The outcome of HIV-positive patients admitted to intensive care units with acute kidney injury

The original publication is available at http://www.intechopen.comPublication of this article was funded by the Stellenbosch University Open Access Fund.Acute kidney injury is a serious clinical problem with significant morbidity and mortality. Several factors are recognized to aggravate the outcome including advanced age, gender, oliguria and the serum creatinine level. What is currently unknown is whether the presence of the human immunodeficiency virus (HIV) aggravates the outcome of patients who develop acute kidney injury (AKI). Sub-Saharan Africa currently bears the brunt of the global HIV pandemic. In South Africa alone more than 5.7 million people are infected ((UNAIDS 2008 report on the global AIDS epidemic, 2009), creating substantial additional pressure on already inadequate social and healthcare infrastructures. Acute kidney injury occurs commonly in HIV-infected patients admitted to hospital and carries with it substantial mortality. In a resource-poor environment clinicians are often forced to select patients with a better chance of survival for admission to the intensive care unit (ICU). A rigorous evaluation of the outcomes of HIV-positive patients admitted to ICU with AKI may assist in identifying factors associated with better survival, and thus aid in the cost-effective management of these patients.Publishers' Versio

The Outcome of HIV-Positive Patients Admitted to Intensive Care Units with Acute Kidney Injury

The original publication is available at http://www.intechopen.comPublication of this article was funded by the Stellenbosch University Open Access Fund.Acute kidney injury is a serious clinical problem with significant morbidity and mortality. Several factors are recognized to aggravate the outcome including advanced age, gender, oliguria and the serum creatinine level. What is currently unknown is whether the presence of the human immunodeficiency virus (HIV) aggravates the outcome of patients who develop acute kidney injury (AKI). Sub-Saharan Africa currently bears the brunt of the global HIV pandemic. In South Africa alone more than 5.7 million people are infected ((UNAIDS 2008 report on the global AIDS epidemic, 2009), creating substantial additional pressure on already inadequate social and healthcare infrastructures. Acute kidney injury occurs commonly in HIV-infected patients admitted to hospital and carries with it substantial mortality. In a resource-poor environment clinicians are often forced to select patients with a better chance of survival for admission to the intensive care unit (ICU). A rigorous evaluation of the outcomes of HIV-positive patients admitted to ICU with AKI may assist in identifying factors associated with better survival, and thus aid in the cost-effective management of these patients.Publishers' Versio

POPULATION DYNAMICS OF THE WANDERING ALBATROSS DIOMEDEA EXULANS AT MARION ISLAND: LONGLINE FISHING AND ENVIRONMENTAL INFLUENCES

The subantarctic Prince Edward Islands (Marion and Prince Edward) support the largest breeding population of the Vulnerable wandering albatross Diomedea exulans. The number of birds breeding at Marion Island has fluctuated over the past three decades apparently as a result of both real changes in the size of the population and changes in the proportion of the population that attempts to breed in a given year. Changes in several demographic parameters that appear to be influenced by both environmental and anthropogenic effects are described. From 1994–2001, the proportion of first-time breeders in the population was positively correlated with the maximum ENSO (Ni&#241o 3) index, whereas from 1984–2000 the annual survival rates of breeding adults were negatively correlated with Japanese pelagic longline fishing effort in the southern Indian Ocean. Adult survival rates were significantly correlated with those on neighbouring Possession Island, Crozet Islands, but differed from those at South Georgia, suggesting common factors operating at an ocean-basin scale. The average survival rate of adult females was lower than that of males. Males who lost partners took 40% longer than females to find a new mate, suggesting a male-biased population. Survival rates of juvenile males and females did not differ. The age distribution of first-time breeders shifted progressively towards younger birds during the 1990s. Higher than expected survival rates of breeding adults during the late 1990s may be linked to large amounts of supplementary food being made available by the initiation of a longline fishery for Patagonian toothfish Dissostichus eleginoides close to the islands at this time. Overall, breeding success was better than recorded at other localities, indicating that breeding conditions at Marion Island were comparatively favourable. The early implementation of both international and national conservation initiatives to reduce the impact of longline fishing on this species and improve its conservation status is encouraged.Afr. J. mar. Sci. 25: 503–51

DECREASE IN NUMBERS OF THE EASTERN ROCKHOPPER PENGUIN EUDYPTES CHRYSOCOME FILHOLI AT MARION ISLAND, 1994/95–2002/03

The number of eastern rockhopper penguins Eudyptes chrysocome filholi breeding at subantarctic Marion Island decreased from about 173 000 pairs in 1994/95 to about 67 000 pairs in 2001/02. During 1994/95–2002/03 pairs fledged on average 0.40 chicks per year, an amount thought insufficient to balance mortality of breeding adults, and there was a decrease in the mass at arrival at breeding colonies of both males and females. Except in 1997/98, the mass of chicks at fledging was less than that recorded at two other localities. These factors suggest an inadequate supply of food for rockhopper penguins at Marion Island. Decreases of rockhopper penguins at several other localities also have been attributed to inadequate food. Rockhopper penguins at Marion Island continued to feed mainly on crustaceans during chick rearing. There was a marked increase in the contribution of fish to the diet in 1999/00 that coincided with an increase in mass at arrival at colonies of both males and females. Trends in numbers of pairs breeding in different sections of Marion Island were not always consistent, indicating the need for island-wide monitoring to establish the overall trend. Afr. J. mar. Sci. 25: 487–49

