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Disseminated herpes simplex virus 2 (HSV-2) infection, is a rare but devastating infection in pregnancy women. We present the case of a 30-year-old gravida 3, para 2-0-0-2, at 26 weeks 2 days gestation who presented with eleven days of vague and indolent symptoms before a diagnosis of disseminated HSV-2 infection with associated hepatitis was made. While the patient clinically improved with empiric acyclovir treatment, possibility of significant harm to the fetus remained, and the patient request elective termination. The authors review the epidemiology, diagnosis, treatment, and prognosis of disseminated HSV-2 infection in pregnancy.
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OBJECTIVES: A remote quality assurance and improvement protocol for point-of-care obstetric ultrasound in low-resource areas was validated against the standard of care for obstetric ultrasound in the United States. METHODS: Compressed movie clip ultrasound images (obstetric sweep protocol) obtained by minimally trained personnel were read and interpreted by physicians with training in obstetric ultrasound. Observed findings were compared among readers and between each reader and the gold standard ultrasound scan report. Descriptive statistics were used for the analysis. RESULTS: The agreements among readers and between readers and the gold standard, for the anterior and posterior variables of the placental location were excellent, with Cohen κ values of 0.81 to 0.88 and 0.77 to 0.9, respectively. Cohen κ values were slight or slight/fair for other placental locations (left, right, fundal, and low), and the sensitivity and specificity ranged widely. The agreement among readers and between readers and the gold standard for fetal number comparisons was also excellent, with Cohen κ values ranging from 0.82 to 1, sensitivity from 0.83 to 1, and specificity from 0.99 to 1. The agreement among readers for fetal presentation comparisons, according to the Cohen κ, ranged from 0.79 to 0.85 and between readers and the gold standard had values of 0.43 to 0.49. For biometric parameters and estimated gestational age calculations based on these parameters, inter-reader reliability ranged from 0.79 to 0.85 for all parameters except femur length. Greater than 94% of obstetric sweep protocol ultrasound ages were within 7 days of the corresponding gold standard age. CONCLUSIONS: Movie clip ultrasound images provided adequate information for remote readers to reliably determine the placental location, fetal number, fetal presentation, and pregnancy dating.
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Sistemas Automatizados de Assistência Junto ao Leito , Telemedicina , Biometria , Feminino , Humanos , Gravidez , Reprodutibilidade dos Testes , Ultrassonografia Pré-NatalRESUMO
RATIONALE AND OBJECTIVES: This study explores the relationship between the development of uterine fibroids and hemoglobin SS sickle cell disease (SCD) by examining the prevalence of uterine fibroids as detected by pelvic magnetic resonance imaging (MRI) in African American (AA) women with and without SCD. MATERIALS AND METHODS: A single-center, retrospective review was performed of all adult AA women at a large, academic medical center who received pelvic MRI from January 1, 2007 to December 31, 2018. Propensity score matching conditional on age and ZIP code evaluated the differences in fibroid prevalence between the two groups. Subanalyses by age in 10-year intervals were also performed. RESULTS: Twenty-one (23.9%) of 88 patients with SCD had fibroids on pelvic MRI versus 1493 (52.1%) of 2868 patients without SCD (p value <0.001). After propensity score matching, 21 (24.7%) of 85 patients with SCD compared to 52 (61.2%) of 85 patients without SCD had fibroids (p value <0.001). Subanalyses in 10-year age intervals showed significance for patients between 30 and 39 years old in which 4 (13.8%) of 29 SCD patients versus 374 (65.3%) of 573 no SCD patients had fibroids (p value <0.001), and for patients between 40 and 49 years old in which 9 (42.9%) of 21 SCD patients versus 667 (73.8%) of 904 no SCD patients had fibroids (p valueâ¯=â¯0.002). CONCLUSION: These findings indicate an overall significantly lower prevalence of uterine fibroids in AA women with SCD, suggesting that SCD may be protective against the development of uterine fibroids in these patients.
