Impact of a Pediatric Emergency Medicine Pharmacist, Institutional Guideline, and Electronic Order Set on Empiric Antimicrobial Use for Febrile Neutropenia.

OBJECTIVES: This study evaluated the difference in appropriateness of antimicrobial selection in pediatric patients with febrile neutropenia (FN) after implementation of an institutional guideline, a dedicated pediatric emergency medicine (EM) pharmacist, and an electronic order set. METHODS: This was a retrospective cohort study that included febrile patients aged younger than 18 years who were at risk of neutropenia, as defined by our institutional algorithm. Charts were evaluated for inclusion by searching for patients who presented to the emergency department (ED) between February 2018 and January 2022 who had International Classification of Diseases, Tenth Revision (ICD-10) codes for patients at risk of FN. Three independent groups were compared before, during, and after interventions. A historical control group (group 1), postdedicated EM pharmacist and institutional guideline cohort (group 2), and postdedicated EM pharmacist, institutional guideline, and electronic order set cohort (group 3) were compared. Secondary outcomes included time from registration in the ED to administration of the first dose of empiric antimicrobials, days to defervescence, pediatric intensive care unit length of stay, and hospital length of stay. RESULTS: Seventy-eight charts were reviewed for inclusion. Among those included (n = 38), there was an increase in appropriate use of antimicrobials from 71% to 92% to 100% ( P = 0.1534) between group 1, group 2, and group 3, respectively. In addition, the interventions in this study lead to an overall decrease in the median time from registration to first dose of antibiotics from 142 minutes to 72 minutes ( P = 0.1370). CONCLUSIONS: This study demonstrated the positive impact a pediatric EM pharmacist along with an institutional guideline and an electronic order set have on appropriate antimicrobial selection in pediatric FN patients. Institutions should consider multipronged approaches to improve the selection and time to administration of appropriate empiric antimicrobials in the ED.

Distribution, metabolism, and excretion of toceranib phosphate (Palladia, SU11654), a novel tyrosine kinase inhibitor, in dogs.

Toceranib phosphate (Palladia, SU11654), a multireceptor tyrosine kinase inhibitor with anti-tumor and anti-angiogenic activity, has been developed for the treatment of mast cell tumors in dogs. An overview of the distribution, metabolism, and excretion of toceranib phosphate in dogs is presented. When [(14)C]-toceranib was orally administered to dogs, the majority of the radioactivity (92%) was excreted in feces and only a small portion (7%) was excreted in urine. Seven days after a single 3.25 mg/kg oral dose, radioactivity was the highest in bile and liver, with measurable concentrations in lymph nodes, colon, adrenals, bone marrow, kidneys, lungs, spleen, pancreas, and skin. Plasma protein binding of toceranib in fresh plasma ranged from 90.8% to 92.8% at concentrations between 20 ng/mL and 500 ng/mL and was independent of concentration. Microsomal and hepatocyte incubations resulted in the formation of a single metabolite. Spectrometric analysis of the metabolite was consistent with the formation of an alicyclic N-oxide of toceranib. The combination of the high rate of fecal excretion and the long elimination half-life of toceranib indicate enterohepatic recirculation of the parent compound and/or the N-oxide metabolite.

Pharmacokinetic properties of toceranib phosphate (Palladia, SU11654), a novel tyrosine kinase inhibitor, in laboratory dogs and dogs with mast cell tumors.