UNUSUAL BREEDING BY SEABIRDS AT MARION ISLAND DURING 1997/98

In 1997/98, breeding at subantarctic Marion Island was exceptionally good for five species of seabirds capable of foraging over wide areas and for a tern. The number of king penguin Aptenodytes patagonicus chicks surviving to the start of spring in 1997 was considerably more than previously recorded. Greater numbers of wandering Diomedea exulans and grey-headed Thalassarche chrysostoma albatrosses, northern giant petrels Macronectes halli and Kerguelen terns Sterna virgata bred than previously recorded, and more southern giant petrels M. giganteus did so than in any other year since 1994. For southern giant petrels, reproductive success was higher than in any other year, as was survival of chicks of northern giant petrels. Conversely, for two seabirds that feed close to the island, gentoo penguin Pygoscelis papua and Crozet shag Phalacrocorax [atriceps] melanogenis, 1997/98 was a particularly poor breeding season. Gentoo penguins initiated breeding later than usual and fledged few chicks. The number of Crozet shags that bred decreased; probably about 25% of the adult population did not breed. For two species with an intermediate foraging range that eat mainly crustaceans, macaroni Eudyptes chrysolophus and eastern rockhopper E. chrysocome filholi penguins, breeding was not noticeably different from normal except that chicks of rockhopper penguins fledged with a slightly heavier mass than in other years. However, for both these penguins, the mass of adults on arrival at colonies decreased substantially in the following (1998/99) breeding season. The unusual breeding by most of the seabirds coincided with the El Niño Southern Oscillation (ENSO) event of 1997/98. This synchrony contrasts with lagged responses to ENSO events of seabirds that breed farther south in the Southern Ocean. Continued monitoring of seabirds over well-separated sites in the Southern Ocean may elucidate how climatic perturbations operating at a global scale impact seabirds in the region.Afr. J. mar. Sci. 25: 453–46

Structural and magnetic properties of CoPt mixed clusters

In this present work, we report a structural and magnetic study of mixed Co58Pt42 clusters. MgO, Nb and Si matrix can be used to embed clusters, avoiding any magnetic interactions between particles. Transmission Electron Microscopy (TEM) observations show that Co58Pt42 supported isolated clusters are about 2nm in diameter and crystallized in the A1 fcc chemically disordered phase. Grazing Incidence Small Angle X-ray Scattering (GISAXS) and Grazing Incidence Wide Angle X-ray Scattering (GIWAXS) reveal that buried clusters conserve these properties, interaction with matrix atoms being limited to their first atomic layers. Considering that 60% of particle atoms are located at surface, this interactions leads to a drastic change in magnetic properties which were investigated with conventional magnetometry and X-Ray Magnetic Circular Dichro\"{i}sm (XMCD). Magnetization and blocking temperature are weaker for clusters embedded in Nb than in MgO, and totally vanish in silicon as silicides are formed. Magnetic volume of clusters embedded in MgO is close to the crystallized volume determined by GIWAXS experiments. Cluster can be seen as a pure ferromagnetic CoPt crystallized core surrounded by a cluster-matrix mixed shell. The outer shell plays a predominant role in magnetic properties, especially for clusters embedded in niobium which have a blocking temperature 3 times smaller than clusters embedded in MgO

Nutritional support of children with chronic liver disease

Anorexia, malabsorption and metabolic derangements contribute to the malnutrition that occurs in most children with chronic liverdisease. Nutritional support should be started early in the management of these children with the co-operation of a paediatric dietitian toimprove quality of life and decrease post-transplant mortality.Nutritional assessment entails a detailed dietary history, physical examination and anthropometry. Weight-based anthropometricmeasures are unreliable while mid-upper-arm circumference and skinfold thickness provide more reliable estimates of nutritional status.Special investigations such as serum vitamin levels and skeletal X-rays further guide management.High energy (130 - 150% of recommended daily intake (RDI)) and protein (3 - 4 g/kg/day) intakes are recommended. Diets are usuallyenriched with medium-chain fatty acids because of their better absorption in cholestatic liver disease. High-dose fat-soluble vitaminsupplements are given while care is taken to avoid toxicity. Initial doses are two to three times the RDI and then adjusted according to serumlevels or international normalised ratio (INR) in the case of vitamin K.Children with good appetites are fed orally. Feeds should be more regular than for other children to avoid prolonged periods of fastingand improve energy intake. Some children require supplementary nasogastric feeds to increase energy intake and avoid overnight fasting

Oudit 300

Exam paper for second semeste