Hostility and helper T-cells in patients with bulimia nervosa

OBJECTIVE

The study aimed to analyze the correlation between lymphocyte counts and several psychopathological variables associated with psychological instability (depression, hostility, impulsivity, self-defeating personality traits, and borderline personality symptoms) in patients with bulimia nervosa (BN).

METHOD

Sixty BN patients were assessed, using specific scales for eating pathology, general psychopathology, impulsivity, depression, and borderline personality features. Lymphocyte and lymphocyte subset counts were performed. Plasma cortisol at 8:00, before and after administration of 1 mg of dexamethasone at 23:00, was determined. The influence of body weight, and the use of tobacco, alcohol, and caffeine was controlled. The relationship between each isolated variable and the number of immune cells was analyzed. In a second step, supplementary post-hoc analysis of the variables was introduced to confirm the accuracy of the psychopathological assessment.

RESULTS

Hostility was negatively correlated with the number of helper T-cells (CD4+). Patients with high hostility had lower CD4+ cell counts and lower CD4+/CD8+ ratios. In the post-hoc control study, hostility was significantly related with other "interpersonal" items.

CONCLUSIONS

These results support the idea that hostility, as an expression of disturbed interpersonal relationships, could play a role as a modulator of immune activity in patients with BN.

[Prognostic factors and mortality among adult patients with acute leukemia and infection]

In order to define mortality rates and clinical findings with prognostic value in febrile infections among our adult patients with acute leukemia we prospectively studied--during a 34 months period--177 episodes of clinical suspected infection which occurred in 49 patients. By means of univariate analysis and a subsequent multiple logistic regression study, the association between 27 clinical and microbiological data and febrile episode survival rates were evaluated. Both the overall mortality rate and the specific one for febrile episodes were high (44.9% and 12.7% respectively). An age over 30 years old (p = 0.025), fever lasting more than five days (p = 0.025), lung involvement (p = 0.001) and fungal isolation in a culture specimen (p = 0.005) were all associated with a higher episode mortality. However, only an age older than 30 years (adjusted odds ratio, A.O.R. = 1.118; 95% confidence interval, C.I.95% = 1.015-1.232; p = 0.025) and pneumonia (A.O.R. = 1.454; C.I.95% = 1.288-1.642; p < 0.001) remained as independent predictors of a greater mortality in the multivariate analysis. Although fever of unknown origin was associated with a better prognosis (p = 0.024) two other variables--viral infections (A.O.R. = 0.642; C.I.95% = 0.421-0.979; P = 0.041) and the isolation of two or more etiologic agents (A.O.R. = 0.795; C.I.95% = 0.651-0.972; p = 0.027)--had a protective value with the multiple regression analysis.

[Chemotherapy schedules and bacteremia in adult patients with acute leukemia]

In a study undertaken to evaluate fluoroquinolone prophylaxis in afebrile granulocytopenic patients, an unexpected association between chemotherapy schedule and a later development of bacteremia--during the subsequent febrile neutropenic episodes--was found. Twenty five febrile neutropenic episodes consecutive to chemotherapy for acute leukemia were studied. Patients received either etoposide and mitoxantrone or citarabine--in standard, intermediate or high doses--combined with daunomicin or mitoxantrone. Microbiologic data analysis showed an increased incidence of bacteremia with combined anthracycline and intermediate or high dose citarabine administration, when compared to etoposide and mitoxantrone use (p = 0.000387). Both groups developed similarly fast and severe neutropenias and equivalent grades of digestive mucositis. Chemotherapy schedule was the only factor associated with a consecutive bacteremia--or not--during the subsequent neutropenic episode. We conclude that effects other than bone marrow aplasia and digestive mucositis may be relevant in infectious susceptibility induced by cytostatic drugs.