Sarcopenic obesity and reduced BMD in young men living with HIV: body composition and sex steroids interplay.

PURPOSE: Sex steroids play a key role on male bone homeostasis and body composition (BC), their role in men living with HIV (MLWH) is less recognized. This study aimed at investigating the prevalence of low BMD, sarcopenia, and sarcopenic obesity (SO) and their relationship with sex steroids in MLWH aged < 50. METHODS: Prospective, cross-sectional, observational study on MLWH younger than 50 (median age 47.0 years). BC and BMD were evaluated with DXA. Two different definitions of sarcopenia were applied: appendicular lean mass/height2 (ALMI) < 7.26 kg/m2 or appendicular lean mass/body weight (ALM/W) < 28.27%. Low BMD was defined for Z-score < -2.0. Sarcopenia coupled with obesity identified SO. Serum total testosterone (T) and estradiol (E2) were measured by LC-MS/MS; free testosterone (cFT) was calculated by Vermeulen equation. RESULTS: Sarcopenia was detected in 107 (34.9%) and 44 (14.3%) out of 307 MLWH according to ALMI and ALM/W, respectively. The prevalence of SO was similar by using both ALMI (11.4%) and ALM/W (12.4%). Sarcopenic and SO MLWH had lower total T and cFT in both the definition for sarcopenia. BMD was reduced in 43/307 (14.0%). Serum E2 < 18 pg/mL was an independent contributing factor for sarcopenia, SO, and low BMD. CONCLUSIONS: T and E2 are important determinants of BC even in MLWH. This is among the first studies investigating the distribution of obesity phenotypes and the prevalence of SO among MLWH showing that SO is present in 11-12% of enrolled MLWH regardless of the definition used. However, deep differences emerged using two different diagnostic definitions.

Application of guidelines for the management of nonalcoholic fatty liver disease in three prospective cohorts of HIV-monoinfected patients.

OBJECTIVES: Current guidelines recommend use of a diagnostic algorithm to assess disease severity in cases of suspected nonalcoholic fatty liver disease (NAFLD). We applied this algorithm to HIV-monoinfected patients. METHODS: We analysed three prospective screening programmes for NAFLD carried out in the following cohorts: the Liver Disease in HIV (LIVEHIV) cohort in Montreal, the Modena HIV Metabolic Clinic (MHMC) cohort and the Liver Pathologies in HIV in Palermo (LHivPa) cohort. In the LIVEHIV and LHivPa cohorts, NAFLD was diagnosed if the controlled attenuation parameter (CAP) was ≥ 248 dB/m; in the MHMC cohort, it was diagnosed if the liver/spleen Hounsfield unit (HU) ratio on abdominal computerized tomography scan was < 1.1. Medium/high-risk fibrosis category was defined as fibrosis-4 (FIB-4) ≥ 1.30. Patients requiring specialist referral to hepatology were defined as either having NAFLD and being in the medium/high-risk fibrosis category or having elevated alanine aminotransferase (ALT). RESULTS: A total of 1534 HIV-infected adults without significant alcohol intake or viral hepatitis coinfection were included in the study. Of these, 313 (20.4%) patients had the metabolic comorbidities (obesity and/or diabetes) required for entry in the diagnostic algorithm. Among these patients, 123 (39.3%) required specialist referral to hepatology, according to guidelines. A total of 1062 patients with extended metabolic comorbidities (any among obesity, diabetes, hypertension and dyslipidaemia) represented most of the cases of NAFLD (79%), elevated ALT (75.9%) and medium/high-risk fibrosis category (75.4%). When the algorithm was extended to these patients, it was found that 341 (32.1%) would require specialist referral to hepatology. CONCLUSIONS: According to current guidelines, one in five HIV-monoinfected patients should undergo detailed assessment for NAFLD and disease severity. Moreover, one in ten should be referred to hepatology. Expansion of the algorithm to patients with any metabolic comorbidities may be considered.

