Evaluation of an early medical school selection program for underrepresented minority students.

PURPOSE: To evaluate the academic performance in the first two years of medical school of underrepresented minority students (URMS) who participated in an early identification and admission program. METHOD: The study involved 39 early-selection URM students who entered one medical school from 1992 through 1999. Successful completion of the first two years of medical school and passing the United States Medical Licensure Examination (USMLE) Step 1 were correlated with Scholastic Aptitude Test I (SAT I) scores and Medical College Admission Test (MCAT) scores. The students were required to maintain an overall grade-point average of at least 3.0 on a 4.0 scale to remain in the program. RESULTS: Students who had combined scores of at least 900 on the SAT I and total scores of at least 18 on the three multiple-choice sections of the MCAT had more success completing the first two years of medical school and passed USMLE Step 1 with greater frequency than did those students who scored at lower levels on these tests. CONCLUSION: An early-selection program for URM students can identify early in their academic careers students who can complete the first two years of medical school and pass the USMLE Step 1.

Identification of 19-hydroxy-progesterone in human placenta.

We have tentatively demonstrated the presence of a 19-hydroxylated C21 steroid, 19-hydroxy-progesterone, in normal human placenta. A 19-hydroxylated steroid such as 19-hydroxy-progesterone, if produced by the placenta, could serve as a precursor for such hypertensinogenic 19-nor-steroids as 19-nor-deoxycorticosterone and 19-nor-progesterone. Freshly delivered, homogenized placental tissue was extracted and subjected to thin layer chromatography. A steroid corresponding to standard 19-hydroxy-progesterone was subsequently purified in HPLC, where authentic 19-hydroxy-progesterone and the sample had the same retention time. The identity of the sample was further confirmed by repeat HPLC after acetylation and mass spectrometry. Our experiment indicates that 19-hydroxy-progesterone is present in term placental tissue, where it appears to be synthesized.

The effect of induced abortion on the risks and outcome of a trial of labor after a previous cesarean birth.

Sixty-one women with previous cesarean deliveries who received prenatal care at Boston City Hospital or one of the neighborhood health centers affiliated with its obstetrical service elected to undergo a trial of labor (TOL) and attempt a vaginal birth after a cesarean (VBAC). Overall, 70 percent of these women achieved a vaginal delivery. When women who gave a history of a previous induced abortion were examined as a separate subgroup, they were able to achieve a vaginal birth not significantly different from those women in the overall group. There were no instances of uterine scar dehiscence or rupture in the series, leading to the conclusion that induced abortion, whether it occurs before or after the primary cesarean, is not a contraindication to a trial of labor with subsequent pregnancies.

Catechol estrogen concentrations in maternal and umbilical circulation at different modes of delivery.

To investigate the role of catechol estrogens in human parturition, these steroids were analyzed in samples from the maternal venous and umbilical venous and arterial plasma at vaginal (n = 28) and abdominal (n = 28) delivery. To ensure the appropriateness of collection of umbilical artery and venous blood samples, progesterone content was also determined. Although there is no significant difference in maternal vein content of catechol estrogens between the two groups, the umbilical venous (p = 0.03) and arterial (p = 0.002) plasma concentrations are significantly higher at vaginal delivery than those measured at abdominal delivery. In view of the present data and the importance of catechol estrogens in prostaglandin synthesis and in potentiating the activity of catecholamines through competitive inhibition of catechol-O-methyltransferase, it is suggested that catechol estrogens may play a role in triggering the events involved in the onset of labor and delivery in humans.

Methadone maintenance in pregnancy: consequences to care and outcome.

A retrospective analysis was conducted on the outcomes of the pregnancies of 26 narcotic-addicted women who were enrolled in a methadone maintenance program. Of these women, 88% continued to use other drugs during their pregnancy, with opiates the most frequently used, and 56% of these women had urine toxicology screens positive for either heroin, cocaine, or benzodiazepines when they presented in labor. When these women were compared with a similar group of 37 pregnant polydrug users who were not in the methadone maintenance program and who delivered during the same 12-month period, there was no difference in the birth weights or in the infants' one- and five-minute Apgar scores. However, the women in the methadone maintenance program had more prenatal visits, more adequate prenatal care, and less anemia than the non-methadone maintenance program drug users. When these two drug-using groups were compared with a control group of pregnant women who delivered within the same time period, there was a significant difference in the birth weights of these two groups. This raises the question of the effectiveness of methadone maintenance programs in promoting fetal growth and well-being and in reducing polydrug use during pregnancy.

Oviductal damage and the effect of estradiol.

Predictable and reproducible epithelial damage can be created by prolonged splinting of the oviduct. Splinting is associated with the flattening of the mucosal folds, pressure atrophy and deciliation of the epithelium. To overcome this detrimental effect, a silastic splint releasing 3 micrograms/day of estradiol has been compared to an inert splint in rabbits. Scanning electron microscopic observations demonstrated a lesser mucosal damage and reciliation with the steroid-releasing splint.

The absence of a catechol estrogen effect on blood pressure in the male rat.

Since catechol estrogens are potent competitive inhibitors of catechol-O-methyl transferase (COMT), it has been suggested that they may prolong the half-life of catecholamines which in turn can cause hypertension. Thus, experiments were carried out to study the effect of catechol estrogens on blood pressure in the male rat following chronic administration. Results demonstrate that 2-hydroxyesterone (2,3-dihydroxyestra-1,3,5(10)-trien-17-one) and 2-hydroxy-estradiol (estra-1,3,5(10)-triene-2,3,17 beta-triol) even when administered in high doses do not alter blood pressure.

