A Meta‐analysis of the Efficacy of Ocular Prophylactic Agents Used for the Prevention of Gonococcal and Chlamydial Ophthalmia Neonatorum

Introduction : Neonatal eye prophylaxis has been routine in North America for more than a century. Contextual changes justify reexamining this practice, and prompted a systematic review of the efficacy of prophylactic agents. Methods : We searched MEDLINE (1966–2008), EMBASE (1980–2008), CINAHL (1982–2008), and the Cochrane library (the first quarter of 2008) for relevant clinical trials and hand‐searched the resulting reference lists. We independently evaluated eligibility and study quality. Meta‐analyses were performed using a random effects model. Results : Each of the eight included studies had substantial methodologic weaknesses. Data to estimate the efficacy of prophylaxis in the prevention of gonococcal ophthalmia neonatorum (GON) were not available. One study found no differences in rates of chlamydial ophthalmia neonatorum (CON) when three agents were compared to no prophylaxis: silver nitrate (relative risk [RR] = 1.06; 95% confidence interval [CI], 0.55–2.02; 2225 newborns), erythromycin (RR = 0.93; 95% CI, 0.48–1.79; 2306 newborns), and tetracycline (RR = 0.82; 95% CI, 0.42–1.63; 2299 newborns). No statistically significant differences were found between agents in the prevention of GON. Erythromycin and povidone‐iodine both decrease the risk of CON when compared to silver nitrate (RR = 0.71; 95% CI, 0.52–0.97; 4514 newborns, and RR = 0.52; 95% CI, 0.38–0.71; 2005 newborns, respectively). Discussion : Failure rates of universal eye prophylaxis support reexamination of this policy where the prevalence of maternal infection is low.     

Effect of metformin on the clinical and metabolic assessment of women with polycystic ovary syndrome

A longitudinal prospective study was conducted in 21 women with polycistic ovary syndrome (PCOS), aged 27.20?±?5.02 years and treated with metformin (1500?mg/day) for 8 weeks. The patients were assessed for spontaneous menstruation, weight, body mass index (BMI), waist circumference, waist/hip ratio (WHR), glucose and insulin concentrations under fasting conditions and after a 75-g glucose tolerance test, lipid profile, testosterone, androstenedione, dehydroepiandrosterone sulfate, sex-hormone binding globulin (SHBG), and insulin-like growth factor (IGF)-I. Spontaneous menstruation was observed in 81% of the women treated with metformin, with no changes in weight or BMI. Waist measurement and the WHR were reduced. The quantitative insulin sensitivity check index (QUICKI) improved from 0.33?±?0.03 to 0.35?±?0.04 (p?<?0.005), and serum total cholesterol and low-density lipoprotein-cholesterol were reduced, while high-density lipoprotein-cholesterol was increased. Serum testosterone concentrations were also reduced. There were no differences in serum triglycerides, SHBG or IGF-I. The occurrence of spontaneous menstruation and changes in the pattern of body fat distribution, the reduction in serum testosterone concentrations, the improvement in lipid profile and the reduction of insulinemia with the use of metformin permit us to conclude that treatment with this drug is of benefit to women with PCOS.     

Digital imaging in clinical dermatology across the UK in the year 2001

Colour photography is an important tool in the daily practice of dermatologists. Digital photography promises quicker acquisition and handling of clinical images. Despite increasing availability and falling costs, dermatologists have been slow in adopting this new technique. To establish to what degree digital photography has found its way into routine practice in dermatology departments in the UK during the year 2001, we conducted a postal survey of all dermatology departments in the UK about usage of digital cameras. A total of 65.4% of the questionnaires were returned. The responses indicated that 71% of departments in teaching hospitals vs. 56% of departments in district general hospitals (DGH) had access to a digital camera. Reasons for not having a digital camera were satisfaction with conventional photography and lack of resources. In 48% of the departments of teaching hospitals or DGH with access to a digital camera, less than 10% of all photos were taken digitally. However, 24% of departments in DGH and 22% in teaching hospitals took more than 80% of their clinical photos digitally, indicating that in many departments digital photography is still in an early phase and only occasionally used, whilst in others a change from conventional photography towards digital photography as the mainly used technique has already taken place. Overall, the main drawbacks of digital photography were poorer resolution in comparison with conventional photography, problems with storage and filing images and time required for downloading and storing images.     

