Severe conjugated hyperbilirubinaemia and neonatal haemolysis.

We report two neonates, one with Rh anti-C isoimmunisation and the other with hereditary pyropoikilocytosis. Both presented with severe, early onset conjugated hyperbilirubinaemia.

Triploid/diploid mosaicism (69XXY/46XX) presenting as severe early onset preeclampsia with a live birth: placental and cytogenetic features.

Triploid/diploid mosaicism was diagnosed following karyotyping of an infant with musculo-skeletal abnormalities delivered because of severe preeclampsia. An area of the placenta appeared unusual with histology suggestive of trophoblastic abnormality. The importance of detailed histopathological examination and ploidy and flow cytometry studies where diagnostic uncertainty exists are highlighted.

Job satisfaction among nursing staff in a military health care facility.

Job satisfaction in the workplace affects absenteeism, turnover, and performance. We conducted a cross-sectional study of 201 nursing personnel to assess satisfaction among nursing staff at a military hospital in the southwestern United States. Participants completed a self-administered survey in which they rated professional status, autonomy, pay, organizational policies, task requirements, and interaction by importance and satisfaction. Autonomy, professional status, and pay were the most important factors and organizational policies was the least important factor. Military staff were slightly more satisfied with staff interactions than civilian staff. Nursing personnel working in specialty care units were significantly more satisfied with interactions and professional status, but they valued organizational policies less than those working in general units. Professionals were significantly more satisfied with pay and autonomy, whereas nonprofessionals were more satisfied with task requirements and professional status.

Interlaboratory comparison studies on the analysis of hair for drugs of abuse.

Eleven laboratories interested in the analysis of human hair for drugs of abuse participated in a study to determine how well drugs could be detected and quantified in hair. For the two exercises completed to date, substances to be determined were limited to cocaine, benzoylecgonine, and morphine. Samples sent to the participating laboratories included hair from drug users, drug-free hair, and hair into which drugs had been soaked. For the first exercise, the hair samples were sent as powders; for the second, they were in the form of short segments. Results from these studies have shown that the laboratories, with a few exceptions, have performed very well qualitatively. However, scatter in quantitative results was high. Various approaches were used to liberate drugs from the hair, with the most commonly used, acid extractions and enzyme digestions, producing similar results. Laboratories using GC/MS generally performed well and reported no false positives. In contrast, one laboratory analyzing hair directly using MS/MS without extractions produced three of the four false positives and the worst quantitative results.

Hair analysis for drugs of abuse: evaluation of analytical methods, environmental issues, and development of reference materials.

Methods for extraction of cocaine, some of its metabolites, morphine, and codeine from hair and methods for analyzing the extracts have been investigated. Results of these studies have shown that extractions with 0.1N HCl are efficient at removing the target compounds from hair and appear to be as effective as enzymatic digestions that dissolve the hair. GC/MS with either electron ionization or chemical ionization was found to provide accurate and unambiguous determinations of the target compounds. Tandem mass spectrometry (MS/MS) also provided accurate results when performed on extracts from hair, but results were ambiguous when MS/MS was performed on hair segments directly. Environmental issues, including the removal of powdered and vapor-deposited cocaine from the hair surface and the effect of various hair treatments on the levels of cocaine entrapped in hair, have also been investigated. Removal of cocaine deposited on hair was incomplete by all approaches tested, making differentiation of hair of cocaine users from hair with environmental exposure of cocaine difficult. Cocaethylene, a cocaine metabolite believed to be formed in the liver, was found in the hair of some cocaine users and may be a good marker for proving drug use. Common hair treatments, such as shampoos, conditioners, and peroxide bleaches, reduced cocaine levels in a fortified hair material by 60 to 80% after 30 treatments. Finally, to assist laboratories in evaluating the accuracy of their methods, two human hair reference materials with recommended concentrations of cocaine, benzoylecgonine, morphine, and codeine determined by GC/MS have been developed.

Correlations of relative sensitivities in gas chromatography electron ionization mass spectrometry with molecular parameters.

The relative molar sensitivities for a number of compounds having a variety of functional groups were obtained in gas chromatography electron ionization mass spectrometry. Comparable results were obtained with a quadrupole and with a magnetic mass spectrometer. The present relative molar sensitivities are in good agreement with relative ionization cross sections obtained by different techniques and different instruments for a variety of compounds with molecular weights below about 200 u. For compounds of higher molecular weight, the present experimental sensitivities are significantly larger than estimates extrapolated from earlier data. The relatively molar sensitivities correlate well with molecular polarizability.