Premature Decline of Serum Total Testosterone in HIV-Infected Men in the HAART-Era

BackgroundTestosterone (T) deficiency remains a poorly understood issue in men with Human Immunodeficiency Virus (HIV). We investigated the gonadal status in HIV-infected men in order to characterize T deficiency and to identify predictive factors for low serum T.Methodology/Principal FindingsWe performed a cross-sectional, observational study on 1325 consecutive HIV male outpatients, most of them having lipodystrophy. Serum total T<300 ng/dL was used as the threshold for biochemical T deficiency. Morning serum total T, luteinizing hormone (LH), estradiol, HIV parameters, and body composition parameters by CT-scan and Dual-Energy-X-ray-Absorptiometry were measured in each case. Sexual behavior was evaluated in a subset of 247 patients. T deficiency was found in 212 subjects, especially in the age range 40\u201359, but was frequent even in younger patients. T deficiency occurred mainly in association with low/normal serum LH. Adiposity was higher in subjects with T deficiency (p<0.0001) and both visceral adipose tissue and body mass index were the main negative predictors of serum total T. Osteoporosis and erectile dysfunction were present in a similar percentage in men with or without T deficiency.Conclusions/SignificancePremature decline of serum T is common (16%) among young/middle-aged HIV-infected men and is associated with inappropriately low/normal LH and increased visceral fat. T deficiency occurs at a young age and may be considered an element of the process of premature or accelerated aging known to be associated with HIV infection. The role of HIV and/or HIV infection treatments, as well as the role of the general health state on the gonadal axis, remains, in fact, to be elucidated. Due to the low specificity of signs and symptoms of hypogonadism in the context of HIV, caution is needed in the diagnosis of hypogonadism in HIV-infected men with biochemical low serum T levels

A patient-driven registry on Behçet’s disease: the AIDA for patients pilot project

IntroductionThis paper describes the creation and preliminary results of a patient-driven registry for the collection of patient-reported outcomes (PROs) and patient-reported experiences (PREs) in Behçet’s disease (BD).MethodsThe project was coordinated by the University of Siena and the Italian patient advocacy organization SIMBA (Associazione Italiana Sindrome e Malattia di Behçet), in the context of the AIDA (AutoInflammatory Diseases Alliance) Network programme. Quality of life, fatigue, socioeconomic impact of the disease and therapeutic adherence were selected as core domains to include in the registry.ResultsRespondents were reached via SIMBA communication channels in 167 cases (83.5%) and the AIDA Network affiliated clinical centers in 33 cases (16.5%). The median value of the Behçet’s Disease Quality of Life (BDQoL) score was 14 (IQR 11, range 0–30), indicating a medium quality of life, and the median Global Fatigue Index (GFI) was 38.7 (IQR 10.9, range 1–50), expressing a significant level of fatigue. The mean Beliefs about Medicines Questionnaire (BMQ) necessity-concern differential was 0.9 ± 1.1 (range – 1.8–4), showing that the registry participants prioritized necessity belief over concerns to a limited extent. As for the socioeconomic impact of BD, in 104 out of 187 cases (55.6%), patients had to pay from their own pocket for medical exams required to reach the diagnosis. The low family socioeconomic status (p &lt; 0.001), the presence of any major organ involvement (p &lt; 0.031), the presence of gastro-intestinal (p &lt; 0.001), neurological (p = 0.012) and musculoskeletal (p = 0.022) symptoms, recurrent fever (p = 0.002), and headache (p &lt; 0.001) were associated to a higher number of accesses to the healthcare system. Multiple linear regression showed that the BDQoL score could significantly predict the global socioeconomic impact of BD (F = 14.519, OR 1.162 [CI 0.557–1.766], p &lt; 0.001).DiscussionPreliminary results from the AIDA for Patients BD registry were consistent with data available in the literature, confirming that PROs and PREs could be easily provided by the patient remotely to integrate physician-driven registries with complementary and reliable information

Ophiolites and related metamorphic rocks of the Kütahya region, NW Turkey

The Izmir-Ankara-Erzincan suture zone is the major Neotethyan suture in northern Anatolia. Two areas of ophiolitic and related metamorphic rocks from this zone have been studied, near to the town of Kütahya. The Besdegirmen area, north of Kütahya, includes dismembered ophiolitic rocks (the Kinik Ophiolite) and consists of serpentinised pyroxenite and peridotites together with gabbros and gabbro dykes. The Kaynarca area, southeast of Kütahya, contains metamorphic sole rocks (mainly amphibolites, amphibole-schists and quartz-schists) at the base of the ophiolite. Microprobe study indicates that the Besdegirmen gabbros contain very calcic plagioclase (An87-100) and magnesio-hornblende as the principal phases. Despite some mineralogical and chemical similarities to rocks reported from arc settings the Besdegirmen gabbros are interpreted as oceanic in origin. Trace element and REE data from gabbro and dyke samples show the patterns which are transitional between midocean ridge and island arc basalts suggesting a backarc setting for the ophiolitic rocks from the Besdegirmen area. Unlike many other Tethyan ophiolites the Kinik Ophiolite appears to represent a fragment of Neotethyan ocean basin, rather than a supra-subduction zone environment. Isotopic dating suggests a Late Cretaceous (Santonian) age for the formation of the Besdegirmen gabbros. For the Kaynarca amphibolites, microscopic and microprobe results prove at least two stages of metamorphism. The first stage is represented by a high grade amphibolite facies metamorphism and late greenschist facies metamorphism resulting in counterclockwise P-T paths. In contrast, the second stage metamorphism is marked by a medium to high pressure overprint of the first stage metamorphic rocks of Kaynarca. The low crossite content of the amphiboles, and the absence of high pressure mineral assemblages such as glaucophane and lawsonite, suggest the transition between blueschist facies and greenschist facies metamorphism for the second stage. Trace element and REE data from the amphibolite samples are comparable to ocean island basalts. The Kaynarca rocks formed as an ocean island, and the Kaynarca sole rocks were formed by intra-oceanic thrusting during the closure of Izmir-Ankara-Erzincan ocean. Isotopic data indicate an earliest Late Cretaceous metamorphic (Turonian-Cenomanian) age for the Kaynarca sole rocks. The sub-ophiolite metamorphic rocks were overprinted by LT-HP metamorphism related to Late Cretaceous subduction. Final emplacement related to the terminal collisional event occurred at the end of the Cretaceous

Candidate Teachers' Tour in Campus with Their Metaphoric Images

In this study the experiences of candidate teachers and their metaphoric images about the components of the campus such as "faculty member, student, administration, counselor, assistant, lectures, registration office and library" are analyzed. The work group of this study consists of candidate teachers studying in Hacettepe University, The Faculty of Education, OFMA (Secondary Education Science and Mathematics Education Programme). Different from other studies the data of this research are prepared by lotus blossom technique and collected by using worksheets. In the light of the data acquired by this research, comments are made about metamorphic images of the candidate teachers which reflect their ideas in regard of the components of the campus. (c) 2011 Published by Elsevier Ltd. Open access under CC BY-NC-ND license.WoSScopu