Dance as physical exercise for older people

The importance of adequate physical activity for older people cannot be overestimated. Evidence exists that physical exercise can improve quality of life; benefit brain areas involved with executive control; delay the age-related decline in functional ability; offer a degree of protection against certain physical and mental disorders; reduce the prevalence of falls by improving flexibility, balance, and muscle strength; and potentially promote longevity. On cellular and molecular levels, aging is said to be marked by genomic instability, telomere attrition, epigenetic alterations, impaired protein homeostasis, deregulation of systems involved in nutrient sensing, a decline in mitochondrial integrity and biogenesis, cellular senescence, stem cell exhaustion, and changes in intercellular communication. Plausible indications are that physical activity, especially aerobic and resistance training, can have positive anti-aging effects through attenuation of such cellular and molecular mechanisms. Not everyone likes structured exercise; however, various alternatives exist. One alternative is recreational dancing – an activity primarily selected for fun and social interaction, rather than health benefits. We briefly examined the potential benefits of amateur/recreational dance, as a form of exercise, for the health and well-being of older people. A literature search was performed through electronic databases as well as manually. Electronic databases searched were EBSCOhost Research Interface databases; Academic Search Complete; APA; CINAHL and MEDLINE.http://www.sajs.co.zahj2021Internal MedicinePsychiatr

The kynurenine pathway activities in a sub-Saharan HIV/AIDS population

BACKGROUND : Tryptophan is an essential amino acid for the synthesis of proteins and important metabolites such as serotonin, melatonin, tryptamine and niacin. After protein synthesis, more than 90 % of tryptophan catabolism occurs along the kynurenine pathway. The inflammation-inducible enzyme indoleamine 2,3 dioxygenase (IDO) is responsible for the first rate-limiting step in the kynurenine pathway, i.e., oxidation of tryptophan to kynurenine. Excessive IDO activity in conditions such as HIV/AIDS may lead to tryptophan depletion and accumulation of metabolites downstream from kynurenine. Little is known about the kynurenine pathway of HIV/AIDS patients in sub-Saharan regions. This study, in a low income sub-Saharan HIV/AIDS population, examined the effects of activities in the kynurenine pathway on plasma levels of tryptophan, kynurenine and the neurotoxin quinolinic acid, and on de novo synthesis of nicotinamide. METHODS : Plasma samples were obtained from a cohort of 105 HIV patients and 60 controls. Kynurenine pathway metabolites were analysed using gas chromatography – mass spectrometry. ELISA and flow cytometry were used to assess plasma inflammatory markers. RESULTS : IDO activity, depletion of tryptophan, as well as accumulation of kynurenine and the neurotoxin quinolinic acid, were not only significantly greater in the patients than in the controls, but also markedly greater than in HIV/AIDS patients from developed countries. Tryptophan levels were 12.3 % higher, kynurenine levels 16.2 % lower, quinolinic acid levels 43.2 % lower and nicotinamide levels 27,2 % lower in patients on antiretroviral treatment than in antiretroviral-naïve patients. Patients’ kynurenine pathway metabolites correlated with the levels of inflammatory markers, including that of the major IDO-inducer, interferon-gamma. Indications are that the rate of de novo synthesis of nicotinamide in the kynurenine pathway correlates with increases in quinolinic acid levels up to a point where saturation of the enzyme quinolinate phosphoribosyl transferase occurs. CONCLUSIONS : Higher levels of inflammatory activity in this low income sub-Saharan HIV/AIDS population than in patients from developed countries lead to greater tryptophan depletion and greater accumulation of metabolites downstream from tryptophan with quinolinic acid levels often reaching levels associated with the development of HIV/AIDS-associated neurocognitive dysfunction. De novo synthesis of nicotinamide from quinolinic acid contributes to the maintenance of nicotinamide, and by implication NAD levels, in HIV/AIDS patients from low income populations. Antiretroviral treatment partially corrects disturbances in the kynurenine pathway.Medical Research Council of South Africa and the South African Sugar Association (SASA Project 213).http://www.biomedcentral.com/bmcinfectdis/hb201

Levels of procalcitonin, C-reactive protein and neopterin in patients with advanced HIV-1 infection

