Search

Salmonella arizona bacteremia was diagnosed in four snakes. Clinical signs were variable and ranged from animals having no clinical signs to profound lethargy. Diagnosis was based upon ante-mortem recovery of the organism from blood in all four snakes and from tissues collected post-mortem in two snakes. Pulsed field gel electrophoresis (PFGE) was used to determine relatedness of the isolates. The serotype for three of the isolates was 51:Z4,Z23. The fourth isolate was genetically different from the others, but had a similar serotype (48:Z4,Z23). These S. arizona serotypes appear to be pathogenic in snakes.

Per World Health Organization (WHO) data, 1 million people commit suicide yearly, with more than 80% occurring in lowand middle-income countries; India and China alone account for 60% of worldwide occurrences. In India, suicide deaths among women are equivalent in number to deaths from perinatal causes and double those due to HIV/AIDS. Despite worldwide prevalence disparities, the literature on suicide continues to comprise studies conducted in Western, high-income countries. Only 1.3% of studies published on suicide originate from India or China. Suicide is a crime in India and thus under-reporting and general stigma likely contribute to the paucity of relevant literature; there is a critical need to study suicide in India. We present descriptive findings from a cross-sectional survey conducted in rural Gujarat, India, that expands the discussion on suicide among young women and poses the question: Are there two types of suicidal ideation among women in rural India? 94 95 96 97 98 METHODS

Background Prenatal care provider weight gain advice consistent with the Institute of Medicine recommendations is related to guideline-adherent gestational weight gain (GWG), yet many women may not receive guideline-congruent advice. We examined pregnant women's recall of prenatal care provider GWG advice in relation to prepregnancy body mass index (BMI). Methods We conducted a prospective cohort study of women (n = 149) receiving prenatal care for a singleton pregnancy at a large academic medical center in 2010. Data were collected via a survey during late pregnancy and medical record abstraction. Results Thirty-three percent of women did not recall receiving the provider GWG advice; 33 percent recalled advice consistent with 2009 Institute of Medicine recommendations. Recalled advice differed by prepregnancy BMI; 29 percent of normal weight, 26 percent of overweight, and 45 percent of obese women reported not receiving advice, and 6, 37, and 39 percent, respectively, recalled advice exceeding Institute of Medicine recommendations. Among the 62 percent who recalled that their provider had labeled their prepregnancy BMI, 100 percent of normal weight, 32 percent of overweight, and 23 percent of obese women recalled the labels “normal weight,” “overweight,” and “obese,” respectively. Conclusions Helping providers give their patients memorable and guideline-consistent GWG advice is an actionable step toward preventing excessive GWG and associated maternal and child health consequences.

This exploratory study completed interviews with 25 depressed pregnant women who had prior depression, and when becoming pregnant, were receiving depression medication or tried to get mental health care. Seventy one percent of women were more than 25 weeks gestation at the time of the interview. Thirty-five percent of women were not receiving treatment. While 94 % told their provider of their pregnancy, 36 % had no opportunity to discuss the risks and benefits of continued pharmacotherapy; 42 % had no opportunity to continue pharmacotherapy. Some providers may be reluctant to treat depressed pregnant women, creating a potential barrier to their receipt of needed care.

