Quantifying and mapping species threat abatement opportunities to support national target setting.

The successful implementation of the Convention on Biological Diversity's post-2020 Global Biodiversity Framework will rely on effective translation of targets from global to national level and increased engagement across diverse sectors of society. Species conservation targets require policy support measures that can be applied to a diversity of taxonomic groups, that link action targets to outcome goals, and that can be applied to both global and national data sets to account for national context, which the species threat abatement and restoration (STAR) metric does. To test the flexibility of STAR, we applied the metric to vascular plants listed on national red lists of Brazil, Norway, and South Africa. The STAR metric uses data on species' extinction risk, distributions, and threats, which we obtained from national red lists to quantify the contribution that threat abatement and habitat restoration activities could make to reducing species' extinction risk. Across all 3 countries, the greatest opportunity for reducing plant species' extinction risk was from abating threats from agricultural activities, which could reduce species' extinction risk by 54% in Norway, 36% in South Africa, and 29% in Brazil. Species extinction risk could be reduced by a further 21% in South Africa by abating threats from invasive species and by 21% in Brazil by abating threats from urban expansion. Even with different approaches to red-listing among countries, the STAR metric yielded informative results that identified where the greatest conservation gains could be made for species through threat-abatement and restoration activities. Quantifiably linking local taxonomic coverage and data collection to global processes with STAR would allow national target setting to align with global targets and enable state and nonstate actors to measure and report on their potential contributions to species conservation.

Cause of death among HIV patients in London in 2016.

OBJECTIVES: Since 2013, the London HIV Mortality Review Group has conducted annual reviews of deaths among people with HIV to reduce avoidable mortality. METHODS: All London HIV care Trusts reported data on 2016 patient deaths in 2017. Deaths were submitted using a modified Causes of Death in HIV reporting form and categorized by a specialist HIV pathologist and two HIV clinicians. RESULTS: There were 206 deaths reported; 77% were among men. Median age at death was 56 years. Cause was established for 82% of deaths, with non-AIDS-related malignancies and AIDS-defining illnesses being the most common causes reported. Risk factors in the year before death included: tobacco smoking (37%), excessive alcohol consumption (19%), non-injecting drug use (10%), injecting drug use (7%) and opioid substitution therapy (6%). Thirty-nine per cent of patients had a history of depression, 33% chronic hypertension, 27% dyslipidaemia, 17% coinfection with hepatitis B virus and/or hepatitis C virus and 14% diabetes mellitus. At the time of death, 81% of patients were on antiretroviral therapy (ART), 61% had a CD4 count < 350 cells/µL, and 24% had a viral load ≥ 200 HIV-1 RNA copies/mL. Thirty-six per cent of deaths were unexpected; 61% of expected deaths were in hospital. Two-thirds of expected deaths had a prior end-of-life care discussion documented. CONCLUSIONS: In 2016, most deaths were attributable to non-AIDS-related conditions and the majority of patients were on ART and virally suppressed. However, several potentially preventable deaths were identified and underlying risk factors were common. As London HIV patients are not representative of people with HIV in the UK, a national mortality review is warranted.

Haematological and biochemical profiles during the puerperium in dairy cows - Short communication.

The main aim of the current study was to assess the prevalence of anaemia in Holstein dairy cows during the puerperium, and the haematological and biochemical profile of dairy cows with and without anaemia. The study was conducted in seven dairy herds in São Paulo State, Brazil. The evaluated sample comprised a total of 336 Holstein cows. Blood samples were collected at postpartum day 25 ± 3. Haematological analysis included white blood cell, red blood cell and platelet count, haematocrit value, haemoglobin concentration, mean corpuscular volume, mean corpuscular haemoglobin and mean corpuscular haemoglobin concentration. The biochemical profile encompassed cholesterol, non-esterified fatty acids, ß-hydroxybutyrate, albumin, globulin, fibrinogen, calcium and total bilirubin concentrations. The prevalence of anaemia was 16.3% in all herds, and this was not affected by clinical diseases, milk production, parity and body score condition. Moreover, anaemic cows had lower red blood cell count, haematocrit, haemoglobin, serum cholesterol and calcium concentrations and higher white blood cell and platelet counts, mean corpuscular haemoglobin, red cell distribution width, non-esterified fatty acids, ß-hydroxybutyrate, fibrinogen and globulin concentrations when compared with non-anaemic cows. The results indicate changes in energy balance and an inflammatory process in anaemic cows.