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Anemia Falciforme , Leiomioma , Neoplasias Uterinas , Adulto , Negro ou Afro-Americano , Feminino , Hemoglobina Falciforme , Humanos , Leiomioma/diagnóstico por imagem , Leiomioma/epidemiologia , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: This study evaluates the utility of whole-body PET-CT for the initial staging and subsequent surveillance imaging of patients with completely resected stage II and stage III melanoma. METHODS: A single-center, retrospective review of patients who received perioperative whole-body PET-CT from January 1, 2005 to December 1, 2019 within three months of initial melanoma diagnosis was performed. RESULTS: Of 258 total patients with completely resected melanoma who had a PET-CT within 3 months after their melanoma diagnosis, 113 had stage II and 145 had stage III melanoma. PET-CT detected distant metastasis in 3 (2.7%) of 113 stage II patients and 7 (4.8%) of 145 stage III patients. 179 of 258 patients had adequate follow-up time to determine whether they received surveillance cross-sectional imaging and whether they had a melanoma recurrence. 143 (79.9%) received subsequent surveillance imaging, 74 of whom developed a recurrence. In 64 (86.5%) of 74 cases, recurrence was detected by routine surveillance. 26 (34.2%) of 76 stage II and 65 (63.1%) of 103 stage III patients developed a recurrence. The median time to recurrence among the 179 patients for stage II and III was 16.3 and 13.0 months, respectively. CONCLUSIONS: These findings indicate that baseline staging with whole-body PET-CT rarely provides information that changes initial management. Rather, the value of the initial PET-CT is as a baseline for subsequent surveillance scans. Therefore, it may be premature to discourage cross-sectional imaging for patients with stage II and III melanoma without supportive evidence or a reliable biomarker of recurrent disease.
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Melanoma/patologia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Compostos Radiofarmacêuticos/metabolismo , Feminino , Seguimentos , Humanos , Masculino , Melanoma/classificação , Melanoma/diagnóstico por imagem , Melanoma/cirurgia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos RetrospectivosRESUMO
BACKGROUND: The Baylor College of Medicine International Pediatric AIDS Initiative at Texas Children's Hospital created a global health corps named the Pediatric AIDS Corps (PAC) in June 2005. This report provides descriptive details and outputs for PAC over its first 5 years. METHODS: Demographic data were gathered about PAC physicians employed from July 2006 to June 2011. A 21-question survey was used to query PAC physicians about their experiences in the program. Data concerning clinical experiences and educational programs also were reviewed. RESULTS: A total of 128 physicians were employed with PAC. The median duration served was 22.7 months. Eighty-seven percent indicated that experience affected their future career choice, with half continuing to work with children and families living in resource-limited areas after they left PAC. Patient care was identified as the most rewarding part of their work (73%), whereas deaths (27%) were the most difficult. Baylor College of Medicine International Pediatric AIDS Initiative enrollment of HIV-infected children and adolescents into care and treatment increased from 6107 to 103 731 with the addition of PAC physicians. Approximately 500 local health care professionals per quarter benefited from HIV clinical attachments that were not available before PAC arrival. PAC physicians visited outreach sites providing in-depth HIV mentoring of local health care professionals, leading to 37% of the sites becoming self-sufficient. CONCLUSIONS: The positive evaluation by the PAC and the scale-up of clinical and educational programs support the recent calls for the development of a national global health corps program.
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Síndrome da Imunodeficiência Adquirida/epidemiologia , Síndrome da Imunodeficiência Adquirida/terapia , Atitude do Pessoal de Saúde , Países em Desenvolvimento/estatística & dados numéricos , Saúde Global/estatística & dados numéricos , Infecções por HIV/epidemiologia , Infecções por HIV/terapia , Cooperação Internacional , Missões Médicas/organização & administração , Pediatria/organização & administração , África , Criança , Pré-Escolar , Comportamento Cooperativo , Estudos Transversais , Feminino , Humanos , Lactente , Comunicação Interdisciplinar , Masculino , Faculdades de Medicina , Inquéritos e Questionários , TexasRESUMO
PURPOSE: There is potential value in developing a brief assessment tool for assessing recovery after musculoskeletal injuries. Our goal was to investigate the association between a one-item global self-assessment of recovery and commonly used measures of recovery status. METHOD: We followed a cohort of 6,021 adults with acute whiplash-associated disorders for six months. Pain, depression, work status and physical health were assessed at baseline and follow-up. The question "How do you feel you are recovering from your injury?" (six response options from "all better" to "getting much worse") and functional limitations were administered at follow-up. RESULTS: Responses to the recovery question was associated with our other indices of recovery. Those "all better" had the lowest pain intensity, pain-related limitations, depression and work disability, and the best general physical health. Incrementally poorer recovery ratings on the recovery question were associated with greater pain, functional limitations and depression, poorer physical health and being off work, although "no improvement" and "getting a little worse" were similar. Recovery categories also reflected different degrees of actual improvements over the preceding follow-up period. CONCLUSIONS: Our findings suggest that a single recovery question is a useful tool for conducting brief global assessments of recovery of musculoskeletal injuries.