Background Diabetes and obesity have reached epidemic proportions in the U.S. with rates consistently higher among Hispanics as compared to non-Hispanic whites. Among Hispanic women diagnosed with gestational diabetes mellitus (GDM), 50% will go on to develop type 2 diabetes within 5 years of the index pregnancy. Although randomised controlled trials among adults with impaired glucose tolerance have shown that diet and physical activity reduce the risk of type 2 diabetes, such programs have not been tested in high-risk postpartum women. The overall goal of this randomised controlled trial is to test the efficacy of a culturally and linguistically modified, individually-tailored lifestyle intervention to reduce risk factors for type 2 diabetes and cardiovascular disease among postpartum Hispanic women with a history of abnormal glucose tolerance during pregnancy. Methods/Design Hispanic pregnant women who screen positive for GDM will be recruited and randomly assigned to a Lifestyle Intervention (n = 150) or a Health & Wellness (control) Intervention (n = 150). Multimodal contacts (i.e., in-person, telephone, and mailed materials) will be used to deliver the intervention from late pregnancy (29 weeks gestation) to 12 months postpartum. Targets of the intervention are to achieve Institute of Medicine Guidelines for postpartum weight loss; American Congress of Obstetrician and Gynecologist guidelines for physical activity; and American Diabetes Association guidelines for diet. The intervention draws from Social Cognitive Theory and the Transtheoretical Model and addresses the specific cultural and environmental challenges faced by low-income Hispanic women. Assessments will be conducted at enrollment, and at 6-weeks, 6-months, and 12-months postpartum by trained bicultural and bilingual personnel blinded to the intervention arm. Efficacy will be assessed via postpartum weight loss and biomarkers of insulin resistance and cardiovascular risk. Changes in physical activity and diet will be measured via 7-day actigraph data and three unannounced 24-hour dietary recalls at each assessment time period. Discussion Hispanic women are the fastest growing minority group in the U.S. and have the highest rates of sedentary behavior and postpartum diabetes after a diagnosis of GDM. This randomised trial uses a high-reach, low-cost strategy that can readily be translated into clinical practice in underserved and minority populations. Trial registration NCT01679210

Growing literature on negative childhood stress emphasizes the need to understand cortisol values from varying biomarker samples.This work aimed to examine cortisol samples for usability, associations, and individual stability in neonates.The sample consisted of preterm infants (n=31).Analyses on cortisol collected from cord blood and from saliva and urine samples on days 1, 7, and 14 included Spearman correlations and paired t-tests.Usability rates were 80.6% (cord blood), 85.9% (saliva), and 93.5% (urine). Salivary and urinary cortisol levels had significant correlation on day 1 only (p=0.004). Significant differences in individual stability of cortisol concentrations existed except in urine on days 1 and 7 and in saliva on days 7 and 14.Usability was highest for urine samples. We found little correlation between cortisol sample levels at each time; individual stability of cortisol concentrations was minimal. Interpretation of cortisol findings in all studies should be performed cautiously.

Gestational diabetes mellitus (GDM) is defined as carbohydrate intolerance with first onset or first identification in pregnancy. It is one of the most common complications of pregnancy with a prevalence ranging from 3% to upwards of 16% depending on the screened population and whether a 1 or 2-step screening algorithm is utilized. Its occurrence has historically been predominantly attributed to pro-diabetogenic placental hormone secretion. However, there is emerging evidence to indicate that its mechanistic underpinnings are more complex; similar to type 2 Diabetes Mellitus (T2DM), adipose tissue dysfunction and associated inflammation may be key etiologic factors for the development of GDM. In support of this view, women with a history of GDM are at high risk of subsequent T2DM development and their offspring at increased risk of obesity and metabolic syndrome across their life span. With immediate and long term consequences of GDM on mother and offspring, etiologic understanding that can inform therapeutic and preventative targets is essential. This review article explores the existing literature as it relates to associations of GDM with expansion of adipose tissue depots, secretion of adipose derived biologically active factors, and inflammation and inflammatory related substances.

To compare classification of pre-pregnancy body mass index (BMI) using self-reported pre-pregnancy weight versus weight measured at the first prenatal visit. Retrospective cohort of 307 women receiving prenatal care at the faculty and resident obstetric clinics at a Massachusetts tertiary-care center. Eligible women initiated prenatal care prior to 14 weeks gestation and delivered singleton infants between April 2007 and March 2008. On average, self-reported weight was 4 pounds lighter than measured weight at the first prenatal visit (SD 7.2 pounds; range: 19 pounds lighter to 35 pounds heavier). Using self-reported pre-pregnancy weight to calculate pre-pregnancy BMI, 4.2 % of women were underweight, 48.9 % were normal weight, 25.4 % were overweight, and 21.5 % were obese. Using weight measured at first prenatal visit, these were 3.6, 45.3, 26.4, and 24.8 %, respectively. Classification of pre-pregnancy BMI was concordant for 87 % of women (weighted kappa = 0.86; 95 % CI 0.81–0.90). Women gained an average of 32.1 pounds (SD 18.0 pounds) during pregnancy. Of the 13 % of the sample with discrepant BMI classification, 74 % gained within the same adherence category when comparing weight gain to Institute of Medicine recommendations. For the vast majority of women, self-reported pre-pregnancy weight and measured weight at first prenatal visit resulted in identical classification of pre-pregnancy BMI. In absence of measured pre-pregnancy weight, we recommend that providers calculate both values and discuss discrepancies with their pregnant patients, as significant weight loss or gain during the first trimester may indicate a need for additional oversight with potential intervention.

