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Objective: Current practice guidelines discourage use of lithium during breast-feeding, despite limited data. This study aimed to quantify lithium exposure in nursing infants. Method: In 10 mother-infant pairs, the authors obtained assays of lithium in maternal serum, breast milk, and infant serum and indices of infant renal and thyroid function. Results: Maternal serum, breast milk, and infant serum daily trough concentrations of lithium averaged 0.76, 0.35, and 0.16 meq/liter, respectively, each lithium level lower than the preceding level by approximately one-half. No serious adverse events were observed, and elevations of thyroid-stimulating hormone, blood urea nitrogen, and creatinine were few, minor, and transient. Conclusions: Serum lithium levels in nursing infants were low and well tolerated. No significant adverse clinical or behavioral effects in the infants were noted. These findings encourage reassessment of recommendations against lithium during breastfeeding and underscore the importance of close clinical monitoring of nursing infants.

Objective: Lithium has been used during pregnancy for more than four decades, but quantification of fetal lithium exposure and clinical correlations of such exposure are limited. The study objectives were to 1) quantify the rate of lithium placental passage, 2) assess any association between plasma concentration of lithium at delivery and adverse perinatal events, and 3) determine whether lithium concentrations can be reduced by briefly suspending therapy proximate to delivery. Method: Maternal blood and umbilical cord blood were obtained at delivery for assay of lithium concentrations, and obstetrical outcome data were collected prospectively for 10 participants. These data were combined with results from MEDLINE and PsycINFO searches that identified 32 cases in which maternal lithium was administered throughout delivery. Statistical analysis of the pooled data was conducted. Results: The ratio of lithium concentrations in umbilical cord blood to maternal blood (mean=1.05, SD=0.13) was uniform across a wide range of maternal concentrations (0.2-2.6 meq/liter). Significantly lower Apgar scores, longer hospital stays, and higher rates of CNS and neuromuscular complications were observed in infants with higher lithium concentrations (>0.64 meq/liter) at delivery. Withholding lithium therapy for 24-48 hours before delivery resulted in a 0.28 meq/liter reduction in maternal lithium concentration. Conclusions: Lithium completely equilibrates across the placenta. Higher lithium concentrations at delivery are associated with more perinatal complications, and lithium concentrations can be reduced by brief suspension of therapy proximate to delivery. Treatment guidelines are proposed to improve neonatal well-being when lithium use is indicated in late pregnancy.

Objective: The purpose of this study was to determine the extent of infant medication exposure through breast-feeding during maternal treatment with paroxetine. Method: Breast milk and paired maternal and infant sera were collected after 10 days of maternal treatment with paroxetine at a stable daily dose (10-50 mg/day). All samples were analyzed by means of high-performance liquid chromatography with ultraviolet detection and a limit of detection of 2 ng/ml. Results: Breast milk paroxetine concentrations were highly variable (2-101 ng/ml) and were present in all breast milk samples (N=108). A significant gradient effect was observed, with greater paroxetine concentrations found in later portions of breast milk (hind milk) than in early portions (fore milk). No clear time course of paroxetine excretion into breast milk was demonstrated, although maternal paroxetine daily dose reliably predicted both trough and peak breast milk concentrations over a 24-hour period. In 16 mother and infant serum pairs, no detectable concentrations of paroxetine were found in the serum of the nursing infants. Conclusions: This study extends previous data by demonstrating the presence of paroxetine in the breast milk of nursing women treated with this medication. The low concentrations of paroxetine in infant serum and lack of any observable adverse effects after maternal use of this medication while breast-feeding parallels the available data on other selective serotonin reuptake inhibitors.

A Green Salad Without onions? No thanks. Scrambled eggs got the blahs? Not when you add a few chopped onions to the skillet. For an onion lover, this vegetable is […]

Greater Cincinnati health care leaders have shared their views about the health care reform bill. The respondents are Cincinnati Visiting Nurse's Wallen Falberg, health care consultant Hirsch Cohen, Greater Cincinnati Health Council's Coleen O'Toole, Employer Health Care Alliance's Sharron DiMario, Legal Aid Society of Greater Cincinnati's Col Owens, Christ Hospital's Susan Croushore, and Humana of Ohio's Tim Cappel.

