Disappearance of intramolecular stacking due to one-atom movement or increment of a 'propylene linker' in pyrazolo[3,4-d]pyrimidine-based flexible models.

In the crystal structures of 4,6-dimethylthio-1-[3-(4, 6-dimethylthio-2H-pyrazolo[3, 4-d]pyrimidin-2-yl)propyl]-1H-pyrazolo[3,4-d]pyrimidine, C(17)H(20)N(8)S(4), and 1-[4-(4-methoxy-6-methylthio-1H-pyrazolo[3, 4-d]pyrimidin-1-yl)butyl]-5-methyl-6-methylthio-4, 5-dihydro-1H-pyrazolo[3,4-d]pyrimidin-4-one, C(18)H(22)N(8)O(2)S(2), only intermolecular stacking due to aromatic pi-pi interactions between pyrazolo[3,4-d]pyrimidinerings is present.

Evaluation of vancomycin use in a pediatric teaching hospital based on CDC criteria.

This study was performed to determine whether vancomycin use at our pediatric hospital was consistent with modified Centers for Disease Control and Prevention guidelines. Vancomycin use was inappropriate in 54% of patients. Inappropriate use briefly decreased by 14% after educational efforts. Further education regarding vancomycin use was deemed necessary and is continuing.

Prevention of group B Streptococcus infection in neonates.

OBJECTIVE: To review the epidemiology of group B Streptococcus (GBS) infection, risk factors for infection, and clinical manifestations of disease in the neonate, as well as the role of chemoprophylaxis and immunoprophylaxis in prevention of GBS disease and current recommendations for prevention. DATA SOURCES AND STUDY SELECTION: MEDLINE searchers (1976-1997) of the English-language literature. DATA SYNTHESIS: Despite clinical advances in health care in the past two decades, GBS remains a leading cause of serious neonatal infection. Most early-onset GBS infections can be prevented through the use of intrapartum antimicrobial chemoprophylaxis. Preventing GBS infection in neonates is more cost-effective than treating GBS infections, and implementing prevention programs can reduce morbidity and mortality resulting from GBS disease. Many proposals have been made regarding prevention strategies; however, they have not been implemented widely and consistently in the US. To coordinate both pediatric and obstetric supported strategies, the Centers for Disease Control and Prevention (CDC) recently published recommendations for prevention of neonatal GBS disease through two possible strategies. In the first strategy, intrapartum antibiotic chemoprophylaxis should be offered to all women identified by prenatal culture as colonized and those who develop premature membrane rupture or onset of labor at less than 37 weeks gestation. The second strategy involves administration of intrapartum antibiotics to all women who develop one or more risk factors at the time of membrane rupture or onset of labor. CONCLUSIONS: GBS is difficult to eradicate, causing many women to be colonized with the organism during pregnancy and labor, thereby infecting their infant. Prevention strategies have been published for more than 10 years without successful implementation. Although optimal prevention management has not been defined, following one of two strategies recommended by the CDC can prevent the majority of GBS infections in neonates.

Drug use during lactation.

Breast-feeding is an essential physiologic process that provides ideal nutrition to the infant as well as protection against disease. All drugs are excreted into breast milk and are bioavailable to the infant. However, most medications do not pose significant risk to the nursing infant, and breast-feeding should be continued despite medication use in most cases. These decisions should be made using a stepwise approach Pharmacists should be aware of which drugs are contraindicated and which drugs should be used cautiously, in addition to which drugs should be recommended if necessary during lactation information on use of specific drugs is presented in this article. With knowledge of the principles of drug passage into breast milk, the goal of the pharmacist should be to minimize the infant's exposure to drugs while supporting the mother's desire to continue breast-feeding.

Routine monitoring of gentamicin serum concentrations in pediatric patients with normal renal function is unnecessary.

OBJECTIVE: Due to increasing demands for cost containment within the healthcare system, we evaluated the need for routine gentamicin concentrations (i.e., peak and trough with third dose). DESIGN: Single-institution study performed concurrently with hospitalization. SETTING: A 225-bed pediatric teaching hospital. PARTICIPANTS: The study population consisted of 150 hospitalized pediatric patients (53% medicine, 47% surgical patients) from 3 months to 15 years old with normal serum creatinine. OUTCOME MEASURES: If the administered dose produced diagnoses-appropriate peak concentrations of at least 4 micrograms/mL or 5 micrograms/mL in bacteremia/septicemia and at least 6 micrograms/mL or 8 micrograms/mL in patients with pneumonia if trough serum gentamicin concentrations were less than 2 micrograms/mL, if the patient was noted by the attending physician to be clinically responding as well as objectively having a decreased white blood cell count and was afebrile, and if there was not an increase of 0.5 mg/dL or more in serum creatinine during the course of therapy. RESULTS: Patients received a mean dose of gentamicin 2.51 +/- 0.14 mg/kg i.v. q8h, which resulted in a mean peak concentration of 6.1 +/- 1.7 micrograms/mL (range 2.4-11.7) and a mean trough concentration of 0.5 +/- 0.3 microgram/mL (range 0.1-1.8). Peak and trough concentrations were at least 4 micrograms/mL and less than 2 micrograms/mL in 96% and 100% of patients, respectively. No patient required a dosage change due to lack of clinical response. CONCLUSIONS: Our data do not support the routine monitoring of gentamicin concentrations in pediatric patients older than 3 months of age who are receiving appropriate standard doses of gentamicin and have normal renal function.

A review and critical analysis of treatment research related to articulation and phonological disorders.

This article contains a summary of aspects of research designs and strategies found in 63 published reports in which the effectiveness of treatment of articulation or phonological disorders was evaluated. These research reports were published in four nationally refereed journals that contained most of the literature published in the decades of the 1970s and 1980s. A total of 91 items were evaluated in each report by two reviewers working independently, including types of research designs, details about subjects, sampling, and types of independent and dependent variables used by researchers. Comparisons were made within each decade and across both decades to identify strengths and limitations. Some significant differences in research designs and variables under investigation occurred between the decades. A critical analysis was performed, and suggestions for changes are discussed.