Age of HIV Acquisition Affects the Risk of Multi-Morbidity after 25 Years of Infection Exposure.

INTRODUCTION: Understanding the intersection of HIV, aging and health is crucial due to the increasing number of people aging with HIV. OBJECTIVE: The objective of the study was to assess the prevalence of, and risk factors for individual comorbidities and multi-morbidity in people living with HIV with similar duration of HIV infection, notwithstanding a 25-year difference at the time of HIV acquisition. METHODS: In a cross-sectional multicentre retrospective study, we compared three match-control age groups. The "Young" were selected from Romania and included HIV-positive patients prenatally infected and assessed at the age of 25-30 years. The "Old" and the "Geriatric" were selected from Italy. These respectively included subjects infected with HIV at the age of 25 years and assessed at the age of 50-55 years, and those infected at the age of 50 years and assessed at the age of 75-80 years. Each group was sex and age matched in a 1:5 ratio with controls selected from the CINECA ARNO database from Italy. We described non-infectious comorbidities (NICM), including cardiovascular disease, hypertension, dyslipidaemia, diabetes, chronic kidney disease, and multi-morbidity (MM≥ 3 NICM). RESULTS: MM prevalence in the "Young" group compared to controls was 6.2% vs 0%, while in the "Geriatric" was "68.2% vs 3.6%. Using "Young" as a reference, in multivariate analyses, predictors for MM were as follows: HIV serostatus (OR=47.75, IQR 14.78-154.25, p<0.01) and "Geriatric" vs "Young" (OR=30.32, IQR 5.89-155.98, p<0.01). CONCLUSION: These data suggest that age at acquisition of HIV should be considered as a risk factor for NICM and MM.

The Management of Geriatric and Frail HIV Patients. A 2017 Update from the Italian Guidelines for the Use of Antiretroviral Agents and the Diagnostic Clinical Management of HIV-1 Infected Persons.

OBJECTIVE: This article deals with the attempt to join HIV and geriatric care management in the 2017 edition of the Italian guidelines for the use of antiretrovirals and the diagnostic-clinical management of HIV-1 infected persons. METHODS: The outlined recommendations are based on evidence from randomized clinical trials and observational studies published in peer-reviewed journals and/or presented at international scientific conferences in recent years. The principles of starting antiretroviral therapy in elderly patients and the viro-immunological goals are the same as in the general HIV population. However, there are some specificities to consider, related to the host as well as the therapy itself. HIV care in elderly patients must shift from a combined AntiRetroviral Therapy specific approach to a more comprehensive management, and from a disease-based model (list of co-morbidities) to a multi-morbidity and frailty standpoint. The implementation of a geriatric approach, based on the Comprehensive Geriatric Assessment, is essential and consists of a broader evaluation of health status. This multidimensional and multidisciplinary evaluation is focused on the development of a tailored intervention plan. Polypharmacy is a frequent condition in the older population and an independent risk factor for negative health-related outcomes. This can be overcome with a multidisciplinary and cooperative approach involving HIV specialists, geriatricians and primary care physicians. CONCLUSION: The inclusion of geriatric care becomes necessary due to the novel needs of an evolving patient population. It is important to underline that the HIV specialist will continue to lead multidimensional interventions and optimize quality of care for HIV-positive people.

Sensory and instrumental characterization of fast inverting oil-in-water emulsions for cosmetic application.

