Rescue corticosteroids in twin pregnancies and short-term neonatal outcomes.

OBJECTIVE: To estimate the efficacy of a rescue course of antenatal corticosteroids in twin pregnancies. DESIGN: Retrospective cohort study. SETTING: Tertiary-care centre. POPULATION: Twins born from 24 to <34 weeks of gestation in a single maternal and fetal medicine practice from 2006 to 2011. METHODS: We compared neonatal outcomes in 88 twins exposed to a single course of corticosteroids with outcomes in 42 twins exposed to two courses of corticosteroids: the initial course and a single rescue course. Analyses were adjusted to control for correlation between twins born to the same mother. MAIN OUTCOME MEASURE: Short-term neonatal respiratory morbidity. RESULTS: Rescue corticosteroids were associated with fewer days of mechanical ventilation (7.3 ± 3.3 versus 33.9 ± 25.3 days, P = 0.003), fewer days with a fraction of inspired oxygen of >21% (6.3 ± 4.3 versus 33.3 ± 25.8 days, P = 0.003), a lower incidence of mechanical ventilation >14 days or death while on mechanical ventilation (0 versus 12.5%, P = 0.016), and a lower incidence of retinopathy of prematurity (0 versus 12.5%, P = 0.016). The proportion of neonates with respiratory distress syndrome did not differ between the groups (adjusted odds ratio 1.28, 95% confidence interval 0.50-3.26). There were no differences found for birthweight, head circumference and length. CONCLUSIONS: In twins born before 34 weeks of gestation, exposure to rescue corticosteroids may be associated with improved neonatal outcomes. Further studies are warranted to assess the effect of rescue corticosteroids in twin pregnancies.

The global carbon metabolism regulator Crc is a component of a signal transduction pathway required for biofilm development by Pseudomonas aeruginosa.

The transition from a planktonic (free-swimming) existence to growth attached to a surface in a biofilm occurs in response to environmental factors, including the availability of nutrients. We show that the catabolite repression control (Crc) protein, which plays a role in the regulation of carbon metabolism, is necessary for biofilm formation in Pseudomonas aeruginosa. Using phase-contrast microscopy, we found that a crc mutant only makes a dispersed monolayer of cells on a plastic surface but does not develop the dense monolayer punctuated by microcolonies typical of the wild-type strain. This is a phenotype identical to that observed in mutants defective in type IV pilus biogenesis. Consistent with this observation, crc mutants are defective in type IV pilus-mediated twitching motility. We show that this defect in type IV pilus function is due (at least in part) to a decrease in pilA (pilin) transcription. We propose that nutritional cues are integrated by Crc as part of a signal transduction pathway that regulates biofilm development.

Repeat pediatric visits to a general emergency department.

STUDY OBJECTIVE: To determine the rate of repeat visits among children cared for in a general emergency department and associated demographic and clinical variables. METHODS: We carried out a chart review of patients seen in the ED of a general hospital serving both inner-city and suburban populations. Our subjects were all children younger than 18 years seen in the study ED between July 1, 1992, and June 30, 1993 (N = 4,276). RESULTS: We found 291 repeat visits (defined as a subsequent visit within 14 days) n 245 children. Among the 242 repeat visits for related complaints, 200 were unanticipated and most without a clear medical need. Mantel-Haenszel adjusted odds ratios (MHORs) showed a significantly increased risk of repeat visit with public insurance (controlled for age: MHOR, 2.57, and 95% confidence interval [CI], 1.93 to 3.43; controlled for race: MHOR, 2.70, and 95% CI, 1.99 to 3.66) and age younger than 2 years (controlled for insurance MHOR, 1.67, and 95% CI, 1.27 to 2.19; controlled for race: MHOR, 1.89, and 95% CI, 1.47 to 2.47. CONCLUSION: Repeat visits were more likely for respiratory diagnoses and less likely for minor trauma. Both visits and repeat visits were more likely in patients from poorer census tracts than in those from equidistant, more affluent ones.

Response of peripheral-blood mononuclear cells to glutamate decarboxylase in insulin-dependent diabetes.

Insulin-dependent diabetes is characterised by autoantibodies to several pancreatic-islet-cell antigens, including glutamate decarboxylase. We measured the proliferative responses to this antigen of peripheral-blood mononuclear cells from patients with newly diagnosed insulin-dependent diabetes, relatives of diabetic patients, and healthy controls. The likelihood of a positive response was substantially greater among the diabetic patients and relatives positive for islet-cell autoantibodies (ICA) than among subjects at low risk of diabetes (controls and ICA-negative relatives). Glutamate decarboxylase may have a pathogenetic role in insulin-dependent diabetes.

Implantation of posterior chamber lens in the absence of capsular and zonular support.

We have developed surgical techniques for implanting a posterior chamber lens in the absence of capsular and zonular support by securing both haptics of the posterior chamber lens to the sclera at the ciliary sulcus with 10-0 prolene suture. These techniques have been successfully performed and have produced good visual results in six monocularly aphakic patients who had contact lens intolerance and/or contraindications to anterior chamber lens implantations. In consideration of the high incidence and the great variety of complications associated with anterior chamber lenses, these newly developed surgical techniques will be a useful alternative to anterior chamber lenses, even in patients who do not have definite contraindications to anterior chamber lens implantations.