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Atitude Frente a Saúde , Cervicalgia/psicologia , Cervicalgia/reabilitação , Traumatismos em Chicotada/psicologia , Traumatismos em Chicotada/reabilitação , Adaptação Psicológica/fisiologia , Adulto , Análise de Variância , Depressão/etiologia , Depressão/psicologia , Avaliação da Deficiência , Feminino , Humanos , Masculino , Cervicalgia/fisiopatologia , Medição da Dor , Valor Preditivo dos Testes , Prognóstico , Recuperação de Função Fisiológica/fisiologia , Inquéritos e Questionários , Traumatismos em Chicotada/fisiopatologiaRESUMO
This article evaluates a cardiac screening program by analyzing wait times and exploring associations between administratively tracked variables and confirmed cardiac diagnosis. The findings indicate that the wait times for specialist consultation are shorter than previously reported in Alberta and age and sex have the strongest associations with a confirmed cardiac diagnosis.
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Doenças Cardiovasculares/diagnóstico , Acessibilidade aos Serviços de Saúde/normas , Programas de Rastreamento , Atenção Primária à Saúde/organização & administração , Especialização , Idoso , Feminino , Humanos , Masculino , Auditoria Médica , Pessoa de Meia-Idade , Serviços de Saúde SuburbanaRESUMO
Health professional capacity for delivery of HIV/AIDS care and treatment is severely constrained across sub-Saharan Africa. African health professional expertise in pediatrics is in particularly short supply. Here we describe a Pediatric AIDS Corps program that was designed to place pediatricians and other physicians in Africa on a long-term basis to expand existing health professional capacity for pediatric and family HIV/AIDS care and treatment. In the first 2 years of this program, 76 physicians were placed in 5 African countries that have been hit hard by HIV/AIDS. Enrollment of HIV-infected children in care more than quadrupled over a 24-month period, to 26 590. We believe that this pilot program can serve as a model for larger-scale efforts to immediately expand access for African children and families to life-saving HIV/AIDS care and treatment.
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Síndrome da Imunodeficiência Adquirida/epidemiologia , Síndrome da Imunodeficiência Adquirida/terapia , Recursos em Saúde/provisão & distribuição , Mão de Obra em Saúde , Pediatria/educação , Médicos/provisão & distribuição , Adulto , África/epidemiologia , África Subsaariana/epidemiologia , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/terapia , Pessoal de Saúde/tendências , Recursos em Saúde/tendências , Acessibilidade aos Serviços de Saúde/tendências , Mão de Obra em Saúde/tendências , Humanos , Masculino , Pediatria/tendências , Médicos/tendências , Projetos PilotoRESUMO
OBJECTIVE: To validate a method for determination of the ankle-brachial index (ABI) in the seated position. BACKGROUND: Peripheral arterial disease (PAD) is a prevalent disorder that is associated with quality of life impairment and increased risk of a major cardiovascular event. The ABI is the initial test for screening and diagnosis of PAD. To prevent error due hydrostatic pressure, accurate measurement of the ABI requires supine patient positioning. Access to ABI measurement is limited for patients who are immobilized or unable to lie flat. METHODS: Patients presenting to a vascular laboratory for suspected arterial disease were enrolled. Arm and ankle blood pressures were measured in the supine and seated positions. Seated ankle pressures were corrected by the following physiology-based formula: Corrected ankle pressure = Measured ankle pressure - D*(.078), where D = the vertical distance between the arm and ankle cuffs (mm). This formula equates to a correction factor of 78 mm Hg per meter distance between the arm and ankle cuffs. Corrected ankle pressure measurements were used for seated ABI calculation. RESULTS: Complete data were available for 100 patients. Mean ABI was 0.97, and 31% of patients had an ABI < or =0.9. There was excellent correlation between supine and corrected seated ankle pressure measurements (r = 0.884-0.936, P < .001). The difference between measurements was negligible (<5 mm Hg). Similarly, there was excellent correlation between supine and seated ABI measures (r = 0.936, P < .001). There was no significant difference between the supine and seated ABI measures. CONCLUSION: We have developed and validated a method for determination of the ABI in the seated position which can be used to broaden availability of PAD testing. This method could also be incorporated into new technologies for ABI determination in the seated position.
