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Abortion-related legislation on the state level has encroached on reproductive care access, disproportionately affecting underserved communities. This was first brought to the forefront following legislative actions such as Senate Bill 8 (SB8) in Texas, which bans abortions following detection of cardiac activity. Enforcement of this bill uses private plaintiffs through civil lawsuits based on the estimated gestational age. Senate Bill 4 not only expands abortion complication reporting, but it also renders all physician-administered medicine for the purpose of ending a pregnancy as felonies, punishable by jail time ranging from 180 days to 2 years and $10,000 fine (even in the case of maternal medical emergency). This publication reports an inner-city health care system experience in Texas following these legislative actions.The safety net hospital for Dallas County, Parkland Hospital and William P. Clements Jr University Hospital, are both level IV designated maternal care facilities, with annual delivery rates of approximately 14,000. The inclusion criteria included patients presenting with a fetus with cardiac motion at <22 weeks without preterm labor and with a medical indication for delivery, such as vaginal bleeding, preterm premature membrane rupture, and/or preeclampsia with severe features. Potential candidates were identified from direct patient care and electronic health records. Before the passage of SB4 and SB8, these conditions led to patients receiving counseling and being offered expectant management or labor induction. Following the effective date, expectant management occurred alongside medical intervention when faced with immediate threat to maternal life. All cases were managed by and discussed with maternal fetal medicine leadership due to the potential of a felony. Fetal or neonatal demise was the primary perinatal outcome of the review, whereas primary maternal outcomes included time from presentation to delivery, indications for delivery, and maternal morbidities.Study results determined that 28 pregnant patients met the inclusion criteria between September 2021 and May 2022. Preterm premature rupture of membranes affected 26 of 28 patients, 7 of which had fetal parts or umbilical cord prolapsed into the vagina. A mean of 9.2 days was recorded between presentation and delivery. A total of 27 patients experienced loss of the fetus or infant (96%). Of the 8 infants with cardiac motion at birth, 7 died within 24 hours, and 1 remains hospitalized. Some 12 of the 28 patients experienced clinical chorioamnionitis and hemorrhage, with 9 of these patients requiring intensive care unit admission, readmission, or dilatation and curettage. A single patient at 20 weeks' gestation required hysterectomy due to hemoperitoneum from uterine rupture with placenta accreta spectrum.This analysis concludes that in these 2 Texas hospitals, significant maternal morbidity was associated with state-mandated expectant management for periviable obstetric complications. It is clear that a high risk of serious morbidity exists for pregnant patients at <22 weeks presenting with medical indications for delivery, with simultaneous poor fetal outcomes. In fact, serious maternal morbidity due to expectant management occurred for 57% of patients, versus 33% for those with similar medical conditions electing immediate pregnancy interruption in other states. Questions raised by this analysis include “How imminent must death be?” and “What does the threat of death need to be?” Although the study is limited by its small sample size, it is clearly indicative of the possible imminent future for maternal health care as mandated by this legislation.

