Optimizing ozone treatment for pathogen removal and disinfection by-product control for potable reuse at pilot-scale.

Reclaimed water poses environmental and human health risks due to residual organic micropollutants and pathogens. Ozonation of reclaimed water to control pathogens and trace organics is an important step in advanced water treatment systems for potable reuse of reclaimed water. Ensuring efficient pathogen reduction while controlling disinfection byproducts remains a significant challenge to implementing ozonation in reclaimed water reuse applications. This study aimed to investigate ozonation conditions using a plug flow reactor (PFR) to achieve effective pathogen removal/inactivation while minimizing bromate and N-Nitrosodimethylamine (NDMA) formation. The pilot scale study was conducted using three doses of ozone (0.7, 1.0 and 1.4 ozone/total organic carbon (O3/TOC) ratio) to determine the disinfection performance using actual reclaimed water. The disinfection efficiency was assessed by measuring total coliforms, Escherichia coli (E. coli), Pepper Mild Mottle Virus (PMMoV), Tomato Brown Rugose Fruit Virus (ToBRFV) and Norovirus (HNoV). The ozone CT values ranged from 1.60 to 13.62 mg min L-1, resulting in significant reductions in pathogens and indicators. Specifically, ozone treatment led to concentration reductions of 2.46-2.89, 2.03-2.18, 0.46-1.63, 2.23-2.64 and > 4 log for total coliforms, E. coli, PMMoV, ToBRFV, and HNoV, respectively. After ozonation, concentrations of bromate and NDMA increased, reaching levels between 2.8 and 12.0 µg L-1, and 28-40.0 ng L-1, respectively, for average feed water bromide levels of 86.7 ± 1.8 µg L-1 and TOC levels of 7.2 ± 0.1 mg L-1. The increases in DBP formation were pronounced with higher ozone dosages, possibly requiring removal/control in subsequent treatment steps in some potable reuse applications.

Contaminants of emerging concern reduction and microbial community characterization across a three-barrier advanced water treatment system.

This research investigated the removal of contaminants of emerging concern (CECs) and characterized the microbial community across an advanced water treatment (AWT) train consisting of Coagulation/Flocculation/Clarification/Granular Media Filtration (CFCGMF), Ozone-Biological Activated Carbon Filtration (O3/BAC), Granular Activated Carbon filtration, Ultraviolet Disinfection, and Cartridge Filtration (GAC/UV/CF). The AWT train successfully met the goals of CECs and bulk organics removal. The microbial community at each treatment step of the AWT train was characterized using 16S rRNA sequencing on the Illumina MiSeq platform generated from DNA extracted from liquid and solid (treatment media) samples taken along the treatment train. Differences in the microbial community structure were observed. The dominant operational taxonomic units (OTU) decreased along the treatment train, but the treatment steps did impact the microbial community composition downstream of each unit process. These results provide insights into microbial ecology in advanced water treatment systems, which are influenced and shaped by each treatment step, the microbial community interactions, and their potential metabolic contribution to CECs degradation.

Experimental and Simulation Studies on Hematite Interaction with Na-Metasilicate Pentahydrate.

Iron ore is a fundamental pillar in construction globally, however, its process is highly polluting and deposits are becoming less concentrated, making reusing or reprocessing its sources a sustainable solution to the current industry. A rheological analysis was performed to understand the effect of sodium metasilicate on the flow curves of concentrated pulps. The study was carried out in an Anton Paar MCR 102 rheometer, showing that, in a wide range of dosages, the reagent can reduce the yield stress of the slurries, which would result in lower energy costs for transporting the pulps by pumping. To understand the behavior observed experimentally, computational simulation has been used by means of quantum calculations to represent the metasilicate molecule and the molecular dynamics to study the adsorption of metasilicate on the hematite surface. It has been possible to obtain that the adsorption is stable on the surface of hematite, where increasing the concentration of metasilicate increases its adsorption on the surface. The adsorption could be modeled by the Slips model where there is a delay in adsorption at low concentrations and then a saturated value is reached. It was found that metasilicate requires the presence of sodium ions to be adsorbed on the surface by means of a cation bridge-type interaction. It is also possible to identify that it is absorbed by means of hydrogen bridges, but to a lesser extent than the cation bridge. Finally, it is observed that the presence of metasilicate adsorbed on the surface modifies the net surface charge, increasing it and, thus, generating the effect of dispersion of hematite particles which experimentally is observed as a decrease in rheology.

