bluuebunny/crossref_metadata_2025_split huggingface dataset:
Randomized Clinical Trial of Antibiotic Therapy for Antenatal Pyelonephritis
Authors: Brost Brian C. , Campbell Barry , Stramm Sue , Eller Daniel , Newman Roger B. 
Published: March 2007

Objective: The aim of this study was to prospectively evaluate the efficacy of a therapeutic course
of intravenous antibiotics followed by oral antibiotics vs. intravenous antibiotics alone to prevent
recurrent urinary tract infection.Methods: Pyelonephritis was documented by strict criteria in 67 pregnant women who were then
treated with appropriate intravenous antibiotics until afebrile and asymptomatic for 48 h. Women
were then randomized to completion of a 10‐day course of oral nitrofurantoin 100 mg qid or no
further antibiotic therapy. Urine cultures (UC) were obtained 2 and 6 weeks after discharge, and
at delivery. A positive UC or readmission for pyelonephritis was considered endpoints for participation
in the study. Antibiotic suppression was not used.Results: Readmission for pyelonephritis prior to the 2‐week follow‐up visit occurred in 2/36
(5.6%) women randomized to the oral therapy group compared to 4/31 (12.9%) in the no oral
treatment group (P = 0.29). At the 2‐week follow‐up visit, 6/31 (19.4%) women had a positive UC
in the oral therapy compared to 8/26 (30.1%) in the no oral treatment group but this difference was
not statistically significant (P = 0.31).Conclusions: Completion of 10 days of antibiotic therapy with oral medication does not significantly
reduce the risk of recurrent pyelonephritis immediately post‐parenteral treatment. Women in
the no oral treatment group had a non‐significant increase in positive UC at the 2‐week follow‐up
visit. The high rates of recurrent urinary tract infection during pregnancy in both groups underscore
the need for regular UC and for the possible role of oral antibiotic suppression.
Role of Genital Mycoplasmas in Bacteremia: Should We Be Routinely Culturing for These Organisms?
Authors: Garland Suzanne M. , Kelly V. Nigel 
Published: March 2007

Objective: The purpose of this study was to examine the role of the genital mycoplasmas
Mycoplasma hominis and Ureaplasma urealyticum as causes of bacteremia in a tertiary referral obstetrical, gynecological,
and neonatal intensive care facility, over a period of 12 years from 1983 to 1994 inclusively.Methods: All clinically significant blood cultures were reviewed and the percentage of septicemic
episodes for genital mycoplasmas was compared to the total isolation rate, including conventional
bacteria.Results: The overall positivity rate for all pathogenic organisms isolated from the blood cultures
of infants ranged from 4.5% to 7.7% per annum. U. urealyticum represented 0.8% of these positive
isolates and M. hominis 0.4%. For adults, the overall positivity rate from blood cultures ranged from
6.5% to 13.5%, with U. urealyticum representing 9.6% of these positive isolates and M. hominis 9.9%.Conclusions: With M. hominis having an established role in such clinical entities as postabortal and
postpartum fever and U. urealyticum strongly implicated with chronic lung disease in low birth
weight infants, it is appropriate to examine blood cultures for genital mycoplasmas in an obstetric
institution.
Varicella Pneumonia Complicating Pregnancy: A Report of Seven Cases
Authors: Schutte Teresa J. , Rogers Louise C. , Copas Pleas R. 
Published: March 2007

Background: Pneumonia is the most common complication of varicella‐zoster infection in adults and
has potentially devastating effects when complicating pregnancy. Due to the significant morbidity
and mortality associated with this complication during pregnancy and the small number of reported
cases in the literature, we present this report to help educate physicians who care for pregnant
women.Cases: Seven patients are presented in this report. These patients presented at various stages in
pregnancy, from 17 to 31 weeks of gestation. Three of the patients had unremarkable hospital
courses. Three of the patients had hospital stays over 21 days in duration. One patient died from
complications of varicella pneumonia after 31 days of hospitalization. The obstetric outcomes of the
7 patients described include 1 non‐viable delivery at 20 weeks gestation, 3 term deliveries, 2 preterm
deliveries, and 1 patient who has not yet delivered. All of the patients presented were treated with
intravenous acyclovir therapy. Of the patients described, 3 required intubation and ventilatory
support. Other complications encountered include disseminated intravascular coagulation (DIC),
adult respiratory distress syndrome (ARDS), metabolic encephalopathy, pneumothorax, superimposed
bacterial pneumonia, and sepsis.Conclusion: The course and treatment of varicella pneumonia complicating pregnancy are discussed.
Current recommendations regarding the use of varicella‐zoster immune globulin (VZIG)
are also reviewed.
Molecular Mechanisms of Parturition
Authors: Ferré F. 
Published: March 2007