Precipitation is the main axis of tropical plant phylogenetic turnover across space and time.

Early natural historians-Comte de Buffon, von Humboldt, and De Candolle-established environment and geography as two principal axes determining the distribution of groups of organisms, laying the foundations for biogeography over the subsequent 200 years, yet the relative importance of these two axes remains unresolved. Leveraging phylogenomic and global species distribution data for Mimosoid legumes, a pantropical plant clade of c. 3500 species, we show that the water availability gradient from deserts to rain forests dictates turnover of lineages within continents across the tropics. We demonstrate that 95% of speciation occurs within a precipitation niche, showing profound phylogenetic niche conservatism, and that lineage turnover boundaries coincide with isohyets of precipitation. We reveal similar patterns on different continents, implying that evolution and dispersal follow universal processes.

National review of deaths among HIV-infected adults.

This review describes patterns of mortality among adults infected with HIV in the UK and assesses the contributions of late diagnosis of HIV infection and non-HIV-related disease to such mortality. In total, 387 adults with HIV who died between 1 October 2004 and 30 September 2005 after receiving care at 90 clinical centres in the UK were reviewed. Causes of death and scenarios accounting for death were measured. Of the 387 deaths, 218 (56.3%) were readily attributable to infection with HIV. Only 123 (31.8%) deaths were considered not directly related to HIV. Late diagnosis of HIV accounted for 24.0% of all deaths and 35.2% of HIV-related deaths. Infection with HIV remains the main cause of mortality among infected patients in the era of highly active antiretroviral therapy. Late diagnosis of infection with HIV may be the largest potentially remediable factor for HIV-associated death.

The pathology of severe morbidity and mortality caused by HIV infection in Africa.

PIP: AIDS is the leading cause of death among adults in at least two capital cities in Africa: Abidjan, Cote d'Ivoire, and Kinshasa, Zaire. Knowledge of the causes of morbidity and mortality in HIV-positive people in Africa is, however, less than complete due to limited postmortem diagnostic facilities, difficulties in obtaining consent for postmortem examinations, and a general lack of pathologists. Although HIV affects all organs, either directly or by facilitating opportunistic infections and tumors, pulmonary insufficiency, wasting, cerebral lesions compromising vital centers, and overwhelming toxic systemic infection are the major causes of HIV disease. Virtually every pathological lesion described in developed countries has also been seen in Africa. This paper discusses what is known of the major serious pathologies in sub-Saharan Africa. It is clear that more pathological diagnostic and follow-up data are needed before an accurate picture of the patterns and pathogeneses of the various manifestations of HIV infection in Africa can be drawn. Sections consider HIV-1 and HIV-2 infection, Mycobacterium tuberculosis infection, non-tuberculosis pulmonary disease, diarrhea and the wasting syndrome, neuropathology, specific systemic infections, tumors associated with HIV infection, and pediatric AIDS in Africa.^ieng

Association between Kaposi's sarcoma and atherosclerosis: implications for gammaherpesviruses and vascular disease.

The treatment of HIV-positive patients with protease inhibitors has been suggested to increase their risk of atherosclerosis. The cause of this accelerated atherogenesis is unknown, but on the basis of previous studies we postulated that it could be linked to the presence of human herpesvirus-8. A retrospective analysis of post-mortem reports showed a strong correlation between Kaposi's sarcoma and the presence of atheroma. This hypothesis merits further investigation.

The mortality and pathology of HIV infection in a west African city.

BACKGROUND: HIV disease is epidemic in Africa, but associated mortality, underlying pathology and CD4+ T-lymphocyte counts have not previously been evaluated in a representative study. Such data help to determine the management of HIV-positive people. Both HIV-1 and HIV-2 infections are prevalent in Côte d'Ivoire, and the pathology of HIV-2 infection in Africa is unclear. METHODS: Consecutive adult medical admissions to a large city hospital in Côte d'Ivoire were studied in 1991, and a sample of HIV-positive deaths autopsied. RESULTS: Of 5401 patients evaluated, 50% were HIV-positive; 38% of these died, with a median survival of 1 week. At autopsy (n = 294, including 24% of HIV-positive deaths in hospital), tuberculosis (TB), bacteraemia (predominantly Gram-negative rods) and cerebral toxoplasmosis caused 53% of deaths. TB was seen in 54% of cadavers with AIDS-defining pathology and Pneumocystis pneumonia in 4%. The median CD4+ T-lymphocyte counts in those who died was < 90 x 10(6)/l. Compared with HIV-1-positives, patients with HIV-2-positivity had a greater frequency of severe cytomegalovirus infection, HIV encephalitis and cholangitis. CONCLUSIONS: In this population, HIV-positive adults present to hospital with advanced disease associated with high mortality. The three major underlying pathologies (TB, toxoplasmosis and bacteraemia) are either preventable or treatable. TB is an underestimated cause of the 'slim' syndrome in Africa. The patterns of pathology in HIV-2-positive patients suggest a more prolonged terminal course compared with HIV-1. There is an urgent need for attention towards the issues of therapy and care for HIV disease in developing countries.