Transpyloric Feeding is Associated With Improved Oxygenation Compared With Gastric Feeding Among Nonintubated Extremely Low Birth Weight Infants.

OBJECTIVE: To study the impact of transpyloric (TP) feed initiation on short-term oxygenation and manual oxygen blender titration among extremely low birth weight infants. STUDY DESIGN: This retrospective study evaluated several measures of oxygenation among extremely low birth weight infants receiving positive pressure respiratory support for 96 hours before and after TP tube placement in a single neonatal intensive care unit during the years 2017- 2020. The measures included the achieved oxygen saturation (SpO2), the baseline fraction of inspired oxygen (FiO2), the SpO2/FiO2 ratio, the number and severity of hypoxemic episodes and the frequency of manual oxygen titrations (titration index) and were analyzed using an interrupted time series regression approach. RESULTS: A total of 56 infants were evaluated. No significant differences were observed in any oxygenation measures during TP vs gastric feeding among 14 intubated infants. However, among 42 nonintubated patients, significant improvements were observed in the median SpO2/FiO2 ratios (P = .001), median titration index (P = .05), median number of hypoxemic episodes (P = .02), and median severity of hypoxemic episodes (P = .008) after TP tube placement. CONCLUSIONS: The transition from gastric to TP tube feeding was temporally associated with acute improvement in oxygenation for nonintubated infants, but not for intubated infants.

Use of Nanoscale Zero-Valent Iron for Remediation of Clayey Soil Contaminated with Hexavalent Chromium: Batch and Column Tests.

This study investigated the reduction of hexavalent chromium (Cr(VI)) in a clayey residual soil using nanoscale zero-valent iron (nZVI). Five different ratios between nZVI and Cr(VI) were tested in batch tests (1000/11; 1000/23; 1000/35; 1000/70, and 1000/140 mg/mg) with the soil. With the selected proportion resulting best efficiency, the column tests were conducted, with molded specimens of 5 cm in diameter and 5 cm in height, with different nZVI injection pressures (10, 30, and 100 kPa). The soil was contaminated with 800 mg/kg of Cr(VI). The Cr(VI) and Cr(III) analyses were performed following the USEPA 3060A and USEPA 7196A standards. The results show that the reduction of Cr(VI) is dependent on the ratio between nZVI and Cr(VI), reaching 98% of efficiency. In column tests, the pressure of 30 kPa was the most efficient. As pressure increased, contaminant leaching increased. The permeability decreased over time due to the gradual increase in filtration and formation of oxyhydroxides, limiting nZVI mobility. Overall, nZVI is efficient for soil remediation with Cr(VI), but the injection process can spread the contaminated if not properly controlled during in situ application.

Influence of nanoscale zero-valent iron on hydraulic conductivity of a residual clayey soil and modeling of the filtration parameter.