Toceranib phosphate (Palladia, SU11654), an oral tyrosine-kinase inhibitor, is under investigation for the treatment of mast cell tumors in dogs. The pharmacokinetics of toceranib phosphate has been characterized in dogs. Means of the following pharmacokinetic parameters were estimated following a 1.0 mg/kg i.v. dose to laboratory beagles: plasma clearance of 1.45 L/kg/h, volume of distribution of 29.7 L/kg, and terminal half-life of 17.7 h. Following single oral doses of 3.25 mg/kg administered to laboratory beagles, mean C(max) estimates ranged from 68.6 ng/mL to 112 ng/mL with t(max) ranging from 5.3 h and 9.3 h postdose. Terminal half-life was estimated at 31 h. Oral bioavailability was 76.9%. There were no statistically significant (P > 0.05) differences with any pharmacokinetic parameter due to fed/fasted state or with time during 13 weeks of every-other-day dosing at 3.25 mg/kg. Toceranib concentrations were proportional with dose over the range of 2.0 to 6.0 mg/kg. The pharmacokinetics of toceranib in client-owned dogs of a variety of pure and mixed breeds with mast cell tumors was similar to that in healthy laboratory dogs. In summary, toceranib phosphate exhibited moderate clearance, a high volume of distribution, and a moderate elimination half-life. After a single oral dose at 3.25 mg/kg, the concentration vs. time curve showed broad, sustained exposure with measurable concentrations for more than 48 h. These pharmacokinetic parameters support every-other-day administration of toceranib phosphate at an initial dose of 3.25 mg/kg for the treatment of mast cell tumors in dogs.

Aphelenchoides hylurgi as a carrier of white, hypovirulent Cryphonectria parasitica and its possible role in Hypovirulence spread on blight-controlled american chestnut trees.

Individual nematodes were isolated from American chestnut blight-controlled cankers to determine if they were carriers of biocontrol (hypovirulent) isolates of the chestnut blight fungus, Cryphonectria parasitica. These hypovirulent isolates have a white fungal colony phenotype due to infection by the virus CHV1. Of 1,620 individual Aphelenchoides hylurgi isolated, 29.4% carried propagules of the blight fungus and 8.2% of these yielded white hypovirulent isolates. In attraction and movement tests in Petri plates, A. hylurgi moved 2 cm over 24 hr to mycelial discs of white hypovirulent C. parasitica and pigmented C. parasitica strains in nearly equal numbers. After 2 days of nematode movement to fungal colonies on agar in Petri plates and 21 days of nematode growth, large numbers of A. hylurgi were extracted from both white hypovirulent and pigmented C. parasitica strain colonies. Lower numbers of A. hylurgi were extracted from excised young American chestnut blight cankers that were inoculated with A. hylurgi and incubated for 22 days. A. hylurgi inoculated on the surface of an excised American chestnut canker moved within 24 hr to the small, spore-bearing C. parasitica reproductive structures (stromata) on the canker surface. The results indicate that A. hylurgi may play a role in the spread of hypovirulence on American chestnut trees.

Inhibition of glycolytic enzymes by endogenous aldehydes: a possible relation to diabetic neuropathies.

Endogenous saturated and unsaturated aldehydes were found in significant elevations in serum of diabetic humans and rats. These compounds, originating from the lipid peroxidation processes, are shown here to be potent inhibitors of the glycolytic enzymes, phosphofructokinase and glyceraldehyde-3-phosphate dehydrogenase. The inhibition process is non-competitive and progressive. The aldehyde mixture, when supplemented to the standard rat diet at 1/100 ratio, caused nerve damage that is reminiscent of diabetic polyneuropathies.

Peptide inhibitors of dengue virus and West Nile virus infectivity.