Background: High-level aminoglycoside resistance (HLAR) that precludes bactericidal synergism with penicillins or glycopeptides and nephrotoxicity related to aminoglycoside treatment are major problems in treating Enterococcus faecalis endocarditis. Objective: To evaluate the efficacy and safety of ampicillin plus ceftriaxone for treating endocarditis due to E. faecalis with and without HLAR. Design: Observational, open-label, nonrandomized, multicenter clinical trial. Setting: 13 centers in Spain. Patients: 21 patients with HLAR E. faecalis endocarditis and 22 patients with non-HLAR E. faecalis endocarditis. All were at risk for nephrotoxicity related to aminoglycoside use. Intervention: 6-week course of intravenous ampicillin, 2 g every 4 hours, plus intravenous ceftriaxone, 2 g every 12 hours. Measurement: Clinical and microbiological outcomes. Results: The clinical cure rate at 3 months was 67.4% (29 of 43 patients) among all episodes. During treatment, 28.6% of patients with HLAR E. faecalis endocarditis and 18.2% of patients with non-HLAR E. faecalis endocarditis died of infection-related causes. The rate of clinical and microbiological cure in patients who completed the protocol was 100% in the HLAR E. faecalis endocarditis group. No episodes of breakthrough bacteremia occurred, although there were 2 relapses in the non-HLAR E. faecalis endocarditis group. Treatment was withdrawn in 1 case because of fever and skin rash. Limitations: The study had a small sample and was observational. Conclusion: The combination of ampicillin and ceftriaxone is effective and safe for treating HLAR E. faecalis endocarditis and could be a reasonable alternative for patients with non-HLAR E. faecalis endocarditis who are at increased risk for nephrotoxicity.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2005.07.002 Byline: Patricia Santiago-Munoz, Scott Roberts, Jeanne Sheffield, Barbara McElwee, George D. Wendel Abstract: The purpose of this study was to evaluate the prevalence of hepatitis B and hepatitis C virus co-infection among pregnant women who are infected by human immunodeficiency virus and who attend an obstetric complications prenatal clinic. Author Affiliation: Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas, TX Article History: Received 1 March 2005; Revised 1 June 2005; Accepted 30 June 2005 Article Note: (footnote) Presented at the Twenty-Fifth Annual Meeting of the Society for Maternal Fetal Medicine, Reno, Nevada, February 7-12, 2005.

Background: We report the largest series of group B streptococcal (GBS) bacteremia cases reported at a single institution. Methods: During a 10-year period 1985-1994), 90 GBS bacteremia cases (0.95% of significant bacteremic episodes) were detected. We describe the 51 episodes that occurred m nonpregnant adults for winch enough clinical and microbiological information is available. Result: Incidence of GBS has significantly increased during the study period from 0.08 per 1000 admissions in 1985 to 0.3 per 1000 in 1994). Mean age of patients was 63.3 years (range, 21-88 years) and 53% were men. The most common underlying conditions were liver diseases (35.3%), and deaths 33-3%), and diabetes mellitus (27.5%). Only 2 patients did not have any underlying condition and no patient with the human immunodeficiency virus had GBS bacteremia in our series. The origin of the episodes of bacteremia were as follows: primary bacteremia (39.2%), skin and soft tissue infections (15.7%), urinary tract infections (11.8%), pneumonia (9.8%), peritonitis (9.8%), catheter infection (5.9%), postendoscopic bacteremia (5.9%), and endocarditis (2%). All isolates were susceptible to penicillin G pottassium, ampicillin sodium, cephalothin sodium, cefotaxime sodium and vancomycin hydrochloride. One ciprofloxacin hydrocholoride -- resistant strain was discovered and resistance to erythromycin stearate increased from 8% in 1992 to 18% in 1994. The overall mortality late was 33.3% and death were considered related to the GBS bacteremia in 25.5% of the cases. Factors for poor prognosis were central nervous system diseases, alcoholism, shock, renal failure, and consciousness impairment. Conclusions: Group B streptococcus is a rising cause of bacteremia in elderly patients with severe underlying conditions. It conveys high morbidity and morality rates. Macrolides should not be used empirically for treatment of patients with penicillin allergies.

Background: Recurrent pneumococcal infections are known to occur occasionally in patients with profound immune defects. We performed a case-control analysis of recurrent pneumococcal bacteremias. Patients and Methods: The 547 episodes of Streptococcus pneumoniae bacteremia detected from January 1, 1985, to December 31, 1994, were reviewed. We selected all cases with more than 1 episode separated by 30 days or more ('cases') and compared each of them with 2 controls (patients with single episodes of pneumococcal bacteremia). Results: Fifteen patients (2.8%) had 31 episodes of pneumococcal bacteremia. Except for multiple myeloma (P