Preclinical alcoholic cardiomyopathy, myocardial damage in the absence of overt congestive heart failure in chronic alcoholics, is well characterized at necropsy, but attempts to identify such a clinical entity before death have produced conflicting results. dying subjects only at rest, the inclusion of older alcoholics and limitations of noninvasive techniques may explain some of the disagreement. To determine if preclinical alcoholic cardiomyopathy could be identified independent of the aforementioned limitations, 2S asymptomatic chronic alcoholics aged S days per week for >S years, underwent radionuclide ventriculography for measurements of systolic and diastolic function at rest, peak supine exercise and during recovery, and echocardiography for assessment of chamber size, wall thickness and left ventricular mass. Red blood cell levels of selenium and thiamine were measured to determine whether abnormalities were present in these 2 potential mediators of alcoholic cardiomyopathy. For comparison, an age-matched group of healthy control subjects was also studied. For alcoholics and control subjects at rest, mean ejection fraction (67 +/- 7% vs 71 +/- 6%) and diastolic peak filling rate (3.4 +/- 0.6 vs 3.3 +/- 0.6 end-diastolc volumes per second [EDV/s]) were similar. At peak exercise, the mean ejection fraction 83 +/- 6 vs 82 4- 10), change in ejection fraction (14 /- 10 vs 14 7) and peak fining rate (8.9 +/- 2.0 vs 9.S +/- 1.9 EDV/s) were also similar, but election fraction failed to increase appropriately in 3 alcoholics (120/o), suggesting possible stress-induced myocardial dysfunction. Left ventricular chamber size, fractional shortening, wall thickness and ventricular mass by echocardiography were similar in the alcoholic and control groups, as were red blood cell levels of selenium and thiamine. Repeat studies aftor 4 weeks of abstinence from alcohol showed persistence of the exemise-induced abnormal response in 2 of the 3 alcoholics. These data suggest that the occurrence of preclinical cardiomyopathy in young, asymptomatic chronic alcoholics is rare and may require exercise stress testing to be detected. (Am J Cardiol 1991;67:183-187), Chronic alcoholism can result in heart disease and the appearance of clinical symptoms of congestive heart failure (weakness, breathlessness, abdominal discomfort, and pooling of blood in the extremities). This has been attributed to both a direct toxic effect of alcohol on the heart and the detrimental effect that chronic alcohol abuse has on nutritional status. The effects of alcoholism on the heart have been well documented at autopsy, but attempts to characterize the effects of excessive alcohol consumption on the heart before death have yielded conflicting results. To determine the effects of alcoholism on cardiovascular function in younger, relatively healthy alcoholics, 25 men under the age of 40 (average age 34 years) who had consumed one pint of whiskey or one six-pack of beer daily for at least five years were assessed. An age-matched group of nonalcoholic subjects served as a control group. On virtually all cardiovascular parameters measured (resting and exercise mean ejection fraction, diastolic peak filling rate, end-diastolic volumes per second, left ventricular size, wall thickness and mass, and red blood cell selenium and thiamine levels), there were no differences between alcoholics and control subjects. In three alcoholic subjects, exercise failed to induce an appropriate increase in ejection fraction (the percentage of blood ejected from the ventricle during maximal contraction of the heart), suggesting a possible dysfunction in these subjects. After four weeks of abstinence from alcohol, this deficit was still present in two of the three subjects. Hence, the occurrence of alcohol-induced cardiomyopathy in young alcoholics is quite rare, and may require exercise testing to be detected. (Consumer Summary produced by Reliance Medical Information, Inc.)