Viral fusion proteins mediate cell entry by undergoing a series of conformational changes that result in virion-target cell membrane fusion. Class I viral fusion proteins, such as those encoded by influenza virus and human immunodeficiency virus (HIV), contain two prominent alpha helices. Peptides that mimic portions of these alpha helices inhibit structural rearrangements of the fusion proteins and prevent viral infection. The envelope glycoprotein (E) of flaviviruses, such as West Nile virus (WNV) and dengue virus (DENV), are class II viral fusion proteins comprised predominantly of beta sheets. We used a physio-chemical algorithm, the Wimley-White interfacial hydrophobicity scale (WWIHS) in combination with known structural data to identify potential peptide inhibitors of WNV and DENV infectivity that target the viral E protein. Viral inhibition assays confirm that several of these peptides specifically interfere with target virus entry with 50% inhibitory concentration (IC50) in the 10 microM range. Inhibitory peptides similar in sequence to domains with a significant WWIHS scores, including domain II (IIb), and the stem domain, were detected. DN59, a peptide corresponding to the stem domain of DENV, inhibited infection by DENV (>99% inhibition of plaque formation at a concentrations of <25 microM) and cross-inhibition of WNV fusion/infectivity (>99% inhibition at <25 microM) was also demonstrated with DN59. However, a potent WNV inhibitory peptide, WN83, which corresponds to WNV E domain IIb, did not inhibit infectivity by DENV. Additional results suggest that these inhibitory peptides are noncytotoxic and act in a sequence specific manner. The inhibitory peptides identified here can serve as lead compounds for the development of peptide drugs for flavivirus infection.

Acute and chronic intrarenal alpha- and beta- adrenergic receptor stimulation of renin release in the conscious dog.

The effect of continuous intrarenal infusion of norepinephrine, isoproterenol, and methoxamine on renin release was studied in the uninephrectomized conscious dog. Chronic intrarenal infusion of norepinephrine produced a biphasic curve of plasma renin activity (PRA) and a sustained 25 mm Hg increase in mean arterial pressure (MAP). The initial increase in PRA peaked at 3 hours, after which PRA returned to control levels. Alpha- or beta-adrenergic antagonists did not attenuate the initial rise in PRA. The PRA increased again after 48 hours of chronic intrarenal norepinephrine infusion and remained elevated thereafter. The second rise in PRA was increased by 30% with alpha-adrenergic blockade. Chronic intrarenal isoproterenol administration produced a similar increase in PRA, which peaked at 3-5 hours and then returned to control levels. In contrast to norepinephrine, chronic isoproterenol administration did not result in a second increase in PRA. At the end of the chronic isoproterenol infusion period, beta-adrenergic receptor refractoriness was demonstrated, as PRA did not increase significantly in response to a fourfold increase in the dose of isoproterenol. An increase in PRA was produced by acute intrarenal infusion of methoxamine. This increase in PRA was blocked by phentolamine, suggesting a vascular alpha-adrenergic receptor-mediated release of renin.

An analysis of the cost-effectiveness of selected protocols for the prevention of neonatal group B streptococcal infection.

OBJECTIVE: To determine the expected neonatal outcome in a hypothetical obstetric population with various screening and intrapartum management protocols for the prevention of neonatal group B streptococcal infections. METHODS: We used decision analysis to investigate the performance of various antenatal and intrapartum group B streptococcal screening protocols combined with selective or universal intrapartum antibiotic prophylaxis in preventing neonatal early-onset group B streptococcal disease. Population characteristics, screening test performance, and treatment efficacy profiles were abstracted from previous investigations. RESULTS: In the absence of screening or treatment, the estimated neonatal attack rate and mortality rate were 3.6 and 0.60 cases per 1000 neonates, respectively. Universal antenatal screening at 26-28 weeks' gestation and selective intrapartum prophylaxis (treatment of colonized women with risk factors) or nonselective prophylaxis (treatment of all colonized women) had attack rates of 1.64 and 1.08 and mortality rates of 0.21 and 0.18 cases per 1000 neonates, respectively. Rapid intrapartum screening and selective prophylaxis had an estimated attack rate of 1.92-2.58 and a mortality rate of 0.26-0.40 cases per 1000 neonates, with results dependent upon the time required to attain test results. Similarly, rapid intrapartum screening and nonselective prophylaxis had an attack rate of 1.44-2.30 and a mortality rate of 0.24-0.38 cases per 1000 neonates. Empirical prophylaxis of all women delivering prematurely, regardless of culture status, had an attack rate of 2.40 and mortality rate of 0.36 cases per 1000 neonates. CONCLUSIONS: Under ideal circumstances, antenatal group B streptococcal screening at 26-28 weeks' gestation with vaginal-rectal cultures and subsequent intrapartum prophylaxis is associated with lower projected neonatal attack and mortality rates than protocols using rapid intrapartum screening methods. However, in a non-research population, difficulties frequently encountered with antenatal screening procedures may minimize these differences.

