Response to highly active antiretroviral therapy among severely immuno-compromised HIV-infected patients in Cambodia.

BACKGROUND: HAART efficacy was evaluated in a real-life setting in Phnom Penh (Médecins Sans Frontières programme) among severely immuno-compromised patients. METHODS: Factors associated with mortality and immune reconstitution were identified using Cox proportional hazards and logistic regression models, respectively. RESULTS: From July 2001 to April 2005, 1735 patients initiated HAART, with median CD4 cell count of 20 (inter-quartile range, 6-78) cells/microl. Mortality at 2 years increased as the CD4 cell count at HAART initiation decreased, (4.4, 4.5, 7.5 and 24.7% in patients with CD4 cell count > 100, 51-100, 21-50 and < or = 20 cells/microl, respectively; P < 10). Cotrimoxazole and fluconazole prophylaxis were protective against mortality as long as CD4 cell counts remained < or = 200 and < or = 100 cells/microl, respectively. The proportion of patients with successful immune reconstitution (CD4 cell gain > 100 cells/microl at 6 months) was 46.3%; it was lower in patients with previous ART exposure [odds ratio (OR), 0.16; 95% confidence interval (CI), 0.05-0.45] and patients developing a new opportunistic infection/immune reconstitution infection syndromes (OR, 0.71; 95% CI, 0.52-0.98). Similar efficacy was found between the stavudine-lamivudine-nevirapine fixed dose combination and the combination stavudine-lamivudine-efavirenz in terms of mortality and successful immune reconstitution. No surrogate markers for CD4 cell change could be identified among total lymphocyte count, haemoglobin, weight and body mass index. CONCLUSION: Although CD4 cell count-stratified mortality rates were similar to those observed in industrialized countries for patients with CD4 cell count > 50 cells/microl, patients with CD4 cell count < or = 20 cells/microl posed a real challenge to clinicians. Widespread voluntary HIV testing and counselling should be encouraged to allow HAART initiation before the development of severe immuno-suppression

Differential leukocyte count method for bovine low somatic cell count milk

Whereas many differential leukocyte count methods for high somatic cell count (SCC) milk from mastitic cows are available, only a few have been developed for low SCC milk. We have developed a flow cytometric differential leukocyte count method for low SCC milk. The procedure consists of 1) 1.5 ml of diluted milk sample (30%, vol/vol dilution with PBS), 2) centrifugation, 3) leukocyte labeling with SYTO 13 and 4) flow cytometric analysis. Four major leukocyte populations can be clearly identified in the green fluorescence-side scatter dot plot: lymphocytes and monocytes (LM), polymorphonuclear neutrophils (PMN), mature macrophages (MO), and cells with apoptotic features based on chromatin condensation and nuclear fragmentation. The optimal processing temperature was 20degreesC. Significant differences among samples with similar differential leukocyte counts were found. Storage of milk samples during 2 d at 7degreesC had no effect on differential leukocyte count. Using the new method, differential leukocyte count was performed in low SCC milk samples from cows in early, mid, and late lactation. In accordance with previous studies, PMN and M P percentages were lower and LM percentages were higher in early lactation than in the other stages of lactation. The percentage of cells with apoptotic features was higher in early lactation than in mid and late lactation. In conclusion, a rapid, simple, accurate, and reproducible standard procedure was developed to determine the differential leukocyte count (MO, PMN, LM, and cells with apoptotic features) of bovine low SCC milk

Effect of mycophenolate mofetil on the white blood cell count and the frequency of infection in systemic lupus erythematosus.

Leukopenia is a common manifestation of SLE. Addition of immunosuppressive therapy in a SLE patient who is already leukopenic is a clinical concern. It could worsen leukopenia, increase the risk of infection, or both. The aim of this study was to analyze the immediate effect of mycophenolate mofetil on the white blood cell count and the rate of infection in SLE patients. Two hundred and forty-four patients within the Hopkins Lupus Cohort who were newly started on mycophenolate mofetil were included in the study. The white blood cell count and interval infection history on the day mycophenolate mofetil was started were compared with the white blood cell count and interval infection history at the next visit. The study was based on 244 patients who began taking mycophenolate mofetil in the cohort. The study population included 47 % African Americans, 44 % Caucasians, and 9 % other ethnicities. There was a slight but not statistically significant increase in the white blood cell count (6.63 vs. 7.01), after starting mycophenolate mofetil. Patients with a baseline white blood cell count \u3c3000/mm(3) did have a statistically significant increase in the white blood cell count after starting mycophenolate mofetil (2.57 vs. 5.13, P = 0.0047). We also found a statistically significant increase in the risk of bacterial infection (but not viral infection) after starting mycophenolate mofetil (4 vs. 9 %, P = 0.0036). Leukopenia does not worsen with mycophenolate mofetil. However, mycophenolate mofetil appears to slightly increase the rate of bacterial (but not viral) infection

CD4 cell count and the risk of AIDS or death in HIV-Infected adults on combination antiretroviral therapy with a suppressed viral load: a longitudinal cohort study from COHERE.

