bluuebunny/crossref_metadata_2025_split huggingface dataset:
Role of Bacterial Vaginosis in Peripartum Infections
Authors: Clark Penny , Kurtzer Traci , Duff Patrick 
Published: March 2007

Objective: The purpose of this prospective investigation was to determine if the presence of bacterial
vaginosis (BV) at the time of delivery was associated with the development of maternal and neonatal
infection.Methods: Vaginal fluid was collected from 390 laboring patients. Smears of the vaginal secretions
were gram stained, and slides were scored and interpreted as normal, intermediate, and BV based on
Gram′s stain criteria. Results of the Gram′s stains were correlated with the clinical diagnoses of
chorioamnionitis, endometritis, and neonatal sepsis.Results: Eighty‐eight percent of patients were term and 12% were preterm. The overall prevalence of BV was 30%. The frequency of BV was similar in both term and preterm women. BV was
significantly more prevalent among nonwhites than whites (37% vs. 25%, P = 0.005). Maternal
characteristics such as mean age, parity, status of the membranes, mean duration of labor, mean
duration of ruptured membranes, mean length of fetal monitoring, mean number of vaginal examinations,
and mode of delivery were similar in patients with BV, intermediate, and normal Gram′s
stains. Forty‐seven (12%) women developed peripartum infection. The frequencies of chorioamnionitis
or endometritis in women with BV or intermediate Gram′s stains were 19/116 (16.4%) and
11/63 (17.5%), respectively. The frequency in each of the 2 groups was significantly increased
compared with the rate in women with normal Gram′s stains: 17/211 (8.1%), [P = 0.034, OR = 2.0
(95% CI, 1.07–3.73) for BV and P = 0.054, OR = 2.1 (95% CI, 1.12–3.94) for intermediate Gram′s
stain]. The incidence of suspected or confirmed neonatal infection was significantly higher in mothers
with intermediate Gram′s stains compared with mothers with normal Gram′s stains (P = 0.02,
OR = 2.18, 95% CI, 1.12–3.94), while no difference in incidence was observed between mothers
with BV and normal Gram′s stains (P > 0.05). The rate of neonatal infection directly correlated
with maternal group B streptococcal colonization rather than with BV.Conclusions: In this population, patients with BV and intermediate Gram′s stains had an increased
frequency of peripartum infection.
Teratogenic and Embryocidal Effects of Zidovudine (AZT) in Sprague‐Dawley Rats
Authors: Christmas James T. , Little Bertis B. , Knoll Kraig A. , Bawdon Roger E. , Gilstrap Larry C. 
Published: March 2007

Objective: The purpose of the present investigation was to analyze the effets of zidovudine on the
postimplantation embryo and fetus.Methods: Pregnant Sprague‐Dawley rats were given various doses (10 mg/kg, 30 mg/kg, 150
mg/kg) of zidovudine or saline by an endotracheal tube during the period of embryogenesis (days
6–8, 9–11, 6–11 postconception). The animals were sacrificed on days 18–19 of pregnancy, and their
fetuses were removed by hysterotomy. Autopsies under low (15×) and high (40×) power light
microscopy were performed on all fetuses.Results: There was no statistically significant difference among the groups with respect to maternal
weight gain. There were more pregnancy resorptions in the group receiving high‐dose zidovudine
(150 mg/kg/day) throughout embryogenesis than in the control group (P = 0.001, respectively).
Four major structural anomalies were noted among the 689 fetuses examined, but zidovudine was
not associated with an increased frequency of congenital anomalies in rats when it was administered
in doses similar to, 3‐, and 15‐fold higher than the regimen recommended for adult humans. The
drug, however, was embryocidal in the high‐dose group (P = 0.002).Conclusions: These findings are consistent with previous studies of preimplantation mouse embryos
that demonstrated an embryocidal effect on preimplantation conceptuses. In summary, post‐implantation
embryonic zidovudine exposure was associated with significantly increased pregnancy
losses (resorptions and intrauterine deaths).
Perihepatic Adhesions: Another Look
Authors: Chatwani Ashwin , Mohammed Nina , Amin-Hanjani Soheil , Nyirjesy Paul 
Published: March 2007

