The Impact of Prenatal Exposure to Cocaine on Newborn Costs and Length of Stay

This paper determines newborn costs and lengths of stay attributable to prenatal exposure to cocaine and other illicit drugs, using as a data source all parturients who delivered at a large municipal hospital in New York City between November 18, 1991 and April 11, 1992. We performed a cross-sectional analysis in which multivariate, loglinear regressions were used to analyze differences in costs and length of stay between infants exposed and unexposed prenatally to cocaine and other illicit drugs adjusting for maternal race, age, prenatal care, tobacco, parity, type of delivery, birth weight, prematurity, and newborn infection. Urine specimens, with linked obstetric sheets and discharge abstracts provided information on exposure, prenatal behaviors, costs, length of stay and discharge disposition. Our principal findings show that infants exposed to cocaine and some other illicit drug stay approximately 7 days longer at a cost of $7,731 more than infants unexposed. Approximately 60 percent of these costs are indirect, the result of adverse birth outcomes and newborn infection. Hospital screening as recorded on discharge abstracts substantially underestimates prevalence at delivery, but overestimates its impact on costs.

Caribbean Philosophy and Metaphysical Strictures

A culture with no evident signs of philosophy is a non-existent one. Thus, it is illogical to argue that the Caribbean is devoid of philosophical thinking and exploration. In an effort to hold meaningful discussions on Caribbean philosophy, it is important to establish what Caribbean philosophy is not. I suggest that Caribbean philosophy is not a pastime. It is not a worthless preoccupation. It is not devoid of values and religious and metaphysical truths. Nor is it a pseudo discourse void of the causal history, metaphysical traditions, and logical intellectual ideologies. I explore metaphysics as one key area of Caribbean philosophy, by showing its uniqueness in being pragmatic in its approach. This uniqueness probably sets Caribbean metaphysics apart from unmoored abstract textbook metaphysics. The difference in the nature and scope of Caribbean metaphysics do not imply a weakness, as no philosophy is superior to the other in terms of worth and merit. The key ingredient to a metaphysics is its people, so if all metaphysics were the same, all people would be the same. No two people are the same; therefore, the metaphysics of each culture are built on different templates. I show the uniqueness of Caribbean Metaphysics by arguing that, since all cultures are different in many respects, it is absurd to expect a universal metaphysical discourse and ideology. I propose a pragmatic approach to the understanding of the metaphysical traditions in the Caribbean, with specific reference to Jamaica by investigating certain metaphysical socio-cultural practices and ideologies in areas such as religion, sports, and the ontology of life of the Caribbean people

Conservative Management of Cesarean Scar Ectopic Pregnancy with Fetal Heart Activity and a Very High β-hCG

Cesarean scar ectopic pregnancy (CSP) is a rare type of ectopic pregnancy that is growing in incidence. The diagnosis of most CSP occurs when patients present in unstable conditions requiring surgical management and leading sometimes to hysterectomy. It has been shown that medical management is a safe option for early diagnosed hemodynamically stable CSP. However, no cases of CSP with β-hCG higher than 62,000 IU/L, conservatively treated, have been reported. We report the case of a 29-year-old patient who presented for her first prenatal visit at 13-week gestation and was diagnosed with CSP with present fetal heart tones and a quantitative β-hCG of 144,337 IU/L. She was treated with bilateral uterine artery embolization and systemic methotrexate. Her β-hCG significantly decreased and became undetectable within 10 weeks. We propose that patients with CSP with very high β-hCG and fetal heart activity can be offered conservative or fertility preserving management

Recurrent Cesarean Scar Ectopic Pregnancy Treated with Systemic Methotrexate

Cesarean scar pregnancy (CSP) is a rare event; however its incidence has been rising due to the increasing rates of cesarean deliveries. The majority of cases present with signs or symptoms requiring surgery, which often results in hysterectomy. The recurrence of CSP is even rarer with only few cases which have been reported. This is a report of recurrent cesarean scar ectopic pregnancy (RCSP) that was promptly diagnosed and managed with only systemic methotrexate. This was a 30-year-old woman, with a history of two prior cesarean deliveries followed by a CSP, who presented at 5 weeks and 3 days of gestation for her first prenatal visit. Transvaginal ultrasound revealed a RCSP. Her serum beta-human chorionic gonadotropin (β-hCG) level was 54,295 IU/L. The first CSP, which was diagnosed at a later stage, was treated with uterine artery embolization and systemic methotrexate leading to complete resolution within 10 weeks. The current ectopic was treated with two doses of systemic methotrexate; her serum β-hCG reached undetectable levels within 7 weeks. Thus, patients with a history of prior CSP should be carefully monitored with transvaginal ultrasound during subsequent pregnancies to allow early diagnosis of RCSP, which could then be treated conservatively