Accuracy of WHO CD4 cell count criteria for virological failure of antiretroviral therapy

OBJECTIVES: To examine the accuracy of the World Health Organization immunological criteria for virological failure of antiretroviral treatment. METHODS: Analysis of 10 treatment programmes in Africa and South America that monitor both CD4 cell counts and HIV-1 viral load. Adult patients with at least two CD4 counts and viral load measurements between month 6 and 18 after starting a non-nucleoside reverse transcriptase inhibitor-based regimen were included. WHO immunological criteria include CD4 counts persistently <100 cells/microl, a fall below the baseline CD4 count, or a fall of >50% from the peak value. Virological failure was defined as two measurements > or =10 0000 copies/ml (higher threshold) or > or =500 copies/ml (lower threshold). Measures of accuracy with exact binomial 95% confidence intervals (CI) were calculated. RESULTS: A total of 2009 patients were included. During 1856 person-years of follow up 63 patients met the immunological criteria and 35 patients (higher threshold) and 95 patients (lower threshold) met the virological criteria. Sensitivity [95% confidence interval (CI)] was 17.1% (6.6-33.6%) for the higher and 12.6% (6.7-21.0%) for the lower threshold. Corresponding results for specificity were 97.1% (96.3-97.8%) and 97.3% (96.5-98.0%), for positive predictive value 9.5% (3.6-19.6%) and 19.0% (10.2-30.9%) and for negative predictive value 98.5% (97.9-99.0%) and 95.7% (94.7-96.6%). CONCLUSIONS: The positive predictive value of the WHO immunological criteria for virological failure of antiretroviral treatment in resource-limited settings is poor, but the negative predictive value is high. Immunological criteria are more appropriate for ruling out than for ruling in virological failure in resource-limited settings.

Omphalourachitis mit Urachusabszess und Rektumprolaps bei einem Lamafohlen (Lama glama)

Der Bericht beschreibt die Diagnostik und Therapie einer Omphalourachitis mit Urachusabszess bei einem Lamafohlen. Ein bei diesem Tier sekundär vorliegender Rektumprolaps wurde im Anschluss an die Operation konservativ durch Anlegen einer temporären pararektalen Tabaksbeutelnaht erfolgreich behandelt.

A centrifugal ice microtome for measurements of atmospheric CO₂ on air trapped in polar ice cores

For atmospheric CO2 reconstructions using ice cores, the technique to release the trapped air from the ice samples is essential for the precision and accuracy of the measurements. We present here a new dry extraction technique in combination with a new gas analytical system that together show significant improvements with respect to current systems. Ice samples (3–15 g) are pulverised using a novel centrifugal ice microtome (CIM) by shaving the ice in a cooled vacuum chamber (−27 °C) in which no friction occurs due to the use of magnetic bearings. Both, the shaving principle of the CIM and the use of magnetic bearings have not been applied so far in this field. Shaving the ice samples produces finer ice powder and releases a minimum of 90% of the trapped air compared to 50%–70% when needle crushing is employed. In addition, the friction-free motion with an optimized design to reduce contaminations of the inner surfaces of the device result in a reduced system offset of about 2.0 ppmv compared to 4.9 ppmv. The gas analytical part shows a higher precision than the corresponding part of our previous system by a factor of two, and all processes except the loading and cleaning of the CIM now run automatically. Compared to our previous system, the complete system shows a 3 times better measurement reproducibility of about 1.1 ppmv (1 σ) which is similar to the best reproducibility of other systems applied in this field. With this high reproducibility, no replicate measurements are required anymore for most future measurement campaigns resulting in a possible output of 12–20 measurements per day compared to a maximum of 6 with other systems.