监测产程中阴道检查代替肛门检查的临床研究

目的了解产程中常规采用阴道检查代替传统的肛门检查是否会增加母儿感染及并发症的发生.方法将研究对象随机分成对照组(肛门检查组)445例和实验组(阴道检查组)481例,分别采用传统的肛门检查和5%聚维酮碘溶液消毒后阴道检查来监测产程进展,采用单盲法观察母儿产后的体温,白细胞计数及分类,眼部、肺部、腹部体征,血液或者恶露培养结果等监测指标,记录在统一设计的表格上,按诊断标准确定母儿是否感染.结果两组母儿感染发生率比较差异无显著性意义(P＞0.05);在妊娠合并细菌性阴道病的产妇中,对照组的产褥感染发生率明显高于实验组(P＜0.05).结论 5%聚维酮碘溶液消毒后阴道检查代替传统的肛门检查用于监测产程,不增加母儿感染及并发症的发生,并可减少妊娠合并细菌性阴道病产妇产褥感染发生率,是产时服务中适宜的检查方法.     

The application of hydrocolloids in genital skin care of pre-term infants

Since 1994 the neonatal care research of the Division of Neonatology, Department of Pediatrics, University of Heidelberg has been occupying itself with skin damage and skin hygiene in newborn and pre-term infants. Due to positive practical experiences when applying a hydrocolloid to pre-term infants with skin damage in genitalia, a randomized controlled study was conducted to investigate whether the application of the hydrocolloid or the valid guideline would promote the healing of the damaged skin. A protocol was developed and data was collected over a period of 19 months. The results show, that the length of time needed for skin recovery was shorter when applying a hydrocolloid in comparison to the guideline. A number of further issues were anticipated to be investigated, however could not be evaluated. Reasons for this are in the structural circumstances/conditions while executing/performing the study as well as the study design. These important discoveries, regarding the execution of studies during everyday clinical practice are regarded as important results/findings in this study.     

The use of vaginal specula in improving infection control

Sarah Tattersall reports on an initiative to encourage GP practices to comply with best practice in infection control by providing evidence on the advantages of purchasing single-use vaginal specula.     

Use of vaginal pH in diagnosis of infections and its association with reproductive manifestations

Increase in vaginal secretion pH is an indicator of bacterial vaginosis (BV), but is yet to be in use as a diagnostic tool by clinicians. Similarly, no reports are available on the effect of cervical chlamydia infection and different reproductive manifestations on vaginal secretion pH. This study evaluated the use of vaginal pH for screening of BV, the effect of Chlamydia trachomatis (C. trachomatis) infection, and different reproductive manifestations on vaginal pH of women attending the gynecology outpatient department of a general hospital. Vaginal pH was recorded while diagnosing infections in 358 women, among which 45 were with repeated spontaneous abortion, 79 with infertility, 185 had sign and symptoms of lower genital tract infection, and 49 had no history or symptom of any complications or infections. Normal vaginal pH, BV, and C. trachomatis infection were observed in 72.6, 21.5, and 10.1% of women, respectively. BV and C. trachomatis were observed in 78.6 and 4.1% of women, respectively, with high vaginal pH; 12.3% of women with normal vaginal pH had C. trachomatis infection. C. trachomatis infection or different reproductive manifestations do not lead to change in vaginal pH but high vaginal pH correlated with BV and should be used as a simple tool for its diagnosis.     

Nucleic acid amplification technology for the diagnosis of genital herpes infection

Nucleic acid amplification technologies are well-characterized methods for the rapid and sensitive diagnosis of a wide variety of infectious diseases. Herpes simplex virus amplification is no exception, demonstrating as much as a ninefold enhancement in sensitivity over viral culture in some settings. Currently, there are no US Food and Drug Administration-approved systems for herpes simplex virus amplification; hence, most laboratories utilize in-house-developed PCR-based systems. Unfortunately, the utilization of herpes simplex virus amplification has been confined to the investigations of suspected herpes simplex virus encephalitis, largely due to cost and the need for appropriately trained technical staff. Recent methodological advances will help to render herpes simplex virus nucleic acid amplification technologies more applicable to routine practice. However, the use of nucleic acid amplification technologies for the diagnosis of genital herpes infection remains highly controversial.     

