A population-based risk factor scoring will decrease unnecessary testing for the diagnosis of gestational diabetes mellitus

BACKGROUND: To determine the effectiveness of a population-based risk factor scoring to decrease unnecessary testing for the diagnosis of gestational diabetes mellitus (GDM). METHODS: We formed a risk factor scoring over five, which questions maternal age, body mass index and first-degree relatives with a diagnosis of diabetes mellitus, a prior macrosomic fetus and adverse outcome during the previous pregnancies. All participants underwent a 50-g glucose challenge test (GCT) followed by a 100-g oral glucose tolerence test (OGTT). We opened the 50-g GCT envelope if the participant had a risk score > or = 1 and opened the 100-g OGTT envelope if the 50-g GCT value was > or = 7.2 mmol/l. After all patients delivered we also built other strategies and tested their detection rates. RESULTS: Fourteen patients (3.3%) were diagnosed as having gestational diabetes mellitus via a 100-g OGTT. None of the patients with a score of zero had gestational diabetes mellitus. Logistic regression analysis revealed that an increase in the score by one caused a three times increase in gestational diabetes mellitus risk (OR = 3, CI = 1.9-5). Compared with the universal screening, our strategy to screen if the risk score was > or = 1, followed by a 50-g GCT with a 7.2-mmol/l cut-off value, decreased the number of women to be screened by 30% and diagnosed all cases with GDM. Screening the patients with a score > or = 2 would have decreased the number of women to be screened by 63%, still diagnosing 85% of cases with GDM. Also, risk factor-based screening strategies cause a 50% and 53% reduction in the number of OGTT applied, respectively. CONCLUSION: A well integrated, population-based scoring will decrease the number of unnecessary testing but still diagnose 85-100% of GDM cases.     

Ciprofloxacin treatment in newborns with multi-drug-resistant nosocomial Pseudomonas infections

OBJECTIVES: To evaluate the efficacy and acute side effects of ciprofloxacin treatment in newborns who developed nosocomial Pseudomonas aeruginosa infection. METHODS: Intravenous ciprofloxacin treatment was given to 30 newborns who developed nosocomial P. aeruginosa infection as proven by culture antibiogram results. Initial doses of 10 mg/kg/day were given and increased up to 40 mg/kg/day according to clinical response, laboratory and culture results. During therapy, complete white blood cell counts, urinalysis, liver and renal function tests were performed weekly. All patients were examined daily during treatment for possible symptoms of joint toxicity such as erythema and swelling. The patients were evaluated by general physical examination, with special attention to joints, 1 week after discharge. RESULTS: Two of the patients (6.6%) died due to pseudomonas infection, but the bacteria were successfully eradicated in 28 patients (93.4%). Four patients died from other causes. No laboratory abnormality related to ciprofloxacin was observed during treatment. Swelling and hyperemia of the joints were not encountered during treatment and the 1-week period after discharge. Ciprofloxacin-resistant P. aeruginosa isolates were not grown during the study. CONCLUSION: Ciprofloxacin treatment is effective in life-threatening multi-drug-resistant P. aeruginosa infections.     

Rotavirus infection in children with acute diarrhea as detected by latex agglutination, ELISA and polyacrylamide gel electrophoresis

We examined prospectively, stool specimens from 135 children, 0 to 3 years old, referred for fever, abdominal pain, vomiting and/or acute diarrhea. Rotavirus antigens were detected from fecal samples by latex agglutination (LA), ELISA and polyacrylamide gel electrophoresis (PAGE). Rotavirus antigen positivity by Latex, ELISA and PAGE were 15, 55%, 12.59% and 11.85%, respectively. With PAGE test as reference, the sensitivity and specificity of LA and ELISA tests was 93.75%, 94.96% and 100%, 99.16%, respectively, The positivity ratio between 13-24 months group was meaningful with all tests (P = 0.042 for LA; P = 0.05 for ELISA; P = 0.031 for PAGE). ELISA and LA use found to be as sensitive and specific as PAGE in the diagnosis of rotavirus diarrhea.     

