bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dietary fat plays a major role in obesity: no
Authors: Willett W. C. 
Published: March 2003

SummaryThe percentage of dietary energy from fat has been suggested to be an important determinant of body fat, and this presumed effect has been invoked to justify the general promotion of low‐fat diets. Dietary fat and the prevalence of obesity are lower in poor countries than in affluent countries. However, these contrasts are seriously confounded by differences in physical activity and food availability; within areas of similar economic development, per capita intake of fat and the prevalence of obesity have not been positively correlated. Randomized trials are the preferable method for evaluating the effect of dietary fat on adiposity because they avoid problems of confounding that are difficult to control in other studies. In short‐term trials, a small reduction in body weight is typically seen in individuals randomized to diets with a lower percentage of calories from fat. In a meta‐analysis of these trials, it was estimated that a decrease in 10% of energy from fat would reduce weight by 16 g d–1, which would correspond to a 9‐kg weight loss by 18 months. However, compensatory mechanisms appear to operate because in trials lasting one year or longer, fat consumption within the range of 18–40% of energy has consistently had little, if any, effect on body fatness. Moreover, within the United States (US), a substantial decline in the percentage of energy from fat during the last two decades has corresponded with a massive increase in obesity, and similar trends are occurring in other affluent countries. Diets high in fat do not account for the high prevalence of excess body fat in Western countries; reductions in the percentage of energy from fat will have no important benefits and could further exacerbate this problem. The emphasis on total fat reduction has been a serious distraction in efforts to control obesity and improve health in general.
Epidemiological study on obesity and its comorbidities in urban Chinese older than 20 years of age in Shanghai, China
Authors: Jia WP. , Xiang KS. , Chen L. , Lu Jx. , Wu YM. 
Published: March 2003

SummaryThe aim of this work was to establish the prevalence of overweight and obesity and its associated comorbidities in a Chinese population older than 20 years of age. A group of 2776 randomly selected adults (20–94 years of age) living in the Huayang Community in Shanghai, China, were investigated between 1998 and 2000. Body weight, height, waist and hip circumferences and blood pressure were measured, as were fasting blood glucose, fasting insulin and lipid profile, as well as blood glucose 2 h after a glucose load, and a 75‐g glucose tolerance test was performed. The prevalence of overweight was 29.5% and obesity was 4.3%, with a greater number of women being obese than men. More than one‐third of the population had abnormal lipid levels. Impaired glucose regulation (IGR) occurred in 10.8%; and 9.8% of the population were classified as having type 2 diabetes mellitus. Hypertension was present in 58.4% of this population. About 21% and 29.3% of the population suffered from high total cholesterol and high triglyceride, respectively. The prevalence of metabolic syndrome was 10.2%. The prevalence of diabetes, IGR and metabolic syndrome increased progressively in association with a body mass index (BMI) of >23 kg m−2. Hence, although the prevalence of obesity is low in this Chinese population, higher BMI and waist circumference values are clearly associated with an increasing prevalence of comorbidities. The absolute risk of having diabetes, IGR and metabolic syndrome is high in adults with a BMI of ≥23 kg m−2.
Morphological and Immunophenotypic Features of Chronic Lymphocytic Leukemia
Authors: Matutes Estella , Polliack Aaron 
Published: March 2003