Validation of the IDI-MRSA system for use on pooled nose, axilla, and groin swabs and single swabs from other screening sites

A commercial rapid polymerase chain reaction methicillin-resistant Staphylococcus aureus (MRSA) screening method (IDI-MRSA) is validated for the use with nasal swabs transported in liquid Stuart's medium. We investigated the use of IDI-MRSA for screening for MRSA in pooled nose, axilla, and groin swabs and in single swabs from skin puncture sites, wounds, throat, rectum, and groin using swabs transported in Amies medium without charcoal. We performed the IDI-MRSA test on swabs that had been used for routine MRSA broth culture and which were selected to be about 50% MRSA positive. We compared the IDI-MRSA result with the MRSA culture result. With 201 pooled sets, the sensitivity of IDI-MRSA was 85% and the specificity 95%. With 32 single screening swabs, sensitivity was 94% and specificity 80%. The method is not compromised by swab transport in Amies medium if an additional heating step is used. We had a low rate of initial inhibition (1.3%), which may have been due to the extra heating step used to liquefy gel from the Amies medium. Thus, in this study IDI-MRSA gives similar results to culture with pooled or single swabs from multiple screening sites.     

Efficacy of an RNA detection test kit in the diagnosis of genital chlamydial infection

 A nucleic acid amplification method based on DNA detection, the current standard method for the diagnosis of genital infection by Chlamydia trachomatis, has been shown to potentially yield false-positive results after treatment in the clinical setting. RNA detection methods are more appropriate because viable organisms have multiple RNA copies that are surely detected by the method. In this study, we evaluated the efficacy of a new RNA detection test kit, the VIDAS PROBE CT test, in the diagnosis of genital chlamydial infection. For comparison, the standard DNA detection method, Amplicor STD-I, was also used in the study. First voided-urine samples and urethral smears from male patients with urethritis, and first voided-urine samples and cervical smears from female patients with cervicitis served as samples for the detection of C. trachomatis. Of the 60 first voided-urine samples from male patients, 21 were positive and 39 negative with the VIDAS PROBE CT test. Amplicor STD-I achieved exactly the same result. In female patients with cervicitis, the two test kits produced the same result, with 2 positive cervical smears and 38 negative. These results suggest that the VIDAS PROBE CT test is as efficient as Amplicor STD-I in the detection of C. trachomatis. While studies including a greater number of patients will be needed for revealing the unique advantages of the new RNA detection test kit, VIDAS PROBE CT, we concluded from the current study that the test may be clinically useful in the diagnosis of genital chlamydial infection. Received: September 24, 2002 / Accepted: October 29, 2002     

Comparison of rectal swabs with fecal cultures for detection of Salmonella typhimurium in adult volunteers

Rectal swabs are generally considered less sensitive than fecal culture, but there are no data directly comparing human rectal swabs with fecal samples for detection of Salmonella. A phase I clinical study of a live oral attenuated Salmonella typhimurium vaccine strain in volunteers receiving a large known inoculum provided the opportunity to compare concurrent rectal swab and fecal cultures. Of 155 paired samples from 9 volunteers, 65 (42%) were culture positive: 35 (54%) by both methods, 20 (31%) by fecal culture only, and 10 (15%) by swab only. When compared with fecal culture, rectal swabs were 64% sensitive and 90% specific. Rectal swabs are of moderate diagnostic utility for detection of Salmonella and may be useful when collection of fecal samples is impractical.     

Prenatal diagnosis of tracheal obstruction: possible association with maternal pertussis infection.

