Uromyces ciceris-arietini, the Cause of Chickpea Rust: New Hosts in the Trifolieae, Fabaceae.

Uromyces ciceris-arietini has been reported on Cicer arietinum (chickpea) and Medicago polyceratia. Plants of Medicago polymorpha in Riverside and San Diego, CA were collected with severe rust caused by U. ciceris-arietini. To confirm the identification and potential new host range, a monouredinial isolate of U. ciceris-arietini from M. polymorpha was inoculated on eight accessions each of C. arietinum and M. polyceratia. All plants showed symptoms of the disease. Consequently, a range of fabaceous hosts were evaluated for their reaction to U. ciceris-arietini. New hosts for U. ciceris-arietini included 29 species of Medicago, specifically M. arabica, M. blancheana, M. ciliaris, M. constricta, M. coronata, M. doliata, M. granadensis, M. intertexta, M. italica, M. laciniata, M. lanigera, M. lesinsii, M. lupulina, M. minima, M. murex, M. muricoleptis, M. orbicularis, M. praecox, M. radiata, M. rigidula, M. rotata, M. rugosa, M. sativa, M. sauvagei, M. scutellata, M. soleirolii, M. tenoreana, M. truncatula, and M. varia, and three species of Melilotus, specifically M. italicus, M. speciosus, and M. spicatus. This isolate of U. ciceris-arietini produced no symptoms on plants in the 33 accessions tested in the genera Anthyllis, Astragalus, Lotus, and Lupinus. DNA sequences are provided to aid in the identification of this pathogen.

Adherence to screening guidelines for breast and cervical cancer in postmenopausal women with coronary heart disease: an ancillary study of volunteers for hers.

Postmenopausal women with coronary heart disease (CHD) who volunteered for the Heart and Estrogen/Progestin Replacement Study (HERS) randomized clinical trial had high rates of gynecological abnormalities. We examined compliance with gynecological cancer screening and factors affecting this behavior. Women who met inclusion criteria for HERS and were seen for screening by the study gynecologist were considered eligible for this study. Data were abstracted from study records, and additional information was obtained by telephone questionnaire. Adherence to mammography, breast examination, pelvic examination, and Pap smear recommendations was assessed. Provider behavior and its effect on compliance were assessed. Compliance rates were 59.1% for monthly breast self-examination (BSE), 67.2% for yearly mammography, 73% for yearly Pap smear and pelvic examination, and 75.7% for provider breast examination. Over 50% of patients had most of their screening tests done within the last year. Provider behavior was significantly related to patient screening compliance for mammography, breast examination, Pap smear, and pelvic examination. Provider gender was not significantly related to adherence. There were no significant differences in compliance rates based on the type of most recent coronary event. Compliance rates did not differ significantly between patients with and without gynecological abnormalities, except for mammography (78.3% versus 48.3%, p = 0.02). The majority of patients were compliant with gynecological screening. Among patients with gynecological abnormalities, mammography compliance was significantly lower. Provider behavior was an important factor in influencing women to obtain preventive screening. There were no significant differences in compliance based on provider gender or type of coronary event preceding HERS enrollment.

Powdery Mildew Caused by an Oidium sp. on Twenty-One Annual Medicago spp. in California.

Powdery mildew was observed in plots of USDA Plant Introduction accessions of medic plants grown for seed increase at Riverside, CA, from 1995 to 1998. White, diffuse to dense, amphigenous mycelia bearing Oidium conidia appeared on shoots in April each year and remained active until the last plants matured in June. Invaded leaflets became necrotic and dropped prematurely, sometimes leaving a green petiole. However, mildew incidence was low in most plots, and symptomless plants occurred in all species. Conidia were ellipsoid-cylindrical and measured 15 to17 × 39 to 47 µm. A sexual state of the fungus was not observed. Morphological characteristics of the anamorph matched those of Erysiphe pisi (1). In growth chambers, conidia from medic plants caused severe mildew of garden pea (Pisum sativum L. 'Early Perfection'). Powdery mildew occurred in plots of Medicago ciliaris, M. constricta, M. coronata, M. disciformis, M. doliata, M. granadensis, M. intertexta, M. italica, M. lesinsii, M. littoralis, M. lupulina, M. minima, M. murex, M. noeana, M. orbicularis, M. rigidula, M. rotata, M. rugosa, M. scutellata, M. truncatula, and M. turbinata. We believe this is the first report of naturally occurring powdery mildew on these species in the United States. Reference: (1) H. J. Boesewinkel. Bot. Rev. 46:167, 1980.

