Cerebrospinal fluid shunt infections in infants and children in Mobile, Alabama

Cerebrospinal fluid shunt systems are used to treat hydrocephalus in infants and children; unfortunately, some shunt systems become infected. We sought to define the epidemiology of shunt infections and shunt survival prior to infection at our institution. We identified 268 shunt procedures performed from January 1990 to June 1996 in 145 patients. There were 29 episodes of shunt infection for an incidence of 10.8% per procedure and 13.1% per patient. Staphylococcus epidermidis was the most common isolate recovered. The probability of shunt infection was highest during the first 8 weeks after a shunt procedure and subsequent infection was less likely after 28 weeks.

Clinical presentation of women readmitted with postpartum severe preeclampsia or eclampsia

OBJECTIVE

To identify symptoms that prompted a group of women readmitted for postpartum severe preeclampsia or eclampsia to seek medical care.

DESIGN

Retrospective, case-control.

SETTING

Tertiary-care teaching hospital.

SUBJECTS

The study group consisted of 53 women readmitted in the postpartum period with severe preeclampsia or eclampsia. The control group was matched two-to-one with an index study participant and consisted of 106 women who had intrapartum severe preeclampsia or eclampsia.

MAIN OUTCOME MEASURES

Patient symptoms, physical findings, laboratory assays.

RESULTS

Neurologic complaints, malaise, and nausea and vomiting were reported more often in women who were readmitted than in mothers with intrapartum preeclampsia (all p values less than .001). Headaches were positively correlated with systolic, diastolic, and mean arterial blood pressure in women who were readmitted (all p values less than .05), although there was no relationship between blood pressure and headaches in the control group. In addition, multivariate analysis revealed that study participants were more likely to deliver at full term, have headaches and malaise, have normal platelet values, and develop seizures than mothers in the control group, chi 2 = 155.7, p < .001.

CONCLUSIONS

Women readmitted for postpartum severe preeclampsia or eclampsia have a clinical presentation that differs from that of intrapartum preeclampsia or eclampsia.

HIV risk among Latino gay men in the Southwestern United States

Using two different methods-bar and community household sampling-159 Latino gay men were recruited in the city of Tucson, Arizona. In addition to demographics, the study questionnaire assessed participants' sexual activity during the last 30 days with primary and nonprimary partners, condom use in the last year, and eight psychosocial constructs that have been predictive of HIV risk in different studies of (mostly white) gay/bisexual men. Questionnaires were available only in English; this Latino sample is thus likely to overrepresent highly acculturated, English-speaking men. Results show that 22% of the sample engaged in unprotected anal intercourse with nonmonogamous partners during the last 30 days; 51% of the sample reported at least one instance of unprotected anal intercourse during the last year. Of those men who practiced any anal intercourse during the last 30 days, 67% practiced unprotected anal intercourse with primary partners and 44% practiced unprotected intercourse with casual partners. Thus, the majority of Latino gay men who practiced anal intercourse in the month prior to the interview were not using condoms. Men who practiced unprotected intercourse with nonmonogamous partners reported lower annual incomes and were less educated. Two cognitive variables (behavioral intentions and perceptions of self-efficacy and self-control) and two behavioral variables (sex under the influence of alcohol and/or drugs and sex in public environments) emerged as the most important correlates of HIV risk.

Blood pressure changes in normotensive women readmitted in the postpartum period with severe preeclampsia/eclampsia

The purpose of this study was to determine whether women who had no clinical evidence of preeclampsia at delivery, but who were later readmitted with postpartum severe preeclampsia or eclampsia, differed in mean arterial pressure (MAP) and clinical presentation from women who either remained normotensive or had severe preeclampsia or eclampsia at the time of delivery. Control subjects did not require readmission and were matched (2:1) with study subjects in consecutive order for date of delivery and maternal age, race, and parity. Women in the study group had a significantly greater increase in MAP after delivery than control subjects, and analysis of variance for linear trends demonstrated highly significant differences between the study and control groups in the average intrapartum and postpartum MAPs. Compared to women in either control group, mothers who were readmitted were significantly more likely to demonstrate a > 10-mm Hg increase in MAP between the intrapartum and postpartum periods (delta MAP). Normotensive women with a delta MAP > 10 mm Hg had more than a threefold risk of readmission in the postpartum period with severe preeclampsia or eclampsia. Women who were readmitted reported a significantly greater frequency of headaches and nausea and vomiting than women with intrapartum preeclampsia. In summary, our findings indicate that MAP increase following delivery in normotensive women who were later readmitted with severe preeclampsia or eclampsia.

