Covid-19 CasesTo rapidly communicate information on the global clinical effort against Covid-19, the Journal has initiated a series of case reports that offer important teaching points or novel findings. The case reports should be viewed as observations rather than as recommendations for evaluation or treatment. In the interest of timeliness, these reports are evaluated by in-house editors, with peer review reserved for key points as needed.

The macroporosity, and to a lesser extent the microporosity, of swelling and shrinking soils is affected by their shrinkage behaviour. The magnitude of the changes in bulk volume in response to changes in water content is usually described by the soil shrinkage characteristic curve (SSCC), i.e. the relation between the void ratio and the moisture ratio. At present, many techniques have been described for determination of the SSCC. We have applied the core method, the rubber-balloon method and the paraffin-coated method on respectively undisturbed soil samples, disturbed soil samples and soil clods collected from seven horizons of a Vertisol and a Lixisol under sugar cane in the Havana province, Cuba. We demonstrated that the balloon and paraffin-coated method showed similar results, whereas the core method produced less pronounced shrinkage. The latter was due to the anisotropic shrinkage as was confirmed by the change of the geometry factor with the moisture ratio, to a possible reorientation of particles when collecting undisturbed soil cores, and to the occurrence of small cracks upon drying. We have further shown that the core method produced much higher scatter, which was explained by higher measuring errors and crumbling of the samples as they dried out. Because of its superior behaviour, the balloon method was then selected to test nine different parametric models that describe the SSCC. A group of four models which performed best in terms of RMSE, coefficient of determination and Akaike Information Criterion could be distinguished.

One goal of the HIV care continuum is achieving viral suppression (VS), yet disparities in suppression exist among subpopulations of HIV-infected persons. We sought to identify disparities in both the ability to achieve and sustain VS among an urban cohort of HIV-infected persons in care. Data from HIV-infected persons enrolled at the 13 DC Cohort study clinical sites between January 2011 and June 2014 were analyzed. Univariate and multivariate logistic regression were conducted to identify factors associated with achieving VS (viral load <200 copies/ml) at least once, and Kaplan–Meier (KM) curves and Cox proportional hazards models were used to identify factors associated with sustaining VS and time to virologic failure (VL≥200 copies/ml after achievement of VS). Among the 4,311 participants 95.4% were either virally suppressed at study enrollment or able to achieve VS during the follow-up period. In multivariate analyses, achieving VS was significantly associated with age (aOR: 1.04; 95%CI: 1.03–1.06 per 5-year increase) and having a higher CD4 (aOR: 1.05, 95% CI 1.04–1.06 per 100 cells/mm3). Patients infected through perinatal transmission were less likely to achieve VS compared to MSM patients (aOR: 0.63, 95% CI 0.51–0.79). Once achieved, most participants (74.4%) sustained VS during follow-up. Blacks and perinatally-infected persons were less likely to have sustained VS in KM survival analysis (log rank chi-square p≤0.001 for both) compared to other races and risk groups. Earlier time to failure was observed among females, Blacks, publically insured, perinatally infected, those with longer-standing HIV infection, and those with diagnoses of mental health issues or depression. Among this HIV-infected cohort, most people achieved and maintained VS; however, disparities exist with regard to patient age, race, HIV transmission risk, and co-morbid conditions. Identifying populations with disparate outcomes allows for appropriate targeting of resources to improve outcomes along the care continuum.

We describe 2 cases of endocarditis caused by methicillin-resistant Staphylococcus aureus that failed to respond to intravenous linezolid therapy but were successfully treated with trimethoprim-sulfamethoxazole plus gentamicin and vancomycin plus rifampin.