Initial and repeat screening for Chlamydia trachomatis during pregnancy.

OBJECTIVES: The objective of this study is to determine the prevalence of Chlamydia trachomatis and risk factors for positive repeat tests in a high-risk population presenting for early prenatal care. METHODS: We completed a retrospective cohort study of 2,484 women who initiated prenatal care prior to 20 weeks gestation, delivered, and received testing for cervical C. trachomatis at Grady Memorial Hospital or a Grady-affiliated clinic between July 1, 1993 and December 31, 1994. We calculated adjusted odds ratios (OR) for selected risk factors for a positive initial test and for a positive subsequent test after an initial negative test. RESULTS: The prevalence of C. trachomatis was 14.8%. At initial testing, 10.4% of the women were positive. If the initial test was negative, 5.7% had a positive subsequent test; but if the initial test was positive, 32.0% had a positive subsequent test (P < 0.001). The variables significantly and independently associated with a positive initial test were black race/ethnicity, age less than 25, unmarried, and less than a high-school education (adjusted OR of 1.66, 3.53, 2.18, and 1.81, respectively). Variables significantly and independently associated with a positive subsequent test after a negative initial test were white race/ethnicity, black race/ethnicity, age less than 25, and less than a high-school education (adjusted OR 8.69, 7.77, 4.12, and 2.27, respectively). CONCLUSIONS: In our inner-city population, most pregnant women have risk factors suggesting the need to rescreen for C. trachomatis in the second half of pregnancy.

Use of the intrauterine device by inner-city women.

OBJECTIVE: To examine the use, effectiveness, acceptability, and continuation rates of the copper T 380 A intrauterine device (IUD) among women attending an inner-city family planning clinic. DESIGN: A 1-year prospective cohort study. SETTING: The family planning clinic of Grady Memorial Hospital, which serves the inner-city indigent population of Fulton and Dekalb counties in metropolitan Atlanta, Ga. PARTICIPANTS: A total of 115 women with 1 or more live births who were in a mutually monogamous relationship for the previous year had the copper T 380 A IUD inserted between December 20, 1990, and June 28, 1991. MAIN OUTCOME MEASURES: Follow-up, consisting of history and a pelvic examination, was done 2, 6, and 12 months after IUD insertion to determine the status of the IUD and to detect any complications related to its use. At the end of the study, the continuation rates, reasons for removal, and complications related to IUD use were assessed. RESULTS: Thirty-seven women were unavailable for follow-up. Eight of those were seen in other clinics at Grady Memorial Hospital, but no mention was made of their IUD status. Fifty-six of the remaining 78 women were known to continue IUD use without any complications at the end of the 12 months. Among the 22 women known to have the IUD removed, 8 women cited no problems. Pelvic pain, menometrorrhagia, desire for permanent sterilization, and expulsion of the device were mentioned as reasons for other IUD removals. Pelvic inflammatory disease was not documented in any of the patients during the year of follow-up. CONCLUSION: With proper screening and counseling, the IUD may be used successfully in selected patients in inner-city family planning clinics.

Laparoscopic silastic band sterilization failures.