BACKGROUND: Most adults infected with HIV achieve viral suppression within a year of starting combination antiretroviral therapy (cART). It is important to understand the risk of AIDS events or death for patients with a suppressed viral load. METHODS AND FINDINGS: Using data from the Collaboration of Observational HIV Epidemiological Research Europe (2010 merger), we assessed the risk of a new AIDS-defining event or death in successfully treated patients. We accumulated episodes of viral suppression for each patient while on cART, each episode beginning with the second of two consecutive plasma viral load measurements 500 copies/µl, the first of two consecutive measurements between 50-500 copies/µl, cART interruption or administrative censoring. We used stratified multivariate Cox models to estimate the association between time updated CD4 cell count and a new AIDS event or death or death alone. 75,336 patients contributed 104,265 suppression episodes and were suppressed while on cART for a median 2.7 years. The mortality rate was 4.8 per 1,000 years of viral suppression. A higher CD4 cell count was always associated with a reduced risk of a new AIDS event or death; with a hazard ratio per 100 cells/µl (95% CI) of: 0.35 (0.30-0.40) for counts <200 cells/µl, 0.81 (0.71-0.92) for counts 200 to <350 cells/µl, 0.74 (0.66-0.83) for counts 350 to <500 cells/µl, and 0.96 (0.92-0.99) for counts ≥500 cells/µl. A higher CD4 cell count became even more beneficial over time for patients with CD4 cell counts <200 cells/µl. CONCLUSIONS: Despite the low mortality rate, the risk of a new AIDS event or death follows a CD4 cell count gradient in patients with viral suppression. A higher CD4 cell count was associated with the greatest benefit for patients with a CD4 cell count <200 cells/µl but still some slight benefit for those with a CD4 cell count ≥500 cells/µl

Home-based versus clinic-based care for patients starting antiretroviral therapy with low CD4⁺ cell counts: findings from a cluster-randomized trial.

OBJECTIVES: African health services have shortages of clinical staff. We showed previously, in a cluster-randomized trial, that a home-based strategy using trained lay-workers is as effective as a clinic-based strategy. It is not known whether home-based care is suitable for patients with advanced HIV disease. METHODS: The trial was conducted in Jinja, Uganda. One thousand, four hundred and fifty-three adults initiating ART between February 2005 and January 2009 were randomized to receive either home-based care or routine clinic-based care, and followed up for about 3 years. Trained lay workers, supervised by clinical staff based in a clinic, delivered the home-based care. In this sub-analysis, we compared survival between the two strategies for those who presented with CD4⁺ cell count less than 50 cells/μl and those who presented with higher CD4⁺ cell counts. We used Kaplan-Meier methods and Poisson regression. RESULTS: Four hundred and forty four of 1453 (31%) participants had baseline CD4⁺ cell count less than 50 cells/μl. Overall, 110 (25%) deaths occurred among participants with baseline CD4⁺ cell count less than 50  cells/μl and 87 (9%) in those with higher CD4⁺ cell count. Among participants with CD4 cell count less than 50  cells/μl, mortality rates were similar for the home and facility-based arms; adjusted mortality rate ratio 0.80 [95% confidence interval (CI) 0.53-1.18] compared with 1.22 (95% CI 0.78-1.89) for those who presented with higher CD4⁺ cell count. CONCLUSION: HIV home-based care, with lay workers playing a major role in the delivery of care including providing monthly adherence support, leads to similar survival rates as clinic-based care even among patients who present with very low CD4⁺ cell count. This emphasises the critical role of adherence to antiretroviral therapy

Augmented Mitotic Cell Count using Field Of Interest Proposal

Histopathological prognostication of neoplasia including most tumor grading systems are based upon a number of criteria. Probably the most important is the number of mitotic figures which are most commonly determined as the mitotic count (MC), i.e. number of mitotic figures within 10 consecutive high power fields. Often the area with the highest mitotic activity is to be selected for the MC. However, since mitotic activity is not known in advance, an arbitrary choice of this region is considered one important cause for high variability in the prognostication and grading. In this work, we present an algorithmic approach that first calculates a mitotic cell map based upon a deep convolutional network. This map is in a second step used to construct a mitotic activity estimate. Lastly, we select the image segment representing the size of ten high power fields with the overall highest mitotic activity as a region proposal for an expert MC determination. We evaluate the approach using a dataset of 32 completely annotated whole slide images, where 22 were used for training of the network and 10 for test. We find a correlation of r=0.936 in mitotic count estimate.Comment: 6 pages, submitted to BVM 2019 (bvm-workshop.org

