Timely Access to Neonatal Intensive Care Units: Non-metropolitan Premature Infants at Risk

Introduction: Infants born at 34 weeks or less gestation are at increased risk of neonatal mortality and morbidity. Neonatal intensive care units (NICUs) are capable of effectively managing the sequelae of prematurity and improving outcomes. Our objective was to evaluate the proportion of Medicaidinsured infants who delivered in NICU hospitals and determine if maternal residence influenced the ability to access such facilities. Methods: We linked American Hospital Association annual survey data to an existing health services database that included birth certificate data, CMS State Medicaid Research Files of Georgia and Area Resource Files. Delivery in a NICU hospital was our primary outcome and maternal residence was our main exposure variable. Covariates were constructed to reflect the plethora of risk factors associated with preterm delivery or NICU access including maternal and fetal demographic characteristics, maternal medical conditions and antenatal care factors. We performed Chi-square and Students t tests when appropriate for bivariate comparisons between women living in metropolitan versus non-metropolitan areas. A p value of < 0.05 was considered statistically significant. We calculated risk ratios for delivering in a NICU hospital and each covariate. A multivariate logistic regression model was fit with significant covariates to determine the influence of maternal residence on delivery in a NICU hospital. Results: All Medicaid-insured women who delivered an infant at 34 weeks or less were included in our study (n=2065). Sixty-seven percent of our population lived in metropolitan areas and nearly 75% delivered in NICU hospitals. Even when adjusting for significant risk factors, non-metropolitan women had 3.16 (95% Confidence interval: 2.72, 3.67) times the risk of not delivering in a hospital without a NICU compared to women living in metropolitan areas. Discussion: Strengthening regionalized perinatal network systems are crucial to improving access to NICU hospitals for preterm infants born to non-metropolitan mothers. Tailoring current policies and outreach efforts to target this disparity should improve neonatal outcomes and help achieve Healthy People 2010 Goals.Master of Public Healt

Resistance of Leishmania (Viannia) braziliensis to nitric oxide: correlation with antimony therapy and TNF-α production

<p>Abstract</p> <p>Background</p> <p>Nitric oxide (NO) produced in macrophages plays a pivotal role as a leishmanicidal agent. A previous study has demonstrated that 20% of the <it>L. (V.) braziliensis </it>isolated from initial cutaneous lesions of patients from the endemic area of Corte de Pedra, Bahia, Brazil, were NO resistant. Additionally, 5 to 11% of the patients did not respond to three or more antimony treatments" (refractory patients). The aim of this study is to investigate if there is an association between the resistance of <it>L. (V.) braziliensis </it>to NO and nonresponsiveness to antimony therapy and cytokine production.</p> <p>Methods</p> <p>We evaluated the <it>in vitro </it>toxicity of NO against the promastigotes stages of <it>L. (V.) braziliensis </it>isolated from responsive and refractory patients, and the infectivity of the amastigote forms of these isolates against human macrophages. The supernatants from <it>Leishmania </it>infected macrophage were used to measure TNF-α and IL-10 levels.</p> <p>Results</p> <p>Using NaNO₂(pH 5.0) as the NO source, <it>L. (V.) braziliensis </it>isolated from refractory patients were more NO resistant (IC50 = 5.8 ± 4.8) than <it>L. (V.) braziliensis </it>isolated from responsive patients (IC50 = 2.0 ± 1.4). Four isolates were selected to infect human macrophages: NO-susceptible and NO-resistant <it>L. (V.) braziliensis </it>isolated from responsive and refractory patients. NO-resistant <it>L. (V.) braziliensis </it>isolated from refractory patients infected more macrophages stimulated with LPS and IFN-γ at 120 hours than NO-susceptible <it>L. (V.) braziliensis </it>isolated from refractory patients. Also, lower levels of TNF-α were detected in supernatants of macrophages infected with NO-resistant <it>L. (V.) braziliensis </it>as compared to macrophages infected with NO-susceptible <it>L. (V.) braziliensis </it>(p < 0.05 at 2, 24 and 120 hours), while no differences were detected in IL-10 levels.</p> <p>Conclusion</p> <p>These data suggest that NO resistance could be related to the nonresponsiveness to antimony therapy seen in American Tegumentary Leishmaniasis.</p

Resistance of Leishmania (Leishmania) amazonensis and Leishmania (Viannia) braziliensis to nitric oxide correlates with disease severity in Tegumentary Leishmaniasis

BACKGROUND: Nitric oxide (NO(•)) plays a pivotal role as a leishmanicidal agent in mouse macrophages. NO(• )resistant Escherichia coli and Mycobacterium tuberculosis have been associated with a severe outcome of these diseases. METHODS: In this study we evaluated the in vitro toxicity of nitric oxide for the promastigote stages of Leishmania (Viannia) braziliensis and Leishmania (Leishmania) amazonensis parasites, and the infectivity of the amastigote stage for human macrophages. Parasites were isolated from patients with cutaneous, mucosal or disseminated leishmaniasis, and NO(• )resistance was correlated with clinical presentation. RESULTS: Seventeen isolates of L. (L.) amazonensis or L. (V.) braziliensis promastigotes were killed by up to 8 mM of more of NaNO(2 )(pH 5.0) and therefore were defined as nitric oxide-susceptible. In contrast, eleven isolates that survived exposure to 16 mM NaNO(2 )were defined as nitric oxide-resistant. Patients infected with nitric oxide-resistant Leishmania had significantly larger lesions than patients infected with nitric oxide-susceptible isolates. Furthermore, nitric oxide-resistant L. (L.) amazonensis and L. (V.) braziliensis multiplied significantly better in human macrophages than nitric oxide-susceptible isolates. CONCLUSION: These data suggest that nitric oxide-resistance of Leishmania isolates confers a survival benefit for the parasites inside the macrophage, and possibly exacerbates the clinical course of human leishmaniasis

Pregnancy prevention in adolescents

No Abstract. South African Family Practice Vol. 47(3) 2005: 24-2

Drugs used to treat pediatric emergencies

This clinical report is a revision of “Preparing for Pediatric Emergencies: Drugs to Consider.” It updates the list, indications, and dosages of medications used to treat pediatric emergencies in the prehospital, pediatric clinic, and emergency department settings. Although it is not an all-inclusive list of medications that may be used in all emergencies, this resource will be helpful when treating a vast majority of pediatric medical emergencies. Dosage recommendations are consistent with current emergency references such as the Advanced Pediatric Life Support and Pediatric Advanced Life Support textbooks and American Heart Association resuscitation guidelines