Silastic band laparoscopic sterilization was introduced in the early 1970s as an alternative to unipolar cautery laparoscopy. Banding eliminates burn injury and reduces tubal destruction. However, in comparison with other methods, the success of Silastic banding may depend more on tubal morphology. This case-control study of 70 banding failures and 140 controls matched for age, gravidity, and date of procedure reveals that morphologic abnormalities of pelvic organs (adhesions or tubal thickening) or a history of a disease known to cause such abnormalities (pelvic inflammatory disease) increases the risk of sterilization failure. The risk of failure is further increased if the procedure is performed immediately postpartum or postabortion rather than as an interval procedure.

Long-term effect of tubal sterilization on menstrual indices and pelvic pain.

OBJECTIVE: To evaluate the long-term effect of tubal sterilization on menstrual indices and pelvic pain. METHODS: Five hundred women undergoing sterilization were interviewed before sterilization, 6-10 months after surgery, and 3-4.5 years later. Four hundred sixty-six non-sterilized comparison women were interviewed in parallel. The study population consisted of low-income, ethnically and regionally diverse women from three participating institutions. RESULTS: When women who were taking oral contraceptives were excluded, no long-term differences was found between sterilized and nonsterilized women in terms of menstrual cycles, bleeding between periods, prolonged or heavy flow, dysmenorrhea, or noncyclic pelvic pain. Hysterectomy was uncommon (3.2%), but statistically more prevalent among sterilized women (4.55%) than nonsterilized women (2.17%) (P = .019). CONCLUSIONS: Tubal sterilization has no long-term effect on menstrual indices or pelvic pain. An increase in severe dysmenorrhea, which emerged as a disturbing but nonsignificant trend at 6-10 months, did not progress over the next 3-4.5 years. Reasons for an increased rate of hysterectomy are not clear, but may be related to a lower threshold for choosing hysterectomy as a treatment option once a woman has been sterilized.

Risk factors associated with low Apgar scores in a low-income population.

The purpose of this study was to identify risk factors associated with Apgar scores of less than 7 in newborns scored at 5 minutes after birth. All newborns were delivered at Grady Memorial Hospital, Atlanta, Georgia, which primarily serves a low-income population. The data were obtained from the obstetric discharge records for 1985-89. In this case-control study, 939 newborns with Apgar scores of less than 7 were compared with 2817 newborns with Apgar scores of 7 or higher. Low birthweight (< 2500 g) and short gestational age (< 37 weeks) were each significantly associated with low Apgar scores. Race was not a significant risk factor for low Apgar scores in this low socio-economic population. It is also demonstrated that maternal risk factors (pregnancy-induced hypertension, prolonged rupture of membranes), method of delivery (caesarean, repeat caesarean, vaginal birth after caesarean section) and male sex were significantly associated with Apgar scores of less than 7. As a result of the risks that were found to be associated with method of delivery, further study of the risks associated with caesarean delivery and of the relative advantage of a caesarean delivery versus vaginal delivery after a previous caesarean section is advocated.

Small apex-to-base heterogeneity in radius-to-thickness ratio by three-dimensional magnetic resonance imaging.

Reported large base-to-apex differences in endocardial area ejection fraction may suggest large variability in myocardial function and load. To test ventricular load heterogeneities, we measured the ratio of radius of curvature to wall thickness (R/T), as a stress index reflecting myocardial load. End-diastolic (ED) and end-systolic (ES) magnetic resonance cross-sectional images were obtained in 15 open-chest dogs at 5 levels from base to apex, from which 4 three-dimensional thick disks were generated from adjacent image planes. The average R/T for each disk was calculated by planar and three-dimensional methods, using both midwall and endocardial radii of curvature. R/T was normalized to the apical value to quantify the relative changes in myocardial load. Normalized R/T using the midwall three-dimensional approach was 1.08, 1.11, 1.06, and 1.0 for ED (P = NS) and 1.25, 1.013, 1.08, and 1.0 for ES (P < 0.02), base to apex, respectively, while the other methods yielded higher values. Therefore, R/T calculated by the three-dimensional midwall approach shows only small apex-to base variations at ED (< 11%) and ES (< 25%), which is substantially less than the variability in area ejection fraction (102%). This suggests only small base-to-apex load heterogeneities, in spite of large changes in the area ejection fraction, an index reflecting specific ventricular geometry rather than local myocardial function.