In this review, we summarize the morphological features and immunophenotypic profile of chronic lymphocytic leukemia (CLL) cells, discuss the value of these investigations as front line diagnostic tests, and emphasize their correlation with the clinical features, disease progression, molecular genetics and pathogenesis of CLL.In CLL, the morphology of the circulating cells is characteristic and typical in the majority of cases. However, 15% of patients, either at diagnosis or during the course of the disease, show atypical morphology reflected by either (1) an increased (>10%) number of circulating prolymphocytes, designated CLL/PL, or
(2) an increased (>15%) number of circulating lymphoplasmacytic and cleaved cells, designated ‘atypical’ CLL. There is strong evidence of a close association between atypical morphology (CLL/PL) and atypical (CLL) and clinical features, e.g. disease progression, advanced stage and survival, molecular genetics, particularly trisomy 12, but also the rare cases with t(11;14) or t(14;19), p53 abnormalities, unmutated immunoglobulin (Ig) VH genes and origin of the cell (naive, pregerminal center cell).CLL cells have a distinct immunological repertoire different from that of other lymphopro‐liferative disorders. The typical CLL phenotype is CD5+, CD23+, FMC7–, weak expression of surface Ig (sIg) and weak or absent expression of membrane CD22 and CD79b. The latter marker identifies an extracellular epitope of the B‐cell receptor (BCR) β chain and its weak or absent expression in CLL may derive from the expression of a truncated form. This, together with the low expression of CD22, might explain the abnormal signal transduction of CLL cells similar to that of anergic B lymphocytes. Because no single marker is specific for CLL, a composite phenotype considering this set of 5 or 6 markers compounded into a scoring system helps to distinguish CLL from the other B‐cell malignancies. Immunophenotypic analysis has also been shown to be useful for minimal residual disease detection and adds valuable prognostic information because the expression of certain markers, such as FMC7 or CD38, seems to be associated with a poor outcome.In addition, CLL cells express a variety of Bcl‐2 family proteins with a profile that favors inhibition of apoptosis which, together with the interaction with microenvironmental (e.g. stromal) cells and the release of cytokines, explains the long life span and subsequent accumulation of CLL cells in various organs. Despite controversies relating to the expression of adhesion molecules (selectins and integrins) in CLL cells, it appears that some of these molecules do play a role in the pathogenesis, biology and clinical patterns of the disease. In conclusion, morphology and immunophenotype are the two essential investigations, which must be carried out in all cases of CLL. Both provide relevant information in terms of diagnosis, course of the disease, prognosis and pathogenesis.
Differential metabolic response in AIDS‐related chronic protozoal diarrhoea
Authors: Sharpstone D. , Phelan M. , Gazzard B. 
Published: March 2003

Objective As the pro‐inflammatory cytokine tumour necrosis factor‐alpha is greater in microsporidiosis than cryptosporidiosis, there may be a distinct metabolic response between the two organisms. Design Male HIV seropositive subjects with an untreated AIDS‐defining diagnosis of microsporidiosis or cryptosporidiosis had measurement of oxygen consumption and carbon dioxide production by indirect calorimetry and body composition analysis to express resting energy expenditure (REE) and substrate oxidation per kilogram of metabolically active tissue. Methods Resting energy expenditure (REE), non‐protein respiratory quotient (NPRQ), fat and carbohydrate oxidation were calculated from respiratory gas analysis. Fat, fat‐free and appendicular muscle masses were measured by dual‐energy X‐ray absorptiometry. Subjects with protozoal diarrhoea were compared to other newly diagnosed, active opportunistic infections. Controls were asymptomaticHIV‐seropositive men matched by peripheral CD4 count. Results Seven subjects with microsporidiosis and six with cryptosporidiosis were compared with 24 subjects with other AIDS‐defining diagnosis (Pneumocystis carinii pneumonia, cytomegalovirus enteritis and Mycobacterium avium‐intracellulare) and 10 controls free from secondary infection. Subjects with cryptosporidiosis had a decreased REE, a significantly increased NPRQ (P< 0.05), decreased fat oxidation (P < 0.05) and increased carbohydrate oxidation compared to microsporidiosis. Subjects with other AIDS diagnoses had an increased REE (P < 0.01) and fat oxidation and decreased carbohydrate oxidation compared to cryptosporidiosis, and a similar metabolic response to microsporidiosis. Conclusions The metabolic response to cryptosporidiosis differs from microsporidiosis and associated weight loss may be mediated by different mechanisms. Metabolism in other AIDS diagnoses, including microsporidiosis, is compatible with a cachectic response.
Detection of Mycoplasma fermentans in broncho‐alveolar lavage fluid specimens from AIDS patients with lower respiratory tract infection
Authors: Ainsworth Jg , Clarke J , Lipman M , Mitchell D , Taylor‐Robinson D 
Published: March 2003