A fetus with the sonographic appearance of echogenic and enlarged lungs and dilated trachea and bronchi, indicating laryngotracheal obstruction, is reported. Additionally, the fetus had ascites and subcutaneous edema and the amniotic fluid volume was reduced. Doppler flow investigation of the systemic venous circulation revealed signs of heart failure, and color Doppler visualized possible increased pulmonary flow. Following termination of pregnancy, autopsy confirmed the sonographic observations and revealed a hypoplastic thymus. During the present pregnancy the mother suffered from sustained cough, and serological tests revealed acute pertussis infection. Polymerase chain reaction investigation for Bordetella pertussis in the amniotic fluid was negative. The possibilities of pertussis toxins as noxious factors and of an atypical presentation of DiGeorge anomaly are discussed.     

Psychiatric co-morbidity among subjects with heroin and cocaine use disorders and its association with HCV infection

Abstract

Aim: This study aims to determine whether psychiatric co-morbidity is associated with HCV infection in a substance misuse population.

Methods: We identified all subjects in the National Drug Treatment Monitoring System (NDTMS) during the period January 2007–December 2010 for whom information was recorded which identified their psychiatric co-morbidity status and their HCV status. Multivariate analysis was used to identify risk factors that could predict HCV infection.

Results and conclusions: The HCV prevalence rate was 32%. HCV infected subjects were younger (21.4% versus 23.1%) when they first started to use drugs, they were more likely to be white (85.1% versus 13.1%) and male (74% versus 72.6%), to have urgent housing problems (13.0% versus 9.7%), to inject (42.8% versus 18.8%), and to share injecting paraphernalia (35.4% versus 9.2%). After adjusting for demographics and drug and alcohol use behaviours, the Odds Ratio of psychiatric co-morbidity for HCV infection was 1.33 (95% CI 1.01–1.75). The results suggest that psychiatric co-morbidity is associated of HCV infection.

Clinical implications: It is important to take psychiatric co-morbidity into account when treating these patients and designing intervention strategies.     

An algorithm for a selective use of throat swabs in the diagnosis of group A streptococcal pharyngo-tonsillitis in general practice.

A prospective evaluation was made of an algorithm for a selective use of throat swabs in patients with sore throat in general practice. The algorithm states that a throat swab should be obtained (a) in all children younger than 15 years; (b) in patients aged 15 years or more who have pain on swallowing and at least three of four signs (enlarged or hyperaemic tonsils; exudate; enlarged or tender angular lymph nodes; and a temperature > or = 38 degrees C); and (c) in adults aged 15-44 years with pain on swallowing and one or two of the four signs, but not both cough and coryza. Group A streptococci were found by laboratory culture in 30% of throat swabs from 1783 patients. Using these results as the reference, the algorithm was 95% sensitive and 26% specific, and assigned 80% of the patients to be swabbed. Its positive and negative predictive values in this setting were 36% and 92%, respectively. It is concluded that this algorithm may be useful in general practice.     

阴道联合腹部超声在异位妊娠诊断中的应用价值

目的:探讨阴道联合腹部超声在异位妊娠诊断中的应用价值。方法:本研究选取2017年1月—2019年11月我院收治的经手术确诊的100例异位妊娠患者,所有患者术前经腹部及经阴道超声检查,比较两种检查结果。结果:经阴道超声检查对异位妊娠检出率显著高于腹部超声检查(P<0.05);腹部联合阴道超声检查对异位妊娠检出率显著高于腹部或经阴道单独超声检查(P<0.05),且误诊率及漏诊率显著低于腹部或经阴道单独超声检查(P<0.05);经阴道超声检查对异位妊娠典型影像学表现检出率显著高于腹部超声检查(P<0.05),腹部联合阴道超声检查对异位妊娠典型影像学表现检出率均显著高于腹部或经阴道单独超声检查(P<0.05)。结论:阴道联合腹部超声提升异位妊娠检出率,可推广应用。     

Current controversy,confusion, and imprecision in the use and interpretation of rectal MRI

Abdominal Radiology - There has been a rapid increase in the utilization of MRI in rectal cancer staging in the USA essentially replacing endorectal ultrasound and mimicking the trend in Europe...