No abstract

We enrolled 427 consecutive patients with tuberculosis diagnosed in Cité Soleil, Haiti in a trial of short-course intermittent therapy. All patients received supervised therapy with isoniazid, rifampin, pyrazinamide, and ethambutol thrice weekly for 8 wk, followed by isoniazid and rifampin thrice weekly for 18 wk. At entry, the 177 human immunodeficiency virus (HIV)-infected patients (42%) were found significantly more likely to have extrapulmonary tuberculosis and negative tuberculin skin tests (p < 0.05). Treatment was well tolerated by both groups of patients, and adherence to the treatment regimen was over 90%. Among patients with pulmonary or intrathoracic tuberculosis, 9% of HIV-seropositive and 1% of HIV-seronegative patients died during therapy (p < 0.001), whereas 81% and 87%, respectively, of those in the two groups were cured. Relapses occurred in 5.4% of HIV-seropositive and 2.8% of HIV-seronegative patients who completed treatment (p = 0.36). Survival after tuberculosis was poorer in HIV-seropositive patients, whose probability of dying was 33% at 18 mo after diagnosis as compared with 3% for HIV-seronegative patients (p < 0.001). HIV-seropositive patients who died had significantly lower median CD4 lymphocyte counts than did HIV-seropositive patients who survived (p < 0.001). Treatment of tuberculosis with short-course, thrice-weekly, supervised therapy in the setting of a developing country is highly efficacious in both HIV-seropositive and -seronegative patients.

Women attending Haitian slum-based antenatal clinics were evaluated for sexually transmitted diseases (STDs): 110 (11%) of 996 were syphilis seroreactive, 313 (35%) of 903 had trichomoniasis, 110 (12%) of 897 had gonococcal or chlamydial cervical infection (or both), and 418 (47%) of 891 had at least one STD. Syphilis seroreactivity was associated with illiteracy (P = .007), lower socioeconomic status (P < .001), and a history of spontaneous abortion (P = .02). Of 663 evaluated sera, 56 (8%) had human immunodeficiency virus (HIV) antibodies. In multivariate analysis, positive HIV serostatus was associated with syphilis seroreactivity (P = .006), partner's unemployment (P = .002), and history of a previous sex partner (P = .04). Risk factors for gonococcal or chlamydial cervical infection were evaluated. Clinical assessment of cervical discharge, a World Health Organization algorithm, and a decision model based on local risk factors were 64%, 77%, and 89% sensitive, respectively, and 44%, 38%, and 43% specific, respectively, for predicting cervical infection. Alternative treatment approaches should be validated while waiting for affordable, simple, rapid, and accurate laboratory diagnostic tests for gonococcal and chlamydial cervical infections.

No abstract

Infection with the human immunodeficiency virus type 1 (HIV-1) results in decreased cell-mediated immunity, which includes decreased delayed hypersensitivity to skin test antigens. HIV-1 seropositivity and skin test reactivity to purified protein derivative (PPD) were determined among 2042 healthy Haitian adults with normal chest radiographs. Among HIV-1-seropositive individuals, 52.3% (146/279) had PPD reactions greater than or equal to 10 mm compared with 67.2% (1184/1763) of the seronegative adults (P less than .001). However, the percentage of HIV-1-seropositive individuals with PPD reactions greater than or equal to 5 mm was similar to the percentage of seronegative adults with PPD reactions greater than or equal to 10 mm (180/279 [64.5%] vs. 1184/1763 [67.2%]). Assuming that the rate of prior infection with Mycobacterium tuberculosis was similar for HIV-1-seronegative and -seropositive populations, these data provide support for the recent recommendations to use induration of greater than or equal to 5 mm as evidence of past infection with M. tuberculosis in HIV-1 seropositive adults.

Of 4588 pregnant women in a high-risk Haitian population, 443

The El Paistle (Deep) Field is a deep, abnormally pressured gas field located in Kenedy County, South Texas. A combination of factors make drilling and completing wells in this field as difficult a challenge as can be found in nearly any drilling area in the world today. These factors include abnormal pore pressures which routinely require mud weights of 18.0 to 19.0 ppg to control; short, difficult to detect pore pressure transition zones; and bottom hole temperatures in excess of 310 degrees Fahrenheit at 15,000 feet. Development in the field has now spanned a nine-year period. During the early stages, four out of the eight wells drilled in the field did not achieve the desired objectives due to the harsh drilling conditions. Since then, eleven additional wells have been drilled in the field with only one failing to achieve the desired objective. Improvements made in drilling techniques, well planning, supervision, well control practices, cementing procedures and well completion procedures are reviewed in depth in the paper.While some problems remain to be solved, drilling in the E1 Paist1e (Deep) Field has References and illustrations at end of paper.progressed to the point where it can now be considered almost routine.

The El Paistle (Deep) Field is a deep, abnormally pressured gas field located in Kenedy County, South Texas. A combination of factors make drilling and completing wells in this field as difficult a challenge as can be found in nearly any drilling area in the world today. These factors include abnormal pore pressures which routinely require mud weights of 18.0 to 19.0 ppg to control; short, difficult to detect pore pressure transition zones; and bottom hole temperatures in excess of 310 degrees Fahrenheit at 15,000 feet. Development in the field has now spanned a nine-year period. During the early stages, four out of the eight wells drilled in the field did not achieve the desired objectives due to the harsh drilling conditions. Since then, eleven additional wells have been drilled in the field with only one failing to achieve the desired objective. Improvements made in drilling techniques, well planning, supervision, well control practices, cementing procedures and well completion procedures are reviewed in depth in the paper.While some problems remain to be solved, drilling in the E1 Paist1e (Deep) Field has References and illustrations at end of paper.progressed to the point where it can now be considered almost routine.