Metabolism of [ring-U-14C] agaritine by precision-cut rat, mouse and human liver and lung slices

Agaritine [(beta-N-[gamma-L(+)glutamyl]-4-hydroxymethylphenylhydrazine] is present in the common cultivated mushroom Agaricus bisporus and several agaritine derivatives have been shown to produce tumours in experimental animals. In this investigation the metabolism of [ring-U-14C]agaritine has been studied in precision-cut rat, mouse and human liver slices and in precision-cut rat and mouse lung slices. To confirm the functional viability of the tissue slice preparations, the metabolism of 7-ethoxycoumarin was also studied. Liver and lung slices from all species metabolized 50 microM 7-ethoxycoumarin to 7-hydroxycoumarin, which was conjugated with D-glucuronic acid and sulfate. Incubation of rat, mouse and human liver slices, and rat and mouse lung slices with 25 microM [14C]agaritine resulted in a time-dependent formation of metabolite(s), which bound covalently to tissue slice proteins. Agaritine metabolite covalent binding was greater in mouse liver than in rat and human liver slices and was greater in mouse lung than in rat lung slices. No correlation was observed between agaritine metabolite covalent binding and tissue slice gamma-glutamyltransferase activity. Additional studies with mouse liver slices showed that [14C]agaritine was also metabolized to a number of unknown polar metabolites. These results demonstrate that agaritine can be metabolized by enzymes present in mammalian liver and lung.

Decisions to get HIV tested and to accept antiretroviral therapies among gay/bisexual men: implications for secondary prevention efforts

The objective of this study was to report prevalence rates of adherence by HIV-seropositive individuals to medical recommendations for the treatment of HIV infection, a behavioral pattern referred to as AIDS secondary prevention. We report cross-sectional data (n = 2,593) from two household-based and two bar-based samples of gay/bisexual men, gathered in 1992 in Tucson, Arizona, and Portland, Oregon. The main outcome variables were prevalence of HIV antibody testing and adherence to recommended secondary prevention behaviors to prevent onset of AIDS symptoms. Approximately one-third of the gay/bisexual men in these samples do not know their current HIV status. Of the gay/bisexual men who do know that they are HIV-seropositive, approximately three-fourths adhere to each of the secondary prevention recommendations, as appropriate to their stage of disease progression. In a multivariate logistic model, three variables distinguished between HIV-seropositive men who did and did not adhere: perceived antiviral treatment norms (OR = 1.4, CI = 1.1-1.7), perceived efficacy of secondary prevention treatments (OR = 1.4, CI = 1.1-1.7), and quality of the relationship with one's health-care provider (OR = 2.5, CI = 1.6-4.0). These findings indicate that efforts to support AIDS secondary prevention behaviors can occur not only through health education to change the perceptions of at-risk communities about the options available to delay the onset of opportunistic infections among HIV-seropositive individuals but also by enhancing effective doctor/patient communication.

The effects of antenatal steroid use in premature rupture of membranes

We sought to determine if antepartum steroid treatment offers any clinical benefits to patients with premature rupture of membranes. One hundred and forty-five maternal-neonatal pairs were studied. Forty-five maternal-neonatal pairs with premature, preterm rupture of membranes received steroids during 24-35 weeks' gestation. One hundred maternal-neonatal pairs received no antenatal steroids. The 2 groups were identical with regard to gestational age at rupture of membranes, gravity, parity, race, fetal gender, socioeconomic status, smoking, and preterm labour risk factors. Study of the data revealed that maternal chorioamnionitis was less frequent in the steroid group (p < 0.001). Bronchopulmonary dysplasia (oxygen dependent at discharge at term gestational age) was less frequent in the steroid group (p < 0.05). The remainder of the data revealed no statistically significant differences in preterm delivery rate, necrotizing enterocolitis, respiratory distress syndrome, intraventricular haemorrhage rate or severity of haemorrhage, hospital days, latency to delivery, or ventilator days. Antepartum steroid use in preterm rupture of membranes appears to offer clinical benefit in premature infants by lessening the rate of bronchopulmonary dysplasia in those infants receiving antepartum steroids.

Predictors of repeat HIV testing among gay and bisexual men

OBJECTIVE

To examine the prevalence and predictors of repeat HIV testing.

DESIGN, SETTING AND PARTICIPANTS

Cross-sectional data from two random household-based and bar-based samples of gay/bisexual men in two medium-size cities (Tucson, Arizona and Portland, Oregon) with substantial numbers of AIDS cases, in 1992 (n = 2602).

MAIN OUTCOME MEASURE

The prevalence and predictors of repeat testing among men who reported being HIV-tested at least once but not being HIV-positive (n = 1583).

RESULTS

In total, 51% of the sample had been tested three or more times, and 15% were tested more than once every 6 months. Men with higher risk were more likely to be repeatedly tested, although oral but not anal risk was a significant predictor of repeat testing in regression analyses. Men who did not know the HIV status of their primary partner were less likely to be repeatedly tested. Men who perceived that social norms favored secondary prevention, specifically adherence to medical recommendations for the treatment of HIV infection, and who communicated more often about testing were more likely to be repeatedly tested.

CONCLUSIONS

Policy and clinical recommendations for repeat testing must be based on consideration of the complexity and multi-faceted nature of repeat testing. For some individuals, repeat testing may play a legitimate role in HIV prevention by reinforcing safe behavior and providing confirmation of HIV-negative status. However, for others repeat testing may indicate a need for different or more intensive interventions to encourage safe sex.

