Loss to Clinic and Five-Year Mortality among HIV-Infected Antiretroviral Therapy Initiators

Missing outcome data due to loss to follow-up occurs frequently in clinical cohort studies of HIV-infected patients. Censoring patients when they become lost can produce inaccurate results if the risk of the outcome among the censored patients differs from the risk of the outcome among patients remaining under observation. We examine whether patients who are considered lost to follow up are at increased risk of mortality compared to those who remain under observation. Patients from the US Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) who newly initiated combination antiretroviral therapy between January 1, 1998 and December 31, 2009 and survived for at least one year were included in the study. Mortality information was available for all participants regardless of continued observation in the CNICS. We compare mortality between patients retained in the cohort and those lost-to-clinic, as commonly defined by a 12-month gap in care. Patients who were considered lost-to-clinic had modestly elevated mortality compared to patients who remained under observation after 5 years (risk ratio (RR): 1.2; 95% CI: 0.9, 1.5). Results were similar after redefining loss-to-clinic as 6 months (RR: 1.0; 95% CI: 0.8, 1.3) or 18 months (RR: 1.2; 95% CI: 0.8, 1.6) without a documented clinic visit. The small increase in mortality associated with becoming lost to clinic suggests that these patients were not lost to care, rather they likely transitioned to care at a facility outside the study. The modestly higher mortality among patients who were lost-to-clinic implies that when we necessarily censor these patients in studies of time-varying exposures, we are likely to incur at most a modest selection bias.     

Pleural Rubs in Tietze's Syndrome

In dealing with scoliosis in childhood, carefully kept records and periodic examinations will establish the trend of the deformity. A decision can be made as to whether the curve will progress or stabilize. Conservative treatment in some cases results in a well-balanced trunk with acceptable cosmetic appearance.Increasing scoliosis can be prevented by forceful correction and spinal fusion. Pseudarthrosis is the most common reason for loss of correction. Roentgenograms are not totally reliable in determining the intactness of the fusion mass. Surgical exploration and repair should be done if there is any doubt as to the presence of a mature, solid graft.Following the establishment of a solid graft, trunk support should be continued in young patients whose vertebral growth is not complete.     

The Relation of Pancreatic Disease to Weber-Christian Disease

A case of acute Weber-Christian disease is reported, in which pancreatitis was accompanied by evidence of dissemination of pancreatic enzymes causing necrosis of fat and vessels. There is clinical and experimental evidence in the literature to suggest that widespread vascular dissemination of lipase occurs in cases of pancreatitis or pancreatic carcinoma. Review of the autopsy literature of cases of Weber-Christian disease shows that a majority had pancreatitis and systemic involvement of fat. A minority showed lesions confined to the panniculus, which tended to ulcerate; these lesions were in other ways not typical of Weber-Christian disease. In this group none had autopsy evidence of pancreatitis.The opinion is expressed that Weber-Christian disease results from disruption of pancreatic tissue and subsequent vascular dissemination of pancreatic enzymes.     

Reproductive life history of Thornicroft’s giraffe in Zambia

Knowledge of the reproductive life history of giraffe in the wild is sparse. Giraffe have two fairly unusual reproductive patterns among large mammals: they can become pregnant while lactating, and calf mortality is extremely high. Longitudinal records are largely absent, so tracking reproductive parameters tends to combine information from captive and field studies. In this study, we examine longitudinal data obtained over a 33‐year period in one population of Thornicroft’s giraffe in order to chart their reproductive careers. We found that age at first parturition was 6.4 years, or slightly later than in captivity. Giraffe bred throughout the year, with cows producing offspring on average every 677.7 days. About half of the calves died before one year of age, but death of a calf did not reduce interbirth interval. We conclude that the lifetime reproductive success of giraffe is more dependent on longevity and calf survivorship than on reproductive rate.