Objective  To investigate the role of Mycoplasma fermentans in lower respiratory tract disease of HIV‐positive patients.Methods  A polymerase chain reaction (PCR) assay was used to detect M. fermentans in broncho‐alveolar lavage (BAL) fluid and peripheral blood mononuclear cells (PBMCs) collected from 78 hospitalized HIV‐positive patients with lower respiratory tract disease (the index group). BAL specimens were also assessed from two control groups; 25 HIV‐positive patients without respiratory symptoms and 46 patients with a respiratory illness who did not have risk factors for HIV.Results  Seventy‐one (91%) of the 78 patients who comprised the index group had AIDS. Sixty‐one patients provided BAL and PBMC specimens; 16 provided a BAL specimen and one only a PBMC specimen; 15 (25%) of the 61 patients had M. fermentans positive BAL fluid, of whom 10 (67%) also had a positive PBMC specimen. In contrast, of the 46 patients who had a negative BAL fluid, only three (6.4%) had a positive PBMC sample (P < 0.00001 Fisher's exact test). Overall, 21 (27%) of 77 patients had M. fermentans positive BAL fluid. Of these positive patients, 16 also had another microorganism in the BAL fluid and for five patients M. fermentans was detected alone. Compared with patients in the index group, none of the 46 BAL fluid specimens from patients at low risk of HIV infection was M. fermentans positive (P < 0.001, χ2 15.13). Two (8%) of the 25 HIV‐positive patients without respiratory symptoms had a M. fermentans positive BAL fluid, positivity that was also statistically different from the index group (P = 0.045, χ2 4.01).Conclusions  M. fermentans frequently invades the lower respiratory tract of AIDS patients as an opportunist and may cause disease in some.
The impact of the M184V substitution in HIV‐1 reverse transcriptase on treatment response
Authors: Miller V , Stark T , Loeliger AE , Lange JMA 
Published: March 2003

The M184V mutation in the HIV‐1 reverse transcriptase gene is primarily associated with rapid, high‐level lamivudine (3TC) resistance. It has also been observed to arise under selective pressure by abacavir, to which it confers low‐level resistance.Although the development of viral drug resistance remains a major concern in antiretroviral therapy, it is known that some immunological and clinical benefit can still be derived from highly active antiretroviral therapy (HAART) regimens despite resistance‐associated virological failure. This residual benefit on a failing regimen is commonly attributed to the preservation of fitness‐reducing protease inhibitor (PI) resistance mutations under continued drug pressure. However, fitness‐reducing nucleoside reverse transcriptase inhibitor (NRTI) mutations may also contribute to the effect. M184V is both common in the treated population and fitness‐reducing. A number of studies, both of dual nucleoside therapy and HAART, have noted a residual treatment effect for 3TC despite the assumed or observed presence of M184V and high‐level phenotypic resistance. The speed and consistency with which this mutation is selected by 3TC under suboptimal viral suppression therefore makes M184V a particularly interesting model for further clinical studies on the association of drug resistance with ongoing treatment benefit.While fitness considerations are likely to be a major contributor to the clinical observations noted, there are a number of other potential mechanisms that may contribute to a continuing response to 3TC in the presence of M184V. These include the delay and reversal of zidovudine (ZDV) resistance, hypersensitization to other NRTIs, reduced reverse transcriptase (RT) processivity and a possible reduction in RT pyrophosphorolysis.The full impact of M184V on therapeutic prospects will require further elucidation; ideally, the risk/benefit of preserving this substitution would be investigated in randomized trials. However, existing data suggest that the presence of this mutation may preserve some benefit in spite of the loss of 3TC susceptibility which, with further study, may prove valuable.
Cellulite: a review
Authors: Rossi Ana Beatris R , Vergnanini André Luiz 
Published: March 2003

AbstractGynoid lipodystrophy (cellulite) is an extremely controversial topic. A lack of knowledge regarding specific aetiopathogenic factors, as well as the opportunism of some professionals and the media, has fuelled debate regarding the scientific basis of this condition. This article reviews the clinical, epidemiological, histopathological and therapeutic aspects of cellulite.
Purpuric contact dermatitis in patients with allergic reaction to textile dyes and resins
Authors: Lazarov A , Cordoba M 
Published: March 2003