Contaminated clay soils pose problems to public health and the environment in several parts of the world. Very little is known about the transport of decontaminating agents used in remediation process under natural, undisturbed conditions. Nanomaterials, especially those made of nanoscale zero-valent iron (nZVI), have been most frequently used for remediation of contaminated soils because of their higher reactivity, lower toxicity, and lower cost than other metallic nanoparticles. Even though the nanoparticle size is smaller than soil pores, clogging may occur over time due to agglomeration of nanoparticles, which could reduce the soil's natural permeability and thereby cause filtration of the nanoparticles. The use of a stabilizer in the nanoparticles can modify the reactivity but improves their mobility in the soil system. Thus, the objective of this work was to evaluate the hydraulic conductivity of residual clay soil under the injection of different types and concentrations of nZVI with and without surfactant stabilizer (NANOFER 25, NANOFER 25S, and NANOFER STAR in powder at 1 g/L, 4 g/L, 7 g/L, and 10 g/L concentrations), and to model transport of these nZVI suspensions in this soil system. Undisturbed cylindrical soil samples collected from the field were used, and hydraulic conductivity tests were performed using a column apparatus. The results showed that the presence of the stabilizer in the nZVI influenced the nanoparticles' mobility. The nZVI concentrations of 1 and 4 g/L did not affect the natural soil hydraulic conductivity. However, higher concentrations reduced the hydraulic conductivity value, which retarded the migration of nZVI as reflected in the value of filtration parameter.

Quantitative Assessment of Life Cycle Sustainability (QUALICS): Framework and its application to assess electrokinetic remediation.

In recent years, the broader environmental impacts of remediation that arise from different remediation activities has drawn attention of practitioners, remediation design professionals and academicians to evaluate the net environmental benefit of environmental remediation projects. The main objective of this paper is to describe the Quantitative Assessment of Life Cycle Sustainability (QUALICS) framework, a new tool developed to strengthen decision-making in the selection of sustainable remedial technologies for the clean-up of contaminated sites. The proposed framework is a combination of two multi-criteria evaluation methods namely, the Integrated Value Model for Sustainable Assessment (MIVES) and Analytic Hierarchy Process (AHP). The QUALICS uses a multi-criteria assessment framework to support decision-making in remediation projects. A description of the methodology adopted for sustainability assessment of alternative remedial strategies using QUALICS framework is presented in this study. In addition, a case study is discussed to demonstrate the application of the QUALICS framework for the sustainability assessment of different remediation options for clean-up of a contaminated site. The case study involves sustainability assessment of different remediation options namely, electrokinetic remediation (EKR), excavation/disposal, and phytoremediation for remediation of a contaminated site. A sensitivity analysis was also performed for the EKR option by varying different parameters including electrode materials, energy source, electrolyte used, to analyze their influence on the sustainability of the alternative remedial options. The proposed framework can also be applied to any project in general to quantify and compare the sustainability indices of each of the alternative options considered and thereby identify the most sustainable option.

Biostimulation and rainfall infiltration: influence on retention of biodiesel in residual clayey soil.

This study investigates the retention of biodiesel in residual clayey soil during biostimulation by nutrients (nitrogen, phosphorus, and potassium) under conditions of rainfall infiltration. Several column tests were conducted in a laboratory under different void ratios (1.14, 1.24, and 1.34), varying moisture contents (15, 25, and 35%), and in both the presence and absence of biostimulation. The volume of biodiesel (which was equivalent to the volume of voids in the soil) was placed atop the soil and allowed to percolate for a period of 15 days. The soil was subjected to different rainfall infiltration conditions (0.30 or 60 mm). The greatest reductions in residual contaminants occurred after 60 mm of rain simulation, at values of up to 74% less than in samples with the same conditions but no precipitation. However, the residual contamination decay rate was greater with 0-30 mm (0.29 g/mm) of precipitation than with 30-60 mm (0.075 g/mm). Statistical assessment revealed that increased moisture and the presence of nutrients were the factors with the most powerful effect on contaminant retention in the soil. The residual contaminant level was 21 g/kg at a moisture content of 15% and no precipitation, decreasing to 12 g/kg at 35% moisture and no precipitation. Accordingly, it is possible to conclude that biostimulation and rainfall infiltration conditions can decrease the retention of contaminants in soil and allow a greater leaching or spreading of the contamination. All of these phenomena are worthy of careful examination for the in situ bioremediation of organic contamination. HIGHLIGHTS: • The higher moisture in the soil, due to a high initial moisture content and/or infiltration of rainfall, can reduce contaminant retention, • The use of biostimulation through the addition of nutrients to accelerate the biodegradation of toxic organic contaminants may induce inadvertent undesirable interactions between the soil and the contaminant. • When adopting biostimulation for bioremediation, the effects of rainfall should be addressed; ideally, it should be prevented from entering the affected site, in order to avoid increased contaminant leaching and potential spreading.