Antenatal sonographic findings associated with unilateral pulmonary agenesis.

BACKGROUND: Unilateral pulmonary agenesis is a rare anomaly that has a relatively frequent association with other congenital malformations. Prognosis depends in part upon associated anomalies and whether the right or left lung is involved. The prenatal sonographic findings of this defect share some similarities with those of other intrathoracic lesions or congenital diaphragmatic hernia. CASE: Our patient had a twin gestation complicated by early discordant growth and hydramnios. The smaller fetus had cardiac dextroposition, abnormally echogenic left lung tissue, and a flattened but clearly visible left hemidiaphragm. No abdominal viscera were seen in the thoracic cavity. Postnatally, this infant was found to have agenesis of the right lung, a tracheoesophageal fistula, and pyloric stenosis. CONCLUSION: The diagnosis of unilateral pulmonary agenesis should be considered in a fetus with the sonographic findings of a shift of the mediastinal structures, echogenic lungs, and an intact diaphragm.

The frequency of glove contamination during cesarean delivery.

OBJECTIVE: To determine the frequency of glove contamination associated with fetal extraction during cesarean delivery. METHODS: The study was performed in 25 women having scheduled or unscheduled cesarean delivery. Surgeons double-gloved for all procedures. Immediately before and after delivery of the fetus, the dorsal aspect of the fingers and hand of the surgeon's outer glove was swabbed with cotton-tip applicators and cultured for aerobic and anaerobic organisms. Only the glove from the hand that was used to deliver the infant was cultured. RESULTS: Nine of 25 cultures (36%, 95% confidence interval [CI] 17-55) performed immediately before fetal extraction were positive for staphylococci. No other organisms were isolated. Cultures performed following fetal extraction showed non-staphylococcal bacteria in 11 of 14 (79%, 95% CI 58-100) laboring women and one of 11 (9%, 95% CI 0-26) nonlaboring women, a statistically significant difference (P < .01). In the laboring patients, non-staphylococcal bacteria were isolated with similar frequency from the dorsal aspect of the hand (seven of 14, 50%, 95% CI 24-76) and the fingers (ten of 14, 71%, 95% CI 47-95). These cultures yielded mostly bacterial species from the Enterobacteriaceae family. CONCLUSION: In laboring patients with ruptured membranes, delivery of the fetal head frequently results in contamination of the surgeon's glove with pathogenic bacteria. This finding may partially explain the increased frequency of post-cesarean endometritis associated with manual extraction of the placenta.

Prediction of fetal macrosomia using humeral soft tissue thickness.

OBJECTIVE: To determine the usefulness of an objective assessment of humeral soft tissue thickness in estimating birth weight in a population at risk for macrosomia. METHODS: Shortly before delivery, ultrasound examinations were performed on 95 women at risk of having macrosomic infants. In each case, the fetal humeral soft tissue thickness (the distance between the outer edge of the humerus to the skin surface on transverse views of the upper arm) was measured three times, and an average was taken. RESULTS: The humeral soft tissue thickness correlated significantly with birth weight (R2 = 0.40, P < .001) and ponderal index (R2 = 0.20, P = .02). The humeral soft tissue thickness was significantly higher in macrosomic infants (P < .001), in those with an abnormally high ponderal index (P = .02), and in infants whose deliveries were complicated by shoulder dystocia (P = .05). There was no apparent effect of maternal diabetes on the humeral soft tissue thickness. The humeral soft tissue thickness was more sensitive in predicting macrosomia than was the ultrasound-estimated fetal weight (88 versus 71%), but less specific (75 versus 91%). CONCLUSION: The humeral soft tissue thickness correlates with birth weight. However, its clinical use compared with other predictors remains to be defined.

