. Significant differences among heterosexual condom users and non-users varied according to gender and HIV serostatus. Affect domains of interpersonal sensitivity and hostility were significant, as were the variables of regular drug or alcohol use and combining sex with drugs or alcohol. Employment was strongly associated with condom use in HIV-negative women whose regular sexual partners were HIV-positive men. ConclusionThe risk of vaginal sex without condoms in HIV-serodiscordant heterosexual couples may be reduced by specific psychological counseling and attention to drug and alcohol use as risk factors. Further research on the effect of employment of HIV-negative women is required.

Correlates of Nontransmission in US Women at High Risk of Human Immunodeficiency Virus Type 1 Infection through Sexual Exposure

Seventeen women who were persistently uninfected by human immunodeficiency virus type 1 (HIV-1), despite repeated sexual exposure, and 12 of their HIV-positive male partners were studied for antiviral correlates of non-transmission. Thirteen women had > or = 1 immune response in the form of CD8 cell noncytotoxic HIV-1 suppressive activity, proliferative CD4 cell response to HIV antigens, CD8 cell production of macrophage inflammatory protein-1 beta, or ELISPOT assay for HIV-1-specific interferon-gamma secretion. The male HIV-positive partners without AIDS had extremely high CD8 cell counts. All 8 male partners evaluated showed CD8 cell-related cytotoxic HIV suppressive activity. Reduced CD4 cell susceptibility to infection, neutralizing antibody, single-cell cytokine production, and local antibody in the women played no apparent protective role. These observations suggest that the primary protective factor is CD8 cell activity in both the HIV-positive donor and the HIV-negative partner. These findings have substantial implications for vaccine development.

The Human Toxicity of Certain Trace Elements

Abstract A review of the medical toxicology of cadmium, cobalt, selenium, arsenic, nickel, copper, manganese, tellurium, vanadium, molybdenum, zinc, and tin; emphasis is on industrial sources of in...

Salmonellosis in Patients with Neoplastic Disease.

Excerpt Ninety-six different salmonella isolations from 92 patients occurring over an 11-year period at Memorial Center were reviewed;Salmonella typhimuriumandSalmonella derbyinfections made up alm...