Maternal intestinal flora and wheeze in early childhood.

BACKGROUND: Increasing evidence links altered intestinal flora in infancy to eczema and asthma. No studies have investigated the influence of maternal intestinal flora on wheezing and eczema in early childhood. OBJECTIVE: To investigate the link between maternal intestinal flora during pregnancy and development of wheeze and eczema in infancy. METHODS: A total of 60 pregnant women from the Boston area gave stool samples during the third trimester of their pregnancy and answered questions during pregnancy about their own health, and about their children's health when the child was 2 and 6 months of age. Quantitative culture was performed on stool samples and measured in log(10)colony-forming units (CFU)/gram stool. Primary outcomes included infant wheeze and eczema in the first 6 months of life. Atopic wheeze, defined as wheeze and eczema, was analysed as a secondary outcome. RESULTS: In multivariate models adjusted for breastfeeding, day care attendance and maternal atopy, higher counts of maternal total aerobes (TA) and enterococci (E) were associated with increased risk of infant wheeze (TA: OR 2.32 for 1 log increase in CFU/g stool [95% CI 1.22, 4.42]; E: OR 1.57 [95% CI 1.06, 2.31]). No organisms were associated with either eczema or atopic wheeze. CONCLUSIONS AND CLINICAL RELEVANCE: In our cohort, higher maternal total aerobes and enterococci were related to increased risk of infant wheeze. Maternal intestinal flora may be an important environmental exposure in early immune system development.

Effect of source strength and attenuation on dual photon absorptiometry.

A systematic error in dual photon absorptiometry (DPA) measurements of bone mineral density (BMD) related to source strength has been previously described and attributed to an erroneous algorithm for deadtime correction. Since detected counts (or photon flux) is a product of source strength and attenuation, the effect of various source activities and attenuation depths on BMD calculations were evaluated using a phantom. Ten DPA scans were acquired at two source strengths, 0.3 and 1.0 Ci, and at each of two water depths, 16.4 and 24.5 cm. These activities and depths are within the range encountered clinically. Scans were acquired and processed using a commercially available lumbar spine scanner and software, and were reanalyzed with two upgraded versions of software. Mean BMD obtained with the initial software varied by 2 to 14% with changes in both sources strength and attenuating depth. Software revisions reduced but did not entirely eliminate these differences. The remaining 6% discrepancy is of sufficient magnitude to influence both patient management and research investigations.

Nugent score related to vaginal culture in pregnant women.

OBJECTIVE: To relate Gram-stained smears, using the Nugent criteria, to quantitative and qualitative vaginal cultures in pregnant women. METHODS: Two independent evaluators using the Nugent criteria, a standardized method of Gram-stain interpretation designed to detect bacterial vaginosis, scored 104 vaginal smears from pregnant women. The quantitative and qualitative vaginal cultures were assessed at the same time and the results expressed as log(10) colony-forming units per gram of vaginal secretion. The Nugent scores were compared with the microbiologic findings. RESULTS: The prevalence of normal, intermediate, or bacterial vaginosis vaginal flora as determined by Gram stain was 68%, 21%, and 11%, respectively. A comparison of the mean bacterial counts with the Nugent score showed a weak negative correlation for Lactobacillus species and a positive correlation for gram-variable and gram-negative rods. Additional analysis revealed a strong positive correlation between the mean bacterial counts analyses of Peptostreptococcus, a genus not included in the Nugent scoring system, and the Nugent score. In addition, the Prevotella counts correlated strongly with both the Nugent score and the Peptostreptococcus counts. The quantitative counts for Lactobacillus did not vary significantly among the three defined groups of vaginal microflora; however, significant increases in the concentrations of Gardnerella vaginalis and Prevotella were found as the Nugent score increased. CONCLUSION: A strong correlation was found among the gram-variable and gram-negative genera comprised by the Nugent score. Peptostreptococcus also correlated strongly with the Nugent score and with the Prevotella counts, suggesting that this genus may play a role in determining vaginal health.

Quantitative and qualitative effects of douche preparations on vaginal microflora.

