Relationship Between Methadone, Selective Serotonin Reuptake Inhibitors, and Neonatal Abstinence Syndrome.

OBJECTIVE: To compare incidence and severity of neo- natal abstinence syndrome (NAS) in neonates exposed to methadone and selective serotonin reuptake inhibitors (SSRIs) with neonates ex- posed to methadone alone. STUDY DESIGN: Retro- spective cohort study of women on methadone main- tenance with live births be- tween January 1, 2003, and December 31, 2009, at a tertiary care hospital. Data were abstracted from electronic medical records, exclud- ing cases of multiple gestations and lack of neonatal abstinence score documentation. Data analysis included Mann-Whitney U, Fisher's exact test, a receiver operat- ing characteristic curve, and a scatter diagram. RESULTS: A total of 91 cases comprised our study population, with 85 (93.4%) assigned to the methadone- only group and 6 (6.6%) assigned to the methadone and SSRIs group. NAS incidence was not significantly different between the methadone/SSRI group and the methadone group (5/6 [83.3%] vs. 43/85 [50.6%], p=0.21). However, severity of NAS (median 14.0 vs. 10.0, p=0.04) and neonatal intensive care unit stay were significantly higher and longer in the methadone/ SSRI group. CONCLUSION: While currently neonates exposed to SSRIs are not screened for NAS, health care providers may need to pay closer attention to the effects of SSRIs on neonates.

Endometriosis-associated infertility: double intrauterine insemination improves fecundity in patients positive for antiendometrial antibodies.

PROBLEM: Prospective registry study evaluating effects of endometriosis (E) and serum antiendometrial antibodies (AEA) on fecundity in intrauterine insemination (IUI) cycles. METHOD OF STUDY: AEA assays on 572 consecutive women receiving 969 single and 274 double IUI cycles. Logistic regression was utilized. RESULTS: Fecundity was 11.5% (143/1243 cycles). Double IUI improved fecundity with significance achieved in certain study groups. Compared to the AEA- subgroup, all study groups except for the E+ AEA- group had significantly lower fecundity. Two study groups receiving double IUI had significantly increased fecundity, E- AEA+ (OR: 5.1, CI: 1.1-22.7, P=0.032) and E+ AEA+ (OR: 4.1, CI: 1.2-14.0, P=0.025) and significant predictors of pregnancy (E- AEA+, OR: 7.8, CI: 1.7-36.2, P=0.009 and E+ AEA+, OR: 4.2, CI: 1.2-15.1, P=0.026). CONCLUSION: Double IUI improves fecundity in AEA+ patients. E-associated infertility is better diagnosed by the AEA assay than by surgery. Double IUI should be attempted prior to assisted reproductive technologies in AEA+ patients with normal fallopian tubes.

Adult diagnosed Dandy Walker malformation presenting as an acute brainstem event--a case report and review of the literature.

The Dandy Walker Malformation (DWM) is an infrequent condition seen in pediatric patients. Adult presentation of DWM is extremely rare. This condition usually presents in childhood with hydrocephalus and cerebellar signs and symptoms. This case describes a woman with an undiagnosed DWM who was asymptomatic until the age of 56 when she developed the acute onset of headache, nausea, vomiting, and diplopia. Her history and physical exam were consistent with an acute brainstem infarct. MRI revealed the underlying malformation. The clinical and radiological findings are discussed as well as their implications and possible etiologies.

Screening for erectile dysfunction in the primary care practice: results of a survey.

To evaluate the screening patterns of primary care physicians (PCP) with regards to erectile dysfunction, a study was performed using an Institution Review Board Approved SHIM (Sexual Health Inventory for Men) questionnaire of 131 male patients presenting to the Family Practice Clinic at West Virginia University School of Medicine in Morgantown. A total of 109 surveys were completed and the data were compiled and analyzed with descriptive statistics using SPSS version 10.0 software. Of these patients, over 92% were Caucasian. The average age bracket for the study population was 40-50, and the average number of risk factors for ED, not including age, was 1.65. Forty-one percent of patients had a SHIM score less than or equal to 21, indicative of an element of ED. A total of 84% had primary care physicians, 22% of patients with a PCP were screened for ED. Of those who were screened by their PCP over half were initiated by the patient. As a result of this study, we believe the SHIM instrument should be performed on patients with any identifiable risk factor since effective treatment of ED is available, and ED can be associated with occult cardiac disease.