Separate evolution of virulent newcastle disease viruses from Mexico and Central America.

An outbreak of Newcastle disease (ND) in poultry was reported in Belize in 2008. The characteristics of three virulent Newcastle disease virus (NDV) isolates from this outbreak (NDV-Belize-3/08, NDV-Belize-4/08, and NDV-Belize-12/08) were assessed by genomic analysis and by clinicopathological characterization in specific-pathogen-free (SPF) chickens. The results showed that all three strains belong to NDV genotype V and are virulent, as assessed by the intracerebral pathogenicity index and the polybasic amino acid sequence at the fusion protein cleavage site. In 4-week-old SPF chickens, NDV-Belize-3/08 behaved as a typical velogenic viscerotropic NDV strain, causing severe necrohemorrhagic lesions in the lymphoid organs, with systemic virus distribution. Phylogenetic analysis of multiple NDV genotype V representatives revealed that genotype V can be divided into three subgenotypes, namely, Va, Vb, and Vc, and that all tested Belizean isolates belong to subgenotype Vb. Furthermore, these isolates are nearly identical to a 2007 isolate from Honduras and appear to have evolved separately from other contemporary viruses circulating in Mexico, clustering into a new clade within NDV subgenotype Vb.

Follow-up of HIV-infected women diagnosed by antenatal screening in Barbados from 1996-2004.

A follow-up study was undertaken to analyze the impact of the early diagnosis of HIV in women by antenatal voluntary counseling and testing (VCT) by way of making a difference to their health status and the social behavior of these women. This is a descriptive study. The study population included all HIV-infected women in this country who were diagnosed to be HIV infected by way of VCT during 1996-2004. Sixty-one (37.4%) never attended the HIV clinic for their care or treatment. The median delay between the time of diagnosis of HIV infection and the time of their presentation to the follow-up clinic was 36 months. Of the 79 women who reported to have been sexually active only 33 had a steady partner; 54 had had one or more casual sex partners at some point in time since their HIV diagnosis. One third never used condoms with their steady partner and one sixth never used condoms with casual partners. Overall, 89 women had one or more repeated pregnancy, mostly from different partners. In conclusion, many of the women diagnosed from antenatal VCT fail to utilize the available health care facilities and continue to engage in risk-taking behaviors.

Uptake of health care services and health status of HIV-infected women diagnosed through antenatal HIV screening in Barbados, 1996-2004 / Utilización de los servicios de atención sanitaria y estado de salud de las mujeres seropositivas al VIH diagnosticadas mediante el tamizaje prenatal para el VIH en Barbados, 1996-2004

OBJECTIVES: To study utilization of HIV-related health care services and to describe the health status of HIV-infected women diagnosed through antenatal voluntary counseling and testing (VCT) for HIV infection in Barbados. METHODS: This is a descriptive study. The study population includes all HIV-infected women in Barbados diagnosed as HIV-infected through VCT for HIV infection during 1996-2004. RESULTS: The median duration of HIV infection from time of diagnosis to the time of this report for the 163 women diagnosed during the study period was 72 months (low range, 9 months; high range, 117 months). Of the 163 women, 102 (62.6 percent) had attended the centralized HIV/AIDS clinic for follow-up (care, treatment, and monitoring), whereas 61 (37.4 percent) had never attended the clinic. The median time lag between diagnosis of HIV infection and first presentation to the HIV/AIDS clinic was 36 months (low range, 1 month; high range, 114 months). Of the HIV-infected women who attended the HIV/AIDS clinic, more than one-fourth had severe immunodeficiency at the time of their first follow-up visit. Of the 53 women undergoing highly active anti-retroviral therapy (HAART) at the time of the study, 23 (43.4 percent) began the therapy within three months of their first follow-up visit. CONCLUSIONS: Early HIV diagnosis through antenatal VCT is not enough to ensure that women with HIV will get adequate and timely HIV-related health care. These women suffer significant premature mortality, largely related to inadequate follow-up.