OBJECTIVE: To determine the effect of douching on the quantitative and qualitative makeup of the vaginal microflora. METHODS: We first evaluated the effect of douching with a solution of physiologic saline to determine the effect of washing the vaginal surface. Two douche preparations, one containing 0.04% acetic acid and one containing 0.30% povidone-iodine, were evaluated subsequently to determine whether any effects occurred in addition to those noted with saline. Duplicate vaginal swab samples were obtained at predetermined intervals from ten healthy volunteers for three sampling cycles before and after use of the douche preparations for various periods of time. Samples were analyzed for total facultative and obligately anaerobic bacterial populations. RESULTS: The use of a douche preparation containing acetic acid caused a transient reduction of the total bacterial counts, with most of the change attributable to the effect of washing the surface of the vaginal vault as noted with physiologic saline. In contrast, the povidone-iodine preparation caused a significant reduction in total counts compared with those obtained after use of a physiologic saline solution by the same subjects (P = .02). Little change in the qualitative makeup of the vaginal microflora occurred. CONCLUSION: The use of povidone-iodine douches decreases the numbers of the dominant bacterial species beyond those expected with other douches. In some individuals, such changes may allow rapid proliferation of potential pathogens during this altered state, increasing the risk of associated infections.

Comparison of in vivo and in vitro efficacy of ceftizoxime.

Two hundred obligately anaerobic bacterial isolates from human clinical sources were tested for susceptibility to ceftizoxime using a standard National Committee for Clinical Laboratory Standards microwell system. In general, the minimal inhibitory concentrations (MIC50) ranged from less than 0.125 to 32 microgram/ml; however, the MIC50 for Bacteroides fragilis averaged greater than 128 microgram/ml. This finding is inconsistent with the results of in vivo testing of ceftizoxime in an animal model of intra-abdominal sepsis (B fragilis is a major contributor to the development of intra-abdominal abscesses). Various modifications of in vitro assay parameters, including basal media (brain-heart infusion [BHI] or Wilkins-Chalgren [WC]) and methods (microwell, broth, and agar dilutions), were compared. Ten B fragilis isolates from the original clinical study were used. Results indicate that the activity of ceftizoxime decreased between two- and fourfold after storage for 48 hours at -80 degrees C, regardless of methodology or basal media. When microwell was compared with broth dilution, there was a four- to 64-fold decrease in MIC values by the latter method using BHI but little variation using WC. No differences were observed when the incubation time was varied. Preliminary data indicate that MIC values from broth dilution using BHI correspond with those of agar dilution assays. These results suggest methodologic as well as environmental discrepancies with regard to susceptibility testing of ceftizoxime. These differences may lead to misinterpretation of the true susceptibility of organisms to this agent, particularly when the results are compared with in vivo observations.

19-Acetylenic-deoxycorticosterone inhibits 19-hydroxylase and 11 beta-hydroxylase activities in dispersed bovine zona fasciculata cells.

19-Acetylenic-deoxycorticosterone (19-A-DOC) is believed to be a competitive irreversible inhibitor of the synthesis of 19-nor-deoxycorticosterone (19-nor-DOC), a potent mineralocorticoid implicated in some forms of human and animal hypertension. It has been shown to inactivate 11 beta/19-hydroxylase in hamster adrenal mitochondria. Dispersed bovine zona fasciculata cells were incubated for one hour with 1.5 x 10(-8) M ACTH and 0, 1, 10, or 100 microM 19-A-DOC and tritiated deoxycorticosterone (DOC) substrate. Steroids were separated using two sequential thin-layer chromatography systems and their tritium content was counted and corrected for recovery. The 19-A-DOC decreased synthesis of 19-hydroxydeoxycorticosterone, the precursor of 19-nor-DOC. The inhibitor also impaired 11-hydroxylation of DOC to form corticosterone. The data suggest that 19-A-DOC is an effective inhibitor of 11 beta/19-hydroxylase activity in dispersed bovine adrenal cells.

Evaluation of the AnaeroPack system for growth of clinically significant anaerobes.