This study comprised a registry and an emergency department treatment trial using recombinant tissue plasminogen activator. During 1 year, 1,028 patients with documented acute myocardial infarction (AMI) were evaluated for eligibility for thrombolytic therapy. Of these, 221 patients (22%) were eligible for thrombolytic therapy under currently accepted criteria, 175 (79%) of them were correctly identified by emergency department physicians for thrombolytic therapy, and 160 were enrolled in the trial. Only 3 patients (2%) enrolled by emergency department physicians did not subsequently evolve documented AMI. In all, 807 patients (78%) were ineligible for thrombolytic therapy: 335 (33%) because of [is greater than or equal to]1 contraindications, 364 (36%) because of nondiagnostic electrocardiograms on presentation, and 105 (10%) because of age [is greater than]75 years, or [is greater than]6 hours of chest pain at presentation, or both. Mortality in treated patients at 14 days was 5.6%, and survival at 1 year was 92%. The mean time from hospital arrival to thrombolytic treatment was 55 [+ or -] 27 minutes. Initial management of AMI with recombinant tissue plasminogen activator in the emergency department provided rapid and safe treatment comparable to that reported in trials that started treatment in the coronary care unit. The proportions of eligible patients could be increased from 1 in 5 to 1 in 3, if patients currently excluded only because of age [is greater than]75 years or because of [is greater than]6 hours of chest pain were offered treatment. (Am J Cardiol 1990;66:1298-1303), In acute myocardial infarction (AMI, or heart attack), the blood supply to the heart is impaired by the occlusion of one or more of the coronary arteries, usually by a blood clot. Myocardial infarction results in damage to the heart muscle and may cause death. A recognized treatment for AMI is the administration of thrombolytic agents, such as tissue plasminogen activator (TPA), which dissolve the thrombi, or clots, occluding the coronary arteries. To evaluate the practicality, benefits, and safety of emergency room physicians administering TPA to patients diagnosed as having AMI, 1,028 cases were reviewed. The patients had been admitted to hospitals in the Seattle-Tacoma metropolitan area with diagnoses of presumptive AMI. A total of 807 patients were ineligible for TPA treatment for various reasons, including having had more than one AMI incident, symptoms for more than six hours, age over 75 years, high blood pressure, and recent injury. Of the 221 eligible patients, 7 refused TPA treatment, 46 were not treated because they were incorrectly evaluated in the emergency room as being ineligible, and 168 were treated. The average time to initiate TPA treatment was 55 minutes after hospital admission. At 14 days following AMI, 5.6 percent of the TPA-treated patients had died; at one-year follow-up, the survival rate was 92 percent. If the age and time-from-onset criteria for eligibility were relaxed so that patients over 75 years of age and those with AMI symptoms of more than six hours duration could be treated, the percentage of eligible patients would rise from 20 percent to over 30 percent. Emergency room administration of TPA appears to be as safe and efficacious as administration begun in the coronary care unit. (Consumer Summary produced by Reliance Medical Information, Inc.)

Objective: The authors' goal was to determine the concentration of antidepressants in amniotic fluid during maternal treatment of depression. Method: Women treated with antidepressants undergoing amniocentesis for obstetrical reasons were enrolled. Antidepressant concentrations in amniotic fluid and maternal serum were determined with high-performance liquid chromatography. Results: Amniotic fluid was obtained from 27 women, and the amniotic fluid's antidepressant concentrations were highly variable. For the parent compounds, the amniotic fluid concentrations of selective serotonin uptake inhibitors averaged 11.6% (SD = 9.9%) of maternal serum concentrations (N = 22). Amniotic fluid to maternal serum ratios were higher for venlafaxine: 172% (SD = 91%) (N = 3). Of interest, the amniotic fluid to maternal serum ratios for the metabolites (N = 19) did not demonstrate a consistent pattern compared to the parent compound ratios. In 10 subjects, the amniotic fluid to maternal serum ratio for the metabolites was higher than the parent compound and lower in the remaining nine subjects. Conclusions: The pattern of antidepressant concentrations in amniotic fluid is similar to recent data for placental passage. Although the significance of amniotic fluid exposure remains to be determined, these results demonstrate that maternally administered antidepressants are accessible to the fetus in a manner not previously appreciated.

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What do you do when you run out of freezer space, canning jars and appetite, and still have mountains of produce? Oh, you found more zucchini. I just picked these [...]

TriHealth has mandated that employees who refused to get the vaccination shot for 2010 could be penalized with unpaid administrative leave. Other hospital employers, such as University Hospital and Cincinnati Children's Hospital and Medical Center have fired employees for forgoing flu shots. Insights on the vaccination rates among hospital employees are also given.