Impact Of Hepatitis C Co-Infection On CD4 Cell Count In HIV Infected Subjects

Background: Human immunodeficiency virus (HIV) and Hepatitis C virus (HCV) co-infection is reported to be common among HIV infected subjects due to share routes of transmission. The fact that HCV infection may act as cofactor for HIV disease progression has been suggested.\ud Objective: To determine if HCV and HIV co-infection affect the immunocompetence (CD4) of the infected subjects and response to Highly Active Anti Retroviral therapy.\ud Subjects and methods: Fifty HIV/HCV co-infected and fifty HIV monoinfected adults were retrospectively studied. Their baseline CD4 cell counts were done using Dynal beads technique before commencement of HAART and repeated after six months.\ud Results: The CD4 cell counts of co-infected subjects were lower than the mono-infected subjects. Sixty eight percent of the co-infected subjects had CD4 cell count less than 200cells/uL, and they responded poorly to HAART therapy than the mono-infected subjects (P<0.05). Those with CD4 cell count greater than 200cells/uL responded better to treatment than those with CD4 cell count less than 200cells/uL (P<0.001)\ud Conclusion: HCV/HIV co-infection affects the immunocompetence of the patients and HCV may acts as cofactor for HIV disease progression. It is needful to screen all HIV positive subjects for HCV antibody as this will improve their clinical management and outcome

The use of homeopathic nosodes in the prevention of mastitis in organic dairy herds (OF0186)