Fathers’ experiences of support during pregnancy and the first year following childbirth – findings from a Swedish regional survey

Background

Support during pregnancy is mainly directed towards pregnant women, although parenthood is viewed as a joint project by society and by parents themselves. Research has shown that fathers often feel excluded by health care professionals. The aim of the present study was to describe personal and professional sources of support used by prospective and new fathers and to study factors associated with fathers having no support from anyone in mid-pregnancy.

Methods

This was a prospective longitudinal study of 655 new fathers living in a northern part of Sweden who completed four questionnaires.

Results

The majority of fathers reported having good personal support at most time points, but 18% reported that they did not have support from anyone, when asked in mid-pregnancy. A logistic regression analysis showed that the following factors were associated with not receiving support from anyone: having previous children (odds ratio (OR) = 3.4; 95% confidence interval (CI) = 1.7–7.0, P <0.001), expectations from the midwife to attend antenatal visits (OR = 1.9; 95% CI = 1.1–3.4, P <0.05), not attending parent education classes (OR = 2.3; 95% CI = 1.1–4.8, P <0.05), not feeling involved by the prenatal midwife (OR = 1.9; 95% CI = 1.1–3.3, P <0.05), and not being offered the opportunity to attend fathers’ groups (OR = 3.5; 95% CI = 1.1–12.3, P <0.05).

Conclusion

Although personal support seemed satisfying for the majority of fathers, those with no support from close family/friends also lacked support from midwives as well in terms of the organization of care.     

Hemodynamic significance of the paraumbilical vein in portal hypertension: assessment with duplex US

Hemodynamic evaluation of portal and umbilical venous flow with duplex ultrasound (US) was performed in 11 patients with cirrhosis of the liver and a large umbilical vein. Two of these patients had hepatofugal flow in the umbilical vein exceeding hepatopetal flow in the portal vein. These two patients had no evidence of esophageal varices and bleeding. The remaining nine patients had esophageal varices. In these patients, the hepatopetal flow in the portal vein exceeded the hepatofugal flow through the umbilical vein. The authors conclude that duplex US may help identify the massive hepatofugal flow through a large umbilical vein that may reduce the likelihood of esophageal varices and variceal bleeding.     

Solitary pulmonary nodules: CT assessment

Computed tomography (CT) was used to examine 634 solitary pulmonary nodules (SPNs). Each lesion was assessed as benign or indeterminate on the basis of CT criteria. Benign nodules made up 44% of all SPNs and 58% of the 431 that were 2 cm or less in diameter. All malignant SPNs were assessed as indeterminate, and adenocarcinoma (42%) was the most common primary malignancy. A total of 176 (63% of benign SPNs) were correctly assessed as benign by CT. Ninety SPNs assessed as diffusely calcified were not so identified by conventional tomography at outside institutions. An SPN can be reliably assessed by CT as benign if it exhibits high attenuation values, exceeding a critical level and distributed diffusely throughout a CT section through the center of the lesion and a well-defined edge. Although 38 of 283 (13.4%) primary lung cancers contained localized calcification, there was no significant overlap with the diffuse calcification of benign lesions. Central carcinoid tumors may contain focal ossification, but such lesions may be recognized by noting the proximity of larger bronchi. Assessment of SPNs by CT is most effective for lesions 2.0 cm or less in diameter. For larger lesions, the frequency of benign disease was decreased (14.3% of 203), as was the percentage of benign SPNs correctly assessed as benign by CT (37.9%).