Prevalence and risk factors of lipohypertrophy in insulin-injecting patients with diabetes.

INTRODUCTION: Our objective was to assess the frequency of lipohypertrophy (LH) and its relationship to site rotation, needle reuse, glucose variability, hypoglycaemia and use of insulin. METHODS: The study included 430 outpatients injecting insulin who filled out a wide-ranging questionnaire regarding their injection technique. Then, a diabetes nurse examined their injection sites for the presence of LH. RESULTS: Nearly two-thirds (64.4%) of patients had LH. There was a strong relationship between the presence of LH and non-rotation of sites, with correct rotation technique having the strongest protective value against LH. Of the patients who correctly rotated sites, only 5% had LH while, of the patients with LH, 98% either did not rotate sites or rotated incorrectly. Also, 39.1% of patients with LH had unexplained hypoglycaemia and 49.1% had glycaemic variability compared with only 5.9% and 6.5%, respectively, in those without LH. LH was also related to needle reuse, with risk increasing significantly when needles were used > 5 times. Total daily insulin doses for patients with and without LH averaged 56 and 41 IU/day, respectively. This 15 IU difference equates to a total annual cost to the Spanish healthcare system of > €122 million. This was also the first study in which the use of ultrasound allowed the description of an "echo signature" for LH. CONCLUSION: Correct injection site rotation appears to be the critical factor in preventing LH, which is associated with reduced glucose variability, hypoglycaemia, insulin consumption and costs.

Peripheral intravenous catheter use in Europe: towards the use of safety devices.

BACKGROUND: Peripheral intravenous catheters are among the most widely used medical devices in the world. European patients are increasingly aware of the risk of health care associated infections and the role catheters play in their facilitation. AIMS: We intend to show that European health care providers are increasingly aware of the occupational risks of bloodborne infections such as HIV and hepatitis which can be transmitted by the needles from catheters and that the political will is building to take action to ensure safer devices are provided. METHODS: We review the wide variety of peripheral intravenous catheters which are specially engineered to reduce these risks. RESULTS: Available safety devices include spring-loaded retractable needles, guards that shield the dangerous tips and closed, needle-free access valves for intravenous sets. CONCLUSIONS: It is no longer necessary for patients and professionals to take risks to health and life when solutions which minimize these risks are at hand.

Matching the peripheral intravenous catheter to the individual patient.

Up to eighty percent of all patients admitted to hospital worldwide will receive a peripheral IV and this procedure is now considered indispensable to human health. However, despite its global use, the choice of catheter is not always governed by clear and universal guidelines. After reviewing the few best-practice recommendations which exist, we propose a patient--and therapy--driven matrix for deciding on the gauge and length of peripheral catheter for the individual patient. This matrix takes patient age, clinical stability, current state of veins, therapy duration and the nature of the medication to be delivered into consideration. Use of such a matrix will not deliver a formulaic answer but will orient choices along logical, evidence-based lines. This approach will be an advance on the all-too-common reliance on habit and tradition in the choice of peripheral IV catheter.

131I dose-dependent thyroid autoimmune disorders in children living around Chernobyl.

We assessed the major lymphocyte subsets in the peripheral blood, thyroid ultrasonography, levels of serum autoantibodies to thyroglobulin (AbTg), thyroid hormones, and thyroid-stimulating hormone (TSH) in 53 children without any chronic diseases living continuously around Chernobyl. The subjects ranged in age from 7 to 14 years and had different doses of 131I to their thyroid. Healthy children living on noncontaminated areas were assessed as controls. The majority of children with doses of 131I had normal levels of thyroid hormones. However, the percentages of positive sera for AbTg, TSH levels, ultrasonographic thyroid abnormalities, and abnormal echogenicity were significantly higher in children with doses of 131I than in controls. The dose of 131I to thyroid correlated positively with serum AbTg levels, percentage of CD3+CD4+ cells, and CD3+CD4+/CD3+CD8+ cell ratio and negatively with number of CD3+CD8+ and CD3-/CD16, CD56+ cells. Thus, our study demonstrates an association between dose of 131I and autoimmune thyroid disorders in this population of children.

Analysis of blood lymphocyte subsets in children living on territory that received high amounts of fallout from Chernobyl accident.

The major lymphocyte subsets in the peripheral blood were assessed in 120 children 6-13 years old living on areas that received high levels of radioactivity as fallout after the Chernobyl nuclear power plant accident. Seventy-one of the children were suffering from recurrent respiratory disease (RRDC) and 49 were not (non-RRDC). As controls, a total of 87 RRDC and non-RRDC living on noncontaminated areas were evaluated. We did not find significant differences in major lymphocyte subsets between the values in non-RRDC living on radionuclide-contaminated areas and noncontaminated areas. However, RRDC living on radionuclide-contaminated areas had a significantly lower percentage of CD3+ T and CD3+CD4+ T-helper/ inducer cells compared to control RRDC. Furthermore, the decrease in percentage of CD3+CD4+ cells was more profound in RRDC living in radiation-contaminated settlements with an average summary dose (ASD) Cs-137(134) and Sr-90 for the population > 1.0 mSv than in RRDC living in contaminated settlements with an ASD Cs-137(134) and Sr-90 < 1.0 mSv. These data indicated that long-time exposure to small doses of radiation could affect the immune system in children living around Chernobyl.