Plasma fibronectin concentrations during normal term labor.

We measured plasma concentrations of fibronectin in 30 normal parturients in early labor and at the time of delivery, using a rapid immunoturbidimetric assay. We compared these values with those of 30 healthy nonpregnant control women. The mean plasma concentrations of fibronectin in women in early labor and at delivery were 400 +/- 104 and 410 +/- 147 micrograms/mL, respectively (not significant). Both of these values were higher than the mean fibronectin concentration in controls, 283 +/- 81 micrograms/mL (P less than .0001). We conclude that plasma concentrations of fibronectin are higher in pregnant women than in nonpregnant controls and that they remain relatively constant during uncomplicated term labor.

Use of a DNA probe for the rapid detection of group B streptococci in obstetric patients.

OBJECTIVE: To determine the accuracy of a DNA probe as a rapid diagnostic test for detecting colonization of the female genital tract by group B streptococci during pregnancy. METHODS: Two rayon-tipped applicators were used to collect secretions from the posterior vaginal wall of 440 pregnant women. One of the applicators was inoculated into selective Todd-Hewitt broth and used as the reference standard for identification of group B streptococci. The other applicator was used for analysis with the DNA probe, preceded by either 2.5 hours of incubation for the initial 75 patients, or 3.5 hours' incubation for the remaining women. Following hybridization with an acridinium-labeled probe, chemiluminescence was measured with a luminometer. RESULTS: The prevalence of positive cultures was 20%. For the initial 75 patients whose cultures were amplified by incubation for 2.5 hours, the DNA probe had a sensitivity of 44%, specificity 94%, positive predictive value 79%, and negative predictive value 77%. For the cultures that were incubated for 3.5 hours, respective values were 71, 90, 61, and 94%. All vaginal specimens that had an average initial cell count of 1.5 x 10(3) cells/mL were accurately detected by the probe after 3.5 hours' growth amplification. False-positive results occurred primarily when the specimens were grossly contaminated with blood (26 of 39). The mean time required to perform the assay, including 3.5 hours of growth amplification, was 4.3 hours. CONCLUSIONS: The DNA probe demonstrated good overall sensitivity and gave no false-negative results when group B streptococci were present in concentrations of 1 x 10(4) cells/mL or greater. Sensitivity improved significantly with 3.5 hours' growth amplification as compared with 2.5 hours (P < .05), reflecting better identification of lightly colonized patients.

The perioperative morbidity of scheduled cesarean hysterectomy.

OBJECTIVE: To compare the outcomes of patients undergoing scheduled cesarean hysterectomy with those of women treated with cesarean delivery and subsequent hysterectomy. METHODS: Through a retrospective review of 43 patients, we investigated the morbidity associated with scheduled cesarean hysterectomy and compared these findings with the combined morbidity of scheduled cesarean delivery and subsequent abdominal hysterectomy in a control population. Controls were included only if the subsequent hysterectomy was performed within 3 years of the index cesarean delivery. Each study subject was assigned two controls matched for age, parity, number of previous cesarean deliveries, and indications for procedures. The incidence of the following major morbidity events was compared between the groups: transfusion, urinary tract injury, fistula formation, cellulitis or endometritis, postoperative abscess or hematoma formation, ileus, pneumonia, and wound complications requiring prolonged therapy (seroma, hematoma, infection). RESULTS: The number of women receiving transfusions after scheduled cesarean hysterectomy was greater than among controls (39.5 versus 15.1%; P < .05). The proportion of patients with major morbidity, exclusive of transfusion, was significantly greater in the control population (44%) than in women with scheduled cesarean hysterectomy (16%) (P < .05). The cumulative number of women with a major complication, such as transfusion or a morbid event, was 22 of 43 in the study group versus 44 of 86 in the control population, a nonsignificant difference. CONCLUSION: We found no significant difference in the cumulative perioperative complication rates in women undergoing scheduled cesarean hysterectomy compared with a population of similar patients treated with cesarean delivery and subsequent abdominal hysterectomy.