Background Cesarean sections are the most common surgical procedure for women in the United States. Of the over 4 million births a year, one in three are now delivered in this manner and the risk adjusted prevalence rates appear to vary by race and ethnicity. However, data from individual studies provides limited or contradictory information on race and ethnicity as an independent predictor of delivery mode, precluding accurate generalizations. This study sought to assess the extent to which primary, unscheduled cesarean deliveries and their indications vary by race/ethnicity in one academic medical center. Methods A retrospective, cross-sectional cohort study was conducted of 4,483 nulliparous women with term, singleton, and vertex presentation deliveries at a major academic medical center between 2006–2011. Cases with medical conditions, risk factors, or pregnancy complications that can contribute to increased cesarean risk or contraindicate vaginal birth were excluded. Multinomial logistic regression analysis was used to evaluate differences in delivery mode and caesarean indications among racial and ethnic groups. Results The overall rate of cesarean delivery in our cohort was 16.7%. Compared to White women, Black and Asian women had higher rates of cesarean delivery than spontaneous vaginal delivery, (adjusted odds ratio {AOR}: 1.43; 95% CI: 1.07, 1.91, and AOR: 1.49; 95% CI: 1.02, 2.17, respectively). Black women were also more likely, compared to White women, to undergo cesarean for fetal distress and indications diagnosed in the first stage as compared to the second stage of labor. Conclusions Racial and ethnic differences in delivery mode and indications for cesareans exist among low-risk nulliparas at our institution. These differences may be best explained by examining the variation in clinical decisions that indicate fetal distress and failure to progress at the hospital-level.

OBJECTIVES Feeding intolerance (FI) in preterm infants is common but the etiology remains unclear. This study examined FI as a stress-related disease involving brain-gut interactions and tested the model of allostatic load and complications of prematurity. Specific aims were to describe demographic/medical variables and biomarker levels at each time and over time for the sample; describe/compare variables and biomarker levels at each time for infants with/without FI; and compare biomarker interquartile/interpercentile distributions between infants with/without FI. METHODS Preterm infants

This is the first study evaluating obstetrics and gynecology (OB/Gyn) provider and staff perceptions of barriers to accessing pharmacotherapy for perinatal depression outside the obstetric setting. Four, 90 min focus groups were conducted with OB/Gyn physicians, advance practice nurses, and support and nursing staff (n = 28). Data were analyzed with a grounded theory approach. Participants perceived that community mental health providers and pharmacists often do not want to participate in pharmacotherapy for perinatal women. Participants believed the solution is training for community mental health providers in the risks and benefits of pharmacotherapy for perinatal depression and improved communication between OB/Gyn’s and community mental health providers. Community mental health provider and pharmacist reluctance to provide pharmacotherapy hinders OB/Gyn’s perceived ability to address perinatal depression. Community mental health provider and pharmacist training are needed to mitigate precipitous discontinuation of treatment and to improve access to pharmacotherapy for perinatal women.

Many medical schools are currently undergoing curriculum reform. When considering the means by which students will be evaluated in a revised curriculum, the need to reduce the prevalences of depression and anxiety associated with academic stress must be weighed against the importance of academic outcomes. Pass/fail evaluation, as compared with tiered grading, is commonly presented as a means to adequately assess student performance while minimising stress and anxiety. The purpose of this literature review was to determine the impact of pass/fail grading on medical student well-being and academic outcomes.A systematic search was performed of the available literature published between January 1980 and August 2010, using the PubMed, Ovid Medline, Ovid PsycINFO and ERIC databases. Eligible papers assessed the impact of pass/fail grading on medical student well-being, academic outcomes or both. Academic outcomes included but were not limited to objective measures, such as performance on the US Medical Licensing Examination, and subjective measures, such as student desirability by residency programmes. Reference lists in identified papers were searched and all identified papers were run through a citation index.Four papers met the inclusion criteria for both well-being and academic outcomes. An additional five papers met the inclusion criteria for academic outcomes only. The four papers that focused on well-being reported improvement in specified areas. No significant difference was identified in any of the five papers examining objective academic outcomes or in those papers that examined the quality of residency programmes attained. Results from two studies suggested that some programme directors believe pass/fail grading creates disadvantages for students in attaining a residency, whereas a third study yielded mixed results about its impact on residency attainment.Student well-being is enhanced and objective academic performance is not adversely affected by a pass/fail evaluation system, but students' ability to obtain a desired residency programme may be hindered by individual programme directors' preferences for tiered grading systems. There is an overall paucity of literature on this topic and additional study is needed.

