Contribution of zinc to reduce CD4+ risk factor for 'severe' infection relapse in aging: parallelism with HIV.

Aging and HIV have parallelism in immunodeficiency status because of the appearance of infections or relapse leading to death in both conditions. HIV-RNA is predictor for HIV progression correlated with CD4+ depletion. CD4+ and plasma zinc levels (zincaemia) may be predictors for infections relapse in aging because of zinc relevance for normal immune efficiency against infections and for CD4+ growth. Moreover, zincaemia decreases in aging and infection. A total of 67 elderly subjects affected by infections resistant to antibiotic therapy were recruited. A total of 28 HIV+ subjects with HAART therapy were also used. CD4+ depletion (507 mm3) and zincaemia deficiency (76 microg/dl), as compared to CD4+ (700-1100 mm3) and zincaemia (85-100 microg/dl; age 40-75 years) normal ranges, are possible limits (Cox hazard regression) for severe infections relapse, such as chronic obstructive bronchitis and bronchopneumonia by bacteria or Candida complication, in aging. CD4+ and zincaemia values are within the lower limits of normal range in urinary tract infections. Zincaemia and HIV-RNA or CD4+ are inversely correlated (r = 0.57 and r = 0.72, respectively) in HIV+ HAART treated subjects. Consequently there is no appearance of opportunistic infections. Parallelism between aging and HIV may exist because of the resemblance in marked zinc deficiency and CD4+ depletion with high scores in relative risks for severe infections relapse. Supplementing zinc (12 mg Zn++/day) for one month in infected elderly subjects and HAART therapy in HIV+ subjects reduces risk scores in CD4+ and zincaemia deficiencies for infections relapse, suggesting that the zinc beneficial effect may be independent either by HIV-virus or pathogen agents involved. While HAART may reduce the occurrence of opportunistic infections in HIV by means of also major zinc bioavailability, supplementing zinc can be recommended in elderly people as resistance to infections. Since zinc deficiency is correlated with CD4+ depletion, this latter may also be good diagnostic marker to detect 'clear immunodeficiency' in aging, as in HIV condition.

[Etiologic, prognostic and social health aspects of urinary infections in hospitalized elderly with an indwelling urinary catheter]. / Aspetti etiologici, prognostici e riflessi socio-sanitari delle infezioni delle vie urinarie in soggetti anziani ospedalizzati portatori di catetere vescicale a permanenza.

The aim of the study is to evaluate, in a short case-report, the concomitant urinary tract infections in a group of institutionalized elderly people with urinary indwelling catheter. Mental, functional and sanitary status was determined. 61 subjects over 65 years old (23 male and 38 female) were recruited and subdivided into three groups. Streptococcus faecalis was the main cause of urinary tract infections, Gram negative infections were overall predominant. High levels of dysautonomia with strong, global cognitive ability compromise were present in 75% of pattern. DMI and RSS test showed a marked not self-contained in 77% of recruited people and a high stress in the relatives. A significant statistical correlation among functional, sanitary, status and outcome institutionalization was present.

Course of pain sensitivity in aging: pathogenetical aspects of silent cardiopathy.

Aging is often considered a risk factor for silent ischemic cardiopathy. Using endermic electric stimuli, we assessed the course of pain threshold and pain tolerance in 23 male subjects affected by silent myocardial ischaemia, and in 20 male subjects with symptomatic cardiopathy; we also attempted to define the role played by age. Values of pain threshold were assessed using the same method in a group of 40 healthy subjects, five for each age decade, between 10 and 90 years. Our data show a significant difference in pain threshold and tolerance between subjects with silent and symptomatic cardiopathies (34.7 +/- 12.6 mA versus 25.2 +/- 12.5 mA: P < 0.001 for the threshold and 68.5 +/- 21.2 mA versus 46.0 +/- 22.3: P < 0.001 for tolerance). The fact that the significance of our results is superior to that of other studies may be due to the particular method of stimulation used and to the uniformity of the sample studied (sex, age, exclusion of subjects with anxiety-depressive symptoms). No difference was found in pain threshold as regards age. It seems probable that the difference found between subjects with silent and symptomatic cardiopathies is due to the different modulation of the perception of pain at a central level, independently of the age factor.

[Silent cardiopathy and aging. Assessment of pain threshold and tolerance]. / Cardiopatia silente ed invecchiamento. Valutazione della soglia e tolleranza dolorifica.

The increase in pain threshold is one of the most significant hypothesis regarding the origin of silent ischaemic cardiopathy. The relations between silent ischaemia and aging aren't clear, although age is considered a risk factor in this pathology, in relation to a supposed peripheral neuropathy. In our study we evaluated the trend of pain threshold and of pain tolerance in subjects affected by silent ischaemic cardiopathy; we especially considered the role of aging. We studied 15 subjects with silent ischaemic cardiopathy and 15 with symptomatic cardiopathy; we evaluated the pain threshold and tolerance in three points using short and low frequency transcutaneous electrical impulses. All subjects were male; the exclusion criterion was a high level of anxiety and depression. Pain threshold values were measured with the same method in 40 healthy subjects, 5 per each decade and ranged from 10 to 90 years. Our data show a significant difference in pain threshold and tolerance between subjects affected by silent and non silent cardiopathy (33.9 +/- 12.9 mA vs 25.0 +/- 12.6 mA: p = 0.001 in the comparison of thresholds, and 66.8 +/- 20.9 mA vs 45.0 +/- 21.8: p = 0.000 in the comparison of tolerances). Regarding the higher significance of our data, compared with other studies, we considered the importance of our particular stimulation method and of the uniformity of the studied group. We didn't note any correlation between pain threshold and age. These data suggest that the differences evident between subjects with silent and symptomatic cardiopathy are linked to a different modulation of central pain perception uncorrelated with age.