The humoral immune response of transplant recipients to influenza vaccination has been studied in detail. In contrast, the hemagglutinin inhibiting (HI) antibody response evoked by natural influenza infection and its impact on viral kinetics is unknown. In this prospective, multicenter, cohort study of natural influenza infection in transplant recipients, we measured HIantibody titers at presentation and 4 weeks later. Serial nasopharyngeal viral loads were determined using a quantitative influenza A polymerase chain reaction (PCR). We analyzed 196 transplant recipients with influenza infection. In the cohort of organ transplant patients with influenza A (n = 116), seropositivity rates for strain‐specific antibodies were 44.0% (95% confidence interval [CI] 31.5‐53.2%) at diagnosis and 64.7% (95% CI 55.4‐72.9%) 4 weeks postinfection. Seroconversion was observed in 32.8% (95% CI 24.7‐41.9%) of the cases. Lung transplant recipients were more likely to seroconvert (P= .002) and vaccine recipients were less likely to seroconvert (P= .024). A subset of patients (n = 30) who were unresponsive to prior vaccination were also unresponsive to natural infection. There was no correlation between viral kinetics and antibody response. This study provides novel data on the seroresponse to influenza infection in transplant patients and its relationship to a number of parameters including a prior vaccination status, virologic measures, and clinical variables. This prospective, multicenter cohort study of transplant recipients reports the strain‐specific hemagglutinin‐inhibiting antibody response to natural influenza infection and demonstrates that serologic response rates are poor in this population and antibody responses are largely unrelated to nasopharyngeal viral measures.

Objective: To define the incidence, risk factors, and characteristics of bloodstream infections (BSIs) after invasive nonsurgical cardiologic procedures (ICPs). Methods: Retrospective case-control study; multivariate analysis. Results: Between January 1991 and December 1998, 22 006 ICPs were performed in our hospital and 25 BSIs were documented within 72 hours after ICP. Overall incidence of bacteremia was 0.11% (25 cases) (0.24% after percutaneous transluminal coronary angioplasty [14 cases of 5625 patients], 0.6% after diagnostic cardiac catheterization [9 cases of 14 034 patients], and 0.8% after electrophysiologic studies [2 cases of 2347 patients]). These 25 patients with bacteremia were compared with 50 controls randomly selected among patients who underwent an ICP but did not have BSIs. Patient-related risk factors for BSI were age older than 60 years (20 cases [80%] vs 28 controis [56%]), valvular disease (4 [16%] vs 1 [2%]), congestive heart failure (7 [28%] vs 1 [2%]), indwelling bladder catheter before the ICP (5 [20%] vs 1 [2%]), more than 1 puncture for the ICP (5 [20%] vs 3 [6%]), a prolonged procedure (83.7 vs 65.1 minutes); and/or more than 1 ICP performed (2 [8%] vs 0). Multivariate analysis identified the presence of congestive heart failure (odds ratio, 21; 95% confidence interval, 6.8-66.0) and age older than 60 years (odds ratio, 1.9; 95% confidence interval, 1.9-6.3) as independent risk factors for BSI after ICP. Bloodstream infection was detected a median of 1.7 days after the procedure. Gram-negative bacteremia accounted for 17 cases (68%) of the BSIs. Among the patients with BSI, the duration of hospital stay was significantly increased (21 vs 6 days). The overall mortality rate was 0.009% for patients who underwent an ICP (8.0% for the 25 patients with bacteremia documented within 72 hours after ICP). Conclusions: Bloodstream infection should be included among the potential complications of ICP. Elderly patients with recent congestive heart failure episodes constitute a subgroup with a higher risk of postprocedure bacteremia. Therapy with antimicrobial agents against gram-positive and gram-negative bacteremia should be initiated after performing blood cultures in patients with signs suggestive of infection. Arch Intern Med. 2001;161:2110-2115