OBJECTIVE: The aim of this study was to perform short-term sensory testing and instrumental (conductivity and rheological) characterization of a fast inverted oil-in-water (o/w) emulsion base, also known as a SWOP (Switch-Oil-Phase) emulsion, and reference o/w and water-in-oil (w/o) emulsion bases under various testing conditions: in the presence of ions and at different temperatures. SWOP emulsions are known as metastable o/w emulsions, which invert into w/o emulsions on application of mechanical energy, while rubbing it onto the skin and due to their properties SWOP emulsion are especially suitable as a cosmetic vehicle in, for example, sun-protection products. METHODS: Sensory testing, which included the evaluation of twenty attributes of the investigated emulsion bases, was performed by a panel of 20 healthy assessors experienced in the evaluation of cosmetic products. Rheological characterization of the investigated emulsion bases included continuous flow testing and oscillatory measurements under various testing conditions. Additionally, conductivity measurements were combined with rheological characterization to monitor stability changes of investigated emulsions. The instrumental and sensory results were analysed statistically and compared. RESULTS: The obtained results indicated that the investigated emulsions behaved differently in the presence of ions (originating from artificial sweat solution) and at different temperatures (under storage and application conditions). Namely, the SWOP emulsion showed similar behaviour to the reference o/w emulsion under storage conditions, but in the presence of ions and at skin temperature, the SWOP emulsion was followed by re-establishment of a stable w/o system, whereas reference o/w emulsion was irreversibly destroyed. The statistical analysis of chosen sensorial attributes indicated that the reference w/o emulsion was significantly different in comparison with the reference o/w and SWOP emulsions, mainly, standing in good agreement with the results of rheological characterization. CONCLUSION: The study showed that rheological measurements potentially could be related to certain sensory attributes and used for faster development of SWOP emulsions in the future. Finally, SWOP emulsions should be considered for further investigation as suitable vehicles in cosmetic products due to their favourable physicochemical and sensory characteristics which could be partially predicted with instrumental characterization.

Does oral health counseling effectively improve oral hygiene of orthodontic patients?

AIM: The aim of this study was to compare the effectiveness of oral health counseling sessions with traditional oral hygiene education in orthodontic patients with fixed appliances. STUDY DESIGN: randomised control trial with experimental and control group. A group of 99 adolescents with fixed orthodontic appliances were randomly assigned to oral health counseling (experimental) or traditional health education (control) group. Subjects in the control group received verbal instructions and a demonstration of the modified Bass brushing technique on a model. The experimental group also received the verbal information with demonstration on the model and in addition a personalised 40-minutes counseling session on oral hygiene. Plaque Index (PI) and gingivitis (G) were recorded before, 1 and 6 months after the counseling session/traditional education. RESULTS: Oral health counseling and traditional education improved the oral hygiene of orthodontic patients. PI values were significantly lower after 6 months compared to the baseline in both groups, but the prevalence of gingival inflammation remained significantly lower only in the experimental group. CONCLUSION: Oral health counseling increased plaque removal efficacy and control of gingival inflammation. The efficiency of counseling and traditional education was similar. Counseling is a promising approach that warrants further attention in a variety of dental contexts.

Biodegradation of petroleum sludge and petroleum polluted soil by a bacterial consortium: a laboratory study.

This article presents a study of the efficiency and degradation pattern of samples of petroleum sludge and polluted sandy soil from an oil refinery. A bacterial consortium, consisting of strains from the genera Pseudomonas, Achromobacter, Bacillus and Micromonospora, was isolated from a petroleum sludge sample and characterized. The addition of nitrogen and phosphorus nutrients and a chemical surfactant to both the samples and bioaugmentation to the soil sample were applied under laboratory conditions. The extent of biodegradation was monitored by the gravimetric method and analysis of the residual oil by gas chromatography. Over a 12-week experiment, the achieved degree of TPH (total petroleum hydrocarbon) degradation amounted to 82-88% in the petroleum sludge and 86-91% in the polluted soil. Gas chromatography-mass spectrometry was utilized to determine the biodegradability and degradation rates of n-alkanes, isoprenoids, steranes, diasteranes and terpanes. Complete degradation of the n-alkanes and isoprenoids fractions occurred in both the samples. In addition, the intensities of the peaks corresponding to tricyclic terpenes and homohopanes were decreased, while significant changes were also observed in the distribution of diasteranes and steranes.

Morphology and viscoelastic properties of sealing materials based on EPDM rubber.