Objective: The objective of our study was to determine if pelvic inflammatory disease (PID) was the
only cause of perihepatic adhesions.Methods: One hundred consecutive patients undergoing elective sterilization by laparoscopy were
enrolled in this study. The preoperative workup included a history, physical examination, cervical
culture for Neisseria gonorrhoeae and Chlamydia trachomatis, leukocyte count, C‐reactive protein,
and liver‐function tests. During the laparoscopic procedure, the pelvis and liver surface were inspected
for evidence of any adhesions. If perihepatic adhesions were discovered in a patient without
any evidence of prior PID, then cultures from the adhesion, peritoneal fluid, and tubal specimens
were obtained for N. gonorrhoeae, C. trachomatis, Mycoplasma hominis, Ureaplasma urealyticum,
anaerobes, and facultative aerobes. Tubal specimens were also obtained for histologic examination.Results: Of 100 patients, 7 patients had perihepatic adhesions without any laparoscopic evidence
of prior PID. The preoperative cultures were negative. Three of these patients had no history of
sexually transmitted disease or PID. Their anti‐chlamydial antibody titers were also negative. Of the
remaining 4 patients with perihepatic adhesions, 2 had a history of gonococcal or chlamydial
infection and 2 had histological evidence of chronic salpingitis.Conclusions: The study suggests that PID may not be the only cause of perihepatic adhesions.
Chronic Endometritis and Positive Mycoplasma Cultures: Is There a Correlation?
Authors: Chatwani Ashwin , Nyirjesy Paul , Amin-Hanjani Soheil 
Published: March 2007

Objective: This study was undertaken to assess the impact of mycoplasma strains (Mycoplasma hominis or Ureaplasma urealyticum) on the development of chronic endometritis.Methods: Fifty‐eight patients with acute pelvic infection were enrolled in this prospective cohort study. Endometrial cultures and biopsies were obtained on admission and 5–7 and 21–28 days after completion of treatment.Results: Of 148 samples, 40 were positive for mycoplasma strains (group A) and 58 were positive for mycoplasma with other pathogens (group B). Twenty‐seven samples were positive for other pathogens only (group C). Chronic endometritis was seen in 7 (17.5%), 30 (51.7%), and 10 (37%) in group A, B, and C patients, respectively.Conclusions: The presence of mycoplasma strains in the endometrial cavity was not found to be associated with an increased incidence of chronic endometritis.
Comparative Study of the Effectiveness of Oral Fluconazole and Intravaginal Clotrimazole in theTreatment of Vaginal Candidiasis
Authors: Mikamo Hiroshige , Izumi Koji , Ito Kunihiko , Tamaya Teruhiko 
Published: March 2007

Objective: A study was carried out to compare 3 treatment regimens
for vaginal candidiasis.Methods: A total of 150 women with clinical and mycological evidence of vaginal candidiasis were
randomized to receive 50 mg of oral fluconazole daily for 6 days (50 women), a single oral 150 mg dose of fluconazole (50 women), or 100 mg of intravaginal clotrimazole daily for 6 days (50 women). They were assessed at 5–15 days (short‐term assessment) and again at 30–60 days (long‐term assessment) after the completion of treatment.Results:Candida species were completely eradicated from the vagina in 88% or 80% in the 6‐day oral fluconzaole group, 76% or 70% in the single oral fluconazole group, and 72% or 60% in the intravaginal clotrimazole group at short‐term or long‐term
assessment, respectively. The rates of clinical effectiveness were 92% or 88% in the 6‐day oral fluconzaole group, 80% or 76% in the single oral fluconazole group, and 72% or 58% in the intravaginal clotrimazole group at the short‐term or long‐term assessment, respectively. Treatment‐related side effects
were not found in any group.Conclusions: This study suggests that the treatment of vaginal candidiasis with oral fluconazole is effective and that a single oral fluconazole dose might be one choice in the treatment of vaginal candidiasis.
Doxycycline or Ofloxacin for Outpatient Chlamydial Pelvic Inflammatory Disease? A Cost‐Benefit and Cost‐Effectiveness Analysis
Authors: Rosenberg Michael J. , Waugh Michael S. 
Published: March 2007