Treatment of urinary infections in pregnancy using single versus 10-day dosing.

Pregnant patients with symptomatic and asymptomatic urinary tract infections were treated with a long and a short antibiotic regimen. Two hundred two patients were randomized prospectively to a single oral dose of 3.5 g ampicillin plus 1 g probenecid (98 patients) versus 500 mg ampicillin orally four times a day for 10 days (104 patients). The multiple-dose cure rate was statistically significantly better than that of the single-dose regimen (67.3% versus 57.1%, respectively). Interestingly, for resistant organisms, the cure rate for the long and short regimens was similar (48% versus 43%, respectively). In vitro susceptibility testing does not appear to be a good predictor of cure, at least for the single-dose group. Single-dose therapy with ampicillin and probenecid does not provide an optimal cure rate or prevent reinfection during pregnancy. Possible reasons for these findings are discussed.

Three-dimensional mapping of acute ischemic regions using MRI: wall thickening versus motion analysis.

Three-dimensional (3D) endocardial wall motion and thickening were compared as quantitative methods for distinguishing ischemic from non-ischemic myocardium and for their potential to map regional left ventricular (LV) function. Data were obtained by gated magnetic resonance (MR) images in seven open-chest dogs with acute ischemia. The LVs were reconstructed in 3D at end diastole (ED) and end systole (ES) with a helical coordinate system that wraps the endocardium and epicardium. Thickness and percent wall thickening were calculated by a 3D volume element method. Wall motion was calculated by the 3D displacement of the endocardium perpendicular to the wall using both fixed and floating centroids. Monastral blue nonstaining identified the ischemic regions from five anatomical slices of the LV, which corresponded to the in vivo image planes. Thickening and motion were compared at the centers of the ischemic and the remote normal zones, in addition to comparing the functional maps of the entire LV to the postmortem anatomical maps. All methods distinguished between the center of the ischemic zone and the remote normal zone; however, thickening discriminated most strongly between zones. Comparison of the 3D in vivo maps with the 3D postmortem maps showed that the sensitivity, specificity, and overall accuracy of the thickening algorithm exceeded those obtained by the wall motion algorithms with fixed or floating centroids. Thus wall thickening utilizing the 3D volume element approach is superior to 3D wall motion algorithms in distinguishing ischemic from nonischemic zones and in mapping regional function in the entire LV.

Nifedipine versus ritodrine for suppressing preterm labor.

Fifty-eight women in preterm labor were selected randomly to receive either oral nifedipine or intravenous ritodrine hydrochloride. In comparison to ritodrine, nifedipine had similar tocolytic efficacy with fewer adverse maternal and fetal side effects. On Doppler studies nifedipine had an insignificant effect on umbilical blood flow. Preliminary data suggest that nifedipine is a safe, effective and well-tolerated tocolytic agent. It may prove to be a suitable alternative to ritodrine hydrochloride, especially for women in whom beta-sympathomimetics are contraindicated.

Quantification and validation of left ventricular wall thickening by a three-dimensional volume element magnetic resonance imaging approach.