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Tornozelo/irrigação sanguínea , Determinação da Pressão Arterial/métodos , Pressão Sanguínea , Artéria Braquial/fisiopatologia , Doenças Vasculares Periféricas/diagnóstico , Postura , Idoso , Idoso de 80 Anos ou mais , Braço/irrigação sanguínea , Estudos Transversais , Feminino , Humanos , Pressão Hidrostática , Masculino , Pessoa de Meia-Idade , Modelos Cardiovasculares , Doenças Vasculares Periféricas/fisiopatologia , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Decúbito DorsalRESUMO
The Pediatric AIDS Corps (PAC) are a group of physicians that were hired to provide clinical care and treatment to children and their families infected with HIV/AIDS and to help educate local health care professionals in the management of children with HIV/AIDS located in the high prevalence areas of sub-Saharan Africa. Prior to their departure the PAC were required to participate in a 4-week educational training program that included travel and tropical medicine and HIV infections in children, teaching skills, bioethics, and good clinical practice in human research training. Evaluation of the program was done using a 50-question pretest/posttest design, a standard postcourse evaluation, and a PAC focus group follow-up. Fifty-two physicians were hired who had been trained in the following specialties: pediatrics (77%), medicine/pediatrics (9%), family medicine (8%), and internal medicine (6%). Posttest scores improved by a mean of 10 points for all PAC physicians (p < 0.001) but those that had been in Africa for 5 months or more prior to the course continued to score higher than the other participants. Reviewing the results by category demonstrated significant improvement in all areas (p < or = 0.002) except for general pediatrics for the HIV/AIDS infected patients (p = 0.124) and psychosocial issues (p = 0.376). Changes for the next training were implemented based upon the information obtained from the PAC focus group. The foundation provided by this educational course was an important beginning for the PAC physicians. Other groups providing specialized care to patients in developing countries might consider a similar educational program.
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Síndrome da Imunodeficiência Adquirida/terapia , Educação Médica Continuada/estatística & dados numéricos , Cooperação Internacional , Síndrome da Imunodeficiência Adquirida/epidemiologia , África Subsaariana/epidemiologia , Criança , Feminino , Humanos , Masculino , Pediatria/educaçãoRESUMO
OBJECTIVE: To determine if fetal membranes might be one of the sources of Fas and Fas ligand in amniotic fluid. STUDY DESIGN: Human fetal membranes from elective cesarean section (n = 6) were fixed in paraformaldehyde. Rolls of paraffinembedded fetal membranes were cut into 5-micron sections. After blocking with horse and goat sera, sections were incubated overnight with primary antibodies followed by the appropriate secondary antibodies. Avidin-biotin complex and diaminobenzidine were used for immunoperoxidase localization. Expression of Fas and Fas ligand was read by light microscopy. RESULTS: Both Fas and Fas ligand were localized in amnion, chorion and decidual layers. In amnion, Fas and Fas ligand were expressed predominantly in epithelial cells and fibroblasts, while there was no immunostaining in the subepithelial compact connective tissue. In the chorion, the expression was mainly in the chorionic trophoblast, with inconsistent expression in the reticular layer. In the decidua, the expression of Fas and Fas ligand was less prominent than in amnion and chorion. CONCLUSION: Localization of Fas and Fas ligand in human fetal membranes suggests that fetal membranes could be one of the sources of soluble Fas and Fas ligand in amniotic fluid.