Comparison of probe sheaths for endovaginal sonography.

OBJECTIVE: To compare the effectiveness of commercially available probe covers with less expensive condoms. METHODS: During a 10-month period, sonographers performed endovaginal ultrasound examinations on patients by randomly testing either commercially available probe covers or condoms on the vaginal probe. After use, the sheaths were tested for damage by filling them with water to observe for leakage and thereby determine the breakage rate. RESULTS: Perforations were noted in 15 of 180 probe covers and three of 180 condoms (8.3 versus 1.7%, P < .05; relative risk [RR] 5.4, 95% confidence interval [CI] 1.4-18.5). Potential contamination of the endovaginal probe occurred during nine of 174 examinations and one of 178 examinations in which probe covers and condoms, respectively, were used (P < .05; RR 9.7, 95% CI 1.2-67.7). CONCLUSION: Condoms are less expensive and superior to commercially available probe covers for covering the ultrasound probe during endovaginal examinations.

Modification of an intrauterine shunt catheter to reduce the incidence of spontaneous displacement.

OBJECTIVE: To determine which of four types of catheters would be the least likely to become displaced spontaneously when employed as a fetoamniotic shunt, by testing the force required to remove the catheters from a lamb's bladder. METHODS: The catheter designs tested were unfeathered straight, unfeathered pig-tailed, superficially feathered, and deeply feathered. The catheters were placed percutaneously into the urinary bladders of recently euthanized newborn lambs. The force required to withdraw the catheters was determined, employing nine measurements for each catheter design. RESULTS: The mean force required to remove the straight catheter was 12 g (95% confidence interval [CI] 2-21 g), the pig-tailed catheter 22 g (95% CI 13-32 g), and the superficially feathered catheter 149 g (95% CI 139-160 g). Extracting the deeply feathered catheter consistently required a force greater than 300 g, which was the upper limit of detection for our instruments. CONCLUSION: Feathering the catheter increases the force required to extract it from a fetal viscus. We believe that use of feathered catheters will significantly reduce the incidence of unwanted spontaneous displacement.

Effect of delayed inoculation of selective media in antenatal detection of group B streptococci.

OBJECTIVE: To determine accuracy of group B streptococcal culture swabs immediately inoculated after sampling compared with swabs transported to the laboratory and inoculated subsequently. METHODS: Lower genital tract specimens were collected by sweeping two rayon-tipped swabs across the lower vagina and rectum of gravidas at 35-37 weeks' gestation. One swab was placed immediately in selective growth medium (immediate inoculation group). The other was placed in standard transport media, sent routinely to the clinical laboratory, and transferred subsequently to selective growth medium within 2 hours (delayed inoculation group). RESULTS: Matched specimens were collected from 374 women during the study period. Ninety-three women had positive cultures, a colonization rate of 24.9%. Concordant results were found in 364 of 374 (97.3%). Six women had negative results by the immediate method but positive by the delayed method, and four women had positive immediate cultures but negative by the delayed method. There was no statistically significant difference between the two methods in the detection of positive cultures. CONCLUSION: Use of immediate inoculation instead of delayed inoculation in culturing group B streptococcus specimens does not result in an improved detection rate.

Acute fatty liver of pregnancy in a patient with chronic active hepatitis and associated hepatocyte alpha 1-antitrypsin inclusions.