Oral nystatin prophylaxis to prevent invasive candidiasis in Neonatal Intensive Care Unit

The use of oral nystatin to prevent fungal colonisation and infection in neonates in the Neonatal Intensive Care Unit (NICU) is still an open question and not yet recommended as a standard of care. To determine whether prophylactic oral nystatin results in a decreased incidence of invasive candidiasis in the newborn infants, a total of 3991 infants were divided randomly into two groups. Group A infants (n = 1995), only those neonates who were identified as yeast carriers (oral moniliasis) were treated with oral nystatin. Group B infants, all neonates who were admitted to the unit received oral nystatin, was routinely administered three times a day. Group A was divided into groups A1 and A2 (who were treated only if identified as yeast carriers). Urine and rectal cultures were taken on admission and then weekly thereafter. There were 215 (14.2%), 27 (5.6%) and 36 (1.8%) patients positive for invasive candidiasis in groups A1, A2 and B respectively. Oral nystatin prophylaxis significantly reduced the invasive candidiasis (P = 0.004) in extremely low-birth weight (ELBW) and very low-birth weight (VLBW) infants. Prophylactic administration of oral nystatine to the ELBW and VLBW infants results in a decreased risk of invasive candidiasis.     

The analysis of anterior skull base from two different perspectives: coronal and reconstructed sagittal computed tomography

The aim of the study was to determine the heights of the anterior skull base and the distances between the anterior nasal spine and the skull base at three levels by means of coronal and reformatted sagittal images of computed tomography. The present study was performed on coronal and reformatted sagittal CT scans of 30 patients with sinonasal complaints. On the coronal view, the heights of the cribriform plate, the roof of ethmoid, and lateral lamella and the medial take-off angle between the ethmoid roof and cribriform plate were measured at different levels. On the reformatted sagittal images the distances from the nasal spine to the anterior cranial base at three different levels were measured. Then, the side-to-side variability of these measurements was statistically compared. The variations with normal distribution and abnormal distribution were analysed by paired t test and Wilcoxon paired-signed rank test, respectively. A statistically significant difference was detected only between the right and left sides in the height of the lateral lamella at the crista galli level (p < 0.05). The lateral lamella at the crista galli level on the left side was higher than on the right side. No statistically significant differences between the left and the right sides were noted in the heights and the distances of other data (p > 0.05). The normal anatomy of the anterior skull base has been described in detail on coronal and reconstructed sagittal computed tomography. These measurements may be helpful in the presurgical evaluation of patients undergoing endoscopic sinus surgery to optimize surgical safety.     

The hydrophobic domain of the Mycobacterial Erp protein is not essential for the virulence of Mycobacterium tuberculosis

Erp (exported repetitive protein) is a member of a mycobacterium-specific family of extracellular proteins. A hydrophobic region that is localized at the C-terminal domain and that represents a quarter of the protein is highly conserved across species. Here we show that this hydrophobic region is not essential for restoring the virulence and tissue damage of an erp::aph mutant strain of M. tuberculosis as assessed by bacterial counts and lung histology analysis in a mouse model of tuberculosis.     

Transient tachypnea of the newborn (TTN): a role for polymorphisms of surfactant protein B (SP-B) encoding gene?

BACKGROUND: Transient tachypnea of the newborn (TTN) is usually a benign self-limiting respiratory disorder in the immediate neonatal period. The lipophilic surfactant-associated protein B (SP-B) was demonstrated to be the most relevant structural component of the surfactant system for immediate postnatal pulmonary adaptation. We hypothesized genetic variations of surfactant protein B (heterozygous 121 ins 2 mutation er intron 4 polymorphisms) to be related to TTN. PATIENTS AND METHOD: We screened genomic DNA of 83 healthy term neonates (gestational age: 39 (37 - 41) completed weeks [median and range]; birth weight: 3325 +/- 541 grams [mean +/- SD]) and 75 infants presenting with TTN (gestational age: 38 (37 - 41) completed wecks [median and range]; birth weight: 3091 +/- 435 grams [mean +/- SD]) by means of PCR-amplification, fragment length and sequence analysis. TTN was diagnosed an the basis of the clinical signs with respiratory rate > 60 breaths/minute, fraction of inspired oxygen > 0.21, and characteristic radiographic findings within less than 24 hours after birth. Newborns with any infection, pulmonary or cardiac congenital malformations, postnatal asphyxia and infants born to diabetic mothers were excluded. RESULTS: In TTN-group the frequency of male infants (68.4 % versus 44.6 %, p < 0.05) and caeserian section were significantly higher (68.4 % versus 30.1 %, p < 0.05). We did not find any statistical difference in frequency of intron 4 variations between controls and TTN-group (8.4 % versus 10.7 %). None of the infants were heterozygous for the 121ins2 SP-B mutation. CONCLUSIONS: WC conclude polymorphisms of intron 4 and heterozygous 121 ins 2 mutation not to associated with TTN.