OBJECTIVES: To compare the value of procalcitonin, C-reactive protein (CRP) and neopterin as indicators of immune deficiency, co-infection, efficacy of treatment, and disease progression, in patients with advanced HIV-1 infection. DESIGN: Cross-sectional, investigating baseline blood measurements and clinical observations in 82 HIV-positive patients divided into an antiretroviral treatment (ART) group and an ART-naïve group. SETTING: Secondary general hospital in Pretoria. RESULTS: Procalcitonin and CRP levels showed no significant differences between the ART and ART-naïve groups, and no correlations with CD4 counts or viral loads. CRP levels were significantly higher with TB co-infection (p<0.05). Neopterin levels were raised above normal in 92% of the ART-naïve group and in 75% of the ART group. The levels were significantly higher (p<0.05) in the ART- naïve group. Negative correlations were found between neopterin and CD4 counts for the total patient group (r=-0.482; p<0.001). Neopterin was significantly (p<0.05) higher in the HIV/TB co-infection group than in those without TB. Higher neopterin levels at baseline were associated with a decline in CD4 counts over the ensuing 6-month period, and patients with higher baseline neopterin levels developed more complications over the 6-month period. CONCLUSIONS: Compared with procalcitonin and CRP, neopterin appears to be associated with the degree of immunodeficiency and of co-infection with TB. Neopterin levels may be investigated further as a measure of disease progression or treatment response.The Medical Research Council of South Africa (MRC grant A0S541) and the South African Sugar Association (SASA grant 213).www.sajhivmed.org.z

Tryptophan depletion in context of the inflammatory and general nutritional status of a low-income South African HIV-infected population

BACKGROUND : The essential amino acid tryptophan cannot be synthesised in the body and must be acquired through dietary intake. Oxidation of tryptophan, due to immune induction of the enzyme indoleamine 2,3- dioxygenase (IDO), is considered to be the main cause of tryptophan depletion in HIV infection and AIDS. We examined plasma tryptophan levels in a low-income sub-Saharan HIV-infected population and compared it to that of developed countries. Tryptophan levels were further examined in context of the general nutritional and inflammatory status. METHODS : This cross-sectional study included 105 HIV-positive patients recruited from the Kalafong Hospital in Pretoria, South Africa, and 60 HIV-negative controls. RESULTS : Patient tryptophan levels were in general markedly lower than those reported for developed countries. In contrast to reports from developed countries that showed tryptophan levels on average to be 18.8 % lower than their control values, tryptophan levels in our study were 44.1 % lower than our controls (24.4 ± 4.1 vs. 43.6 ± 11.9 μmol/l; p < 0.001). Tryptophan levels correlated with both CD4 counts (r = 0.341; p = 0.004) and with proinflammatory activity as indicated by neopterin levels (r = −0.399; p = 0.0001). Nutritional indicators such as albumin and haemoglobin correlated positively with tryptophan and negatively with the pro-inflammatory indicators neopterin, interleukin 6 and C-reactive protein. The most probable causes of the lower tryptophan levels seen in our population are food insecurity and higher levels of inflammatory activity. CONCLUSIONS : We contend that inflammation-induced tryptophan depletion forms part of a much wider effect of pro-inflammatory activity on the nutritional profile of HIV-infected patients.MV was the project leader. PB developed and validated the GC-MS method for the analysis of tryptophan and performed the biochemical and immunological analyses. MV and PB were responsible for the project design, analyses of the results and writing of the manuscript. PL was involved in the sourcing of patients and the clinical examination of all patients.The authors wish to thank the participants and staff of the Immunology Clinic at Kalafong Hospital and the South African National Blood Service at the Pretoria West satellite site.This research was supported by grant funding received from the Medical Research Council of South Africa and the South African Sugar Association (SASA Project 213).http://www.jhpn.net/index.php/jhpnam2016Internal MedicinePhysiologyPsychiatr

A non-specific biomarker of disease activity in HIV/AIDS patients from resource-limited environments

