Risk factors for and clinical characteristics of severe hyperlactataemia in patients receiving antiretroviral therapy: a case-control study

BACKGROUND

Symptomatic hyperlactataemia and lactic acidosis (SHLA) are potentially life-threatening complications associated with stavudine (d4T), an antiretroviral therapy (ART) drug widely used in developing countries.

METHODS

Cases comprised all symptomatic patients with measured lactates >or= 5 mmol/L referred to a South African hospital between August 2003 and November 2005. Matched controls were selected according to facility and duration on ART.

RESULTS

Seventy-one cases and 142 controls were included in the study. The majority of cases presented between 6 and 18 months on ART. Female sex [adjusted odds ratio (AOR) 23.4; 95% confidence interval (CI) 4.0-136.6], a baseline weight between 60 and 75 kg (AOR 4.5; 95% CI 1.4-14.1) or, in particular, >or= 75 kg (AOR 19.4; 95% CI 4.1-82.5) at ART initiation and gaining >or= 6 kg in the first 3 months on therapy (AOR 3.5; 95% CI 1.3-9.5) were independent risk factors identifying patients who may subsequently develop SHLA. Weight loss of >or= 2 kg (AOR 6.1; 95% CI 2.0-18.3), a rise in alanine aminotransferase (ALT) >or= 10 U/L (AOR 3.1; 95% CI 1.1-8.9), the presence of at least one of three major symptoms (vomiting, nausea and abdominal pains) of SHLA (AOR 12.6; 95% CI 3.3-47.2) and peripheral neuropathy (AOR 3.4; 95% CI 1.1-9.8) were the clinical parameters that were most able to identify patients with early manifestations of SHLA.

CONCLUSIONS

This is the first case-control study for SHLA in Southern Africa. Given these findings, we advise that stavudine is avoided in overweight women. Weight loss, a rise in ALT, peripheral neuropathy and/or gastrointestinal symptoms should prompt healthcare workers to assess for SHLA, especially at between 6 and 18 months on ART.

Roles of Fe superoxide dismutase and catalase in resistance of Campylobacter coli to freeze-thaw stress

We demonstrated that oxidative stress plays a role in freeze-thaw-induced killing of Campylobacter coli following analysis of mutants deficient in key antioxidant functions. Superoxide anions, but not H(2)O(2), were formed during the freeze-thaw process. However, a failure to detoxify superoxide anions may lead to spontaneous disproportionation of the radicals to H(2)O(2).

Sequential mechanical and pharmacological thromboprophylaxis in the surgery of hip fractures. A pilot study

Two hundred and thirty-eight patients with femoral neck fractures were entered into a randomised pilot study comparing the use of sequential treatment by 'Flowtron DVT' garments in the perioperative period followed by Enoxaparin (Clexane-Rhône-Poulenc Rorer), and Enoxaparin alone. One hundred and ninety-three patients were excluded indicating the difficulty of achieving pure comparisons in this population. The remaining 44 were randomised: 21 received Enoxaparin from the time of admission, and 23 had sequential treatment. There was no statistically significant difference in the incidence of thromboembolism. Patient preference did not indicate a favoured treatment subjectively. The operation field was drier in the sequential group, although this did not reach significance. Sequential treatment was not shown to be better or worse than treatment with Enoxaparin, but the trends favoured sequential treatment rather than drug treatment alone. The technique allows the operation to be carried out without the problems produced by low dose heparins and mobilisation is not hindered by compression garments.

A comparison of intermittent calf compression and enoxaparin for thromboprophylaxis in total hip replacement. A pilot study

A prospective randomised trial was carried comparing the use of Enoxaparin with intermittent pneumatic calf compression garments for thromboprophylaxis in total hip replacement. Fifty consecutive patients were studied and randomised to evaluate these two methods. There were 2 deep vein thromboses, one in each group, and no cases of pulmonary embolism. The operative field was judged to be drier in the compression group, but the mean fall in the postoperative haemoglobin level was the same in each. In the peroperative period, 6 patients in the Enoxaparin group needed 2 units of blood and one 3 units. In the compression group, 3 patients needed transfusions of 2 units. Intermittent calf compression has fewer problems than the use of Enoxaparin and has no contraindications.

The effect of hydroxycinnamic acids and potassium sorbate on the growth of 11 strains of spoilage yeasts

Hydroxycinnamic acids and their derivatives occur widely in plants, fruits and wine. The effect of the common hydroxycinnamic acids (caffeic, coumaric and ferulic acids), at concentrations of 100 and 500 mg l-1, on growth of 11 strains of spoilage yeasts was measured spectrophotometrically and compared with that of potassium sorbate. Ferulic acid was the most generally inhibitory hydroxycinnamic acid. At 500 mg l-1 it appreciably inhibited Pichia anomala, Debaryomyces hansenii and Saccharomyces cerevisiae and prevented detectable growth of one strain each of P. anomala and D. hansenii. Caffeic acid was the least inhibitory compound and coumaric acid had an intermediate effect. The more resistant strains of yeast were P. membranaefaciens, Saccharomycodes ludwigii and Zygosaccharomyces bailii. Sensitivity to hydroxycinnamic acid was, in general, associated with sensitivity to potassium sorbate; at a given concentration potassium sorbate was more inhibitory than were any of the hydroxycinnamic acids.