The initial signal for triggering human parturition might be fetal but of trophoblastic origin. Concomitantly, this placental signal would have as its target not only the uterus but also the fetus by activating its hypothalamo-pituitary-adrenocortical axis. The latter would represent a second fetal signal which, at the fetomaternal interface, would amplify and define in time the mechanisms responsible for the onset of labor, implying changes in the myometrial and cervical extracellular matrix associated with the accession of the contractile phenotype for myometrial cells. At each phase of these processes in the utero-feto-placental system, the nature of these signals remains to be identified. Is there a single substance, or rather, and more likely, a combination of several?We appear to be in the presence of dynamic systems of a neuro-immuno-hormonal type which are difficult to describe. Nevertheless, steroid hormones appear to coordinate their successive equilibriums until they become irreversible. Such irreversibility constitutes the essential sign of parturition.
First Trimester Listeria monocytogenes Septicemia
Authors: Goddijn Mariëtte , Schipper Hans G. , Spanjaard Lodewijk , Wolf Hans 
Published: March 2007

Background: Little is known about fetal outcome after Listeria monocytogenes septicemia in the first trimester of pregnancy.Case: A primigravida with L. monocytogenes septicemia at 9 weeks gestation was treated with amoxicillin. At 40 weeks gestation a healthy female infant was born.Conclusion: This case shows that fetal outcome can be normal after appropriate treatment of maternal L. monocytogenes septicemia during embryogenesis.
Determining the Maternal and Fetal Cellular Immunologic Contributions in Preterm Deliveries With Clinical or Subclinical Chorioamnionitis
Authors: McNamara M. F. , Wallis T. , Qureshi F. , Jacques S. M. , Gonik B. 
Published: March 2007

Objective: Our purpose was to determine the maternal and fetal polymorphonuclear contributions to preterm histologic chorioamnionitis and whether this response differs in clinical chorioamnionitis when compared to cases without clinical chorioamnionitis.Methods: Paraffin placenta blocks from 19 preterm deliveries with histologic chorioamnionitis, 9 with clinical chorioamnionitis and 10 without clinical chorioamnionitis, were identified. Only placentas from male fetuses were used. Cytospin slides were generated from tissue specimens for fluorescent in situ hybridization (FISH) and labeled with X and Y chromosome probes. Under fluorescent microscopy, polymorphonuclear cells (PMNs) were identified as having two XX signals (maternal) or a single X and Y pair (fetal).Results: Maternal PMNs comprised 89% and 91% of the cellular response in the groups with and without clinical chorioaminionitis, respectively. This difference in the two groups was not statistically significant.Conclusions: The dominant contribution of PMNs seen in preterm severe histologic chorioamnionitis is maternal in origin. This response is similar in the presence or absence of clinical chorioamnionitis.
Chlorhexidine Vs. Sterile Vaginal Wash During Labor to Prevent Neonatal Infection
Authors: Eriksen Nancy L. , Sweeten Keri M. , Blanco Jorge D. 
Published: March 2007

Objective: The purpose of this study was to determine if a dilute solution of chlorhexidine used as a one‐time vaginal wash intrapartum can reduce the use of postnatal antibiotics and neonatal infection.Methods: Term pregnant women in labor were prospectively randomized to receive either 20 cc of 0.4% chlorhexidine (n = 481) or 20 cc of sterile water (n = 466) placebo. Exclusion criteria included fetal distress, clinical infection, cervical dilatation >6 cm, and known allergy to chlorhexidine. Outcome variables included the incidence of neonatal pneumonia, culture proven neonatal sepsis, and use of the antibiotics in the neonate. Continuous variables were compared using the Mann‐Whitney U‐test and discrete variables were compared with the chi‐square test.Results: The length of ruptured membranes (mean ± S.D.) between the chlorhexidine group (408 ± 589 min) and control group (352 ± 318 min) was not significantly different (P = 0.85, 95% confidence interval 354–462). Fifteen neonates (3.2%) in the chlorhexidine group and 9 (1.9%) in the control group received antibiotics in the postnatal period (P = 0.32, 95% confidence interval 0.72–3.72). There was one case of pneumonia in the control group and no cases of sepsis in either group.Conclusions: A one‐time chlorhexidine vaginal wash does not decrease the use of antibiotics or incidence of neonatal infection in our population.
Septic Shock, Adult Respiratory Distress Syndrome, and Disseminated Intravascular Coagulopathy Following Midtrimester Genetic Amniocentesis
Authors: Johnson J. R. , Stubblefield P. G. , Hamid M. A. , Kasznica J. 
Published: March 2007