Abstract Background Purpuric lesions have been described as an uncommon manifestation of allergic contact dermatitis in individual case reports. Objective We describe a series of patients who developed purpuric allergic contact dermatitis to textile dyes and resins in their personal clothing. Our purpose was to study the patients clinically and histopathologically and to define the most frequent allergens, which cause purpuric allergic contact dermatitis. Methods One hundred and three patients were clinically evaluated and tested with the Textile Color & Finish Series (TCFS) (Chemotechnique Diagnostics) and Standard Series (TRUE Tests) because of suspected allergic contact dermatitis (ACD) to clothing. The patients with clinical features of purpura as presenting sign of ACD were studied. Biopsies from the purpuric lesions were performed in three patients. Results Thirty of the 103 patients (29.1%) had positive reaction to an allergen from the TCFS. Clinically purpuric ACD was observed in 8.7% of all the cases studied (n = 9 of 103). Nine of the 30 patch‐positive patients to the TCFS (30%) demonstrated purpuric macules, papules and patches. Patch testing of the nine patients with purpuric contact dermatitis, with the TCFS, resulted in 26 positive patch test results. The major causative allergens were the following: Disperse Blue 106 and Disperse Blue 124 in 26.9% each, Disperse Blue 85 in 11.5%, and ethyleneurea melamine formaldehyde in 7.7%. Positive patch tests were observed to dimethylol dihydroxyethyleneurea, dimethylol propyleneurea, tetramethylol acetylenediurea, urea formaldehyde, melamine formaldehyde, Disperse Red 17, and Basic Red 46 3.8% in each. Purpuric patch test reaction was observed in five cases. The patch test results had present relevance in all the cases. Lesional biopsies demonstrated acanthosis, spongiosis and parakeratosis. The blood vessels were dilated, without signs of vasculitis. The inflammatory infiltrate was composed of lymphocytes and erythrocytes. The extravasated erythrocytes had a perivascular and interstitial distribution in the superficial and deep plexus and were observed at the dermo–epidermal junction as well as in the epidermis. Conclusion Purpuric contact dermatitis is not an uncommon clinical form of ACD to textile dyes and resins. New allergens, which can evoke the development of purpuric allergic contact dermatitis and have not been described in the literature until now include: ethyleneurea melamineformaldehyde, dimethylol dihydroxyethyleneurea, tetramethylol acetylenediurea, urea formaldehyde, melamine formaldehyde and Disperse Red 17.
Nail changes in Langerhans cell histiocytosis
Authors: Jain Sanjiv , Sehgal Virendra N , Bajaj Pramila 
Published: March 2003

AbstractNail changes in Langerhans cell histiocytosis are distinctly uncommon. Paronychial erythema, swelling and subungual pustules of the fingernails and toenails were cardinal, and were supported by diffuse as well as dense collections of mononuclear Langerhans cells evidenced by microscopic investigation. Oral administration of co‐trimoxazole (800 mg sulphamethoxazole + 160 mg trimethoprim) every 12 h, 50 mg/d cyclophosphamide and 80 mg/d predinisolone were the mainstay of treatment, supported by scalp tar shampoo and local betamethasone lotion application.
Aetiological factors in vulvar dermatitis
Authors: Crone Am , Stewart Ejc , Wojnarowska F , Powell Sm 
Published: March 2003

AbstractAim To determine aetiological factors in vulvar dermatitis.Background Dermatitis of the vulva is a common clinical diagnosis in the specialized vulva clinic, although the exact prevalence is unknown. Aetiological factors are poorly understood in particular the incidence of atopy and seborrhoeic dermatitis. Other factors implicated are iron deficiency and exogenous causes such as contact irritants and allergens.Methods During a 1‐year period, 38 patients with an initial clinical diagnosis of vulvar dermatitis were questioned, examined and investigated with full blood count, serum ferritin, bacterial swab where indicated and punch biopsy. After three patients had been excluded with other diagnoses, prick testing and patch testing were carried out.Results Of the 35 patients with vulvar dermatitis, 34 (97%) had either an atopic background and/or seborrhoeic dermatitis. Iron deficiency occurred in seven patients (20%) and relevant positive patch tests in nine patients (26%). Twenty patients had biopsies and all had confirmatory histology.Conclusion This study suggests that the main aetiological factor in vulvar dermatitis is an endogenous predisposition. Iron deficiency may also contribute, while contact with irritants and allergens may explain the localization and frequently complicates and exacerbates the picture. Secondary sensitization to multiple substances is common.
Erythromelalgia in a patient with AIDS
Authors: Mørk Cato , Kalgaard Ole M , Myrvang Bjørn , Kvernebo Knut 
Published: March 2003

