[A comparative study on drug utilization in primary care depending on the professionals and family consumers]. / Estudio comparativo sobre utilización de medicamentos en atención primaria según los profesionales y las familias consumidoras.

Information on pharmaceutical assistance in health care can be obtained from different sources: pharmacies, medical records, market studies, and family interviews. These allow to evaluate whether the consumed drugs were prescribed or directly purchased, if they are stored at home, and the relation between these facts and the familial characteristics. In the present study we have carried out a comparative analysis of data related to the use of drugs in the Salamanca Province depending of their source: the doctors or the families themselves. We distributed by post a questionnaire to the primary care physicians. We also interviewed a representative sample of the families of the Salamanca Province. We found that those drugs most commonly prescribed by doctors were also the most commonly reported as used by the families: drugs for cardiovascular disease, anti-inflammatory-antirheumatic drugs, and analgesics.

Gram-negative bacteriuria of pregnancy: rapid detection by a chromogenic Limulus amoebocyte lysate assay.

A chromogenic Limulus amoebocyte lysate assay, performed at room temperature, was evaluated for rapid detection (five minutes) of asymptomatic bacteriuria of pregnancy. Development of a distinctive yellow color was used to detect urines containing greater than 10(5) gram-negative bacteria per milliliter. One thousand thirty-nine urine samples were obtained from 664 obstetric patients, with 86 of the specimens shown to contain greater than 10(5) gram-negative urinary tract pathogens. Of these, 74 of 86 were detected by chromogenic Limulus assay; 11 false-positive tests were recorded. At a urine dilution of 1:10, sensitivity and specificity were 88.7 and 98.7%, respectively. Predictive values, based on an attack rate of 10%, were 98.6% for a negative test and 89.9% for a positive test. These data suggest that chromogenic Limulus amoebocyte lysate assay of urine has potential usefulness as a rapid, reliable, and easily performed and interpreted screening test for asymptomatic bacteriuria of pregnancy.

The management of severe preeclampsia and eclampsia with intravenous diazoxide.

Twelve patients with either severe preeclampsia (9) or eclampsia (3) were treated with intravenous diazoxide, 300-mg bolus, for the reduction of diastolic blood pressure (less than or equal 110 torr) after the usual and customary measures had been initiated to include parenteral MgSO4 and diazepam. Diazoxide precipitously decreased both systolic and diastolic blood pressure proportionately (35-50%); the nadir was invariably reached in 5-15 minutes. Diastolic pressure never fell below 50 torr, and mean arterial pressure always exceeded 70 torr. Oliguria was not apparent. The vasodepressor response was fairly persistent for 4 hours in all but 3 patients; 2 of these received a second 300-mg dose. Significant changes in fetal heart activity (bradycardia, dysrhythmia) were observed in only 1 patient. Labor was immediately ablated in all patients, but could be restimulated with oxytocin. All pregnancies were terminated within 7 hours (mean, 3.7 hours), seven of them by cesarean section. Eleven newborns did well. We conclude that the immediate reduction in maternal arterial blood pressure is without apparent hazard to the mother as well as the fetus.

Sampling the fetoplacental circulation. II. Combined laparoscopy-fetoscopy in the pregnant ovine.

Induction of pneumoperitoneum, laparoscopy, and intrauterine endoscopy (fetoscopy) were successfully accompished in 23 pregnant sheep at 45 to 60 days' gestational age. The fetoscope, a conventional 2.7 mm. Hopkins straightforward wide-angle telescope (Stortz 27018A) encased in a prototype 3.1 mm. eccentric cannula, incorporates a 25 gauge needle channel. Multiple pregnancy was encountered in 11 animals. Forty-two separate fetoscopic trials were accomplished; a fetoplacental blood sample was obtained in 52 per cent of the trials. A mean interval of 19 +/- 9 days (+/- S.D., range 6 to 37 days) was allowed between fetoscopy trials. Fetal deaths occurred in nine animals (39 per cent). We believe that laparoscopy permits preselection of the proposed fetoscopy puncture site and will permit the operator to thereby avoid the placenta and/or uterine vessels.

Antimicrobial effect of amniotic fluid against anaerobic bacteria.

Amniotic fluid samples were obtained at term and tested for their antimicrobial effect on anaerobes, Peptostreptococcus (Ps.) anaerobius, Peptococcus (Pc.) prevotii, Bacteroides (B.) fragilis, and B. coagulans with facultative Escherichia (E.) coli serving as control. Amniotic fluid had only temporary bacteriostatic effect on Pc. prevotii and B. fragilis for 8 to 16 hours. This effect lasted for only 8 hours on Ps. anaerobius. On the contrary, the bacteriostatic effect of amniotic fluid was well sustained on E. coli and B. coagulans, lasting for the entire test periods of 20 and 32 hours, respectively. At the end of the time intervals mentioned, Ps. anaerobius, Pc. prevotii, and B. fragilis exhibited logarithmic growth, confirming the earlier reports that it is not nutritionally deficient. Amniotic fluid exhibited temporary bacteriostatic effect on Ps. anaerobius, P. prevotii, and B. fragilis, but this effect was well sustained against B. coagulans.

Sampling the fetoplacental circulation. I. The pregnant ovine.

Intrauterine endoscopy (fetoscopy) was successfully accomplished in 26 specially prepared pregnant sheep at 85 to 110 days' gestational age, with the use of a conventional 2.7 mm. Hopkins straightforward wide-angle telescope (Stortz 27018A) encased in a prototype 3.1 mm. eccentric cannula which incorporates a 25 gauge needle channel. Fetal blood was aspirated in 12 lambs. Twenty-five animals were followed throughout the remainder of pregnancy: nine (36 per cent) aborted within three days-three weeks after endoscopy. The pregnant ovine appeared to be a useful experimental animal model for the development of an intrauterine endoscopy technique.