OBJETIVOS: Estudiar la utilización de los servicios de atención sanitaria relacionados con el VIH y describir el estado de salud de las mujeres infectadas con este virus, diagnosticadas mediante el asesoramiento y la prueba de detección del VIH de carácter voluntario (APDV) durante el período prenatal en Barbados. MÉTODOS: Este es un estudio descriptivo. La población de estudio abarcó a todas las mujeres infectadas por el VIH, diagnosticadas en Barbados mediante el APDV en 1996-2004. RESULTADOS: La mediana de la duración de la infección por el VIH -desde el diagnóstico hasta el momento de este informe- en las 163 mujeres diagnosticadas durante el período de estudio fue de 72 meses (nivel bajo: 9 meses; nivel alto: 117 meses). De las 163 mujeres, 102 (62,6 por ciento) asistieron a la clínica centralizada para el VIH/sida para su seguimiento (atención, tratamiento y monitoreo), mientras que 61 (37,4 por ciento) nunca asistieron a la clínica. La mediana del lapso entre el diagnóstico de la infección por el VIH y la primera presentación a la clínica para el VIH/sida fue de 36 meses (nivel bajo: 1 mes; nivel alto: 114 meses). Más de la cuarta parte de las mujeres infectadas que acudieron a la clínica presentaban inmunodeficiencia grave en el momento de su primera consulta de seguimiento. De las 53 mujeres que se sometieron al tratamiento antirretroviral de gran actividad (HAART) durante el estudio, 23 (43,4 por ciento) comenzaron el tratamiento en los tres meses siguientes a su primera visita de seguimiento. CONCLUSIONES: El diagnóstico temprano mediante el APDV no garantiza que las mujeres con VIH reciban una atención adecuada y oportuna para tratar esa infección. Estas mujeres sufren una mortalidad significativamente prematura, en gran parte debido al inadecuado seguimiento.

Uptake of health care services and health status of HIV-infected women diagnosed through antenatal HIV screening in Barbados, 1996-2004

OBJECTIVES: To study utilization of HIV-related health care services and to describe the health status of HIV-infected women diagnosed through antenatal voluntary counseling and testing (VCT) for HIV infection in Barbados. METHODS: This is a descriptive study. The study population includes all HIV-infected women in Barbados diagnosed as HIV-infected through VCT for HIV infection during 1996-2004. RESULTS: The median duration of HIV infection from time of diagnosis to the time of this report for the 163 women diagnosed during the study period was 72 months (low range, 9 months; high range, 117 months). Of the 163 women, 102 (62.6%) had attended the centralized HIV/AIDS clinic for follow-up (care, treatment, and monitoring), whereas 61 (37.4%) had never attended the clinic. The median time lag between diagnosis of HIV infection and first presentation to the HIV/AIDS clinic was 36 months (low range, 1 month; high range, 114 months). Of the HIV-infected women who attended the HIV/AIDS clinic, more than one-fourth had severe immunodeficiency at the time of their first follow-up visit. Of the 53 women undergoing highly active anti-retroviral therapy (HAART) at the time of the study, 23 (43.4%) began the therapy within three months of their first follow-up visit. CONCLUSIONS: Early HIV diagnosis through antenatal VCT is not enough to ensure that women with HIV will get adequate and timely HIV-related health care. These women suffer significant premature mortality, largely related to inadequate follow-up.

Profile of Hospitalized HIV-Infected Persons in the Highly Active Antiretroviral Therapy Era in Barbados.