[Relationship between cholesterol levels and depression in the elderly]. / Associazione tra livelli di colesterolo e depressione nell'anziano.

The aim of our study is to evaluate the possible association between lower plasma cholesterol and depression in the elderly. 140 subjects over 65 years old of both sexes were enrolled, of which 60 were affected by depression (DSM-III-R and Hamilton test) and 80 composed a control group homogeneous for sex and age with the previous one. Plasma cholesterol, HLD-cholesterol (HDL-C), LDL-cholesterol (LDL-C) and triglycerides were measured. A statistically significant difference between cholesterol and LDL-C (p < 0.001) was noted in the total group, in both males and females. Such modifications were independent of sex. In the group with lower cholesterol (cut-off < = 160 mg/dl) a prevalence of depression three times greater than subjects with higher cholesterol was found. In conclusion, the authors recommended a prudent use of lipid-lowering medications in the elderly because of its uncertain benefits.

[Hyperuricemia and cardiac risK factors: epidemiologic study in the aged]. / Iperuricemia e rischio cardiovascolare: studio epidemiologico nell'anziano.

The aim of our study is to evaluate whether hyperuricemia may be considered a cardiovascular risk factor also in the elderly. 370 subjects over 60-years-old of both sexes were examined of which 148 presented an ischemic heart disease and 222, age and sex homogeneous, were considered as control group. Serum uric acid was determined. A strong difference among the two groups (p < 0.001) was statistically demonstrated. Such modifications were sex independent. A strict correlation of hyperuricemia and hyper trygliceridemia was present; in fact high uric acid levels were mostly found in the group with triglycerides > 200 mg/dl (p < 0.02). In the whole group and in males a stability of uric acid was noted. In females a significant increase among the first (60-69 years) and the second (70-79 years) age class was present. In conclusion, a positive role of hyperuricemia in the ischemic heart disease pathogenesis is possible.

[Reflex sympathetic dystrophy of the upper limb secondary to barbiturate treatment. A report of 3 cases and a review of the literature]. / Distrofia simpatica riflessa dell'arto superiore secondaria a trattamento con barbiturici. Descrizione di tre casi e revisione della letteratura.

The authors describe three cases of reflex sympathetic dystrophy of the upper extremity associated with barbiturate therapy and evidence their common clinical aspects and differences. The most recent knowledge and the most important literature relating to this subject are also reported. On the basis of these, personal observations are discussed and some pathogenetic hypotheses formulated.

[Electrophysiologic diagnosis of carpal tunnel syndrome in patients with diabetes mellitus]. / Diagnosi elettrofisiologica di sindrome del tunnel carpale in corso di diabete mellito.

The authors evaluated 406 patients affected by carpal tunnel syndrome diagnosed by clinical and electromyographic data. Diabetes mellitus was recognized in 57 subjects. The others constituted the control group. The severity of the syndrome was similar in both groups. Also similar was the interval between onset and clinical diagnosis. Such parameters and the severity of the syndrome showed no modification with age in the diabetic group. In the control group, carpal tunnel syndrome was more pronounced in the aged patients, presumably for the longest latency of disease. Carpal tunnel syndrome onset was later in diabetic subjects compared the control. At lastly we found a prevalence of bilaterality in diabetics, and an M/F rate comparable in both groups, as described by other authors.

[Carpal tunnel syndrome secondary to repetitive microtrauma. The clinical and electromyographic aspects]. / Sindrome del tunnel carpale secondaria a microtrauma ripetuto. Aspetti clinici ed elettromiografici.

The authors describe 20 cases of carpal tunnel syndrome (cts), caused by repetitive microtrauma at work. The clinical and electromyographic data are compared with a control group (406 pt affected by non traumatic cts). In the control group, the syndrome appeared more frequently in the right side (mostly in men), in relation to the manual dominance. These data suggest that the importance of "physiological traumatism" is decisive in the pathogenesis of the syndrome. Patients affected by microtraumatic stc show a better EN-Graphic pattern versus the control group, likely imputable to a earlier diagnosis.

Clinical and electromyographic evidence of carpal tunnel syndrome in a hypertensive patient with chronic beta-blocker treatment.

We describe a case of carpal tunnel syndrome (CTS) in a hypertensive man on long term treatment with a beta-blocker, propranolol. The clinical and instrumental findings, including MRI at the wrist, excluded all other possible causes of CTS. The improvement in symptoms and electromyographic findings on discontinuation of the drug suggested that the CTS may have been related to the beta-blocker therapy.

