Levels of Excess Infant Deaths Attributable to Maternal Smoking During Pregnancy in the United States

Objectives: The objectives of the study were: 1) To determine the risk of infant mortality associated with prenatal cigarette smoking; 2) To assess whether the relationship, if existent, was dose-dependent; 3) To explore the morbidity pathway that explains the effect of tobacco smoke on infant mortality, and 4) to compute excess infant deaths attributable to maternal smoking in the United States. Methods: Retrospective cohort study on 3,004,616 singleton live births that occurred in 1997 in the United States using the US national linked birth/infant death data. Excess infant deaths due to maternal smoking were computed using the population-attributable risk (PAR). Results: Overall, 13.2% of pregnant women who delivered live births in 1997 smoked during pregnancy. The rate of infant mortality was 40% higher in this group as compared to nonsmoking gravidas (P < 0.0001). This risk increased with the amount of cigarettes consumed prenatally in a dose-dependent fashion (p for trend <0.0001). Small-for-gestational age rather than preterm birth is the main mechanism through which smoking causes excess infant mortality. We estimated that about 5% of infant deaths in the United States were attributable to maternal smoking while pregnant, with variations by race/ethnicity. The proportion of infant deaths attributable to maternal smoking was highest among American Indians at 13%, almost three times the national average. If pregnant smokers were to halt tobacco use a total of 986 infant deaths would be averted annually. Conclusions: Smoking during pregnancy accounts for a sizeable number of infant deaths in the United States. This highlights the need for infusion of more resources into existing smoking cessation campaigns in order to achieve higher quit rates, and substantially diminish current levels of smoking-associated infant deaths.     

Determinants of postoperative morbidity and mortality in children managed for typhoid intestinal perforation in Kano Nigeria

Background

Intestinal perforation is a serious but poorly understood complication of typhoid fever. This study aims to determine the patient factors associated with postoperative morbidity and mortality.

Posaconazole for the treatment of mucormycosis

Posaconazole (PCZ) is an orally administered, extended-spectrum triazole antifungal agent with activity against the Mucorales. This article describes the clinical and laboratory data supporting its use against this rare group of pathogens. To date, PCZ has been mostly used for salvage therapy and at present there is no strong published clinical evidence to support its role as a single agent in the treatment of mucormycosis. Further studies are required to explore its role as a single agent and in combination therapy for the management of these infections.     

Reversible parkinsonism in a patient with progressive multifocal leucoencephalopathy

A case of pathologically confirmed progressive multifocal leucoencephalopathy presenting with unilateral parkinsonism and cognitive decline that significantly improved over a 12-month period without any treatment is described. The patient had a background of chronic lymphocytic leukaemia, but had been in complete remission for 4 years at the time of diagnosis. This case is highly unusual not only in terms of the mode of clinical presentation in an apparently immunocompetent patient but also in that the patient spontaneously improved without any intervention. Progressive multifocal leucoencephalopathy should therefore be considered in the differential diagnosis of movement disorders developing in patients with a history of lymphoproliferative disease, even if they are in remission. Furthermore, such cases may not always require treatment, as the patient's immune system may overcome the viral disease process with spontaneous resolution of their neurological disorder.     

Effects of beta-phenylethylamine on locomotor activity,body temperature and ethanol blood concentrations during acute ethanol intoxication

Beta-phenylethylamine (PEA) is an endogenous amine which is metabolised by MAO B. The function of this enzyme is known to be modified by ethanol so we have studied the interactions of PEA with ethanol. Rectal temperatures of rats were determined and animals pretreated with ethanol (2.5 g kg⁻¹ IP) 90 min before PEA 20, 40, 100 mg kg⁻¹ IP). Spontaneous locomotor activity (SLA) was then recorded, for 30 min, temperatures redetermined and blood ethanol levels evaluated. PEA increased SLA but did not alter rectal temperatures, and at 40 mg kg⁻¹ it not only attenuated ethanol hypothermia and blood levels but also modified ethanol hypomotility. The highest dose of PEA (100 mg kg⁻¹) decreased blood ethanol concentration and sedation but did not counteract the hypothermia. Thus PEA increased ethanol clearance, though the underlying mechanism is not totally clear. This finding is discussed in relation to its catecholaminergic and enzyme inducing characteristics.     

Opioid Drug Use and Acute Cardiac Events Among Pregnant Women in the United States

Background

Cardiovascular disease remains a leading cause of pregnancy-associated deaths in the United States. The extent to which increasing opioid use among pregnant women contributes to fatal cardiovascular events is unknown. We examined trends in opioid use among pregnant women over the previous decade and the association between changes in temporal trends in opioid drug use and the incidence of acute cardiac events among mothers.

Perinatal mortality associated with abruptio placenta in singletons and multiples

OBJECTIVE: This study was undertaken to investigate the association among plurality (number of fetuses per pregnancy), abruptio placenta, and perinatal mortality. STUDY DESIGN: A retrospective cohort study on 15,051,872 singletons, 413,619 twins, and 22,585 triplets delivered in the United States between 1995 and 1998 was conducted. We compared the occurrence of perinatal death between pregnancies complicated by abruptio placenta and those without with the use of adjusted odds ratios. The generalized estimating equations framework was applied to adjust for intracluster correlations among multiples. RESULTS: Placental abruption occurred among 93,968 singletons (6.2 per 1000), 5051 twin (12.2 per 1000), and 353 triplet (15.6 per 1000) gestations ( P for trend<.0001). Placental abruption was associated with significant risk of mortality irrespective of the plurality subtype. Perinatal mortality was greatest among singletons (adjusted odds ratio [95% CI]=14.3[13.2-15.4]), followed by twins (4.4[3.9-4.9]) and least among triplets (3.0[2.0-4.6]) ( P for trend<.0001). CONCLUSION: As plurality increases from 1 to 3, the risk of placental abruption rises, whereas the risk of abruptio-associated perinatal mortality declines.