Enteropathic AIDS in Uganda. An endoscopic, histological and microbiological study.

Twenty-three Ugandan patients with enteropathic acquired immunodeficiency syndrome (AIDS, 'slim' disease) were studied. Upper gastrointestinal (GI) endoscopy, colonoscopy, biopsy, stool parasitology and culture were performed. Endoscopy revealed oral and/or oesophageal candidiasis in 22 patients. Stool examination and histology of the upper GI tract showed that 11 patients had cryptosporidiosis and three had isosporiasis (total of 61% of patients with coccidian enteritis). One case of possible Mycobacterium avium mycobacteriosis was also identified. Enteropathic AIDS in Uganda presents with a spectrum of infections similar to that found in developed countries, but the incidence of cryptosporidiosis and isosporiasis is higher.

PIP: Of about 40 patients with presumed enteropathic Acquired Immune Deficiency Syndrome (AIDS), i.e., oral thrush, diarrhea, and weight loss, admitted to Mulago Hospital medical wards, Uganda, from October through November 985, 23 patients were studied with upper gastrointestinal tract endoscopy and stool examination. Those patients chosen for study suffered with diarrhea, weight loss, and oral candidiasis and were willing to tolerate endoscopy. Weight loss was not quantified in most patients, but generally it was profound. 10 of the patients gave a history of genital sores or venereal disease. There were 16 males and 7 females with an age range of 19-47 years. All were sexually active, and all denied homosexuality anal intercourse, and intravenous drug abuse. 4 patients had had blood transfusion. The 23 patients represented a cross-section of the population with most social classes included. 20 patients were seropositive with antibody to HIV. Specimens from 2 patients were lost. 1 patient was seronegative. Apart from 5 patients who had been treated with nystatin for oral thrush and clinically presumed esophageal candidiasis, all the patients had oral thrush at the time of endoscopy. 20 patients had obvious esophageal candidiasis, and 1 patient had the appearance of Kaposi's sarcoma in the esophagus. Stool examination and histology of the upper GI tract showed that 11 patients had cryptosporidiosis and 3 had isosporiasis (total of 61% of patients with coccidian enteritis). 1 case of Mycobacterium avium mycobacteriosis also was identified. The incidence of cryptosporidiosis and isosporiasis is higher in Uganda than in developed countries.

The neuropathology of HIV-infected African children in Abidjan, Côte d'Ivoire.

In an autopsy study of HIV-infected children in Abidjan, Côte d'Ivoire, the neuropathology of 76 HIV-1- and 2 HIV-2-positive children was compared with that of 77 frequency-matched HIV-negative children, in whom the systemic pathology was also known. Seventy of the 78 HIV-seropositive children were confirmed as HIV-infected, as determined by combined serology, IgA Western blots and clinicopathological criteria. The HIV-negative children showed a high background level (n = 49, 64%) of neuropathological abnormalities, including nonspecific inflammatory infiltrates, micromineralization, and bacterial and lymphocytic meningitis. In the HIV-positive children, HIV encephalitis was found in 4 (6%), cytomegalovirus in 2 (3%), toxoplasmosis in 3 (4%) and measles encephalitis in one (1%). Bacterial meningitis was equally common in both groups, but cerebral malaria was less common (n = 2, 3%) in HIV-positive than in HIV-negative children (n = 11, 14%). The low prevalence of HIV encephalitis may reflect comparatively early death in HIV infection in Africa as compared with our experience in Europe and the US.

The kinetics of amylobarbitone metabolism in healthy men and women.