Knowledge of sleep aid use is limited despite the high prevalence of insomnia among women before, during, and following breast cancer adjuvant chemotherapy treatments (CTX). This study's purpose was to (1) determine the frequency and characteristics of participants taking sleep aid(s); (2) identify the frequency and percentage of sleep aid use by category (prescription sedative/hypnotics, prescription anti-depressants, prescription analgesics, prescription anti-emetics, over-the-counter (OTC) analgesics, OTC cold/flu/sinus, OTC sleep, alcohol, and herbal supplements); and (3) compare sleep aid use by category in the experimental and control groups within a randomized-controlled clinical trial (RCT).Longitudinal, descriptive, secondary RCT data analysis of women (n=219) receiving out-patient CTX, and at 30, 60, and 90 days following the last CTX and 1 year following CTX1. Participants recorded daily sleep aid use on a Sleep Diary. Analyses included descriptives, chi-square, and RM-ANOVA.Approximately 20% of participants took at least one sleep aid before CTX1; usage decreased over time (12-18%); a second sleep aid was used infrequently. Prescription sedative/hypnotics (46%) and OTC analgesics (24%) were used most frequently. OTC sleep aids were most commonly used as a second aid. Prescription sedative/hypnotics [F(7,211)=4.26, p=0.00] and OTC analgesics [F(7,211)=2.38, p=0.023] use decreased significantly over time.Results reflect the natural course of CTX, recovery, and healing. Comprehensive screening for sleep-wake disturbances and sleep aid use may lead to a better understanding of the risks and benefits of pharmacologic and non-pharmacologic interventions, and ultimately lead to selection of the safest and most effective treatment.

Introduction This resource is a comprehensive tutorial for nonpharmacologic vaginal management of postpartum hemorrhage. Management methods addressed include uterine exploration and evacuation including dilation and curettage, and uterine tamponade techniques including uterine packing and use of commercial products. This module was prepared for use in residencies with significant obstetrical training but is appropriate for use by any individual seeking detailed information on initial conservative management of postpartum hemorrhage. It can be used in conjunction with postpartum hemorrhage simulation, in support of didactic sessions, as a stand-alone discussion, or review of the subject matter. Methods All procedures are presented as an overview with attached step-by-step instructional guides and videos. The presentation contains a narrated web-based presentation with embedded videos. There is a transcription of all audio narration so that the resource is usable for the hearing impaired. Results Pre- and posttests associated with this resource demonstrated a clear improvement in mastery of material as a result of using this module. All trainees completing the module reported that the module increased their knowledge “moderately” or “to a great extent.” Additionally, all trainees reported that they agreed or strongly agreed that they would recommend the module to another learner. Discussion This module can be used in conjunction with a postpartum hemorrhage simulation, in support of didactic sessions, and as a stand-alone discussion or review of the subject matter.

This resource is an audiovisual tutorial for pharmacologic management of postpartum hemorrhage. This module was prepared for use in residencies with significant obstetrical training but is appropriate for use by any individual seeking detailed information on pharmacologic management of postpartum hemorrhage. It can be used in conjunction with postpartum hemorrhage simulation, in support of didactic sessions, and as a stand-alone discussion or review of the subject matter. The presentation contains a narrated slide set with embedded summary tables. There is a transcription of all audio narration so that the resource is usable by the hearing impaired. This module was developed as part of a comprehensive blended learning curriculum for teaching the management of postpartum hemorrhage. The full curriculum included seven online modules followed by face-to-face teaching and learning with task trainers and a multidisciplinary simulation case. Project-associated pre- and posttesting demonstrated clear improvement in mastery of material as a result of using this module. All trainees completing the module reported that the module increased their knowledge “moderately” or “to a great extent.” Additionally, all trainees reported that they “agreed” or “strongly agreed” that they would recommend the module to another learner.