Mastitis is the most significant disease affecting the health, welfare and economic productivity of dairy cattle and is recognised by Defra as a major economic and welfare concern. Research into the efficacy of homeopathic treatments and of management control of mastitis on organic dairy farms have both been identified as research priorities in recent Defra funded reviews of organic dairy farming. This study examined the use of a specific mode of homeopathic treatment in the prevention of mastitis and quantified the effect that the year-round, prophylactic use of nosodes, supplied to the cattle in the drinking water, had on the number of clinical cases of mastitis on somatic cell counts within herds. Context and background Organic dairy farming is a significant industry with milk being the largest single organic product in the UK. Organic milk is produced to defined standards which meet the Advisory Committee on Organic Standards (ACOS) criteria. These standards ‘emphasise animal welfare and, by avoiding artificial fertilisers, pesticides and other non-natural chemicals, and prohibiting the routine use of antibiotics and other conventional drugs, also ensure care for the environment, and promote the highest standards of food quality and safety’ (Omsco 2005). As part of the management of organic dairy cattle with reduced use of conventional pharmaceutical treatments, many organic farmers use homeopathic and other complementary therapies on their animals. Mastitis is recognised as the main animal health problem in organic milk production systems (Bennedsgaard et al 2003). Whilst mastitis levels appear to be similar to those found in conventional production (Hovi and Roderick, 2000) specific problem areas in mastitis control under organic management standards have been identified. One of the overall goals of organic animal husbandry is to avoid disease through management, husbandry, breeding and feeding. According to the EC-Regulation No. 1804/1999 governing organic livestock production, animal health management should be based on disease prevention. However, the preventive use of chemically synthesised allopathic medicinal products like dry cow antibiotics is not permitted. In organic units, phytotherapeutic and homeopathic products and trace elements are to be used in preference to antibiotic and prolonged withdrawal periods need to be observed after conventional medicine use. As a consequence of these requirements, organic dairy farmers look for alternatives to conventional therapy and prophylaxis (Hektoen 2004). Homeopathy is widely used for the treatment of mastitis within UK organic dairy herds and prophylactic use of homeopathic nosodes, either continuously or just during housing, is practised on many organic dairy farms and is thought to offer general protection against mastitis and to reduce somatic cell counts (SCC). Research into the effectiveness of homeopathic treatments was one of the most important research requirements identified in a recent MAFF review of animal health within organic herds ( Hovi & Roderick 1999). The range of homeopathic treatments used on farm today is wide, with treatment practices either focussing on the needs of the individual animal, which is known as constitutional treatment and which employs individual remedies, or aimed at groups of animals using specific remedies, or ‘nosodes’, which are considered to be a very specific form of homeopathy - isopathy (iso - all the same, pathy – treatment/exposure). Unlike specific remedies, nosodes do not account for the individual needs of each animal, but create the potential for protective treatment for a herd or group, they are generally applied in drinking water, and may be used on individual animals, usually by vulval spray. Benefit for the sector and for Defra Mastitis is the most significant disease affecting the health, welfare and economic productivity of dairy cattle, and management and control of mastitis is an important facet of practical dairy herd management. Mastitis is recognised by Defra as a major economic and welfare problem in dairy cattle. Research into the efficacy of homeopathic treatments and of management control of mastitis on organic dairy farms have both been identified as research priorities in recent Defra funded reviews of organic dairy farming. The Study Ninety-six farms participated in a double-blind trial to compare a homeopathic nosode and an inactive control treatment (carrier alone). Treatments were at the farm level and took place over a period of 12 months or 24 months (some farms were swapped to the opposite treatment during a second year). The treatments were randomised to each farm by a third party. During the trial, where available, records were collected of farm monthly bulk tank somatic cell count (BMSSC), a monthly cell count based on National Milk Recording data (NMR) and the annual number of cases of mastitis as recorded by the farmer. Additional farm level data were collected and their relationship to the level of mastitis on the farms investigated. Objectives of the Study The study described in this report explores the use of a specific mode of homeopathic treatment, a nosode, in the prevention of mastitis and quantifies the effect that the year-round, prophylactic use of nosodes, supplied to the cattle in the drinking water, had in reducing the number of clinical cases of mastitis and also quantifying any effect that the use of a nosode has on somatic cell counts within herds. • To quantify the effectiveness of the prophylactic use of homeopathic nosodes for the treatment of mastitis in reducing the incidence of clinical mastitis and the concentration of somatic cells in milk. • To survey management practices on organically managed farms. • To investigate associations between the homeopathic treatment, farm management practice and the incidence of different types of mastitis and to provide guidance for mastitis control in organic dairy herds. Materials and methods In testing the efficacy of a homeopathic nosode it was determined that the study should: • Look at a nosode already being commonly used and commercially available. • Not ask for new recording systems to be used for data collection but to use the existing systems which are in place. • Not interfere in the ‘normal’ practises carried out by the farms, by, for example, repeated prompting of farmers to carry out treatments, or ask them to adopt prescribed ways for describing, recording or treating mastitis. There are three commonly used measures of the udder health of milking cows: a) The bulk tank milk somatic cell count (BMSCC, commonly referred to as SCC) gives a count (in 000’s cells / ml) of white cells and desquamated cells shed by the udder. The BMSCC is not an accurate indicator for the presence of clinical mastitis, but may give information on sub-clinical (undetected) mastitis. b) Somatic cell counts for individual cows from farms which subscribe to commercial milk recording services (ICSCC). c) The number of cases of mastitis. The incidence rate for clinical mastitis (IRCM) is the number of distinct cases of mastitis in 100 cows in a year. The response variables that were measured were: • Farmers’ own record of mastitis cases. • Bulk milk SCC. • Individual cow somatic cell records (ICSCC) if the farms were on a milk recording service. • Farmer’s opinion of his/her success in controlling mastitis. • A large number of variables, recorded using a questionnaire at the farm visits, which could influence mastitis and the effectiveness of the treatment. After visiting a number of homeopathic pharmacies, an agreement was made with Crossgates homeopathic pharmacy1, and Freemans Homeopathic Pharmacy2 (Appendix D) to make the individual herd specific nosode remedies for the farms. The trial was double-blinded, with blinding carried out by the creation of a randomly generated list of A and B’s. As each new farm was recruited, it was allocated to the next A or B in the sequence, the farms being allocated to either nosode treatment or control, one by one, in chronological order. Articles were written in the organic press, Organic Farming, and The Turning Worm, inviting farms to take part in the study. It was clear that farms should only join the study voluntarily and would not be ‘cold called’ or pressurised to join. One hundred and four farms responded to the call, and 96 of these farms went on to take part in the study. The 8 farms which declined to take part either went out of milk production before the study started, or changed their minds about inclusion in the trial before the start of the study. The 96 farms were visited and the study introduced. Farmers were issued with a kit to collect milk from high cell count cows for preparation as a nosode. An 80 part questionnaire (Appendix A) was used to gather the information needed to understand the possible factors that may influence mastitis. During visits the farmers were also asked whether they were willing to fill in a self assessment of their personality type. Number of farms recruited = 96 Total farms completing the study period = 88 Number of farm years followed = 206 Average herd size = 101 cows Number of cows followed in the study = 9,680 Number of cows receiving remedy (R) = 4,734 Number of cows receiving control (P) = 4,946 Total cow years followed = 21,580 cow years (Some farms two years, some 3 years) Farms lost during study = 8 (due to sale of the herd, or going out of milk production and into, for example, heifer rearing) Results The data collected were subject to a number of different analyses:- 1. A test for an effect of the homeopathic nosode in reducing the cell count in milk. 2. A test for an effect of the homeopathic nosode in reducing the annual cases of mastitis. 3. An analysis to identify risk factors associated with increased cell count in milk. 4. An analysis to identify risk factors associated with higher levels of mastitis. No effect of nosode in reducing either the incidence of cases of mastitis or the somatic cell counts in the milk were detected. The following risk factors were found to be associated with composite cell counts:- • A decrease in cell count with increased culling of high cell count cows • A decrease in cell count for farms which use complementary therapies on dry cows • A decrease in cell count for farms which use dry cow therapy, including teat sealants, on dry cows • An increased cell count for farms which did not pre-wipe before milking or pre-wiped the teats with a cloth before milking • An increase in cell count for farms which pre-wipe only the udders of cows which are visibly dirty before milking The following risk factors were found to be associated with the number of cases of mastitis:- • Increasing herd yield is associated with increased mastitis case numbers • Increased calving of cows indoors in a calving box was associated with increased numbers of mastitis cases • Use of an in line clot filer was associated with reduced numbers of mastitis cases • Having an abreast parlour (as opposed to a herringbone or rotary parlour) was associated with a reduced numbers of mastitis cases The extent to which the objectives set have been achieved The effectiveness of homeopathic nosodes in treating mastitis and lowering cell count is quantified and described (Objective 1) and the survey results of management practices on organically managed dairy farms are described (Objective 2). Additionally, the associations between homeopathic treatment, farm management practices, mastitis incidence and cell count are quantified (Objective 4) and management controls which show a reduction in mastitis cases or cell counts are identified as risk factors and described in the report (Objective 5). Conclusions • There was no significant effect of the herd specific nosode on either the cell count of milk or the number of cases of mastitis. • That there were strong ‘within farm’ correlations of cell count and cases i.e. between farms, farms tend to stay at the same level of cases and average cell count from year to year. • That there was a characteristic pattern of seasonal change in cell counts (this is already widely recognised). • The study provides useful and interesting statistics on organic dairy farm production. • The study identified an association between decreased cell count and culling for high cell count, the use of complementary dry cow therapy and the use of traditional dry cow therapy. • The study identified an association between increased cell count and not pre-wiping the udder, pre-wiping using a cloth and only pre-wiping dirty cows. • The study identified an association between higher numbers of mastitis cases and higher average yield and also with higher percentage of cows calving in a calving box. • An association was identified between decreased numbers of mastitis cases and the use of an in-line clot filter and also with farms with an abreast parlour (rather than a herring-bone parlour). • Eighty five per cent of farmers in the survey responded that they did believe in non-conventional remedies, and 62 per cent of farmers responded that they used non-conventional remedies on their own family