Objective: The current Centers for Disease Control and Prevention
(CDC) guidelines include 2 drugs, doxycycline and ofloxacin, for
treatment of the chlamydial component of outpatient pelvic
inflammatory disease (PID). Although ofloxacin costs about $90
more than doxycycline, doxycycline is frequently associated with
side effects and patient compliance with this drug is probably
poor. Because clinicians have little information by which to judge
the tradeoffs between price and compliance for these 2
antibiotics, we examined the impact of patient compliance in the
evaluation of the costs and benefits of using each drug.Methods: The incidence and direct costs of PID sequelae (infertility,
ectopic pregnancy, and chronic pelvic pain) resulting after
partially treated chlamydial PID were taken from previous
estimates. For differing levels of antibiotic compliance, the
probability of cure, probability of the occurrence of sequelae,
and the associated cost of each were calculated. Because the
relationship between partial antibiotic compliance and PID cure is
unknown, we included 3 plausible relationships in our analyses.
The sensitivity analysis was performed by varying key assumptions
and examining the effect of each on future costs.Results: The average probability of future PID sequelae attributable to
chlamydia is slightly less than 2%, with an associated cost of $1,272. With an average compliance for doxycycline of 50%, an
improvement in compliance of as little as 1.8–3.5 percentage points (51.8–53.5%), depending on the
assumption used regarding partial compliance and cure, would make
the use of ofloxacin less costly than doxycycline in the long run.
Even with a cost difference of $90 between the 2 drugs, a
10‐percentage‐point increase in compliance (to 60% compliance) with the more expensive drug would save $2.63 for each $1.00 spent.Conclusions: Since the long‐term costs of PID are likely to overshadow the immediate cost of providing treatment, physicians should carefully consider the
likelihood of patient compliance in selecting an antibiotic.
Single‐Blind, Prospective, Randomized Study of Cefmetazole and Cefoxitin in the Treatment ofPostcesarean Endometritis
Authors: Chatwani Ashwin , Martens Mark , Grimes David A. , Chatterjee Molly , Noah Melvin , Stamp-Cole Marion M. , Perry Kimberly T. , the Cefmetazole Study Group  
Published: March 2007

Objective: The purpose of this study was to compare the clinical efficacy and safety of cefmetazole
given by IV push with that of parenterally administered cefoxitin for the treatment of endometritis following cesarean delivery.Methods: In a single‐blind, multicenter, prospective, randomized study, 355 patients with endometritis after cesarean delivery were enrolled and received medication. Administered was either cefmetazole sodium, 2 g by IV push over 1 min q 8 h, or cefoxitin sodium, 2 g IV q 6 h in a 2:1 ratio. The patients were followed for clinical responses and side effects.Results: The cure rate for cefmetazole was 89% and for cefoxitin it was 79% (P = 0.006). The adverse events were similar in both groups.Conclusions: Cefmetazole was significantly more effective than cefoxitin in the treatment of endometritis following cesarean delivery.
Clinical Trial of the Outpatient Management of Pyelonephritis in Pregnancy
Authors: Brooks Allyson M. , Garite Thomas J. 
Published: March 2007

Objective: This study was designed to determine whether outpatient treatment of pyelonephritis in pregnancy can reduce costs without compromising safety or efficacy.Methods: Pregnant patients with uncomplicated initial episodes of acute pyelonephritis were considered for outpatient management. The outpatient treatment consisted of an initial dose of IV ceftriaxone (2 g), followed by daily outpatient IM ceftriaxone (2 g) until resolution of fever and flank tenderness, followed by a 10‐day course of oral antibiotics. The study group was compared with a group requiring inpatient treatment and a historical control group meeting the criteria for outpatient management but having been treated as inpatients in the previous year.Results: Of the 34 treated as outpatients, only 4 (12%) required hospital admission and 1 developed an upper urinary tract recurrence. None of these patients had premature delivery or any other serious complication. The historical control group (N = 29) included 1 upper urinary tract recurrence, no preterm deliveries, and 1 case of acute respiratory disease syndrome. The outpatient group required an average of 3.4 daily outpatient visits compared with 3.9 days of hospitalization for the historical control group. The inpatient group (N = 39) was significantly more likely to require hospitalization >6 days (P = 0.0004), with a trend toward more frequent upper urinary tract recurrences (6/39 vs. 1/34, P = 0.08). The cost analysis revealed a 3‐fold difference between outpatient and inpatient therapy ($1,100 vs. $3,350, P < 0.001).Conclusions: The outpatient treatment of selected patients with pyelonephritis in pregnancy as a promising approach to reducing costs warrants further investigation.
Endometrial Cultures in Acute Pelvic Inflammatory Disease
Authors: Amin-Hanjani Soheil , Chatwani Ashwin 
Published: March 2007