Can repeated plasma donation by asymptomatic HIV-infected individuals delay the onset of AIDS?

Healthy HIV-positive regular donors of plasma in a programme of passive immunotherapy for AIDS patients were studied over a period of about two years. None developed symptoms of clinical progression; most seemed to make substantial gains of CD4 cells by comparison with asymptomatic individuals who were not donating. The effects of donation did not seem to diminish with repetition, and donor CD4 counts tended towards stabilizing within normal limits. Asymptomatic HIV-positive individuals were compared immunologically with 'normals' and people with AIDS, using a battery of 25 measurements on peripheral blood. The immunological profiles of donor and non-donor asymptomatics, indistinguishable at the start, became dissimilar: donors' profiles resembled AIDS less, non-donors became less like 'normal' and a few non-donor results could not be distinguished from AIDS. Improvement in the CD4 counts and amelioration of the immunological profile in donors provide prima facie evidence that plasmapheresis may be therapeutic for asymptomatic HIV-positive people. Further studies are justified.

Determination of T-lymphocyte subsets on site in rural Tanzania: results in HIV-1 infected and non-infected individuals.

With the FACSCount flow cytometer, counts of CD4, CD8 and CD3 lymphocytes and CD4/CD8 ratios were performed in a rural hospital in Tanzania. A total of 168 subjects (21 HIV-1 seropositive and 147 HIV-1 seronegative) were tested as part of a population-based serosurvey and AIDS education programme; 134 other subjects were hospitalized patients who had signs and symptoms suggestive of AIDS (69 HIV-1 seropositive and 65 HIV-seronegative). Mean values for the 147 HIV-1 seronegative subjects from the local population were 980 CD4 cells (95% CI 930, 1031), 598 CD8 cells (560, 635) and CD4/CD8 ratio 1.78 (1.68, 1.89). Seropositive subjects from the local population had significantly lower CD4 cell counts, higher CD8 counts and a lower CD4/CD8 ratio. CD4 cells were significantly lower and CD8 cells significantly higher in HIV-1 seropositive hospital patients compared to HIV-1 seronegative patients. However, 23 (35%) seronegative hospital patients had CD4 counts lower than 600. These results establish baseline values for the lymphocyte subsets in this population and indicate that this technique can be used in remote areas to monitor progress of HIV-infected individuals.

Correlation of CD8 lymphocyte activation with cellular viremia and plasma HIV RNA levels in asymptomatic patients infected by human immunodeficiency virus type 1.

The relationship between CD8 lymphocyte phenotypic alterations and virological parameters was studied in 47 asymptomatic subjects with human immunodeficiency virus type 1 (HIV-1) infection and CD4 T cell counts above 400/microliters. CD8 subsets were examined by means of three-color flow cytometry, using an extensive panel of monoclonal antibody combinations. Virological parameters were measured by both end-point dilution culture of peripheral blood mononuclear cells (PBMCs) and plasma and branched-DNA (bDNA) signal amplification of plasma HIV RNA. Whereas HIV-infected patients had a near-normal CD4 cell count (mean, 782 cells/microliter), several subsets of activated CD8 cells were markedly expanded relative to values in 23 HIV-seronegative controls. The PBMC cultures were positive in 38 cases and plasma HIV RNA was detected in 31. The percentage of CD4 cells correlated negatively with both cellular viremia and plasma HIV RNA levels. Conversely, a positive correlation was observed between viral load and the percentage of CD8 cells. Among CD8 lymphocytes, the CD38+CD8 and HLA-DR+CD8 subsets correlated best with viral load. Three-color analysis showed that the subpopulations involved in this relationship were CD38+HLA-DR+, CD38+CD28-, HLA-DR+CD28+, HLA-DR+CD57-, CD38+CD57-, CD38+CD45RO+, and HLA-DR+CD45RO+. Our data provide the first evidence that viral load correlates with subsets of activated CD8 lymphocytes in asymptomatic HIV-infected subjects who have near-normal numbers of CD4 lymphocytes.

Endocrine complications of the acquired immunodeficiency syndrome.

Endocrine syndromes in human immunodeficiency virus infection, although not as common as infectious, renal, or neurologic manifestations, are now more frequently recognized. These include unique thyroid function abnormalities, adrenal insufficiency, electrolyte abnormalities, hypogonadotrophic hypogonadism, and multiple endocrine side effects of medications used to treat complications of human immunodeficiency virus infection.