Using microelectrode models for real time cell-culture monitoring

This paper proposes a cell-microelectrode model for cell biometry applications, based on the area overlap as main parameter. The model can be applied to cell size identification, cell count, and their extension to cell growth and dosimetry protocols. Experiments performed with comercial electrodes are presented, illustrating a procedure to obtain cell number in both growth and dosimetry processes. Results obtained for the AA8 cell line are promising.Junta de Andalucía P0-TIC-538

Haematological response of Heterobranchus longifilis fed varying dietary protein levels

Hematological effects of feeding varying dietary crude proteins levels to one hundred and fifty (150) H.longifilis fingerlings was examined on biweekly basis. The fingerlings of mean weights 1.26g plus or minus 0.24g were stocked in eight hapa nets (1mx1m) at 15 fingerlings per hapa. Four experimental diets with crude protein; 35%, 40%, 45% and 50% coded diet 1-4 respectively were fed to the fish for 8 weeks. The blood sample was taken and examined for packed cell volume (PCV) total protein (TP) Hemoglobin (Hb), Serum album, Erythrocyte count (RBC), while blood cell (WBC) mean corpuscle volume (MCV) and mean corpuscle hemoglobin, concentration (MCHC). There was an increase in the values of the hematological indices studied with increase in protein inclusion levels. A higher positive correlation with no significant difference (P greater than or equal to 0.05) exists between the treatments RBC, WBC, Hb and TP. The best RBC (2.10x10 super(6) count/l). WBC (7.65x10 super(4) count/l), PCV (35.4%) and Hb (5.79mg/l) were presented in fingerlings fed 40% crude protein followed by 45% crude protein. The dietary crude protein of 40% is recommended for H. longifilis for sound and healthy conditio