The Positive Predictive Value of Hospital Discharge Data for Identifying Severe Maternal Morbidity With and Without Blood Transfusion.

BACKGROUND: Blood transfusion is 1 of the 21 indicators for severe maternal morbidity (SMM) as defined by the Centers for Disease Control and Prevention (CDC) using administrative data. The CDC SMM definition is being prepared to measure hospital quality of care; however, transfusion coding reliability has been questioned. The authors assessed the positive predictive value (PPV) of administrative data for identifying gold standard SMM using the CDC SMM definition, with and without the transfusion indicator. METHODS: A retrospective cohort study of one hospital's childbirth admissions (2016-2019) was performed. Data were screened for CDC SMM, and subgroups were created for those with transfusion as the sole indicator for SMM (transfusion-only SMM) versus those with at least one other SMM indicator (other SMM). Medical chart review classified CDC SMM cases based on gold standard SMM criteria. Gold standard SMM was defined by validated indicators identified by internal hospital quality reviews and confirmed by expert consensus. The PPV was calculated for all CDC SMM cases and the subgroups. RESULTS: Of 4,212 eligible people, 278 (6.6%) had CDC SMM. Chart review identified 110 gold standard SMM cases among screen-positive cases, yielding an overall PPV of the CDC SMM definition for gold standard SMM of 39.6%. CDC SMM cases identified solely by administrative coding for transfusion were half as likely to meet gold standard criteria, compared to cases identified by other SMM administrative codes (25.9% vs. 49.4%). CONCLUSION: Blood transfusion, coded as an independent risk factor, had a poor PPV for gold standard SMM. Given efforts to use CDC SMM for quality comparisons, more research is needed to reliably identify cases of SMM without relying on blood transfusion codes.

Home-Based Electrochemical Rapid Sensor (HERS): A Diagnostic Tool for Bacterial Vaginosis.

Bacterial vaginosis (BV) is the most frequently occurring vaginal infection worldwide, yet it remains significantly underdiagnosed as a majority of patients are asymptomatic. Untreated BV poses a serious threat as it increases one's risk of STI acquisition, pregnancy complications, and infertility. We aim to minimize these risks by creating a low-cost disposable sensor for at-home BV diagnosis. A clinical diagnosis of BV is most commonly made according to the Amsel criteria. In this method, a fish-like odor, caused by increased levels of trimethylamine (TMA) in vaginal fluid, is used as a key diagnostic. This paper outlines the development of a Home-Based Electrochemical Rapid Sensor (HERS), capable of detecting TMA in simulated vaginal fluid (sVF). Instead of odor-based detection of volatilized TMA, we identify TMA in trimethylammonium form by utilizing HERS and a potentiometric readout. We fabricated the ion selective electrode using a carbon-black-coated cotton string and a TMA-selective membrane consisting of calix[4]arene and sodium tetrakis[3,5-bis(trifluoromethyl)phenyl]borate. When paired with a standard reference electrode, our device was able to quantify TMA concentration in deionized (DI) water, as well as sVF samples at multiple pH levels with a clinically relevant limit of detection (8.66 µM, and theoretically expected Nernstian slope of 55.14 mV/decade).

Paraneoplastic Cushing's syndrome and hypercalcemia arising from metastatic endometrioid endometrial adenocarcinoma: A case report.

•Paraneoplastic Cushing's syndrome is rarely seen in gynecologic cancers, appearing only in case reports•It almost universally results in acute decompensation and portends a poor prognosis•We describe a patient with metastatic endometrial carcinoma with both paraneoplastic Cushing's syndrome and hypercalcemia•High clinical suspicion for malignancy is essential, as these syndromes improve with treatment of the underlying malignancy.

Adrenergic receptors in the bovine mammary artery.

The response of isolated preparations of bovine mammary artery was investigated, with the aim of characterising further the adrenergic receptor subtypes present. Noradrenaline (NA) and the alpha(1) agonist phenylephrine gave sigmoidal dose-response curves with pEC(50) values of 5.97+/-0.07 (N=34) and 6.21+/-0.32 (N=8), respectively. Stimulation of alpha(2) receptors with UK 14,304 produced a weak response with pEC(50) of 6.78+/-0.38 (N=7), and maximal contraction of 17.8+/-9.9% relative to NA. A61603, an alpha(1A) agonist, gave a curve parallel to NA, but shifted to the left (pEC(50) of 6.98+/-0.19 (N=5)); this drug had an increased potency of 10-fold relative to NA, and 4-fold relative to phenylephrine. Schild analysis of curves obtained with the alpha(1) antagonist prazosin gave a pA(2) of 8.70+/-0.47 (N=6-9), whereas the alpha(2) antagonist yohimbine resulted in a pA(2) of 7.65+/-0.16 (N=4). The alpha(1A) receptor antagonists WB4101 and 5-methylurapidil gave pA(2) values of 9.39+/-0.69 (N=4) and 7.72+/-0.02 (N=2-3), respectively. The irreversible alpha(1B) inhibitor CEC reduced the pEC(50) from 5.39+/-0.12 to 4.31+/-0.18 (N=7) only at the highest dose used, and high doses of the alpha(1D) antagonist BMY 7378 produced a shift to the right at giving a pA(2) of 7.37+/-0.08 (N=3). These results suggest major involvement of the alpha(1B) adrenergic receptor subtype in contraction of the bovine mammary artery, which is similar to the human internal mammary artery.