Treatment of Syphilis With Doxycycline in a Pregnant Woman Unable to Be Desensitized to Penicillin.

ABSTRACT: A pregnant woman with a non-IgE-mediated penicillin allergy was treated for syphilis with doxycycline with resolution of infection and no evidence of adverse outcome for mother or infant.

Association of Maternal Obesity with Child Cerebral Palsy or Death.

Objective The primary aim of this study was to determine if there is an association between maternal obesity and cerebral palsy or death in children. Study Design This is a retrospective cohort analysis of a randomized controlled clinical trial previously performed by the Maternal-Fetal Medicine Units Network. Women in the original trial were included if at high risk for preterm delivery. The present study included singletons enrolled in the original study with complete data. Obese and nonobese women were compared. A secondary analysis comparing class 3 obese or classes 1 to 2 obese women to nonobese women was performed. The primary outcome was a composite of cerebral palsy or perinatal death. Results In this study, 1,261 nonobese, 339 obese, and 69 morbidly obese women were included. When adjusted for gestational age at delivery and magnesium exposure, there was no association between maternal obesity and child cerebral palsy or death. In the analysis using obesity severity categories, excess risk for adverse outcome appeared confined to the class 3 obese group. Conclusion In women at high risk of delivering preterm, maternal obesity was not independently associated with child cerebral palsy or death. The association in unadjusted analysis appears to be mediated by preterm birth among obese patients.

Using Spatial Video to Analyze and Map the Water-Fetching Path in Challenging Environments: A Case Study of Dar es Salaam, Tanzania.

Access to clean drinking water remains a significant health problem in the developing world. Traditional definitions of water access oversimplify the geographic context of water availability, the burden of water collection, and challenges faced along the path, mainly due to a lack of fine scale spatial data. This paper demonstrates how spatial video collected in three informal areas of Dar es Salaam, Tanzania, can be used to quantify aspects of the walk to water. These include impediments encountered along the path such as changes in elevation and proximity to traffic. All are mapped along with classic health-related environmental and social information, such as standing water, drains, and trash. The issue of GPS error was encountered due to the built environment that is typical of informal settlements. The spatial video allowed for the correction of the path to gain a more accurate estimate of time and distance for each walk. The resulting mapped health risks at this fine scale of detail reveal micro-geographies of concern. Spatial video is a useful tool for visualizing and analyzing the challenges of water collection. It also allows for data generated along the walk to become part of both a household and local area risk assessment.

Mapping to Support Fine Scale Epidemiological Cholera Investigations: A Case Study of Spatial Video in Haiti.

The cartographic challenge in many developing world environments suffering a high disease burden is a lack of granular environmental covariates suitable for modeling disease outcomes. As a result, epidemiological questions, such as how disease diffuses at intra urban scales are extremely difficult to answer. This paper presents a novel geospatial methodology, spatial video, which can be used to collect and map environmental covariates, while also supporting field epidemiology. An example of epidemic cholera in a coastal town of Haiti is used to illustrate the potential of this new method. Water risks from a 2012 spatial video collection are used to guide a 2014 survey, which concurrently included the collection of water samples, two of which resulted in positive lab results "of interest" (bacteriophage specific for clinical cholera strains) to the current cholera situation. By overlaying sample sites on 2012 water risk maps, a further fifteen proposed water sample locations are suggested. These resulted in a third spatial video survey and an additional "of interest" positive water sample. A potential spatial connection between the "of interest" water samples is suggested. The paper concludes with how spatial video can be an integral part of future fine-scale epidemiological investigations for different pathogens.

The Problem of the Pannus: Physician Preference Survey and a Review of the Literature on Cesarean Skin Incision in Morbidly Obese Women.

OBJECTIVE: This study aims to determine preferences of a nationally representative sample of obstetrician/gynecologists (OB/GYNs) regarding cesarean delivery (CD) incision practices for women with morbid obesity (body mass index ≥ 40 kg/m(2)). STUDY DESIGN: We conducted an online survey using the American College of Obstetricians and Gynecologists database. We compared physician demographics, practice characteristics, and CD incision type preference. RESULTS: After exclusion of ineligible participants, 247 OB/GYNs completed the survey (42% response rate). In nonemergency CD of morbidly obese women, 84% of physicians preferred a Pfannenstiel skin incision (67% preferring taping the pannus; 17% without taping the pannus). In emergency CD, 66% preferred a Pfannenstiel incision (46% without taping the pannus; 20% with taping the pannus) and 20% a vertical incision. For both emergency and nonemergency CD, there was no difference in incision type preferences by provider years in practice, practice scope, or number of CD performed each year. CONCLUSION: Given the preference of a Pfannenstiel incision with taping the pannus during CD of morbidly obese women, further investigation is needed to assess the risks and benefits of this incision and the practice of elevating the pannus.