Comparisons of risk factors for HIV-1 infection in Jefferson and Mobile County, Alabama

A study of the Alabama state AIDS database was conducted to determine whether differences exist in demographic and risk characteristics between patients with HIV-1 in Jefferson and Mobile County. The authors found that the age distribution of patients with HIV-1, the percent of those having AIDS, and the percent of those surviving were very similar. However, significant differences existed in patient-reported risk factors in the two counties. Homosexuality was reported as the major risk factor in both counties. However, there was proportionately more homosexuality reported in Jefferson County and, conversely, more heterosexuality reported in Mobile. There also were significant differences in race and gender distributions in the two counties. This was due in part to the proportionately higher prevalence of African American females of reproductive age with HIV-1 in Mobile County. This may pose a significantly greater risk for pediatric AIDS among African American females in Mobile County.

Intraoperative duplex monitoring of the carotid bifurcation for the detection of technical defects

OBJECTIVES

Intraoperative Duplex examination can be used to identify technical imperfections during carotid endarterectomy. The objectives of this study were: (1) to evaluate the technical feasibility of intraoperative Duplex; (2) to compare Duplex findings with contrast arteriography; (3) to correlate intraoperative Duplex findings with postoperative complications and with Duplex data obtained during follow-up.

DESIGN

Prospective clinical study.

SETTING

Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands.

MATERIALS

44 patients underwent Duplex scanning at the completion of carotid endarterectomy. In addition intraoperative arteriography was performed in the first 16 consecutive patients. Follow-up included a Duplex examination at three monthly intervals during the first postoperative year.

OUTCOME MEASURES

Technical defects and flow disturbance at the time of surgery, and postoperative restenosis.

RESULTS

At contrast arteriography a distal intimal ridge with 15-20% diameter reduction was observed in two, an occlusion of the external carotid artery in three and moderate kinking in one patient. All abnormalities were identified at Duplex imaging. In none of the cases were the Duplex findings considered an indication to re-explore the endarterectomised internal carotid artery. Postoperative complications occurred in six patients: three strokes, two transient ischaemic attacks and two internal carotid occlusions (in one patient combined with a stroke). Severe spectral broadening (spectral class D) correlated significantly with early postoperative complications (p = 0.027). In contrast, moderate defects on Duplex imaging did not correlate significantly with early complications. Duplex examination during the first year of follow-up demonstrated recurrent stenosis in four patients. Intraoperative spectral broadening did not correlate significantly with the development of common or internal carotid restenosis. However, external carotid recurrent stenosis was positively related to intraoperative flow disturbance (p = 0.0003).

CONCLUSION

Duplex scanning is easy to use after completion of carotid endarterectomy. There is good agreement between intraoperative Duplex scanning and contrast arteriography. Extensive spectral broadening of the Doppler velocity signal is associated with an increased prevalence of early postoperative complications. Restenosis at follow-up appears to be related to severe flow disturbance as was demonstrated for the external carotid artery.

Effects of poloxamer 188 in a rabbit model of hemorrhagic shock

Poloxamer 188 is a synthetic surfactant that reduces the viscosity of whole blood without hemodilution. It is postulated that poloxamer 188 would improve outcome if administered during retransfusion following hemorrhage. Rabbits were anesthetized and instrumented for 3 hours of hemodynamic monitoring. After stabilization, blood was withdrawn over a 5 minute period to reduce mean arterial pressure to 35 mmHg (4.7 kPa). Following a 60 minute shock period, animals were randomly assigned to 1 of 5 experimental groups (n = 8 in each): (1) Shock (no retransfusion); (2) Transfusion (retransfusion of autologous shed blood); (3) Volume (retransfusion with autologous blood and infusion of an additional volume of normal saline equivalent to the volume of poloxamer 188 given in the next 2 experimental groups); (4) Low and (5) High drug (i.v. bolus of 200 mg/kg of poloxamer 188 over 5 minutes at retransfusion, followed by a continuous infusion of poloxamer 188 at 50 mg/kg/hr in the Low drug group and 200 mg/kg/hr in the High drug group). All animals in a surgery Control group (n = 6) remained stable during the 3 hour monitoring period. In contrast, none of the animals in the Shock group remained alive, confirming this to be a relevant model of trauma and severe hemorrhagic shock. There were significantly more animals surviving at the end of the monitoring period in the two groups that received poloxamer 188 (numbers of animals alive after 3 hours = 7 of 8 in the High group and 6 of 8 in the Low group) compared to the Transfusion (4 of 8) and Volume (2 of 8) groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Social class, social support and obesity risk in children

Selected characteristics of the social environment are tested as predictors of children's risk for obesity. Data were collected during the summer of 1991 at the University of South Alabama Springhill Paediatric Clinic (Mobile, AL, USA). Data were collected on 77 children, aged 2.5-5 years, and their primary caretaker. Obesity risk was measured by the child's weight for height score and calorie intake. Caretaker's socio-economic status, marital status, and social support predict children's obesity risk for this sample. Lower social class position, lower expressive social support, and unmarried status of the caretaker are associated with a higher calorie intake and a higher weight for height score in the child.