In this applicative study, the ratio of active and inactive filler loadings was the prime factor for determining the dynamic-mechanical behaviour of ethylene-propylene-diene monomer rubbers. Scanning electron microscopy was used to study the structure of reinforced dense and microcellular elastomeric materials. The effects of filler and blowing agent content on the morphology of composites were investigated. Microcellular samples cured in salt bath show smaller cells and uniform cell size compared with samples cured in hot air. Dynamic-mechanical thermal analysis showed appreciable changes in the viscoelastic properties by increasing active filler content, which could enable tailoring the material properties to suit sealing applications.

Hydrophilic gels containing chlorophyllin-loaded liposomes: development and stability evaluation.

The aim of this study was to develop and characterize hydrophilic gels containing chlorophyllin(CHL)-loaded liposomes as well as to evaluate their stability. Two different CHL-loaded liposome dispersions using non-hydrogenated and hydrogenated soybean lecithin were prepared, characterized for their particle size, polydispersity index and trapping efficiency and incorporated in Carbopol 940 NF hydrogel. The gels obtained were analyzed for flow properties, pH values and CHL content. The control liposome-free gel was obtained by incorporating the CHL solution in the hydrogel. The stability of the gels was evaluated in terms of rheological properties, pH values and CHL content during 6 months' storage at 20 +/- 2 degrees C. Suitable gel formulations for topical use were obtained revealing shear-thinning plastic flow behaviour without significant thixotropy during the whole period of examination. High yield values of the samples during the whole period indicated a long-term stability of the gel formulations. The gel formulations expressed a mild acid value acceptable for topical preparations. After 6 months' storage the CHL content was highest in the gel containing non-hydrogenated lecithin liposomes, followed by the gel containing hydrogenated lecithin liposomes and liposome-free gel, indicating that the encapsulation of CHL in liposomes led to a greater stability of CHL.

Vehicle-controlled effect of urea on normal and SLS-irritated skin.

It is known that, depending on the concentration, treatment with urea could improve skin barrier function, despite its penetration-enhancing properties. This controversial skin effect of urea has been explored systematically in this study in terms of the effect of vehicle on the performance of urea. In the first part, a series of four semi-solid emulsions with 5% (w/w) urea, varying in the type of emulsion, nature of emulsifier and polarity of oil ingredients, have been evaluated with regard to their skin hydrating and transepidermal water loss (TEWL)-modifying properties. Placebo samples were tested alongside the urea-containing ones. Two best performing moisturisers from the above were chosen for the second part of the study, in which sodium lauryl sulphate (SLS)-irritated skin was treated with both placebo and urea-containing samples. In addition to TEWL and skin hydration level, the erythema index (EI) was measured before, during and after the treatment. The results have shown that barrier-improving and hydrating abilities of urea are bi-directional and dependent on both the type of vehicle used for its delivery and the state of skin.

Polymer-stabilized emulsion systems: structural characteristics and physical stability evaluation.

In the course of investigation of the effects of polymeric emulsifier (Simulgel A) on the structural characteristics and physical stability (during storage time) of semisolid o/w emulsion systems with different emulsifier concentrations, dispersed droplets of an internal oil phase (4.5-11.5 microm size) were discovered. The degree of dispersity was increased along with increasing polymeric emulsifier concentration (from 1 to 5% m/m), which was shown by microscopic analysis. Experiments were also carried out using pH, electrical conductivity, and rheological (rotational and oscillatory) measurements. Emulsion samples expressed a mild acid value acceptable for topical preparations during a 6-month period. Electrical conductivity of fresh samples ranged from 0.423 to 2.009 mS/cm and after a 6-month period this slightly increased to 0.663-2.890 mS/cm. All emulsion samples revealed plastic flow behavior in fresh state, with changes in flow pattern during storage time. Viscoelastic properties defined by the oscillatory rheometry results were in good correlation with parameters of rotational rheometry and degree of internal phase dispersity. High yield stress values (flow tests) and favorable low values of damping factor (oscillatory studies) both indicated good internal structuring and long-term stability of sample containing 3% m/m of polymeric emulsifier.