The AnaeroPack (Mitsubishi Gas Chemical America, Inc., New York, N.Y.) system was compared with the GasPak (Becton Dickinson Microbiology Systems, Cockeysville, Md.) system and a conventional anaerobe chamber to evaluate the ability of the AnaeroPack system to support the growth of clinically significant anaerobes. The AnaeroPack system requires no catalyst or water, produces no hydrogen, and is oxygen absorbing and carbon dioxide generating. It is simple to use and reduces preparation time to a minimum. One hundred forty clinical isolates obtained from various anatomic sites and 10 American Type Culture Collection type strains were evaluated. Isolates were plated on various media, and bacterial growth was examined after 24, 48, 72, and 168 h of incubation. Criteria for evaluation and comparison of systems included rate and quality of growth, colonial morphology, hemolytic reactions, and pigment production. Results indicate that the AnaeroPack system is highly effective in creating an anaerobic atmosphere. The AnaeroPack system never failed to reduce the methylene blue indicator, while the GasPak system failed 15% of the time. The rate or quality of growth achieved by the AnaeroPack system compared with that of established anaerobic culturing techniques was similar and significantly better for several genera including the Bacteroides fragilis group, Fusobacterium, Clostridium, and Peptostreptococcus. The AnaeroPack system appears to be an excellent alternative to established methods for generating an environment for anaerobic incubation.

Laparoscopic myomectomy-an unusual cause of meralgia paresthetica.

Meralgia paresthetica may be associated with diabetes, trauma, infection, and use of self-retaining retractors. Our patient experienced left upper thigh paresthesia after undergoing laparoscopic myomectomy with extensive dissection of the left retroperitoneal space. Neurologic evaluation confirmed meralgia paresthetica. The patient was observed for 4 months, by which time the neuropathy resolved spontaneously.

Mixed-effect models for predicting microbial interactions in the vaginal ecosystem.

Three statistical models that predict microbial interactions within the vaginal environment are presented. A large data set was assembled from in vivo studies describing the healthy vaginal environment, and the data set was analyzed to determine whether statistical models which would accurately predict the interactions of the microflora in this environment could be formulated. During assembly of the data set, two new variables were defined and were added to the data set, that is, cycle (sequence of menstrual cycle) and flow stage (subdivision of cycle determined by day of menstrual cycle). Concentrations of total aerobic (includes facultative) bacteria, total anaerobic bacteria, and a Corynebacterium sp. were identified by correlation analysis as variables with significant predictors. By using a regression method with a backward elimination procedure, significant predictors of these outcome variables were identified as the concentrations of Lactobacillus spp., anaerobic Streptococcus spp., and Staphylococcus spp., respectively. For all three outcome variables, pH and flow stage were also identified as significant independent variables. Because some of the data in the data set are repeated measurements for a subject, a mixed-effect model that accounts for the random effects of repeated-measurement data fit best the data set for predicting interactions between various members of the vaginal microflora. The predictive accuracies of the three models were tested by a comparison of model-predicted outcome-variable values with actual mean in vivo outcome-variable values. From these results, we concluded that it is possible to accurately predict vaginal microflora interactions by using a mixed-effect modeling system. The application of this type of modeling strategy and its future use are discussed.

Normal vaginal microflora during use of various forms of catamenial protection.

Although the effect of vaginal tampons on microbial flora during menstruation has been studied, the effects attributable to particular tampon fibers have received inadequate attention. The purpose of this report is to review previous studies and describe the results of laboratory tests that compare the effects of use of various tampons on the normal changes that occur in vaginal microflora during menstruation. Tampon and swab samples were obtained from volunteers on days 2, 4, and 21 after the start of menses. Statistical evaluation of the qualitative and quantitative data revealed that the same numerically dominant phenotypes were present regardless of sample type, sample time, or catamenial product. In general, total bacterial counts decreased during menstruation, and the total bacterial counts from tampon samples tended to be lower than those in concomitant swab samples. Predictable changes in total numbers of the dominant species were noted when the data were evaluated by day of menstrual cycle. Results indicate that the tampon type had little effect on the qualitative and quantitative composition of the vaginal microflora during the menstrual cycle.