BACKGROUND: Acute fatty liver of pregnancy is a rare, potentially fatal condition that shares many of the signs and symptoms of severe preeclampsia. Early reports of this condition noted alarmingly high fetal and maternal mortality rates. However, recent reports have described more favorable outcomes due to prompt recognition and aggressive treatment. We here describe a patient with acute fatty liver of pregnancy superimposed on chronic active hepatitis. CASE: A 27-year-old woman, para 0-1-2-1, presented at 36 weeks' gestation with a 2-week history of malaise, nausea, emesis, diarrhea, and an 18-lb weight loss. The serum concentrations of transaminase enzymes, bilirubin, and alkaline phosphatase were increased, and a mild coagulopathy was present. The patient underwent repeat cesarean delivery and intraoperative needle biopsy of the liver. Histologic examination of the biopsy demonstrated the characteristic changes of acute fatty liver of pregnancy and chronic active hepatitis with associated alpha 1-antitrypsin hepatocyte inclusions. The serum alpha 1-antitrypsin level was mildly elevated and the phenotype was normal (PiMM), excluding alpha 1-antitrypsin deficiency. Viral and autoimmune etiologies for chronic hepatitis were excluded by laboratory studies. The woman experienced rapid resolution of symptoms and laboratory abnormalities in the immediate postoperative period. CONCLUSION: Acute fatty liver of pregnancy may occur in patients with underlying chronic liver disease. Prompt delivery is necessary to reduce the risk of fetal and maternal mortality.

Pulmonary function of preeclamptic women receiving intravenous magnesium sulfate seizure prophylaxis.

Pulmonary function was studied in ten preeclamptic women in labor (mean gestational age 38.1 +/- 0.9 weeks measured from the last menstrual period) receiving continuous intravenous (IV) infusions of magnesium sulfate. Baseline maximal inspiratory pressure, maximal expiratory pressure, functional vital capacity, and forced expiratory volume at 1 second were measured immediately before a 6-g IV loading dose of magnesium sulfate and 2 hours after the initiation of a continuous 2-g/hour infusion of magnesium sulfate. Serum magnesium levels were measured at the same time pulmonary function tests were performed. All values are reported as the mean +/- standard deviation. The maximal inspiratory pressure, an indicator of generalized respiratory muscle weakness, decreased from a baseline value of 26.2 +/- 7.7 to 19.4 +/- 6.3 cm H2O (P less than .05). The maximal expiratory pressure, an indicator of expiratory muscle strength, decreased from a baseline value of 30.6 +/- 9.2 to 25.2 +/- 7.1 cm H2O (P less than .005). The functional vital capacity decreased from a baseline value of 3.37 +/- 0.49 to 3.19 +/- 0.73 L, and the forced expiratory volume at 1 second decreased from a baseline value of 2.61 +/- 0.58 to 2.36 +/- 0.68 L at 2 hours (P less than .05). The mean serum magnesium level was 1.7 +/- 0.2 mg/dL before the administration of the IV loading dose and 4.51 +/- 0.67 mg/dL 2 hours after initiation of the continuous infusion. Our results demonstrate a significant decrease in pulmonary function tests in term preeclamptic patients receiving magnesium sulfate for seizure prophylaxis.(ABSTRACT TRUNCATED AT 250 WORDS)

Assessment of rapid identification tests for genital carriage of group B streptococci.

OBJECTIVE: The purpose of this study was to assess the relative value of reported methods for rapid identification of group B streptococcal colonization of the female genital tract. DATA SOURCES: Trials of group B streptococcal identification techniques published in peer-reviewed journals were located using a computerized literature search and cited references from relevant articles or text chapters. METHODS OF STUDY SELECTION: Reports were included in the analysis if the methodology fulfilled the following criteria: 1) A reference culture method was used for comparison; 2) performance characteristics were presented or could be calculated; 3) the method could be performed in a standard laboratory on a 24-hour-a-day basis; and 4) results could be routinely available within 12 hours. DATA EXTRACTION AND SYNTHESIS: Performance characteristics such as sensitivity, specificity, and predictive values for the various methods were evaluated and compared. Factors such as colonization rates and methods for identifying carriers were included in the overall assessment of test performance. CONCLUSIONS: The overall sensitivity of current methods for the rapid detection of group B streptococcal colonization is low. However, some rapid antigen detection tests are highly sensitive in identifying heavily colonized patients, and therefore may be useful for selecting high-risk patients for intrapartum antibiotic prophylaxis.