Background: Midtrimester genetic amniocentesis is a commonly performed procedure, with acknowledgment of some risk to mother and fetus.Case: We present an unusual case of midtrimester genetic amniocentesis with bowel injury and resulting septic shock, adult respiratory distress syndrome, and disseminated intravascular coagulation. A total abdominal hysterectomy and bilateral salpingoophorectomy were required for resolution of sepsis. The patient also required prolonged ventilatory support postoperatively.Conclusion: Although relatively safe, genetic amniocentesis can result in serious morbidity, and attention to technique should be maintained.
Ovarian Abscess Caused by Peptostreptococcus magnusFollowing Transvaginal Ultrasound‐GuidedAspiration of Ovarian Endometrioma and FixationWith Pure Ethanol
Authors: Mikamo H. , Kawazoe K. , Sato Y. , Itoh M. , Tamaya T. 
Published: March 2007

Background: Transvaginal ultrasound‐guided aspiration of ovarian endometrioma has been applied
and emphasized as a safe and simple procedure.Case: Two 27‐year‐old infertile women, both gravida 0, para 0, underwent medical follow‐up
examinations for cases of ovarian endometrioma. Both had undergone transvaginal ultrasoundguided
aspiration of ovarian endometrioma. Because both were continuously febrile and had abdominal
pain and cysts with tenderness in spite of antibiotic therapies, both underwent laparotomies
for treatment. In both cases, enucleation of the ovarian abscess revealed purulent and malodorous
fluid that demonstrated Peptostreptococcus magnus in culture.Conclusion: We theorize that following transvaginal ultrasound‐guided aspiration of ovarian endometrioma
and fixation with pure ethanol, anaerobic infection by P. magnus occurred, and a cyst
formed in the abscess.
Initial and Repeat Screening for Chlamydia trachomatisDuring Pregnancy
Authors: Allaire Alexander D. , Huddleston John F. , Graves William L. , Nathan Lawrence 
Published: March 2007

Objectives: The objective of this study is to determine the prevalence of Chlamydia trachomatis and
risk factors for positive repeat tests in a high‐risk population presenting for early prenatal care.Methods: We completed a retrospective cohort study of 2,484 women who initiated prenatal care
prior to 20 weeks gestation, delivered, and received testing for cervical C. trachomatis at Grady
Memorial Hospital or a Grady‐affiliated clinic between July 1, 1993 and December 31, 1994. We
calculated adjusted odds ratios (OR) for selected risk factors for a positive initial test and for a
positive subsequent test after an initial negative test.Results: The prevalence of C. trachomatis was 14.8%. At initial testing, 10.4% of the women were
positive. If the initial test was negative, 5.7% had a positive subsequent test; but if the initial test was
positive, 32.0% had a positive subsequent test (P<0.001). The variables significantly and independently
associated with a positive initial test were black race/ethnicity, age less than 25, unmarried,
and less than a high‐school education (adjusted OR of 1.66, 3.53, 2.18, and 1.81, respectively).
Variables significantly and independently associated with a positive subsequent test after a negative
initial test were white race/ethnicity, black race/ethnicity, age less than 25, and less than a highschool
education (adjusted OR 8.69, 7.77, 4.12,and 2.27, respectively).Conclusions: In our inner‐city population, most pregnant women have risk factors suggesting the
need to rescreen for C. trachomatis in the second half of pregnancy. Infect.
Prevalence of Cervicovaginal Infections DuringGestation and Accuracy of Clinical Diagnosis
Authors: Simões J. A. , Giraldo P. C. , Faúndes A. 
Published: March 2007