1. Sodium amylobarbitone (3.54 mg/kg) was given by intravenous injection to seven healthy men and nine healthy women who were not receiving other drugs. Serum amylobarbitone and urine hydroxyamylobarbitone concentrations were measured by gas-liquid chromatography. There was no significant difference between the groups either in the serum amylobarbitone concentration/time curves or in the urinary excretion of hydroxyamylobarbitone.2. The serum amylobarbitone concentration decayed over 48 h as a double exponential function of time; the first exponential component had a mean half-time of 0.6 h (males 0.56 +/- 0.06 h, females 0.62 +/- 0.08 h, +/- S.E.) and the second exponential component had a mean half time of 21 h (males 22.7 +/- 1.6 h, females 20.0 +/- 1.0 h, +/- S.E.).3. The urinary excretion of hydroxyamylobarbitone over 48 h accounted for 34% of the dose (males 33.8 +/- 3.2%, females 35.2 +/- 3.0%, +/- S.E.). One male and two female subjects excreted hydroxyamylobarbitone partly as a conjugate which was readily hydrolysed in acid.4. An elimination constant (k(el)) derived from the serum concentration/time curve by the application of a two compartment model was approximately proportional to beta (h(-1)), the rate constant of the second exponential component. There was a positive correlation (r=0.78, P<0.001) between beta and the mean rate of urinary excretion of hydroxyamylobarbitone during the 24 to 48 h period.

Helicobacter pylori clearance in the treatment of non-ulcer dyspepsia.

One hundred and thirty north Nigerian patients with non-ulcer dyspepsia were treated with tripotassium dicitrato bismuthate and amoxycillin, or antacid. Symptoms resolved in 28 (33%) of bismuth and amoxycillin recipients completing the trial compared with 1 (4%) of the antacid recipients. Symptomatic improvement did not relate to clearance of Helicobacter pylori.

Disseminated pneumocystis carinii infection in AIDS.

Eight patients with AIDS and Pneumocystis carinii infection were studied. Protean manifestations were a feature not untypical of disseminated pneumocystosis. Aerosolised pentamidine as prophylaxis against P carinii pneumonia was ineffective at suppressing dissemination. The knowledge that extrapulmonary infection can occur has implications for the detection and treatment of, and prophylaxis against, P carinii infection. The survival of patients with disseminated pneumocystosis is particularly poor, and may be due to a lack of clinical awareness and consequent delay in diagnosis.

Cyclin D1 expression and HHV8 in Kaposi sarcoma.

BACKGROUND: Human herpesvirus 8 (HHV8) appears to be the agent responsible for Kaposi sarcoma. The mechanism remains undetermined but may involve cell cycle regulating genes including D type cyclins which are pivotal in cell cycle progression. Recent HHV8 genetic analysis has revealed the presence of a v-cyclin which is homologous to D type cyclins. AIMS: First, to assess whether there is an independent relation between endogenous cyclin D1 expression in Kaposi sarcoma and HHV8 status; second to determine whether v-cyclin mRNA expression varies with Kaposi sarcoma stage. METHODS: Cyclin D1 immunohistochemistry was performed on 17 paraffin embedded Kaposi sarcoma samples from 16 patients. HHV8 status was assessed in 15 of these using nested polymerase chain reaction (PCR) to ORF 26 and the newly described technique of TaqMan PCR. An additional 10 fresh Kaposi sarcoma samples (early and nodular) were examined for HHV8 v-cyclin RNA. RESULTS: One case, which did not contain amplifiable HHV8, showed strong cyclin D1 staining. The remaining cases were negative or weakly staining; v-cyclin transcript load was higher in early Kaposi sarcoma. CONCLUSIONS: While endogenous cyclin D1 expression is independent of HHV8 status, v-cyclin transcription is higher in early lesions, supporting the "viral hit" hypothesis.

New approach to risk determination: development of risk profile for new falls among community-dwelling older people by use of a Genetic Algorithm Neural Network (GANN).

BACKGROUND: Falls risk in older people is multifactorial and complex. There is uncertainty about the importance of specific risk factors. Genetic algorithm neural networks (GANNs) can examine all available data and select the best nonlinear combination of variables for predicting falls. The aim of this work was to develop a risk profile for operationally defined new falls in a random sample of older people by use of a GANN approach. METHODS: A random sample of 1042 community-dwelling people aged 65 and older, living in Nottingham, England, were interviewed at baseline (1985) and survivors reinterviewed at a 4-year follow-up (n = 690). The at-risk group (n = 435) was defined as those survivors who had not fallen in the year before the baseline interview. A GANN was used to examine all available attributes and, from these, to select the best nonlinear combination of variables that predicted those people who fell 4 years later. RESULTS: The GANN selected a combination of 16 from a potential 253 variables and correctly predicted 35/114 new fallers (sensitivity = 31%; positive predictive value = 57%) and 295/321 nonfallers (specificity = 92%; negative predictive value = 79%); total correct = 76%. The variables selected by the GANN related to personal health, opportunity, and personal circumstances. CONCLUSIONS: This study demonstrates the capacity of GANNs to examine all available data and then to identify the best 16 variables for predicting falls. The risk profile complements risk factors in the current literature identified by use of standard and conventional statistical methods. Additional data about environmental factors might enhance the sensitivity of the GANN approach and help identify those older people who are at risk of falling.

