Mean corpuscular volume as a marker for adherence to antiretroviral therapy among HIV infected children and adolescents in Uganda

Mean corpuscular volume, which is an inexpensive and widely available measure to assess, increases in HIV infected individuals receiving zidovudine and stavudine raising the hypothesis that it could be used as a surrogate for adherence.^ The aim of this study was to examine the association between mean corpuscular volume and adherence to antiretroviral therapy among HIV infected children and adolescents aged 0–19 years in Uganda as well as the extent to which changes in mean corpuscular volume predict adherence as determined by virologic suppression.^ The investigator retrospectively reviewed and analyzed secondary data of 158 HIV infected children and adolescents aged 0–19 years who initiated antiretroviral therapy under an observational cohort at the Baylor College of Medicine Children's Foundation - Uganda. Viral suppression was used as the gold standard for monitoring adherence and defined as viral load of < 400 copies/ml at 24 and 48 weeks. ^ Patients were at least 48 weeks on therapy, age 0.2–18.4 years, 54.4% female, 82.3% on zidovudine based regimen, 92% WHO stage III at initiation of therapy, median pre therapy MCV 80.6 fl (70.3–98.3 fl), median CD4% 10.2% (0.3%–28.0%), and mean pre therapy viral load 407,712.9 ± 270,413.9 copies/ml. For both 24 and 48 weeks of antiretroviral therapy, patients with viral suppression had a greater mean percentage change in mean corpuscular volume (15.1% ± 8.4 vs. 11.1% ± 7.8 and 2.3% ± 13.2 vs. -2.7% ± 10.5 respectively). The mean percentage change in mean corpuscular volume was greater in the first 24 weeks of therapy for patients with and without viral suppression (15.1% ± 8.4 vs. 2.3% ± 13.2 and 11.1% ± 7.8 vs. -2.7% ± 10.5 respectively). In the multivariate logistic regression model, percentage change in mean corpuscular volume ≥ 20% was significantly associated with viral suppression (adjusted OR 4.0; CI 1.2–13.3; p value 0.02). The ability of percentage changes in MCV to correctly identify children and adolescents with viral suppression was higher at a cut off of ≥ 20% (90.7%; sensitivity, 31.7%) than at ≥ 9% (82.9%; sensitivity, 78.9%). Negative predictive value was lower at ≥ 20% change (25%; specificity, 84.8%) than at ≥ 9% change (33.3%; specificity, 39.4%).^ Mean corpuscular volume is a useful marker of adherence among children and adolescents with viral suppression. ^

Significado de la Leucopenia en pacientes con bacteriemia

Objetivo: Evaluar parámetros clínicos, bacteriológicos y morbimortalidad de las bacteriemias en pacientes con leucopenia (<4.000 leucocitos/mm 3) y compararlas con bacteriemias con leucocitosis (>12.000/mm3). Material y métodos: Estudio protocolizado, descriptivo y observacional en pacientes con 2 o más hemocultivos positivos para el mismo germen hospitalizados en un servicio de clínica médica desde Marzo de 1989 a Agosto de 2007. Resultados: Se identificaron 728 bacteriemias, 94 (12,91%) con leucopenia (Grupo A) y 407 (55,90%) con leucocitosis (Grupo B). La edad media fue de 55,57 años (DS±16,93) en A y de 58,40 años (DS±17,34) en B. No hubo diferencias en la permanencia media: 19,59 días (DS±18,67) en A vs 21,21 (DS±19,53) en B ni en el sexo masculino (65,96 vs 57,25%)(pNS). La adquisición nosocomial (57,44 vs 40,29%) y el foco desconocido (25,53 vs 9,33%) y abdominal (17,14 vs 9,21%) fueron más frecuentes en A (p<0.01). La comorbilidad mayor (82,98 vs 41,24%), neoplasias (45,74 vs 12,84%) y la inmunosupresión (31,91 vs 6,17%) fueron significativas en A (p<0.01). La anemia (86,17 vs 62,40%) y la trombocitopenia (84,04 vs 25,06%) predominaron en A (p<0.01). Los Bacilos Gram Negativos predominaron en A (61,71 vs 37,83%)(p<0.01) [Klebsiella (17,02 vs 9,82%) y Pseudomonas (10,64 vs 1,47%) las más frecuentes (p<0.05)] y en B fue más frecuente S. aureus (31,69 vs 11,70%)(p<0.01). La mortalidad fue de 39,36% en A y 25,30% en B (p=0.006) y se asoció en el grupo A a mayor mortalidad en las primeras 24 horas (32,43 vs 16,50%), inmunosupresión (27,02 vs 7,76%), neumococcemias (52,94 vs 23,07%), sepsis (100 vs 88,35%) y trombocitopenia (75,67 vs 30,09%)(p<0,01).- Conclusiones: Las bacteriemias en pacientes leucopénicos comparadas con aquellas con leucocitosis se asociaron significativamente a adquisición nosocomial, foco desconocido y abdominal, presencia de comorbilidad mayor, neoplasias e inmunosupresión, a bacteriemias por Klebsiella y Pseudomonas y a significativa mayor mortalidad. Palabras claves: leucopenia, bacteriemias