Peripheral neuropathy and multiple myeloma in aging: a case report.

A 67-year-old man affected by moderate weight loss, acral paresthesia and plantar burning sensation was admitted to our department. Electromyographic (EMG) and electroneurographic (ENG) studies confirmed a peripheral, asymmetrical, motor-sensorial polyneuropathy (PPN). Hematological data and bone marrow biopsy discovered a non-secerning multiple myeloma (MM). All other probable causes of peripheral neuropathy could be excluded, and the possible relationship between nerve damage and neoplasia was confirmed. Furthermore, all possibilities of association of MM with PPn, namely the osteosclerotic variant, the Crow-Fukase syndrome, and the amyloid one have been evaluated. The only finding of osteolytic bone areas by radiology, the absence of organomegaly, diabetes mellitus, skin alterations, and of amyloid deposition in muscles and nerves, exclude the possible connection of the case to any of the listed possibilities. On the other hand, some clinical aspects differ, in part, to others described in the literature. In conclusion, the association between PPN and MM as the result of multiform clinical variants could be considered.

[Profile of thyroid hormones in aging: evaluation of a hospitalized elderly population]. / Profilo degli ormoni tiroidei nell'invecchiamento: valutazione su di una popolazione anziana ospedalizzata.

The aim of the study is to evaluate thyroid serum levels in a geriatric community to confirm the presence of a low T3 syndrome during normal ageing. The authors consider 413 subjects (125 male and 288 female) admitted to our Geriatric Division. The group affected by thyroid and extrathyroid disease (such us malnutrition, diabetes mellitus, renal failure, etc.) was withdrawn. In the selected patients (271) was operated a statistical evaluation to correlate the hormonal parameters (T3, T4, TSH, FT3, FT4) with age and sex. According to international literature, we confirm a progressive T4 and FT4 reduction (p less than 0.05) during ageing, both in male and in female. These data range within normal values. On the contrary, TSH shows no modifications with age and sex. Unlike all other parameters, T3 presents a more evident decrement with age, confirming a low T3 syndrome.

Biochemical effects of urapidil on red cell membrane ion transport systems in a population of elderly essential hypertensives.

The aim of our work was to verify the effect of urapidil on membrane ion transport systems. This was a randomized, double-blind, cross-over study which evaluated the clinical and biochemical effects of urapidil (30 mg twice daily in comparison with placebo) in a group of 10 elderly hypertensive patients (3 male, 7 female ranging from 68 to 90 years, mean age 79.2 +/- 7.6 years). For the evaluation in fresh erythrocytes of principal ion transport systems (cotransport Na+/K+, countertransport Na+/Li+, Na+/K+ ATPase pump. intracellular Na+ and K+) we used the nystatin technique. We found that urapidil activated the red cell membrane ions cotransport system (basal values: 83.7 +/- 50.3 mumol Na+ RBC 1-1.h-1, after 1 month of urapidil therapy: 181.5 +/- 89.3 mumol Na+ RBC 1-1.h-1) (P less than 0.01), without significant changes in the other biochemical parameters evaluated. Our data suggest that one of the mechanisms of the urapidil antihypertensive effect could involve an increase in the membrane sodium cotransport system.

[Hypercholesterolemia in the aged: rational approach to the problem]. / Ipercolesterolemia nell'anziano: razionale approccio al problema.

While there are definite data showing the correlation between cholesterol level and cardiovascular disease in adults, so far we lack reliable evidence showing hypercholesterolemia to be an important risk factor in the elderly as well. Having examined all available data, the authors come to the conclusion that in elderly subjects, too, hypercholesterolemia should be treated after careful clinical evaluation of every individual case. Whenever possible therapy should be dietary but in light of recent results obtained with HMG-CoA reductase inhibitors which are effective and well tolerated also in the elderly, adequate pharmacological management should also be feasible in this type of patient.

Vasopressin, prolactin and growth hormone in Alzheimer's disease: their evaluation after metoclopramide stimulation.

Recent studies have shown that there is a relationship between an alteration of central neurotransmitters and the modification of some biohumoral parameters in Alzheimer's Disease (AD). In this study the authors evaluated, after metoclopramide (MTC) stimulation, the concentration curve of vasopressin (AVP), prolactin (PRL) and growth hormone (HGH) in the plasma of 34 subjects (20 males and 14 females, mean age 70.5+/-6.9 years; 17 were AD patients, the others constituted the control group). MTC increased AVP serum concentration in healthy (P <0.001), but not in AD patients. This result seemed to be due to the lack of 'procholinergic' action of the drug in the AD patients probably due to an alteration in their cholinergic pathways. The PRL response to MTC was reduced only in the AD female group (P <0.005), suggesting an alteration in dopaminergic control. Lastly, the HGH response in AD did not differ in the two groups, neither in basal conditions, nor after MTC stimulation. The absence of HGH response both in AD and in healthy subjects, demonstrated the ineffectiveness of MTC stimulation. We can conclude that AVP and PRL responses to MTC stimulation efficiently separated the two groups (AD and controls); the former test showing a higher discriminant power than the latter.