Hydrogen peroxide is a powerful and green oxidant that allows for the oxidation of a wide span of organic and inorganic substrates in liquid media under mild reaction conditions, and forms only molecular water and oxygen as end products. Hydrogen peroxide is therefore used in a wide range of applications, for which the well-documented and established anthraquinone autoxidation process is by far the dominating production method at the industrial scale. As this method is highly energy consuming and environmentally costly, the search for more sustainable synthesis methods is of high interest. To this end, the article reviews the basis and the recent development of the photocatalytic synthesis of hydrogen peroxide. Different oxygen reduction and water oxidation mechanisms are discussed, as well as several kinetic models, and the influence of the main key reaction parameters is itemized. A large range of photocatalytic materials is reviewed, with emphasis on titania-based photocatalysts and on high-prospect graphitic carbon nitride-based systems that take advantage of advanced bulk and surface synthetic approaches. Strategies for enhancing the performances of solar-driven photocatalysts are reported, and the search for new, alternative, photocatalytic materials is detailed. Finally, the promise of in situ photocatalytic synthesis of hydrogen peroxide for water treatment and organic synthesis is described, as well as its coupling with enzymes and the direct in situ synthesis of other technical peroxides.

We determined the characteristics of posttransplant tuberculosis and the impact of rifampin-based antituberculosis regimens on outcomes in the current era. Patients comprised 64 transplant recipients with tuberculosis, divided into 2 consecutive cohorts: an earlier cohort (cases occurring from 2003 to 2007) and a later cohort (cases from 2008 to 2011). Patients from the later versus earlier era had tuberculosis develop later after transplant (odds ratio, 1.01; 95% CI, 1.00–1.02; P= .05), were more likely to be liver transplant recipients (odds ratio, 4.52; 95% CI, 1.32–15.53; P= .02), and were more likely to receive tacrolimus-based immunosuppression (odds ratio, 3.24; 95% CI, 1.14–9.19; P= .03). Mortality rate was 10% in the later cohort and 21% in the earlier cohort (P= .20). Rifampin-based treatment was less likely to be used in patients with prior rejection (P= .04). However, neither rejection rate (P= .71) nor mortality (P= .93) after tuberculosis differed between recipients who received rifampin and recipients who did not. Thus, notable changes have occurred in the epidemiological characteristics of tuberculosis in transplant recipients. Overall mortality rate has improved, with about 90% of the patients now surviving after tuberculosis.

Incidence, characteristics, and risk factors for tuberculosis (TB)-associated immune reconstitution inflammatory syndrome (IRS) in solid-organ transplant (SOT) recipients are not known.

We report a case of a child who was found to have a peritesticular mass on fetal magnetic resonance imaging. Postnatally, the mass was diagnosed as an inguinal hernia and underwent surgical intervention. The patient was found to have meconium periorchitis, which was left in situ.

Hemagglutination-inhibitory antibodies are usually highly strain specific with little effect on infection with drifted or shifted strains. The significance of broadly cross-reactive non-HAI anti-influenza antibodies against conserved domains of virus glycoproteins, such as the hemagglutinin (HA) stalk, is of great interest. We characterize a cohort of 40 H1N1pmd09 influenza-infected patients and identify lower respiratory symptoms (LRSs) as a predictor for development of pneumonia. A binomial logistic regression of log10 pre-existing antibody values shows that the probability of LRS occurrence decreased with increased anti-HA full-length and stalk antibody ELISA titers. However, a multilevel logistic regression model adjusted by other potential serocorrelates demonstrates that only antibodies directed against the stalk of HA correlate with protection from lower respiratory infection, limiting disease progression. Our predictive model indicates that a threshold of protective immunity based on broadly cross-reactive HA stalk antibodies could be feasible.

This study describes the association of allograft loss and immune reconstitution syndrome (IRS) in the course of Cryptococcosis neoformansinfection in renal transplant recipients. Patients comprised 54 renal allograft recipients with cryptococcosis in a prospective, multicenter study. IRS developed in 5.5% (3/54) of the renal transplant recipient with C. neoformansinfection. The renal allograft was lost to chronic rejection in 66% (2/3) of the patients with cryptococcosis who developed IRS compared to 5.9% (3/51) of those who did not (P0.012). Kaplan-Meier survival analysis showed that subsequent to cryptococcal infection the probability of allograft survival was significantly lower in patients who developed IRS compared to those who did not develop IRS (P0.0004). Temporal association of graft loss with IRS suggests a common pathophysiologic basis for these entities with implications relevant for the optimal management of renal transplant recipients with cryptococcosis.