Maternal obesity and neuroprotective magnesium sulfate.

OBJECTIVE: Given the association between risk of cerebral palsy and children born to obese women, the study aim was to estimate whether maternal obesity is associated with reduced effectiveness of conventional antenatal magnesium sulfate dosing for the prevention of cerebral palsy and death. STUDY DESIGN: This is a secondary cohort analysis of a multicenter randomized clinical trial completed by the Maternal-Fetal Medicine Units Network. Women were included in the original trial if deemed high risk for preterm delivery in the subsequent 24 hours. The present study included singleton, nonanomalous fetuses that were randomized to and received magnesium sulfate with complete data available. Outcomes between obese (body mass index ≥30 kg/m(2)) and nonobese women were compared. A secondary analysis of outcomes between morbidly obese (body mass index ≥40 kg/m(2)) and nonmorbidly obese women was performed. The primary outcome was a composite of cerebral palsy or perinatal death before 15 months corrected age. Secondary outcomes included moderate to severe cerebral palsy or death, any cerebral palsy, moderate to severe cerebral palsy, and death. A logistic regression analysis was used to estimate the odds ratio of each outcome. Based on sample size, exposure rate (obesity) and an outcome rate of 10%, assuming an 80% power and a 0.05 alpha error, this study had sufficient power to detect a 2-fold increase in the primary outcome. RESULTS: Of 1188 women randomized to receive magnesium sulfate, 806 were included in this analysis. After adjusting for gestational age at delivery, maternal obesity was not associated with an increased risk of cerebral palsy or death in children born to women who received magnesium sulfate. Women with morbid obesity had higher rates of the primary outcome and cerebral palsy in an unadjusted analysis but did not have increased risks after adjusting for gestational age at delivery. In analyses stratified on gestational age, morbidly obese women who delivered after 28 weeks had increased risks of children with cerebral palsy or death and cerebral palsy, although case numbers were small. CONCLUSION: Among women receiving antenatal neuroprotective magnesium sulfate, maternal obesity is not associated with an increased risk of having a child with cerebral palsy or death.

Discrete regulatory regions control early and late expression of D-Pax2 during external sensory organ development.

The transcription factor D-Pax2 is required for the correct differentiation of several cell types in Drosophila sensory systems. While the regulation of its expression in the developing eye has been well studied, little is known about the mechanisms by which the dynamic pattern of D-Pax2 expression in the external sensory organs is achieved. Here we demonstrate that early activation of D-Pax2 in the sensory organ lineage and its maintenance in the trichogen and thecogen cells are governed by separate enhancers. Furthermore, the initial activation is controlled in part by proneural proteins whereas the later maintenance expression is regulated by a positive feedback loop.

Self-report of current and prior antiretroviral drug use in comparison to the medical record among HIV-infected patients receiving primary HIV care.

OBJECTIVE: Patient antiretroviral (ARV) therapy knowledge is essential for regimen adherence, successful therapeutic response, and minimization of resistance evolution. Moreover, a complete and accurate patient ARV history is needed to construct efficacious and tolerable future regimens. In this study we assessed the ability of HIV-infected patients receiving care in a university infectious diseases clinic to accurately recall current and past ARVs. METHODS: A convenience sample (n = 205) of UNC HIV Clinical Cohort participants (n = 1840) completed a comprehensive in-person interview. Patients were asked about current and ever ARV use and were provided proprietary and generic ARV names and photographs. Self-reported sensitivity for current and ever ARV use (proportion that correctly identified all recorded ARVs), was calculated using the medical record as the gold standard. RESULTS: One hundred and eighty-five patients had received ARVs at some point after enrollment in the cohort study (ever users). For current ARV use (n = 138), self-reported sensitivity was 63% (95% CI: 54-71). For ever use (n = 185), sensitivity was 18% (95% CI: 13-24). CONCLUSION: Self-reported cumulative ARV use is not accurate. Since HIV-infected patients are prescribed a number of medications over their treatment course, it is necessary to develop new medication reconciliation techniques that are not dependent on patient memory or knowledge in order to improve patient outcomes.