Key information on how St. Elizabeth Healthcare helps partner St. Lukes Hospitals increase market share in the healthcare industry are presented. Some of St. Lukes' hospitals, such as the St. Elizabeth Fort Thomas in Kentucky, are struggling with low occupancy rates, prompting St. Elizabeth to invest about $24 million to help St. Lukes increase its market share.

Chinese undergraduate enrollment on Greater Cincinnati's leading universities is rising as China's new rich desire global education for their children. As a result, an emerging revenue stream could be enjoyed by these universities. Efforts to recruit international students are also described.

Hong Kong-based corn processing firm Global Bio-Chem Technology is set to choose in Greater Cincinnati, Ohio as location of its North American headquarters. The interstate access, central location, and low labor and property costs might have enticed Global Bio-Chem to invest in Greater Cincinnati. Statistics on Chinese direct investment in the United States are also presented.

Nonprofit organization Bethesda Inc. is planning to donate $5 million a year for the next three years to Greater Cincinnati health care reforms. Bethesda revealed that it announced its donations to pressure other organizations to help. Key details on Bethesda and its donations are presented.

Hospitals in the Greater Cincinnati Area are expected to need more than 100 information technology (IT) workers to help digitize medical records. Financial incentives from the health care reform bill encouraged investments in electronic medical record systems, increasing the demand for IT workers that would help make information exchange across the health care system easier.

Hospitals in Cincinnati, Ohio have suffered from decreased revenues owing to the economic crisis. Declining patient volumes and bad debt have also adversely impacted hospitals. Comments from executives are also provided.

Analysts and investors do not understand why Omnicare chief executive officer (CEO) Joel Gemunder suddenly retired after nearly thirty years with the Covington, Kentucky company. They believe that new leadership might invigorate the company, which provides pharmacy and related services to the long-term care industry.

Health care organizations in Greater Cincinnati area have tried a number of care and follow up programs, primarily focused on congestive heart failure to prevent readmissions to hospitals. Hospital administrators have made the averting of bounce-backs a priority due to new federal government plans on reimbursement. Insights on the readmission rate are also given.

Chemed Corp.'s Vitas Healthcare Corp. is looking for smaller nonprofit hospices as it looks to become more streamlined in a tougher reimbursement environment. CFO David Williams says they want to acquire these hospices as fast as they can integrate these.

Health Alliance could sell the 31-doctor Greater Cincinnati Associated Physicians Group. The group has seen several members withdraw ever since the group filed a complaint asking to be released from services to Health Alliance.

Cincinnati's Good Samaritan hospital had 6,875 live births in 2009 which is more than any other hospital in Ohio. They specialize in the highest-risk pregnancies and deliveries and other hospitals are trying to grab Good Samaritan's share in this niche.

It is believed that the high demand in housing that will accompany an aging population has yet to arrive, and is not due for years to come. The next few years could lead to leaner times for long-standing independent-living properties and a slow climb for newer centers looking to build occupancy.

Cincinnati, Ohio is in the brink of getting a new corporate headquarters (HQ) due to the planned sale of the 300-employee part of the breast care division of Ethicon Endo-Surgery Inc. to Devicor Medical Products Inc. The Ohio Tax Credit Authority has approved $1.5 million in tax credits for Devicor, which will invest $24 million in to the new HQ.

Jack Cassidy, chief executive officer of Cincinnati Bell Inc., believes that the company's acquisition of CyrusOne is expected to serve outsourcing opportunities in computing operations. Cassidy says that the company plans to launch new data centers to address competition and help boost Cincinnati Bell's revenue.

University Hospital and West Chester Medical Center's top executives have been replaced by leaders with medical degrees. Dr. Michael Edwards was appointed as executive director of University Hospital while Dr. Kevin Joseph has relieved West Chester's top executive Carol King of her duties. How the move will affect UC Health's image among physicians is also discussed.

The University of Cincinnati has announced a plan to add a doctoral program with the potential to produce more faculty members for the nursing field. The doctorate in nursing practice (DNP) is focused on nursing practice rather than research, and in improving patient care. Insights on the growing trend toward DNP training are also given.

Convergys Corp siogned a deal with Duke Energy for its billing software for utilities companies. Convergys hopes to announce more such agreements in 2010 and they may also compete for deals overseas.