Chlamydia trachomatis infection in prelabour amniorrhexis

The prevalence of Chlamydia trachomatis in the lower genital tract and amniotic fluid of women with preterm prelabour amniorrhexis was assessed by DNA amplification for C. trachomatis performed in cervical swabs and amniotic fluid obtained by amniocentesis. C. trachomatis was present in the cervix of 20 (23%) of the cases and in six (30%) of those the organism was also present in the amniotic fluid. There was no association with other pathogens in the lower genital tract or amniotic fluid. The presence of C. trachomatis was not associated with a significant decrease in the amniorrhexis to delivery interval or with an increase in perinatal mortality or morbidity.     

Initial multicenter experience with double nucleoside therapy for human immunodeficiency virus infection during pregnancy.

OBJECTIVE: To study maternal and neonatal effects of combination nucleoside analog therapy administered to human immunodeficiency virus (HIV)-infected pregnant women for maternal indications. METHODS: A multicenter, prospective observational study was undertaken at six perinatal centers in the United States and Canada that supported regional referral programs for the treatment of HIV-infected pregnant women. Demographic, laboratory, and pregnancy outcome data were collected for 39 women whose antiretroviral treatment regimens were expanded to include more than one nucleoside analog for maternal indications. The 40 newborns were monitored at pediatric referral centers through at least three months of age to ascertain their HIV infection status. RESULTS: For all 39 women, zidovudine (ZDV) therapy was instituted at 13.4 +/- 8.2 weeks, with a second agent (lamivudine [3TC] in 85% of cases) being added at a mean gestational age of 17.6 weeks. Duration of therapy with two agents was 20.6 +/- 10.4 weeks overall, with no women stopping medications because of side effects or toxicity. No significant changes in maternal laboratory values were seen, except for an increase in mean corpuscular volume, over the course of pregnancy. No clinically significant adverse neonatal outcomes were noted, with all but the three preterm newborns leaving hospital with their mothers. Neonatal anemia (hematocrit < 50%) was seen in 62% of newborns, with no children needing transfusion; mild elevations of liver function tests, primarily aspartate aminotransferase, were noted in 58% of newborns tested, though none were clinically jaundiced. Overall rate of neonatal HIV infection was 2.5% (95% confidence interval: 0.1-13.2%). CONCLUSION: Combination antiretroviral therapy during pregnancy with two nucleoside analogs was well-tolerated by mothers and newborns, with no significant short-term toxicities or side effects noted. Surveillance of exposed newborns' hematologic and liver function appears warranted.     

Blending Prevention Research and Practice in Schools: Critical Issues and Suggestions

Prevention Science -     

Medication reviews provided by general medical practitioners (GPs) and nurses: an evaluation of their quality

Objective To train general medical practitioners (GPs) and nurses in providing medication review services in the primary care setting and to evaluate the reviews provided. Setting One medical practice in Scotland with five whole‐time equivalent (WTE) GP partners, two practice nurses and six community‐based nurses. Method Training for GPs was provided as a group session plus individual supported clinic sessions. Nurse training consisted of a group session only. Patients aged over 75 were invited to attend the medical practice to receive a medication review. Output measures were: number of patients with pharmaceutical care issues (PCIs) documented, changes made to repeat medicines and computer records, monitoring undertaken, number of PCIs, PCIs identifiable from notes and records but not documented (‘missed’ PCIs). A sample of GP reviews provided before training and all GP and nurse reviews during training were evaluated. Key findings In 45 case note reviews provided prior to training, GPs documented PCIs in 20% of patients; average 0.3 per patient, but missed 1.75 per patient. In 56 reviews provided during training, they documented PCIs in 98% of patients; average 3.0 per patient, missing 0.8 per patient. The proportion of patients with changes to drug therapy or monitoring carried out during training increased significantly compared to pre‐training reviews. Nurses documented PCIs in 97% of 33 patients reviewed, average 1.5 PCIs per patient, but missed 0.8. The mean number of repeat drugs prescribed reduced from 4.73 to 4.42 per patient after nurse review, but increased after GP review from 4.07 to 4.18. Conclusion After training, both GPs and nurses identified PCIs appropriate to their expertise. The sustainability of this effect in the longer term is not known. Since all patients should have repeat medication reviewed regularly, involving these professionals in providing routine reviews would allow pharmacist medication review clinics to be optimised.     

Windows 99: a source of suburban pediatric trauma

BACKGROUND: Falls from windows in urban areas cause a significant number of pediatric injuries. Window falls have not been well described in the nonurban setting. We describe the epidemiology of window falls from residential homes among pediatric patients at a suburban Level I trauma center. METHODS: A review of patients admitted from January 1991 through November 1999 to a center serving a rapidly growing suburban area was performed. RESULTS: A total of 2,322 children, ages 0-14 years, were admitted during the study period. Falls comprised 41% of these admissions, and 11% of falls were from windows, greater than twice the national average. More than 39% of children who fell from windows were admitted directly to the intensive care unit. Overall mortality rate was 4%. Ages 0 to 4 years comprised the largest percentage (83%), and all children who died were in this age group. Children < or = 4 years were more likely to have an Abbreviated Injury Score > or = 2 (head injury) than those ages 10 to 14 years (p = 0.032). More than 31% of all children injured in window falls seen at the study institution between 1991 and 1999 were admitted in the last 2 years. CONCLUSION: Pediatric falls from windows in this suburban area appear to be increasing, with an incidence greater than the national average. Children at greatest risk are less than 4 years old. Further research in injury prevention at the national level aimed at suburban areas may be warranted.     

Evaluation of the Coat-A-Count 125I fentanyl RIA: comparison of 125I RIA and GC/MS-SIM for quantification of fentanyl in case urine specimens

The Coat-A-Count solid phase 125I Fentanyl Radioimmunoassay was evaluated with respect to linearity and precision using equine urine fortified with fentanyl and then compared with a gas chromatographic/mass spectrometric method for quantification of fentanyl in urine. The RIA assay was found to be linear over the urine fentanyl concentration range of 0.25 to 7.5 ng/mL and precise with coefficients of variation (CV) ranging from 9.6 to 19.3%. The RIA calibrators, ranging in fentanyl concentrations from 0.25 to 7.5 ng/mL, and controls, at mean fentanyl concentrations of 0.46 and 1.32 ng/mL, were compared by both the RIA and GC/MS methods. The cross-reactivity with the 125I RIA test was determined for the fentanyl metabolites, norfentanyl and hydroxyfentanyl, and found to be 5% and 35%, respectively. The illicit fentanyl analogs were found to show significant cross-reactivity, ranging from 20 to 100%. The 125I RIA was compared to GC/MS quantifications of fentanyl in 35 positive and 20 negative case urine specimens.