Objectives: The aim of this study was to establish the prevalence of cervicovaginal infections in
normal third‐trimester pregnant women and evaluate the accuracy of clinical diagnosis.Method: A total of 328 pregnant women were followed at the Prenatal Outpatient Clinic of the
Department of Obstetrics and Gynecology at the School of Medical Sciences, Universidade Estadual
de Campinas (UNICAMP), Brazil, from October 1991 to February 1993. The clinical
diagnosis was based on the characteristics of the vaginal discharge, and the etiological diagnosis was
based on bacterioscopy of the vaginal secretion and direct immunofluorescence for Chlamydia trachomatis
. The data were analyzed statistically, determining the sensitivity, specificity, and positive
and negative predictive value of the clinical diagnosis related to the laboratory diagnosis of the
different infections.Results: The prevalence of infection was 39.6% (Candida albicans, 19.2%; bacterial vaginosis,
9.5%; intermediate vaginal flora, 6.7%; Chlamydia trachomatis, 2.1%; and vaginal trichomoniasis,
2.1%). The accuracy of clinical diagnosis was low, with sensitivity between 50% and 65% and
specificity around 60%, with the exception of trichomoniasis, which showed a sensitivity of 100%
and chlamydia, with a sensitivity of 0% and a specificity of 100%.Conclusion: The accuracy of the clinical diagnosis of infections was low, specifically with respect
to the positive predictive value. The results demonstrate the need for specific testing of cervicovaginal
infections at prenatal visits. Reliance on simple vaginal examination results in a low yield for
detection of vaginal infections.
Bilateral Tubo‐Ovarian Abscesses Four Years AfterTotal Abdominal Hysterectomy
Authors: Mendez L. E. , Bhoola S. M. , Horowitz I. R. 
Published: March 2007

Background: Pelvic inflammatory disease (PID) is a common gynecologic disorder. One known
complication of PID is tubo‐ovarian abscess (TOA) formation. The predominant theory on TOA
formation postulates that an ascending infection from the cervix through the uterus to the fallopian
tubes and ovaries results in abscess formation. Other theories include seeding via a hematogenous
infection, diverticular disease, and appendicitis.Case: A 39‐year‐old female patient with abdominal pain was referred to our institution and was
found to have a pelvic mass. After a thorough evaluation, surgical exploration revealed the presence
of TOA. No evidence of gastrointestinal disease was present. The patient’s history was significant
for an uncomplicated total abdominal hysterectomy for benign disease of the uterus four years
prior. Abscess cultures grew Streptococcus intermedius.Conclusion: This case reports the rare occurrence of TOA in a patient who had undergone an
abdominal hysterectomy four years prior to presentation. If the patient reports a surgical history of
prior hysterectomy, TOA is often stricken from consideration. Although unlikely, adnexal abscess
formation should be considered in the differential diagnosis of a patient with abdominal pain and a
pelvic mass, even with a remote history of hysterectomy.
17‐β‐Estradiol Upregulates the Stress Response inCandida albicans: Implications for Microbial Virulence
Authors: O’Connor C. , Essmann M. , Larsen B. 
Published: March 2007

Objective: The influence of 17‐β‐estradiol on the stress response of Candida albicans was studied.Methods: The survival of clinical isolates of C. albicans treated with 17‐β‐estradiol after heat and oxidative stress was measured by viable plate counts. Cellular proteins were analyzed via SDSPAGE.Results: The heat stress response induced by 17‐β‐estradiol in C. albicans grown at 25 ℃ protected
the organisms against the lethal temperature of 48.5 ℃, as shown by viable plate counts.
17‐β‐estradiol also enhanced protection of C. albicans against oxidative stress (menadione exposure).
SDS‐PAGE analysis of cytoplasmic extracts revealed proteins induced by 17‐β‐estradiol
were similar to those induced by heat.Conclusion: 17‐β‐estradiol enhances survival of C. albicans under heat and oxidative stresses. The
proteins induced by 17‐β‐estradiol are probably heat shock proteins. Because heat shock proteins
are considered to be virulence factors, 17‐β‐estradiol may function to promote in vivo survival.
Persistence of Human Papillomavirus DNA inCervical Lesions After Treatment With DiathermicLarge Loop Excision
Authors: Distéfano A. L. , Picconi M. A. , Alonio L. V. , Dalbert D. , Mural J. , Bartt O. , Bazán G. , Cervantes G. , Lizano M. , Carrancá A. G. , Teyssié A. 
Published: March 2007

