Coronary artery disease in diabetic pregnancies

Severe vascular complications of diabetes mellitus include myocardial infarction and when this occurs during pregnancy it is associated with a high risk of maternal mortality. In the absence of myocardial infarction, information is unavailable on pregnancy outcome in diabetic patients with severe coronary artery disease or with prior coronary artery bypass graft. Such a case is presented together with a review of the literature.     

Stage 1 acute kidney injury is independently associated with infection following cardiac surgery

ObjectivesSevere acute kidney injury (AKI) is a known risk factor for infection and mortality. However, whether stage 1 AKI is a risk factor for infection has not been evaluated in adults. We hypothesized that stage 1 AKI following cardiac surgery would independently associate with infection and mortality.MethodsIn this retrospective propensity score–matched study, we evaluated 1620 adult patients who underwent nonemergent cardiac surgery at the University of Colorado Hospital from 2011 to 2017. Patients who developed stage 1 AKI by Kidney Disease Improving Global Outcomes creatinine criteria within 72 hours of surgery were matched to patients who did not develop AKI. The primary outcome was an infection, defined as a new surgical-site infection, positive blood or urine culture, or development of pneumonia. Secondary outcomes included in-hospital mortality, stroke, and intensive care unit (ICU) and hospital length of stay (LOS).ResultsStage 1 AKI occurred in 293 patients (18.3%). Infection occurred in 20.9% of patients with stage 1 AKI compared with 8.1% in the no-AKI group (P < .001). In propensity-score matched analysis, stage 1 AKI independently associated with increased infection (odds ratio [OR]; 2.24, 95% confidence interval [CI], 1.37-3.17), ICU LOS (OR, 2.38; 95% CI, 1.71–3.31), and hospital LOS (OR, 1.30; 95% CI, 1.17-1.45).ConclusionsStage 1 AKI is independently associated with postoperative infection, ICU LOS, and hospital LOS. Treatment strategies focused on prevention, early recognition, and optimal medical management of AKI may decrease significant postoperative morbidity.     

Course of depression,mental health service utilization and treatment preferences in women receiving chemotherapy for breast cancer

Objective

This prospective study aimed to estimate the prevalence and course of depression during chemotherapy in women with Stage I–III breast cancer, identify potential risk factors for depression and determine which treatments for depression were being used and which were most preferred.

Method

Thirty-two women were followed over consecutive chemotherapy infusions, with 289 assessments conducted altogether (mean, 9.0 assessments/subject). Current depression, anxiety, physical symptoms and mental health service use were recorded during each assessment. A linear mixed effects model was used to identify factors associated with depression. Patients also ranked depression treatment preferences. We referred patients with more severe depression for treatment.

Results

Clinically significant depression was identified in 37.5% of patients. Depression severity tended to peak at 12–14 weeks and 32 or more weeks of chemotherapy. Depression severity was associated with anxiety severity, physical symptom burden, non-White race, receiving one's first chemotherapy regimen, Adriamycin-Cytoxan chemotherapy and chemotherapy duration. Most (65.5%) patients preferred evidence-based treatments for depression, and 66.7% of depressed patients were using such treatments.

Conclusions

Depression is common in women receiving chemotherapy for breast cancer. Most patients prefer evidence-based depression treatments. We recommend regular screening for depression during chemotherapy to ensure adequate detection and patient-centered treatment.     

Characteristics of Vibrator Use by Gay and Bisexually Identified Men in the United States

IntroductionRecent reports indicate that vibrator use during solo and partnered sexual activities is common among heterosexual men and women in the United States. However, little research has comprehensively assessed vibrator use among gay and bisexually identified men.AimsThis study sought to document the extent to which gay and bisexually identified men report using vibrators, the sexual and relational situations within which they use them, and how men use vibrators on their own and their partners' bodies.MethodsData were collected from 25,294 gay and bisexually identified men from 50 U.S. states and from the District of Columbia via an internet-based survey.Main Outcome MeasureMeasures included sociodemographics, health-related indicators, sexual behaviors, and those related to recent and past use of vibrators during solo and partnered sexual interactions with other men.ResultsApproximately half (49.8%) of gay and bisexually identified men reported having used vibrators. Most men who had used a vibrator in the past reported use during masturbation (86.2%). When used during partnered interactions, vibrators were incorporated into foreplay (65.9%) and intercourse (59.4%). Men reported frequent insertion of vibrators into the anus or rectum when using them during masturbation (87.3%), which was also common during partnered interactions (~60%), but varied slightly for casual and relationship sex partners. For both masturbation and partnered interactions, men overwhelmingly endorsed the extent to which vibrator use contributed to sexual arousal, orgasm, and pleasure.ConclusionsVibrator use during both solo and partnered sexual acts was common among the gay and bisexually identified men in this sample and was described by men as adding to the quality of their sexual experiences. Reece M, Rosenberger JG, Schick V, Herbenick D, Dodge B, and Novak DS. Characteristics of vibrator use by gay and bisexually identified men in the United States.     

Evaluation of the Gen-Probe PACE II assay for the direct detection of Neisseria gonorrhoeae in endocervical specimens.

Evaluation of a non-isotopic DNA-rRNA hybridization assay [Probe Assay-Chemiluminescence Enhanced System (PACE II, Gen-Probe, San Diego, CA)] for the direct detection of Neisseria gonorrhoeae from clinical specimens was compared with culture. Culture and probe tests were performed on 795 endocervical specimens. Results demonstrated that total positives by culture were 18 (2.3% of total); both culture and the DNA-rRNA assay agreed in all cases but four. The PACE II yielded four hybridization-positive results with negative companion cultures. The sensitivity, specificity, and positive and negative predictive values for PACE II were 100%, 99.5%, and 82%, and 100%, respectively. The four discrepant results were resolved using a competitive nucleic acid hybridization assay with recalculated sensitivity, specificity, and positive and negative predictive values of 100, 99.7, and 91.6 and 100%, respectively. Overall, the DNA-rRNA assay offered a number of advantages over culture. The assay was more rapid, able to be performed directly on clinical specimens, and provided superior transport stability.