OBJECTIVES: To investigate the reasons for hospitalization and its outcome in the era of highly active antiretroviral therapy (HAART) in Barbados. This report also describes the profiles of the HIV-infected persons who were hospitalized in the HAART era. METHODS: The authors examined the admission case notes to conduct an observational, retrospective study of all HIV-infected patients admitted to the Queen Elizabeth Hospital (QEH) during September 1, 2004, through March 31, 2005. Data collected included patients' profile, including the date of diagnosis of HIV infection. Outcome of the current admission in terms of discharge or death and the final diagnosis at the time of discharge or death was noted. RESULTS: Over the 6-month period, there were 160 adult admissions to the QEH where HIV/AIDS was at least one of the final diagnoses. Eighty-four (52.5%) admissions were in persons who were known to be HIV infected prior to the current admission, where a diagnosis of HIV infection was made for the first time during the current hospitalization in the remaining 76 (47.5%) cases. Nearly two thirds of those hospitalized and who had a CD4 count done had CD4 counts of < 200. Overall, opportunistic infection was the most common (38.1%), at discharge or as a final diagnosis, followed by serious bacterial infections, anemia, and HIV nephropathy. The outcome of these admissions was death in 30 (18.7%) cases, whereas the patient was discharged in the remaining 130 (81.3%) cases. CONCLUSIONS: A significant proportion of the hospitalized HIV-infected persons in the HAART era is newly diagnosed. The majority of those hospitalized had severe immunodeficiency, and consequently opportunistic infection was the most common final diagnosis.

Trends in the HIV related hospital admissions in the HAART era in Barbados, 2004-2006.

BACKGROUND: To investigate the reasons for hospitalizations and its outcome in the era of HAART in Barbados. This report also describes the profile of the HIV infected persons who are hospitalized in the HAART era. METHODS: This is a retrospective study of HIV related admissions in this country. We examined the admission case notes of all the adult admissions to the Queen Elizabeth Hospital where one of the discharge diagnosis was HIV infection during the April 2004 through March 2006. Data collected included patients' profile, including the date of diagnosis of HIV infection, outcome of the current admission in term of discharge or death and the final diagnosis at the time of discharge or death. RESULTS: Over the 24 months period there were 431 adult admissions to the medical wards of the Queen Elizabeth Hospital where one of the discharge diagnosis was HIV infection and this accounted for 5.9% of all medical admissions. 258(60%) admissions were in persons who were known to be HIV infected prior to the current admission, where as diagnosis of HIV infection was made for the first time during the current admission in case of remaining 76(47.5%) cases. Nearly half of those hospitalized, had a CD 4 cell counts of < 200/microL. Over all, opportunistic infection was the commonest (35%) discharge diagnosis, followed by serious bacterial infections, anemia and HIV nephropathy. The outcome of these admissions was death in 30 (14.2%) cases where as patient was discharged out in the remaining 181 (85.8%) cases. Of the medical admissions with HIV as one of the discharge diagnosis during the period April 04 through March 05, 43% were newly diagnosed HIV infection and the corresponding figure for the period April 05 through March 06 was 35% (P = 0.54). During the April 05 through March 04 significantly higher proportion of HIV infected adults had Anemia with a Hemoglobin less than 10 g/dL (P = 0.044), HIV related nephropathy (P = 0.0003), HAART toxicity (P = < 0.0001) and a Non-AIDS related conditions (P = 0.043) as one of the final discharge diagnosis. CONCLUSION: A significant proportion of patients admitted with HIV infection were the newly diagnosed and severely immuno-suppressed. An opportunistic infection continues to be the commonest discharge diagnosis, although there was a growing trend in the proportion of the discharge diagnosis being HAART toxicity and Non-AIDS related conditions. Over all hospitalization of HIV infected persons still carries a significant risk of mortality.

Uptake of health care services and health status of HIV-infected women diagnosed through antenatal HIV screening in Barbados, 1996-2004.