Objective: The aim of this study was to identify human papillomavirus (HPV) in cervical intraepithelial
neoplasia (CIN) lesions and to evaluate the persistence of viral DNA after diathermic large
loop excision (DLLE) treatment.Study Design: Biopsies from 36 patients with low‐ and high‐grade CIN lesions were studied
before and after DLLE treatment looking for HPV sequences. DNA was extracted to perform a
radioactive polymerase chain reaction (PCR) using GP 5,6 generic primers. PCR products were
analyzed by the single‐stranded conformational polymorphism (SSCP) which is a simultaneous
detection and typing method. Dot‐blot hybridization with generic and type‐specific biotinylated
oligonucleotide probes was applied in some cases.Results: HPV DNA was found in all pretreatment samples, and the viral type was identified in
80% of them, HPV 16 being the most prevalent. The viral type coincided with that detected in the
first biopsy in all except one case. Seventy five percent of the patients (27 cases) were negative for
CIN at follow up, but 50% of them remained HPV DNA positive.Conclusion: DLLE treatment was effective in removing the CIN lesion but not the HPV. This
fact points out the need to asses the presence of HPV in DNA during the follow‐up, since viral
persistence has been considered a high risk factor for recurrence and/or malignant transformation.
The Ex Vivo Human Placental Transfer of theAnti‐HIV Nucleoside Inhibitor Abacavir and theProtease Inhibitor Amprenavir
Authors: Bawdon R. E. 
Published: March 2007

Objective: The transfer of abacavir, a new nucleoside inhibitor, and amprenavir, a new protease
inhibitor, used for the treatment of human immunodeficiency virus, has been studied in the ex vivo
human placental model.Methods: The ex vivo human placental model used C14 antipyrine to determine the transport
fraction and clearance index of these compounds at both the peak and trough serum concentrations.
The clearance index accumulation and tissue concentrations were determined for each drug by high
pressure liquid chromatography.Results: The clearance index of abacavir was 0.47 ± 0.19 and 0.50 ± 0.07 at peak and trough
concentrations, respectively. The clearance index of amprenavir was 0.38 ± 0.09 and 0.14 ± 0.08 at
peak and trough concentrations, respectively. There was no unusual accumulation of either drug in
the media or tissue when the perfusion system was closed.Conclusion: Abacavir is the first nueleoside compound studied in the perfusion system with a high
clearance index. The transfer of the protease inhibitor amprenavir had a clearance index 2.75 times
greater than the clearance index of ritonavir at peak concentration determined in a previous study.
At trough concentration the clearance index was much less than at the peak concentration. A
similar result was found with ritonavir.
Assessment of Office‐Based Care of SexuallyTransmitted Diseases and Vaginitis and AntibioticDecision‐Making by Obstetrician‐Gynecologists
Authors: McGregor J. A. , Hager W. D. , Gibbs R. S. , Schmidt L. , Schulkin J. 
Published: March 2007

Objective: Survey office‐based obstetric‐gynecologic practitioners regarding their knowledge of infectious
disease care and antibiotic use.
Methods: A survey questionnaire of multiple‐choice questions was mailed to Fellows of the
American College of Obstetricians and Gynecologists about clinical entities for which recommendations
have undergone recent changes or about which there was a lack of consensus in a prior
similar survey (Gibbs RS, McGregor JA, Mead PB, et al.: Obstet Gynecol 83:631–636, 1994).Results: Respondents indicated that oral metronidazole was their most frequent choice to treat
bacterial vaginosis. Ampicillin (57%) was used more often than penicillin (39%) for intrapartum
group B streptococcus prophylaxis. Azithromycin was preferred (61%) over erythromycin‐base
(38%) for chlamydia treatment during pregnancy. There were several modes of practice that deviated
from accepted care: 27% and 29% did not screen for chlamydia and gonorrhea, respectively,
in pregnancy; 17% used cultures for Gardnerella vaginalis to diagnose bacterial vaginosis; 25%
considered quinolones to be safe in pregnancy; 93% felt metronidazole should never be used in
pregnancy; and the majority (66%) would send a patient treated successfully for pelvic cellulitis
home with an oral antibiotic.Conclusion: Respondents’ infectious disease knowledge and practices in obstetrics and gynecology
is appropriate in treating sexually transmitted diseases, bacterial vaginosis, and group B streptococcus.
Numerous deficiencies still exist in screening for sexually transmitted diseases in pregnancy
and diagnosing bacterial vaginosis, as well as in the choice of antibiotics to use or avoid for
certain infections.