Velocities and elastic moduli of basalts from Pacific DSDP sites

Compressional (Vp) and shear (Vs) wave velocities have been measured to 10 kb in 32 cores of basalt from 14 Pacific sites of the Deep Sea Drilling Project. Both Vp and V s show wide ranges (3.70 to 6.38 km/sec for Vp and 1.77 to 3.40 km/sec for V s at 0.5 kb) which are linearly related to density and sea floor age, confirming earlier findings by Christensen and Salisbury of decreasing velocity with progressive submarine weathering based on studies of basalts from five sites in the Atlantic. Combined Pacific and Atlantic data give rates of decreasing velocity of -1.89 and -1.35 km/sec per 100 my for Vp and Vs respectively. New analyses of oceanic seismic refraction data indicate a decrease in layer 2 velocities with age similar to that observed in the laboratory, suggesting that weathering penetrates to several hundred meters in many regions and is largely responsible for the extreme range and variability of layer 2 refraction velocities.

Concentrations and accumulation rates of chemical elements and sediment components in sediments of central equatorial Pacific, DSDP data

Accumulation rates of Mg, Al, Si, Mn, Fe, Ni, Cu, Zn, opal, and calcium carbonate have been calculated from their concentrations in samples from equatorial Deep Sea Drilling Project sites. Maps of element accumulation rates and of Q-mode factors derived from raw data indicate that the flux of trace metals to equatorial Pacific sediments has varied markedly through time and space in response to changes in the relative and absolute influence of several depositional influences: biogenic, detrital, authigenic, and hydrothermal sedimentation. Biologically derived material dominates the sediment of the equatorial Pacific. The distributions of Cu and Zn are most influenced by surface-water biological activity, but Ni, Al, Fe, and Mn are also incorporated into biological material. All of these elements have equatorial accumulation maxima similar to those of opal and calcium carbonate at times during the past 50 m.y. Detritus distributed by trade winds and equatorial surface circulation contributes Al, non-biogenic Si, Fe, and Mg to the region. Detrital sediment is most important in areas with a small supply of biogenic debris and low bulk-accumulation rates. Al accumulation generally increases toward the north and east, indicating its continental source and distribution by the northeast trade winds. Maxima in biological productivity during middle Eocene and latest Miocene to early Pliocene time and concomitant well-developed surface circulation contributed toward temporal maxima in the accumulation rates of Cu, Zn, Ni, and Al in sediments of those ages. Authigenic material is also important only where bulk-sediment accumulation rates are low. Ni, Cu, Zn, and sometimes Mn are associated with this sediment. Fe is almost entirely of hydrothermal origin. Mn is primarily hydrothermal, but some is probably scavenged from sea water by amorphous iron hydroxide floes along with other elements concentrated in hydrothermal sediments, Ni, Cu, and Zn. During the past 50 m.y. all of these elements accumulated over the East Pacific Rise at rates nearly an order of magnitude higher than those at non-rise-crest sites. In addition, factor analysis indicates that some of this material is carried substantial distances to the west of the rise crest. Accumulation rates of Fe in basal metalliferous sediments indicate that the hydrothermal activity that supplied amorphous Fe oxides to the East Pacific Rise areas was most intense during middle Eocene and late Miocene to early Pliocene time.

Chemical composition of bottom sediments and rocks from DSDP Holes 3-14 through 64-477

Data on analyses of chemical composition of DSDP samples of bottom sediments and rocks carried out in P.P. Shirshov Institute of Oceanology are reported. Basal sediments and sedimentary rocks prevail in the sample set.

Chemical composition of East Pacific Rise basal sediments

Analyses by atomic absorption spectrophotometry and spark-source mass spectrography of 25 basal metalliferous sediment units from widely spaced locations on the western flank of the East Pacific Rise show that the deposits are enriched relative to normal pelagic sediment in Fe, Mn, Ni, Cu, Pb, Zn, and many trace elements. The elements are partitioned differently between the various mineralogic constituents of the sediment, with Fe and Mn largely in separate phases and many of the remaining elements primarily associated with reducible ferromanganese oxide minerals but also with iron minerals and other phases. Most of the iron in the deposits is probably of volcanic origin, and much of the manganese and minor elements is derived from sea water. The bulk composition of the deposits varies with age; this is thought to be due to variations in the incidence of volcanic activity at the East Pacific Rise crest where the deposits were formed.

Composition of post-Jurassic deposits from the Northwest Pacific and the Galapagos Rift, data of DSDP Legs 62, 65, and 70

The monogragh contains results of mineralogicai and geochemical studies of Mesozoic and Cenozoic deposits from the Pacific Ocean collected during Deep Sea Drilling Project. Special attention is paid on the aspects of geochemical history of post-Jurassic sedimentation in the central part of the Northwest Pacific, detailed characteristics of the main stages of sedimentary evolution are given: Early Cretaceons (protooceanic), Late Cretaceons (transitional) and Cenozoic (oceanic). Results of mineralogical and geochemical studies of hydrothermal deposits from the Galapagos Rift are given as well.