OBJECTIVES: To study utilization of HIV-related health care services and to describe the health status of HIV-infected women diagnosed through antenatal voluntary counseling and testing (VCT) for HIV infection in Barbados. METHODS: This is a descriptive study. The study population includes all HIV-infected women in Barbados diagnosed as HIV-infected through VCT for HIV infection during 1996-2004. RESULTS: The median duration of HIV infection from time of diagnosis to the time of this report for the 163 women diagnosed during the study period was 72 months (low range, 9 months; high range, 117 months). Of the 163 women, 102 (62.6%) had attended the centralized HIV/AIDS clinic for follow-up (care, treatment, and monitoring), whereas 61 (37.4%) had never attended the clinic. The median time lag between diagnosis of HIV infection and first presentation to the HIV/AIDS clinic was 36 months (low range, 1 month; high range, 114 months). Of the HIV-infected women who attended the HIV/AIDS clinic, more than one-fourth had severe immunodeficiency at the time of their first follow-up visit. Of the 53 women undergoing highly active anti-retroviral therapy (HAART) at the time of the study, 23 (43.4%) began the therapy within three months of their first follow-up visit. CONCLUSIONS: Early HIV diagnosis through antenatal VCT is not enough to ensure that women with HIV will get adequate and timely HIV-related health care. These women suffer significant premature mortality, largely related to inadequate follow-up.

Changing HIV infection-related mortality rate and causes of death among persons with HIV infection before and after the introduction of highly active antiretroviral therapy: analysis of all HIV-related deaths in Barbados, 1997-2005.

OBJECTIVES: To compare the trends in death rates and the causes of deaths before and after the introduction of highly active antiretroviral therapy. METHODS: This is a retrospective study based on chart review of all HIV-related deaths between January 1997 and December 2005. RESULTS: The HIV-specific death rate declined from 34.12 per 100,000 adult population during 1997-1999 to 17.21 per 100,000 adult population during 2003-2005 when highly active anti-retroviral therapy was available. The proportion of all HIV-related deaths among persons newly diagnosed with HIV during the terminal hospitalization decreased from 93% during 1997-1999 to 28% during 2003-2005. Opportunistic infection was at least one of the causes of death in nearly half of all cases. CONCLUSIONS: Although, the HIV-specific death rates have declined significantly since the introduction of highly active antiretroviral therapy, HIV infection continues to contribute to the premature deaths among adults, mainly because of the late presentation.

CD4 cell counts in adults with newly diagnosed HIV infection in Barbados / Recuentos de células CD4 en adultos con diagnóstico reciente de infección por VIH en Barbados

OBJETIVO: Evaluar los recuentos de células CD4 de toda persona con un diagnóstico reciente de infección por VIH que acudió a la Unidad de Remisión Ladymeade (URL), que es el centro nacional de Barbados para la remisión y el tratamiento de casos de infección por VIH y sida. MÉTODOS: El grupo de estudio se compuso de adultos con infección por VIH en quienes el diagnóstico y la remisión a la URL se habían hecho entre enero y diciembre de 2002. A todos los pacientes remitidos a la URL se les había efectuado un recuento de células CD4 en su primera consulta a la unidad como parte de la serie habitual de pruebas realizadas para determinar en qué estado se encontraba la enfermedad y si había necesidad de administrar antirretrovíricos. RESULTADOS: De los 106 adultos con un diagnóstico reciente, 62 (58,5%) eran varones y tenían una edad mediana de 40 años cuando enfermaron; los otros 44 (41,5%) eran mujeres y tenían una edad mediana de 36 años al enfermar. Casi una quinta parte (18,2%) de las mujeres se encontraban entre los 16 y 25 años de edad, mientras que solamente 8,1% de los varones pertenecían a ese grupo etario. A la mayoría (57,6%) de las personas en el grupo de estudio se les hizo el diagnóstico cuando consultaron por trastornos asociados con la infección por VIH o el sida. En general, el recuento mediano de células CD4 cuando se hizo el diagnóstico fue de 183/µL; 52 de 103 adultos (50,5%) con un diagnóstico reciente de infección por VIH tenían un recuento de células CD4 < 200/µL. En los varones, el recuento mediano de células CD4 fue de 161/µL, y 32 de 60 varones (53,3%)...