Prediction of hemorrhagic blood loss with a genetic algorithm neural network.

There is no established method for accurately predicting how much blood loss has occurred during hemorrhage. In the present study, we examine whether a genetic algorithm neural network (GANN) can predict volume of hemorrhage in an experimental model in rats and we compare its accuracy to stepwise linear regression (SLR). Serial measurements of heart period; diastolic, systolic, and mean blood pressures; hemoglobin; pH; arterial PO2; arterial PCO2; bicarbonate; base deficit; and blood loss as percent of total estimated blood volume were made in 33 male Wistar rats during a stepwise hemorrhage. The GANN and SLR used a randomly assigned training set to predict actual volume of hemorrhage in a test set. Diastolic blood pressure, arterial PO2, and base deficit were selected by the GANN as the optimal predictors set. Root mean square error in prediction of estimated blood volume by GANN was significantly lower than by SLR (2.63%, SD 1.44, and 4.22%, SD 3.48, respectively; P < 0.001). A GANN can predict highly accurately and significantly better than SLR volume of hemorrhage without knowledge of prehemorrhage status, rate of blood loss, or trend in physiological variables.

Esophageal varices in Nairobi, Kenya: a study of 68 cases.

Sixty-eight patients with proven esophageal varices wer studied at Kenyatta National Hospital, Nairobi, Kenya. Of these patients, 29.4% had schistosomal portal hypertension, 22.1% cirrhosis and only 8.8% extrahepatic portal vein occlusion. One quarter of the patients had a normal liver biopsy and extrahepatic portal vein that was demonstrated to be patent. Problems relating to liver biopsy sampling resulting in underdiagnosis of specific causes of esophageal varices such as schistosomiasis are discussed. We argue that many of these patients were likely to be suffering from idiopathic portal hypertension, a condition apparently not previously recognized in Africa. Of this last group, 70.6% had suffered gastrointestinal bleeding, as had 50% of the patients with schistosomiasis. Together these two groups accounted for three-quarters of all patients who had bled. The detection of eggs of Schistosoma mansoni in stool and/or rectal snip correlated well with liver biopsy findings in both a positive and negative sense. Only 18% of patients with negative stools and snips had evidence of schistosomiasis in the liver, and positive stools or snips were found in only 14.6% of patients without schistosomal liver involvement. Of the patients in the study, 50% were of the Kamba tribe, although only 12.9% of all medical admissions to the hospital were Kamba (P less than 0.01). Luo patients were significantly more frequent within the group with schistosomiasis (P less than 0.02). Esophageal varices were attributed to tropical splenomegaly syndrome in only one patient. The implications of our results are discussed and our findings are compared with previous work from East Africa.

HIV-related enteropathy in Zambia: a clinical, microbiological, and histological study.

To investigate the etiology of chronic diarrhea associated with human immunodeficiency virus (HIV) infection in Lusaka, we studied 63 HIV-positive patients and 36 seronegative controls clinically and endoscopically. Stools were studied for morphology and for opportunist infections. Fifty-five percent of patients seropositive for HIV who presented with a history of chronic diarrhea had parasites; the most common were Cryptosporidium (32%), Isospora belli (16%), and Strongyloides stercoralis (6%). As indicated by villous blunting and inflammation on duodenal histology, those with diarrhea and parasites showed the most severe damage. We could not implicate mycobacteria or bacterial overgrowth as causes for the enteropathy associated with HIV.

The pharmacokinetics of 7-hydroxymethotrexate following medium-dose methotrexate therapy.

An unambiguous and specific HPLC assay was used to determine the pharmacokinetics of 7-hydroxymethotrexate (7-OHMTX) following the administration of moderate-dose methotrexate (MTX) 100 mg X m-2 to 37 patients with advanced head and neck cancer. There was marked interpatient variation but patient exposure to 7-OHMTX was considerable. There was, however, no correlation between the amount of 7-OHMTX produced and either tumour response or patient toxicity.