AbstractErythromelalgia is a clinical syndrome characterized by burning pain in the extremities together with erythema and increased skin temperature. Typically, the patients experience relief from cold, and aggravation from warmth. Symptoms are hypothesized to be caused by arteriovenous shunting and reduced nutritive skin capillary perfusion with corresponding tissue hypoxia. Erythromelalgia is most often primary, but may be secondary to a wide variety of diseases. We report erythromelalgia in a patient with acquired immune deficiency syndrome (AIDS). At peak pain intensity he actively cooled hands and feet for more than 12 h/day. Many doctors handling human immunodeficiency virus/AIDS patients are unfamiliar with erythromelalgia, and the condition can easily be overlooked, especially the more common milder cases.
Second malignancies in melanoma patients in Thuringia
Authors: Wolff J , Wollina U 
Published: March 2003

AbstractObjectiveThe incidence of melanoma is increasing. Melanoma patients are at risk for the development of second neoplasias. Data for the new German Bundesländer are not available, but would be suitable to define frequency, site and type of secondary malignancies and conclusions for follow‐up of melanoma patients.DesignRetrospective study at the Melanoma Outpatient Clinic of the Department of Dermatology and Allergology at the University of Jena (Germany) for patients seen between June 1966 and June 1999. To investigate the impact of second malignancies on survival a case‐comparison study of mortality was performed. The log‐rank test and χ2 ‐test were used to investigate statistical significance. There were 554 patients with malignant melanoma, 237 male and 317 female, with an age at time of diagnosis between 17.0 and 90.1 years (mean 53.7 years). The mean follow‐up was 5.6 years.ResultsSixty‐one patients (11.0%) developed a second tumour. The total number of tumours was 83. Forty‐five patients developed one, 16 developed ≥ 2 second tumours. Basal cell carcinoma (BBC) was the most frequent neoplasia (17 patients, 22 tumours; mean age 64.9 years). A second melanoma was found in 15 patients, while two developed a third melanoma. The mean tumour thickness was 0.81 mm (in second or third melanomas) compared with 1.92 mm of primary melanomas. Seven female patients developed breast cancer (eight cancers; mean age 57.3 years). The other second tumours included skin cancer (eight), gastrointestinal tract tumours (four), genital cancers (19), brain tumours (two), lung cancer (two) and other tumours (six). The difference in survival of patients with second tumours was not statistically significant from age‐, sex‐ and melanoma thickness‐matched controls.ConclusionsSecond malignancies were seen in 11.0% of melanoma patients. Most important are second skin tumours such as second melanomas and BCC, recommending follow‐up by the dermatologist. In a group of patients with regular follow‐up examinations, no negative impact of second tumours (BCC, melanoma, breast cancer) on overall survival could be detected.
Photosensitivity induced by oral itraconazole
Authors: Alvarez‐Fernández Jg , Castaño‐Suárez E , Cornejo‐Navarro P , Gómez de la Fuente E , Ortiz de Frutos Fj , Iglesias‐Diez L 
Published: March 2003

AbstractA case of photosensitivity induced by itraconazole is reported. A 70‐year‐old woman had erythema, oedema and vesicles on sun‐exposed areas after 5 days of itraconazole treatment for oral candidiasis. Oral photochallenge using itraconazole and sun irradiation was positive, but photopatch test was negative. Photosensitivity from azoles is an uncommon adverse effect. Only three other cases have been described, two induced by ketoconazole and one by itraconazole.