We have developed a method to quantify and map regional wall thickening throughout the left ventricle (LV) with magnetic resonance imaging. In contrast to methods that measure planar wall thickness and thickening, this method uses the three-dimensional (3D) geometry of the left ventricle to calculate the perpendicular thickness of the wall. We tested this method at three levels of increasing complexity using 1) phantom studies, 2) in vivo experiments in dogs with normal cardiac function, and 3) in vivo studies in dogs during acute ischemia. Experiments were conducted in 15 open-chest dogs imaged by a 0.38 T iron core magnet. Five short-axis images at end diastole and end systole were obtained with the spin echo technique by use of the QRS as a trigger for end diastole and the second heart sound, S2, to time end systole. After acquisition of preischemic images, acute ischemia was induced by either coronary artery ligation (n = 5) or intracoronary dental rubber injection (n = 5), which produced severe transmural ischemia. By use of computer-aided contouring of the endocardial and epicardial borders, each image was divided into 16 segments with radial lines originating from the midwall centroid. A 3D volume element was defined as that generated by connecting two matched planar segments in two adjacent image planes. This defined 64 volume elements comprising the entire left ventricle. Thickness and thickening before and during ischemia were then calculated by using the planar segments and the 3D volume elements. In phantom studies, the 3D method was accurate, independent of the angle of inclination of the image plane to the phantom wall, whereas the planar method showed considerable overestimation of thickness when the image plane was oblique to the phantom wall. In the dogs before induction of ischemia, the 3D method demonstrated the well-established normal taper in end-diastolic wall thickness from 1.10 +/- 0.02 cm at the base to 1.05 +/- 0.11 cm at the apex (p less than 0.01). By contrast, the planar method did not detect the decrease in thickness toward the apex (1.13 +/- 0.07 cm at the base vs. 1.16 +/- 0.14 cm at the apex, p = NS). During acute ischemia, thickening was calculated by both methods at the center of the ischemic zone defined by Monastral blue nonstaining and compared with the preischemic values.(ABSTRACT TRUNCATED AT 400 WORDS)

Antenatal and intrapartum factors associated with the occurrence of seizures in term infant.

To identify antenatal and intrapartum risk factors associated with seizures in term newborns, 40 infants who had seizures within 72 hours of birth were compared with 400 controls using logistic regression analysis. The risk of seizure in the term newborn was approximately one per 1000 in the population studied. The logistic regression model identified a group of infants in whom the risk of seizure was approximately one per 100. The risk factors included in the model were antepartum anemia, antepartum bleeding, asthma, meconium-stained amniotic fluid, presentation other than occiput anterior, fetal distress, and shoulder dystocia. Consistent with other studies, our analysis confirmed a strong association between seizures and factors that increase the risk of fetal asphyxia.

Changes in menstrual symptoms among sterilized and comparison women: a prospective study.

Changes in menstrual parameters after tubal sterilization were analyzed in ethnically diverse, poor women from three geographic areas in the United States. Two large suitable comparison groups were similarly studied. Menstrual cycles, duration of menstrual flow, and bleeding between periods were unchanged in the sterilization and comparison groups. The prevalence of dysmenorrhea increased in 10.8% of sterilized women, compared with 2.1% in the comparison groups. This difference was even more significant--16.4 and -0.5%--when usage of oral contraceptives and intrauterine devices was discounted. There was a nonsignificant increase in noncyclic pelvic pain.

Beliefs about contraceptive sterilization among low-income urban women.

Among a group of low-income clinic patients planning to be sterilized, the vast majority--95 percent--reported believing that sterilization is the surest way to avoid getting pregnant and that it is safer than other contraceptive methods. Among a comparison group who also wanted no more children but did not plan to be sterilized, the majority also held these beliefs, but the proportion was lower (76-80 percent). In both groups, however, only between 64 and 70 percent knew that sterilization makes it impossible to have children in the future. Between 63 and 68 percent of the women in the sterilization group believed that having the operation would improve their family relationships, emotional state and other aspects of their lives, but only 35-58 percent of the comparison group held these beliefs. On the other hand, women in the comparison group were more likely than those in the sterilization group to believe that sterilization has negative health and psychological effects--for example, changes in menses (more bleeding or cramping) or defeminization. The beliefs held by both groups suggest that it is a conviction regarding the advantages of sterilization, rather than a relative unawareness of the disadvantages, that distinguishes women who plan to be sterilized from those who, although they want no more children, do not have similar plans. The study results have implications for family planning professionals: Counselors need to be aware that some women seeking sterilization may not understand its permanency or may have an unrealistic appraisal of its potential effect on their lives.(ABSTRACT TRUNCATED AT 250 WORDS)

Prophylactic insulin in gestational diabetes.

