Record linkage to obtain birth outcomes for the evaluation of screening biomarkers in pregnancy: a feasibility study

Background  

Linking population health data to pathology data is a new approach for the evaluation of predictive tests that is potentially more efficient, feasible and efficacious than current methods. Studies evaluating the use of first trimester maternal serum levels as predictors of complications in pregnancy have mostly relied on resource intensive methods such as prospective data collection or retrospective chart review. The aim of this pilot study is to demonstrate that record-linkage between a pathology database and routinely collected population health data sets provides follow-up on patient outcomes that is as effective as more traditional and resource-intensive methods. As a specific example, we evaluate maternal serum levels of PAPP-A and free β-hCG as predictors of adverse pregnancy outcomes, and compare our results with those of prospective studies.     

A Review of the Clinical Presentation of Dientamoebiasis

Among 750 symptomatic and asymptomatic patients, Dientamoeba fragilis was detected at a prevalence of 5.2% and more common than Giardia intestinalis. Most infected patients presented with diarrhea and abdominal pain with symptoms greater than 2 weeks duration being common. Bacterial and viral causes of infection were excluded by routine microbiological techniques. Treatment of D. fragilis infection with either iodoquinol, paromomycin, or combination therapy resulted in the eradication of the parasite and complete resolution of symptoms. Treatment failure/relapses were associated only with the use of metronidazole. Nineteen patients were examined for pin worm, no Enterobius vermicularis, a proposed vector of transmission, were detected. Intermittent shedding of D. fragilis was found to be highly variable. These studies confirm the pathogenic nature of D. fragilis and we recommend laboratories routinely test for the organism.     

Myasthenia Gravis—An Unexpected Cause of Respiratory Failure and Reversible Left Ventricular Dysfunction after Cardiac Surgery

Abstract We report a case of postpericardiotomy myasthenia gravis. A 68‐year‐old male patient without prior history of neuromuscular or autoimmune disorders presented with respiratory failure and severe left ventricular dysfunction four weeks after mitral valve replacement. Markedly elevated acetylcholine receptor antibodies were noted, and the patient responded promptly to immunologic therapy. Awareness of this rare but potentially fatal consequence of cardiac surgery may allow the early institution of specific treatment. (J Card Surg 2010;25:662‐664)     

Measurement of tissue cortisol levels in patients with severe burns: a preliminary investigation

Introduction  

The assessment of adrenal function in critically ill patients is problematic, and there is evidence to suggest that measurement of tissue glucocorticoid activity may be more useful than estimation of plasma cortisol concentrations. Interstitial cortisol concentrations of cortisol represent the available pool of glucocorticoids able to enter the cell and bind to the glucocorticoid receptor. However the concentrations of plasma cortisol may not accurately reflect interstitial concentrations. We elected to perform a preliminary study into the feasibility of measuring interstitial cortisol by microdialysis, and to investigate the relationship between total plasma cortisol, free plasma cortisol and interstitial cortisol in patients with severe burns.     

Acute coronary thrombosis in a patient with diabetes and severe hyperglycemia

The pathophysiological processes responsible for acute coronary events in diabetic patients, in addition to the conventional factors associated with plaque rupture, include an enhanced prothrombotic state. This enhanced prothrombotic state results from multiple abnormalities of the coagulation system including platelet activation, impaired fibrinolysis and increased activity of the coagulation cascade. Studies have also demonstrated that severe hyperglycemia can result in an exacerbation of the underlying prothrombotic state, indicating that patients with extreme hyperglycemia are subject to an even greater thrombotic risk. The present case illustrates the thrombotic hazards associated with severe hyperglycemia.     

Relational Aggression and Adverse Psychosocial and Physical Health Symptoms Among Urban Adolescents

ABSTRACT Objectives: The purpose of this study was to examine relational aggression and its relationship with adverse psychosocial and physical health symptoms among urban, African American youth.
Design and Sample: Quantitative, cross-sectional survey design.
The sample consisted of 185 predominantly African American (95.1%) seventh-grade students (mean age: 13.0; female: 58%) attending 4 urban middle schools.
Measures: The Children's Social Behavior Scale and Social Experience Questionnaire were used to measure relational aggression and relational victimization. The Pediatric Symptom Checklist was used to assess psychosocial difficulties, including internalizing behaviors, externalizing behaviors, and attention problems. Physical health symptoms were measured with questions about colds/flu, headaches, and stomach aches.
Results: 2-way multivariate analysis of variance revealed significant differences in externalizing behavior, with perpetrators reporting higher levels than nonperpetrators. Victims reported more internalizing behavior than nonvictims; however, this was only significant for males. For females, significant negative effects on health outcomes were found, resulting from the interaction of perpetration and victimization.
Conclusions: Findings suggest that relational aggression is a common occurrence among urban, minority adolescents and may result in adverse health outcomes. These results provide several avenues for future research and implications for healthcare practice. Intervention strategies are needed to prevent relational aggression and continual or subsequent adverse health symptoms.