BACKGROUND : A general non-specific marker of disease activity that could alert the clinician and prompt further investigation would be of value in patients with HIV/AIDS, especially in resource limited environments. OBJECTIVE : To investigate the potential of neopterin as non-specific biomarker in patients with advanced HIV/AIDS. METHODS : Cross-sectional study in 105 HIV positive patients (75 on highly active antiretroviral treatment (HAART). Neopterin was assessed by enzyme linked immune-absorbent assay and cytokines by flow cytometry. RESULTS : Neopterin levels were significantly higher (p<0.001) for the total patient than for the control group. Significant correlations between neopterin and plasma indicators of inflammation showed neopterin to be a good indicator of active inflammatory status and of the effect of HAART on the immune system. Neopterin was superior to C-reactive protein and to individual cytokines as indicator of immune deficiency. Increased neopterin levels were associated with a decline in albumin, haemoglobin and the albumin/globulin ratio, and with increases in red cell distribution width. CONCLUSIONS : Plasma neopterin is a good non-specific biomarker of disease activity in HIV/AIDS patients. It is a good indicator of inflammatory activity, perpetuation of inflammation-associated co-morbidities, degree of immune deficiency and has predictive value for underlying disease, and for monitoring the HAART response.The Medical Research Council of South African and the South African Sugar Association.http://www.bioline.org.br/hsam2016Internal MedicinePhysiologyPsychiatr

Radiological chest manifestations in diffuse infiltrative lymphocytosis syndrome (DILS)

This report focuses on the radiological manifestations of diffuse interstitial lymphocytosis syndrome (DILS) in the chest. Awareness of this entity and early diagnosis by radiologists will enable timeous intervention by clinicians.http://www.journals.co.za/sama/m_sajr.htm

Expression of the H- and L-subunits of ferritin in bone marrow macrophages of patients with osteoarthritis

Osteoarthritis is a disease characterized by an increase in the production of reactive oxygen species (ROS) in afflicted joints. Excess iron, due to its role in the production of ROS and crystal deposition in the joints, is implicated in the disease progression of osteoarthritis. Ferritin is a major regulator of the bioavailability of iron, and its functions are determined largely by the combination of H- and L-subunits present in its outer protein shell. The purpose of the study was to investigate the expression of the H- and L-subunits of ferritin in bone marrow macrophages of osteoarthritis patients. The cytokine profiles were assessed as cytokines play an important role in the expression of the ferritin subunits. The H-subunit of ferritin in the bone marrow macrophages was significantly higher (P value = 0.035) in the osteoarthritis patients compared with the controls (107.84; 69.25–167.94 counts/μm2; n= 7 versus 71.07; 58.56–86.26 counts/μm2; n= 19). A marginally significant increase (P value = 0.059) was shown for the expression of the L-subunit in the osteoarthritis patients compared with the controls (133.03; 104.04–170.10 counts/μm2; n= 7 versus 104.23; 91.53–118.70 counts/μm2; n= 19). The osteoarthritis and control groups had comparable C-reactive protein, as well as proinflammatory and anti-inflammatory cytokine concentrations. The major exception was for transforming growth factor-β (TGF-β), which was higher (P value = 0.014) in the plasma of the osteoarthritis patients (16.69; 13.09–21.28 ng/mL; n= 7 versus 8.60; 6.34–11.67 ng/mL; n= 19). Up-regulation of the ferritin subunits decreases the levels of bioavailable iron and provides protection against the unwarranted production of ROS and crystal deposition. A role for TGF-β in the up-regulation of the expression of the H-subunit, and possibly the L-subunit, of ferritin is postulated in osteoarthritis.The Skye foundation and the University of Pretoria’s Postgraduate Mentor Bursary Programme.http://ebm.sagepub.comhb2017Physiolog

Diffuse infiltrative lymphocytosis syndrome (DILS)

Diffuse infiltrative lymphocytosis syndrome (DILS) is characterised by a persistent CD8+ lymphocytosis and lymphocytic infiltration of various organs. The reported prevalence varies between 0.85 – 3%, and appears to be more common in Africans. Patients with DILS tend to have higher CD4+ cell counts and survive longer than those patients without DILS. Most patients present with bilateral parotid gland enlargement and features of the Sicca syndrome. Extraglandular involvement is common with the lungs being the most common site, followed by peripheral neuropathy and liver involvement. DILS is a benign presentation in most patients with few complications. Therapeutic trials are lacking although there are isolated reports of good response to antiretroviral and steroid therapy. With the high incidence of HIV in our population it is likely that DILS is under diagnosed probably due to our ignorance of this disease. Awareness of its various presentations may bring to light undiscovered patients with DILS