Assessment of Efficiency of Repellent Formulations with N,N-diethyl-m-toluamide in Laboratory Conditions.

The affinity of N,N-diethyl-m-toluamide) (DEET) for various polymers that are potential inert carriers (PEG, PVP, NaCMC, PAA) was studied. Mixtures of DEET and the polymers were prepared and analysed for DEET vapour release using head space analysis. Polyvinylpyrrolidone (PVP) showed the highest affinity for DEET. Several insect repellent formulations in the form of a hydrogel, an o/w cream and a stick were prepared with 5% w/w DEET and either 1% w/w or no PVP. The release of DEET from the formulations was investigated by Head Space gas-mass spectrometry at 32 degrees C. The degree of absorption of DEET through the skin was evaluated by applying these topical preparations to shaved rabbit skin and measuring DEET content in the blood samples by gas-mass spectrometry at various time intervals after application. Based on these results the pharmacokinetic parameters were determined. The minimum penetration of DEET through rabbit skin was obtained with a hydrogel containing PVP as a carrier. The biological efficiency of repellent formulations containing 5% DEET (w/w) was evaluated for repellency using the mosquito Aedes aegypti. The results demonstrated that the hydrogel formulation based on polyacrylic acid containing 5% DEET (w/w) supplemented with 1% PVP (w/w), could serve as a suitable vehicle for repellent preparations containing DEET.

An investigation into the use of thermorheology and texture analysis in the evaluation of W/O creams stabilized with a silicone emulsifier.

The aim of the study was to evaluate a range of W/O semisolid emulsion systems (creams) containing white soft paraffin (petrolatum) and a new type of nonionic lipophilic silicone emulsifier (Abil EM 90) using a novel combination of rheological tests. Emulsifier concentrations from 1.5% to 3.0% w/w were used with two manufacturing procedures, cold (25 degrees C) and warm (70 degrees C) emulsification, to determine whether and to what extent these variables alter the structure and consistency of the creams. The techniques comprised linear (continuous flow) and dynamic (oscillatory) rheometry at 25 degrees C, thermal flow experiments (from 10 degrees to 90 degrees C and back to 10 degrees C), and penetrometry studies. The differences in emulsifier concentration produced effects on the rheological properties of the W/ O creams, although the manufacturing process was much more influential. Cold emulsification led to creams with higher viscosity, lower thixotropy, and better elastic properties. The results of penetration tests on creams correlated with those of the rheological studies. The flow properties of white soft paraffin at 25 degrees C were comparable with the creams obtained by cold emulsification, while the elasticity was considerably lower. Thermorheological studies showed evidence for transitional behavior for white soft paraffin on heating, but not for the creams. White soft paraffin showed a higher viscosity (and resistance to the penetrating force) when melted at 70 degrees C and left to solidify at room temperature, compared to the "unmelted" sample. This was the opposite trend to that found with warm and cold emulsified creams. The input of heat during the emulsification process showed a strong effect on the structure and consistency of the W/O creams containing petrolatum and silicone emulsifier, resulting in a less viscous product. The use of the aforementioned techniques represents a useful and novel approach to the evaluation of cream consistency.

Recalled parent-child relations and need for approval of homosexual and heterosexual men.

Young adult male homosexuals were recruited from a homosexual group and were given the Roe-Siegelman Parent-Child Relations questionnaire and the Marlowe-Crowne social desirability scale. Compared to a control group of heterosexuals, the homosexual group rated their mothers significantly more rejecting and their fathers less loving and more rejecting. The Love-Reject factor also showed the between-groups difference for the ratings of fathers; for mothers, the Love-Reject factor difference was marginally significant. The homosexual group also had a significantly higher mean score on the social desirability scale. This study, using direct subject selection and control of test administration, gives a close replication of important parts of Siegelman's (1974) results, especially the ratings of fathers' child-rearing practices and the homosexual-heterosexual difference on the social desirability scale.