Production of extracellular lipases and proteinases during prolonged growth of strains of psychrotrophic bacteria in whole milk

Three strains of psychrotrophic Pseudomonas spp., each with different lipolytic and proteolytic phenotypes (including a proteinase-deficient mutant), were cultured separately in whole milk at 7 degrees C. Growth rates were the same during logarithmic growth phase, but during early stationary phase the cell densities were related to the activities of lipase and proteinase in the cultures. Only one strain underwent pronounced death phase. Proteinase activity was not detected in the culture of the proteinase-deficient mutant, but in those of the other strains it increased to a plateau, or continued to increase linearly. Lipase activity of the culture of each strain reached a peak in early stationary phase; in late stationary phase activity was highest for the proteinase-deficient mutant strain where degradation of lipase by bacterial proteinase would have been least. The ability of psychrotrophic bacteria both to survive for long periods and to produce high levels of proteinases and lipases on prolonged incubation in milk emphasizes the spoilage potential arising from psychrotrophic bacteria in inadequately cleaned dairy equipment.

Assay of proteinases of psychrotrophic bacteria in milk using hide powder azure and a simple procedure for clarification of milk

The clarification of milk by addition of solutions of Triton X-100 and EDTA after digestion of added Hide Powder Azure (HPA) was found to provide a simple method of determining the extracellular proteinase activity of Gram-negative psychrotrophic bacteria in pasteurized whole milk. The light absorbance of the clarified HPA digestion product was measured directly, after a brief incubation period, and was stable to storage of samples in diffuse daylight for at least 2 d. Proteinase produced by growth in refrigerated whole milk of as few as 2.5 X 10(6) cfu ml-1 of Pseudomonas fluorescens AR11 was detected.

Determination of physical properties of bovine serum lipoproteins by analytical ultracentrifugation

Pure samples of low density lipoprotein-one (d 1.019 to 1.039 g/ml), low density lipoprotein-two (d 1.039 to 1.060 g/ml), and high density lipoprotein (d 1.060 to 1.210 g/ml) were isolated from bovine serum and their properties studied in the analytical ultracentrifuge. Approach-to-equilibrium experiments indicated that the lipoprotein classes were homogeneous. Molecular weights of the lipoproteins given by this method (low density lipoprotein-one, 1.14 x 10(6); low density lipoprotein-two, 2.37 x 10(6); high density lipoprotein, .576 x 10(6)) agreed well with those obtained by a high-speed-equilibrium method (1.03 x 10(6), 2.15 x 10(6), and .567 x 10(6)). Linear plots of flotation rate (corrected for viscosity) against the density of the medium were obtained in sedimentation velocity experiments and on extrapolation gave values for the hydrated density of 1.032 g/ml for low density lipoprotein-one, 1.044 g/ml for low density lipoprotein-two, and 1.071 g/ml for high density lipoprotein. The density of the material which would have to be added to high density lipoprotein to give it the physical properties of low density lipoprotein one was less than 1 g/ml, which suggested that it was predominantly lipid.

Immunological properties of bovine serum lipoproteins and chemical analysis of their protein moieties

Four classes of bovine serum lipoproteins were isolated by precipitation with dextran sulfate, ultracentrifugation, and preparative electrophoresis on polyacrylamide gel. Very low density lipoprotein (d less than 1.019 g/ml) was related immunologically to low density lipoprotein-two (d 1.039 to 1.060 g/ml) and high density lipoprotein (d 1.060 to 1.210 g/ml) was related immunologically to low density lipoprotein-one (d 1.019 to 1.039 g/ml), but the two pairs were immunologically distinct. The major N-terminal amino acid of both high density lipoprotein and low density lipoprotein-one was aspartic acid, and that of low density lipoprotein-two was glutamic acid. Very low density lipoprotein had both aspartic acid and glutamic acid as the major N-terminal amino acids. None of the lipoproteins was identical with any other with respect to amino acid composition, but high density lipoprotein and low density lipoprotein-one were similar to each other and different from low density lipoprotein-two. Very low density lipoprotein was similar to both low density lipoprotein-one and low density lipoprotein-two. It is concluded that the proteins of high density lipoprotein and of low density lipoprotein-one are related and are different from that of low density lipoprotein-two. The protein of very low density lipoprotein is related to that of low density lipoprotein-two but may contain polypeptides of high density lipoprotein or low density lipoprotein-one.

Lipid composition of bovine serum lipoproteins

The four classes of lipoproteins (one of very low density, two of low density, and one of high density) were isolated from the serum of a lactating Friesian cow. The proportions of protein and of the different lipid classes were determined in each lipoprotein. Triglycerides predominated in the very low density lipoprotein, and cholesteryl esters and phospholipids in the others. The triglycerides of the very low density lipoprotein were richer in oleic acid than were those of the low density lipoproteins, but its cholesteryl esters were relatively poorer in linoleic and linolenic acid than were those of any of the others. Phytanic acid (3, 7, 11, 15-tetramethylhexadecan-1-oic acid) was in all lipoproteins except those of very low density; it was not in cholesteryl esters but was abundant in triglycerides, particularly in those of the low density lipoproteins. Hydrolysis of the triglycerides of very low density lipoprotein with pancreatic lipase showed that 82% of their stearic acid was esterified to the 1- and 3-positions of glycerol and that 64% of their palmitic acid was esterified to the 2-position.

Lipid composition of some species of Arthrobacter

The lipids from Arthrobacter crystallopoietes, A. pascens, and A. globiformis were investigated. Each strain contained three glycolipids, a monogalactosyl diglyceride, a digalactosyl diglyceride, and a dimannosyl diglyceride, and traces of triand tetraglycosyl diglycerides. The phospholipids in all three strains consisted of bisphosphatidylglycerol, phosphatidylglycerol, and phosphatidylmyoinositol. No evidence could be obtained for the occurrence of mannophosphoinositides. Analysis of the fatty acids by gas-liquid chromatography showed that they are predominantly C(15:0)anteiso and C(17:0)anteiso compounds. No significant differences were observed in the composition of lipids extracted from homogeneous cell preparations of the rod and sphere forms of A. crystallopoietes.