This resource is a comprehensive tutorial module for intravenous fluid resuscitation and blood product replacement during the management of postpartum hemorrhage. The module was prepared for use in residencies with significant obstetrical training but is appropriate for any individual seeking detailed information on fluid and blood product resuscitation in the management of postpartum hemorrhage. It can be used in conjunction with postpartum hemorrhage simulation, in support of didactic sessions, or as a stand-alone discussion or review of the subject matter. The presentation contains a narrated PowerPoint slide set with embedded summary tables. There is a transcription of all audio narration so that the resource is usable by the hearing impaired. The module was developed as part of a comprehensive blended learning curriculum for teaching the management of postpartum hemorrhage. The full curriculum included seven online modules followed by face-to-face teaching and learning with task trainers and a multidisciplinary simulation case. Project-associated pre- and posttesting demonstrated clear improvement in mastery of material as a result of using this module. All trainees completing the module reported that the module increased their knowledge “moderately” or “to a great extent.” Additionally, all trainees reported that they “agreed” or “strongly agreed” that they would recommend the module to another learner.

To assess women's knowledge, concerns, and willingness for adjunct high-risk human papillomavirus (HR-HPV) testing before and after an educational intervention.At the time of their annual gynecologic examination, women aged 30 years and older received an educational intervention about HR-HPV. Subjects completed preintervention and postintervention questionnaires. Demographic characteristics were summarized using frequency measures. Comparisons between the pre-education and posteducation questionnaires were performed using Fisher exact test.Fifty women completed the study. After the educational intervention, 77% of women were willing to be tested for HR-HPV. Sixty-seven percent of women would be likely to return for their annual gynecologic examination even if a Pap smear was not required for 3 years. Education statistically reduced concern regarding a positive HR-HPV result with 60% pre-education and 27% posteducation very concerned (p =.002). When surveyed about what their concerns would be if tested positive for HR-HPV, women associate future cervical cancer diagnosis (38% pre-education vs 48% posteducation, p =.903) but not partner infidelity (0%) with testing positive for HR-HPV. Knowledge concerning HPV, cervical cancer, and cervical cancer screening was statistically improved after the educational intervention in all but 2 questions.Women 30 years and older are willing to have adjunct HR-HPV testing, with education reducing their degree of concern about testing positive. Women who test positive would be most concerned about getting cervical cancer. Women would be willing to return for yearly gynecologic examinations, even if a Pap smear was not needed for 3 years. Education improves women's knowledge of HPV, cervical cancer, and cervical cancer screening, but did not allay the concern for getting cervical cancer.

Intracytoplasmic inclusion bodies suggestive of iridovirus infection were observed in formalin-fixed, paraffin-embedded tissues from a nautilus ( Nautilus spp.) that died without premonitory signs. Transmission electron microscopy revealed enveloped, hexagonal, viral particles that measured approximately 176 nm in diameter. Virions contained a dense central core and morphology typical of iridoviruses. Extracted DNA was amplified using primers homologous to conserved iridovirus sequences. The amplicons were cloned, sequenced, and determined to be approximately 60% similar to reported amphibian iridovirus sequences. A polymerase chain reaction-generated digoxigenin probe was used to detect viral nucleic acid in tissue sections by DNA in situ hybridization and high-affinity cytochemistry. The detected nucleic acid corresponded to the inclusion bodies observed microscopically. This represents a novel iridovirus of mollusks.

cluded: death, RDS, grades 3 or 4 IVH, sepsis, NEC, or retinopathy of prematurity. The primary composite maternal outcome included: death, pulmonary edema, blood transfusion, ARDS, CVA, ATN, DIC, or liver rupture. RESULTS: Of 9960 evaluated pregnancies, 114 delivered 20 weeks and 101 had major fetal birth defects. Overall 28.2% had PAH 19.2% mild GTHN, 2.0% severe GHTN, 3.8% mild PrE, and 3.1% severe PrE. Outcome risks by PAH type (all p-values 0.001) and adjusted ORs (with no PAH as referent) are given (Table). Maternal and perinatal outcomes were elevated the most for severe PrE (2.6 to 9-fold) and least for mild GHTN (0.7 to 2.4-fold). CONCLUSION: The risks of adverse outcomes increase with severity of PAH sub-type. Mild PrE has similar perinatal risks to severe GHTN but maternal risks are greater.