Patients with gestational diabetes were divided into two groups according to the results of three-hour oral glucose tolerance tests. Those with fasting euglycemia (serum glucose 95 mg/dL or lower) on oral glucose tolerance test (class A) were treated with diet alone, whereas those with fasting hyperglycemia on oral glucose tolerance test (class A/B) were treated with both diet and insulin (15 U neutral protamine Hagedorn insulin before breakfast). The frequency of macrosomia (birth weight more than 4000 g) among class A/B gestational diabetics was 16.2%, which was significantly greater than the 5.6% incidence in class A diabetics and the 6.4% incidence in controls. After controlling for potential confounding risk factors, it was determined that class A diabetics had a frequency of macrosomia no different from that of nondiabetics. Nonobese gestational diabetics with fasting hyperglycemia (class A/Bs), who were treated with diet and prophylactic insulin, also had a frequency of macrosomia no different from that of nondiabetics or class A diabetics. However, the diet and insulin regimen did not prevent excess macrosomia in class A/B diabetics who were obese.

Effect of heart rate on the canine end-systolic pressure-volume relationship.

Although the rate dependence of isolated muscle contractility is well known, the ventricular end-systolic pressure-volume relationship (ESPVR) has been reported to be insensitive to heart rate. To resolve this contradiction, we used an isolated, ejecting canine heart preparation perfused at a constant coronary arterial pressure. Heart rate was changed from 60 to 200 beats/min in steps of 20 beats/min. At least 10 pressure-volume loops under different filling pressures were obtained at each heart rate in each of six hearts. Over a heart rate range from 60 to 120 beats/min, the slope of the ESPVR (Ees) increased significantly from 3.5 +/- 0.4 (SE) to 5.3 +/- 0.6 mm Hg/ml. In the range between 120 and 180 beats/min there was little change in Ees (5.3 +/- 0.6 to 5.4 +/- 0.6 mm Hg/ml), but at 200 beats/min Ees increased slightly to 5.7 +/- 0.5 mm Hg/ml. The volume axis intercept (V0) of the ESPVR changed little over the range of heart rate from 60 to 160 beats/min (10.2 +/- 2 ml to 9.4 +/- 1.3 ml) but increased to 15.2 +/- 1.2 ml at a rate of 200 beats/min. The change in ESPVR with increase in heart rate from 60 to 120 beats/min (i.e., increase in Ees without change in V0) is the same as those seen with a positive inotropic intervention with calcium or cathecholamines, whereas the V0 changes over the range from 160 to 200 beats/min is similar to those seen with regional ischemia.(ABSTRACT TRUNCATED AT 250 WORDS)

Cross-cultural variations in the definition of child abuse: nurses in the United States and the United Kingdom.

As a form of social deviance, child abuse is subject to the definitions of various audiences rather than being intrinsic to the act. What is termed abuse varies between cultures, subcultures, etc. An exploratory study investigates similarities and differences in the definition of abuse among a sample of pediatric nurses in two U.S. (N = 18) and two U.K. (N = 34) hospitals. A questionnaire asked respondents to indicate whether they would define each of 14 different acts by a parent to be 'abusive'. The acts, ranging from 'yelling' to 'burning with a cigarette', were presented under two conditions: a five-year old child who, parents claim, (1) was 'yelling and getting on my nerves', and (2) 'would not stop throwing things and damaging furniture even when told to stop over and over'. Attribution of abuse was not greatly influenced by the two given conditions which provoked it. Nurses in the U.K. were slightly more likely than U.S. nurses to consider each act abusive, but the differences were significant for only one item: beating a child with a strap. Differences were reduced controlling for race. Among the U.S. nurses, whites were more likely to see each act as abusive than blacks, but differences were significant for only two items: beating a child with a strap and confinement to a room for the day. Cultural, subcultural, and professional variations in attribution of child abuse are discussed with implications for epidemiological findings. Suggestions for directions in future research on the attribution of abuse are offered.