Determination of PCDD/Fs in breast milk of women living in the vicinities of Da Nang Agent Orange hot spot (Vietnam) and estimation of the infant's daily intake

Seventeen toxic congeners of polychlorinated dibenzo-p-dioxins (PCDDs) and polychlorinated dibenzofurans (PCDFs) were determined in breast milks using the high resolution gas chromatography/high resolution mass spectrometry (HRGC/HRMS) method. Twenty seven breast milk samples were collected from primiparae who have lived over 5 years in wards namely Chinh Gian, An Khe, Khue Trung, and Hoa Thuan Tay which are located near the Da Nang Agent Orange hot spot (the AO/Dioxin hot spot). The samples were then analyzed for PCDD/F residues in order to assess the human exposure to dioxins from the AO/Dioxin hot spot, especially health risk to the breast-fed infants. The average TEQ levels in the four studied cohorts ranged from 8.1 to 26 pg/g lipid, with the highest level up to 51 pg TEQ/g lipid found in the An Khe ward. The TEQ level was correlated with geographical position and ranking in the order of Khue Trung, Hoa Thuan Tay, Chinh Gian and An Khe. The mean estimated PCDD/Fs infant's daily intake in the cohort of Khue Trung, Hoa Thuan Tay, Chinh Gian and An Khe was about 41, 122, 124, and 134 pg TEQ/kg bw/day, respectively, which are much higher than the tolerable daily intake proposed by the World Health Organization (4 pg TEQ/kg bw/day).

Timing of initiation of antiretroviral therapy in human immunodeficiency virus (HIV)--associated tuberculous meningitis

BACKGROUND

The optimal time to initiate antiretroviral therapy (ART) in human immunodeficiency virus (HIV)-associated tuberculous meningitis is unknown.

METHODS

We conducted a randomized, double-blind, placebo-controlled trial of immediate versus deferred ART in patients with HIV-associated tuberculous meningitis to determine whether immediate ART reduced the risk of death. Antiretroviral drugs (zidovudine, lamivudine, and efavirenz) were started either at study entry or 2 months after randomization. All patients were treated with standard antituberculosis treatment, adjunctive dexamethasone, and prophylactic co-trimoxazole and were followed up for 12 months. We conducted intention-to-treat, per-protocol, and prespecified subgroup analyses.

RESULTS

A total of 253 patients were randomized, 127 in the immediate ART group and 126 in the deferred ART group; 76 and 70 patients died within 9 months in the immediate and deferred ART groups, respectively. Immediate ART was not significantly associated with 9-month mortality (hazard ratio [HR], 1.12; 95% confidence interval [CI], .81-1.55; P = .50) or the time to new AIDS events or death (HR, 1.16; 95% CI, .87-1.55; P = .31). The percentage of patients with severe (grade 3 or 4) adverse events was high in both arms (90% in the immediate ART group and 89% in the deferred ART group; P = .84), but there were significantly more grade 4 adverse events in the immediate ART arm (102 in the immediate ART group vs 87 in the deferred ART group; P = .04).

CONCLUSIONS

Immediate ART initiation does not improve outcome in patients presenting with HIV-associated tuberculous meningitis. There were significantly more grade 4 adverse events in the immediate ART arm, supporting delayed initiation of ART in HIV-associated tuberculous meningitis. Clinical Trials Registration. ISRCTN63659091.

Contamination by persistent organic pollutants in dumping sites of Asian developing countries: implication of emerging pollution sources

In Asian developing countries, large amounts of municipal wastes are dumped daily in open dumping sites without proper management. This practice may cause several adverse environmental consequences and increased health risk to local communities. To elucidate contamination by persistent organic pollutants (POPs)--including dichloro-diphenyl-trichloroethane and its metabolites (DDTs), hexachlorocyclohexanes (HCHs), chlordanes, hexachlorobenzene (HCB), and polychlorinated biphenyls (PCBs)--in such dumping sites, soil samples were collected from open dumping sites and respective control sites in Cambodia, India, and Vietnam from 1999 through 2001. Our results demonstrated that DDTs, PCBs, and HCHs were dominant contaminants in the dumping sites. However, the contamination pattern was not consistent, showing higher HCHs in India than in Cambodia and Vietnam. Interestingly, in all of the countries, extremely higher levels of POPs were observed in the dumping sites compared with those in the respective control sites, suggesting significant amplification of POP contamination in the dumping sites of Asian developing countries. Mean concentrations of DDTs and PCBs were 350 and 140 ng/g dry weight, respectively, in the dumping sites of Cambodia and 26 and 210 ng/g, respectively, in India. These residue levels were hundreds to thousands times higher than those in general soils, implying possible risk to human health of the local communities, especially to the rag pickers, including children who work in these sites to collect recyclable materials. Composition of DDT compounds suggested their recent use in populated areas, which in turn might have caused increased levels of DDTs in the open dumping sites. In addition, composition of HCH isomers revealed their different use pattern in different countries.