INTRODUCTION:The number of reproductive-aged women undergoing bariatric surgery is increasing. Most patients have rapid weight loss in the first year or 2 after bariatric surgery, which increases their chance of pregnancy. Weight loss decreases hypertension and diabetes but increases nutritional def

Objective Several conditions are associated with increased preeclampsia (PE) risk. Whether altered maternal angiogenic factor levels contribute to risk in these conditions is unknown. Our objective was to compare angiogenic biomarker patterns in high-risk pregnancies and low-risk controls. Study Design We conducted a planned secondary analysis of a 2-center observational study of angiogenic biomarkers in high-risk women. A total of 156 pregnant women with a PE risk factor and 59 low-risk controls were studied. Serial maternal serum samples were collected during 3 gestational windows: 23-27 weeks, 28-31 weeks, and 32-35 weeks. Soluble fms-like tyrosine kinase 1 (sFlt1), soluble endoglin (sEng), and placental growth factor (PlGF) were measured by enzyme-linked immunosorbent assay. Geometric mean angiogenic biomarker levels and angiogenic ratio (sFlt1 + sEng):PlGF were compared with low-risk controls for each risk group, at each gestational window. Results Gestational biomarker patterns differed in PE risk groups as compared with low-risk controls. Women with multiple gestations had markedly higher sFlt1 and sEng at all gestational windows. Women with prior PE had higher sFlt1 and angiogenic ratio, and lower PlGF, from 28 weeks onward. Women with chronic hypertension had significantly higher angiogenic ratio for all 3 gestational windows, but differences disappeared when women with PE were excluded. Obese and nulliparous women had significantly lower PlGF, but no differences in the angiogenic ratio. Conclusion High-risk groups have altered angiogenic biomarker patterns compared with controls, suggesting that altered production or metabolism of these factors may contribute to PE risk, particularly in women with multiple gestations and prior PE.

Objective Placental soluble fms-like tyrosine kinase-1 may contribute to the pathogenesis of preeclampsia. Here we describe alterations in serum angiogenic factor levels in women with multiple gestation pregnancies, a major preeclampsia risk factor. Study Design We collected serial serum specimens from 101 pregnant women at high preeclampsia risk between 22 and 36 weeks' gestation. Soluble fms-like tyrosine kinase-1 and placental growth factor were measured by enzyme-linked immunosorbent assay. Women who had preeclampsia or gestational hypertension develop were excluded. Results Maternal soluble fms-like tyrosine kinase-1 was higher in multiple gestation (n = 20) compared with high-risk singleton (n = 81) pregnancies for each gestational age range examined. Maternal placental growth factor was significantly higher in multiple vs high-risk singletons before 31 weeks' gestation, whereas the soluble fms-like tyrosine kinase-1/placental growth factor ratio was higher in multiple vs high-risk singletons after 27 weeks. Conclusion Alterations in circulating angiogenic factors are present in women with multiple gestations and may contribute to higher preeclampsia risk in this population.

Objective The objective of the study was to evaluate angiogenic factors for the prediction of preeclampsia in high-risk women. Study Design We collected serial serum specimens from 94 women at high preeclampsia risk between 22 and 36 weeks' gestation. Soluble fms-like tyrosine kinase-1 (sFlt1) and placental growth factor (PlGF) were measured by enzyme-linked immunosorbent assay. Results Mean serum sFlt1 and the sFlt1/PlGF ratio were higher in subjects who developed early-onset (less than 34 weeks) preeclampsia, as compared with subjects without preeclampsia, from 22 weeks gestation onward. In subjects who developed late-onset (34 weeks or later) preeclampsia, sFlt1 was significantly increased after 31 weeks' gestation. The sFlt1/PlGF ratio at 22-26 weeks was highly predictive of early-onset preeclampsia. The within-woman rate of change of the sFlt1/PlGF ratio was predictive of overall preeclampsia risk. Conclusions In high-risk women, serum sFlt1 and the sFlt1:PlGF ratio are altered prior to preeclampsia onset and may be predictive of preeclampsia. Larger studies are needed to confirm these findings.