Objective: The objective of this study was to investigate the correlation of endometrial culture results with the clinical diagnosis of acute pelvic inflammatory disease (PID).Methods: A total of 130 patients admitted with the clinical diagnosis of acute PID were prospectively enrolled in this study. Endometrial cultures by transcervical aspirate currette were obtained from all patients.Results: Of 130 patients, 114 were discharged with a clinical diagnosis of PID. Of these 114 patients, 112 had positive endometrial cultures for pathogenic organisms. The correlation between endometrial culture results and the clinical diagnosis of acute PID was 98.2%. When patients with only mycoplasmas in the endometrial cavity were excluded, the correlation between endometrial culture results and the clinical diagnosis of acute PID was 93.8%.Conclusion: These data demonstrate the exceedingly high degree of correlation between endometrial culture results and the clinical diagnosis of acute PID. Therefore, endometrial cultures may serve as a useful adjunct in the evaluation of patients with a clinical diagnosis of acute PID.
Sexually Transmitted and Other Genital Infections in Women With Cervical Human Papillomavirus Infection
Authors: Sikström B. , Hellberg D. , Nilsson S. , Kallings I. , Mårdh P.-A. 
Published: March 2007

Objective: We investigated possible correlations between latent cervical human papillomavirus infection (CHPI) and other sexually transmitted diseases (STDs).Methods: Of 972 randomly selected women attending 2 family planning clinics and a youth clinic who had agreed to participate in a study concerning STDs, 66 (6.8%) had latent CHPI.Results: An association was found between latent CHPI on one hand and a history of genital chlamydial infection, gonorrhea, recurrent vaginal candidiasis, cervicitis, or pelvic inflammatory disease (PID) on the other, while no correlation between latent CHPI and coexistent STDs was found. No correlation of latent CHPI to either current or past genital warts was noted. In multifactorial analyses, which included the lifetime number of sexual partners and age at first intercourse, we found that all significant associations except a history of gonorrhea vanished.Conclusions: In this study population, screening for other current STDs in women with latent CHPI would be of limited value.
Antifungal Effect of Hydrogen Peroxide on Catalase‐Producing Strains of Candida spp.
Authors: Larsen Bryan , White Sandra 
Published: March 2007

Objective: Clinical isolates of Candida were tested for the presence of catalase and susceptibility to hydrogen peroxide.Methods: MIC was tested by broth dilution technique and catalase was determined by a spectrophotometric procedure.Results: All 38 strains tested were inhibited by hydrogen peroxide in concentrations ranging from 4.4 to 88 mM/l, with non‐albicans isolates generally requiring higher concentrations of hydrogen peroxide for inhibition. Growth media consisting of glucose and protein diminished the antifungal effectiveness of hydrogen peroxide, as did the presence of hemoglobin, in incubation mixtures. However, hydrogen peroxide exerted greater inhibition at pH 4 than at pH 7. Although all Candida isolates tested possessed catalase, there was no apparent correlation between the catalase activity of individual isolates and the minimal antifungal concentration of hydrogen peroxide.Conclusions: This study suggested that, despite the production of catalase by vaginal microorganisms, hydrogen peroxide may exert a regulating influence which may be further modified by the proteins found in the vaginal milieu.
In Vitro Bacterial Contamination of Amniotic Fluid: Effects on Fluorescence Polarization LungMaturity Testing
Authors: Heine R. Phillip , Harding Susan , Emmett Pegi , Ashwood Edward , Lenke Roger R. 
Published: March 2007

Objective: We sought to determine the effect of bacteria on fluorescence polarization (FPOL) testing of amniotic fluid.Methods: Fusobacterium necrophorum and Escherichia coli were inoculated at concentrations of
103 and
106/ml in amniotic‐fluid specimens from 4 patients with no clinical or laboratory evidence of infection. The FPOL results were obtained at inoculation and again at 24 h of incubation. The results were compared using analysis of variance (ANOVA).Results: The FPOL results from inoculated specimens were all within 2% of the uninoculated controls. The specimens incubated with bacteria showed a < 1–19% variation when compared with the time‐zero uninoculated controls. However, uninoculated controls incubated for 24 h exhibited a 2–12% variation when compared with the time‐zero controls, suggesting that the variation present was not secondary to the bacterial co‐incubation.Conclusions: In vitro, neither bacterial inoculation nor prolonged co‐incubation influences FPOL results beyond the effect of incubation alone. FPOL appears to be an appropriate test to assess fetal lung maturity in patients in whom intraamniotic infection is a concern.
Long, Uniform Lactobacilli (Döderlein′s Bacteria): A New Risk Factor for Postoperative Infection After First‐Trimester Abortion
Authors: Platz-Christensen Jens-Jörgen , Påhlson Carl , Larsson Per-Göran 
Published: March 2007