Objective. To evaluate the absolute CD4 cell counts of all the newly diagnosed HIVinfected persons who presented at the Ladymeade Reference Unit (LRU), which serves as the national HIV/AIDS referral and treatment center for the country of Barbados. Design and Methods. The study group was comprised of HIV-infected adults who had been diagnosed with HIV infection and referred to the LRU between January and December 2002. All the patients referred to the LRU had a CD4 cell count done at their first visit to the unit, as part of the routine workup to assess their disease status and need for antiretroviral therapy. Results. Of the 106 newly diagnosed adults, 62 of them (58.5%) were males, who had a median age at presentation of 40 years; the other 44 of them (41.5%) were females, and their median age at presentation was 36 years. Nearly one-fifth (18.2%) of the females were aged 16-25 years, whereas only 8.1% of the males were in this age group. The majority (57.6%) of the study group were diagnosed because they presented with an HIV/AIDS-related illness. Overall, the median CD4 cell count at the time of diagnosis was 183/mL; 52 of 103 adults (50.5%) with a newly diagnosed HIV infection had a CD4 cell count that was < 200. Among males, the median CD4 cell count was 161/mL, and 32 (53.3%) of 60 males had CD4 cell counts < 200. In contrast, among females, the median CD4 cell count was 223, and 20 (46.5%) of 43 females in the proportion of males and females with a CD4 cell count less than 200/mL was not statistically significant (P = 0.63). Conclusions. At the time of HIV diagnosis, over one-half of the adults had an initial CD4 cell count that was consistent with relatively advanced disease. Proportionally more women than men presented at a younger age, and proportionally more women than men presented in the early stages of the disease. These patterns indicate a clear need for enhanced educational efforts regarding the importance of HIV testing for at-risk individuals across Barbados. This testing could improve efforts to reduce transmission as well as the prognosis for patients who receive antiretroviral therapy

CD4 cell counts in adults with newly diagnosed HIV infection in Barbados.

OBJECTIVE: To evaluate the absolute CD4 cell counts of all the newly diagnosed HIV-infected persons who presented at the Ladymeade Reference Unit (LRU), which serves as the national HIV/AIDS referral and treatment center for the country of Barbados. DESIGN AND METHODS: The study group was comprised of HIV-infected adults who had been diagnosed with HIV infection and referred to the LRU between January and December 2002. All the patients referred to the LRU had a CD4 cell count done at their first visit to the unit, as part of the routine workup to assess their disease status and need for antiretroviral therapy. RESULTS: Of the 106 newly diagnosed adults, 62 of them (58.5%) were males, who had a median age at presentation of 40 years; the other 44 of them (41.5%) were females, and their median age at presentation was 36 years. Nearly one-fifth (18.2%) of the females were aged 16-25 years, whereas only 8.1% of the males were in this age group. The majority (57.6%) of the study group were diagnosed because they presented with an HIV/AIDS-related illness. Overall, the median CD4 cell count at the time of diagnosis was 183/microL; 52 of 103 adults (50.5%) with a newly diagnosed HIV infection had a CD4 cell count that was < 200. Among males, the median CD4 cell count was 161/microL, and 32 (53.3%) of 60 males had CD4 cell counts < 200. In contrast, among females, the median CD4 cell count was 223, and 20 (46.5%) of 43 females had a CD4 cell count that was < 200/microL. However, this difference in the proportion of males and females with a CD4 cell count less than 200/microL was not statistically significant (P = 0.63). CONCLUSIONS: At the time of HIV diagnosis, over one-half of the adults had an initial CD4 cell count that was consistent with relatively advanced disease. Proportionally more women than men presented at a younger age, and proportionally more women than men presented in the early stages of the disease. These patterns indicate a clear need for enhanced educational efforts regarding the importance of HIV testing for at-risk individuals across Barbados. This testing could improve efforts to reduce transmission as well as the prognosis for patients who receive antiretroviral therapy.