Objective: The production of hydrogen peroxide (H2O2)
from different strains of lactobacilli in the
vagina has been proposed to play one of the most important protective roles in the vaginal defense
system. New data have, however, suggested that Döderlein′s bacteria, with the morphological
appearance of long lactobacilli, have a low production of H2O2
. The purpose of the present study was to correlate the morphology of lactobacilli with the incidence of infection following legal abortion.Methods: Seven hundred sixty‐nine women with lactobacilli but without Chlamydia trachomatis or bacterial vaginosis in their vaginal wet smears who were to undergo legal abortions were divided into 6 different groups according to the morphological appearance of the lactobacilli. The postoperative infection rates in these different groups were compared. A phenotypic classification of some of the lactobacilli was performed.Results: The presence of Döderlein′s bacteria compared with a mixed flora of lactobacilli increased
the risk of postoperative infection 3 times [relative risk (RR) = 3.0; 95% confidence interval (CI), 1.5‐6.3]. After a logistic regression analysis, the only independent risk factors were the presence of Döderlein′s bacteria and earlier gestational age.Conclusions: We found that the lactobacilli regarded as commensal organisms and “normal, healthy lactobacilli” in the vagina were present in only 18% of these women and that their presence might be hazardous. Therefore, we must reconsider our concept of the “normal” lactobacilli in the vaginal wet smears of healthy women.
Granulocyte Colony‐Stimulating Factorin Amniotic Fluid
Authors: Raynor B. Denise , Clark Penny , Duff Patrick 
Published: March 2007

Objective: The purpose of this study was to determine if granulocyte colony‐stimulating factor
(G‐CSF) is normally present in amniotic fluid and then to determine if amniotic‐fluid G‐CSF levels
are affected by labor and intrauterine infection.Methods: Amniotic fluid was collected from 35 patients in 4 groups: no labor, early labor, late labor, and labor plus chorioamnionitis. G‐CSF levels were measured by enzyme‐linked immunosorbent
assay (ELISA).Results: The mean amniotic‐fluid G‐CSF concentrations prior to labor were lower than during labor (0.49 ± 0.25 ng/ml for prior to labor vs. 1.83 ± 1.0 ng/ml for labor, P < 0.001). With chorioamnionitis, the mean levels were elevated compared with normal labor (25.0 ± 4.8 ng/ml for chorioamnionitis vs. 1.83 ± 1.0 ng/ml for normal labor, P < 0.0001). In early and late labor, G‐CSF was higher than prior to labor (0.49 ± 0.25 ng/ml for no labor vs. 1.48 ± 1.0 ng/ml for early labor, P < 0.02, vs. 2.2 ± 0.8 ng/ml for late labor, P < 0.0005). The mean concentrations in early and late labor were not different.Conclusions: G‐CSF is present in amniotic fluid and increased with labor. When labor is complicated by chorioamnionitis, G‐CSF is significantly elevated.
Pelvic Inflammatory Disease and Involuntary Infertility: Prospective Pilot Observations
Authors: Soper David , Ness Roberta B. 
Published: March 2007

Objective: We prospectively evaluated the rate of adverse reproductive outcomes following pelvic inflammatory disease (PID) in a small cohort of American women.Methods: We enrolled 28 patients having either salpingitis confirmed by laparoscopy or endometritis confirmed by endometrial biopsy. The follow‐up was maintained by clinic visits and telephone contact.Results: A median of 15.4 months of follow‐up was accomplished for 82.1% of these women. Fifty‐two percent (13/25) had unprotected sexual activity without conception for at least 6 months. Fully 55.6% (10/18) of the cohort were involuntarily infertile after at least 1 year of follow‐up.Conclusion: In the first prospective cohort study of the reproductive outcomes of American women having had PID, high rates of infertility at 1 year of follow‐up were experienced by these women.
Efficacy and Tolerance of Single‐dose Azithromycin for Treatment of Chlamydial Cervicitis During Pregnancy
Authors: Miller Joseph M. 
Published: March 2007

Objective: The intent of this study was to determine the efficacy and tolerance of single‐dose oral azithromycin in the treatment of pregnant women with endocervical chlamydial carriage.Methods: A retrospective review of clinic records over a two‐year period identified pregnant patients treated with a single 1‐g dose of azithromycin for chlamydial carriage. The side effects and subsequent chlamydial carriage (test of cure) were noted.Results: A total of 146 pregnant women treated with azithromycin was reviewed. A cure rate of
96% was found. Side effects were reported in 5%.Conclusions: A single 1‐g oral dose of azithromycin is effective for the treatment of chlamydia and is well tolerated in pregnant women.