Necrotizing fasciitis following diagnostic laparoscopy.

A case of necrotizing fasciitis of the abdominal wall, following an uneventful diagnostic laparoscopy in an elderly, diabetic patient is reported. The patient recovered after extensive surgical debridement and antibiotic therapy. The possibility of a lethal infection in patients with impaired immune defense mechanisms is discussed.

Treatment experience with pregnant problem drinkers.

Therapy for heavy drinking was integrated with routine prenatal care at Boston City Hospital's women's clinic. Of 49 pregnant problem drinkers who participated in at least three counseling sessions, 33 (67%) reduced alcohol consumption before the third trimester. Therapeutic success was achieved with some of the heaviest drinkers. The desire to have a healthy baby was a powerful motivating force. Supportive counseling focused on reduction of alcohol consumption and potential benefits to the fetus. Guilt-provoking criticism was avoided. Referrals were made when women did not respond within two weeks. Planning of treatment strategies was facilitated by classification into social, symptom, and alcohol-dependence phases. Primary providers who are knowledgeable, interested, and accepting can successfully treat pregnant patients at risk from alcohol. Examinations of two cohorts of newborns have previously demonstrated benefits to offspring when heavy drinking ceased before the third trimester.

Radioimmunoassay of 2-hydroxyestrone in plasma during the estrous cycle of the rat: interrelationships with estradiol, progesterone, and the gonadotropins.

A RIA for 2-hydroxyestrone (2-OHE1) in rat plasma has been developed. The assay employs an antiserum that is specific for catechol estrogens. Specificity is further ensured by purification of plasma extracts on Sephadex LH-20 columns before RIA. Blood was collected at 0 C in the presence of ascorbic acid to prevent oxidation. Under these conditions, the conversion of 2-OHE1 to methylated derivatives was found to be negligible. Plasma 2-OHE1, LH, FSH, PRL, estradiol, and progesterone were measured at 3-h intervals throughout the 4-day estrous cycle of the rat. The 2-OHE1 concentration varied from undetectable to 11 pg/ml plasma. No clearly defined relationship with the other hormones analyzed was observed. Thus, it is unlikely that changes in circulating 2-OHE1 levels are involved in the regulation of the gonadotropin surge and ovulation.

Alcohol consumption by pregnant women.

Demographic and behavioral characteristics, including use of alcohol, were investigated among 1711 women registering for prenatal care at Boston City Hospital. During personal interviews, 9% reported drinking heavily, 37% moderately, and 53% rarely or not at all. The women who drank heavily differed from the rest of the pregnant population on several traits, including age, education, use of cigarettes, marijuana and other drugs, parity, and association with others who drank heavily. Multiple regression analysis revealed that these traits had little predictive power for whether a woman was a heavy drinker. A systematic drinking history remains the most practical method in identifying problem drinkers.

Delivery of the second twin.

A retrospective chart review of all twin deliveries between April 1, 1977, and March 20, 1980, at the Boston City Hospital and the Brigham and Women's Hospital revealed corrected neonatal mortality rates of 0 for 74 twins in nonvertex presentation delivered by cesarean section and 0 for 76 second-born twins extracted vaginally. Breech extraction of 76 second-born twins weighing more than 1499 g at birth was not associated with a statistically significant increase in the incidence of 5-minute Apgar scores of 7 or less when compared to 74 similarly asymptomatic twins in nonvertex presentation delivered by cesarean section. Vaginal delivery may be considered when the second twin, weighing more than 1500 to 2000 g, is in breech presentation.

Behavioral evaluation of fetal alcohol education for physicians.

Assessment of clinical behavior has been neglected in evaluating alcohol training for professionals. Inclusion of a systematic drinking history in patient charts provides a sensitive yet simple behavioral marker. At Boston City Hospital, a Ten Question Drinking History (TQDH) was incorporated into a prenatal intake procedure and used to monitor staff behavior. Utilization of the TQDH, measured for six time periods, ranged from 92% to 33%. Obstetrical staff was more likely to complete the TQDH when the alcoholism research staff was visible in the clinic and readily available for consultation and referral.

Strategies for prevention of fetal alcohol effects.

The effects of alcohol on the fetus include a wide range of problems; the complete fetal alcohol syndrome is the extreme end of the spectrum. At critical doses alcohol has the potential for multiple adverse effects on the maternal--placental--fetal system. Variability of outcome probably is related to individual differences in drinking patterns as well as in biologic susceptibility. At Boston City Hospital Prenatal Clinic, therapy was provided for pregnant women who reported drinking heavily. Reduction in maternal alcohol consumption before the third trimester was associated with improved neonatal outcome. The obstetrician's office is a potential site for prevention programs. A 10-question drinking history enables physicians to identify pregnant women at risk. Supportive counseling focused on reduction of alcohol use can be integrated with regular prenatal care. Pregnant women who do not respond promptly should be referred to specialized treatment programs. This strategy has the potential to improve the health of both mother and infant.

Infection with Mycoplasma hominis in postpartum fever.

A follow-up of 535 patients after vaginal delivery showed that 9% had a fever of 37.7 degrees C or greater, and 2% had a fever of 38 degrees C or more, on two days. The commonest cause of both categories of fever was Mycoplasma hominis infection as defined by a fourfold or greater rise in mycoplasmacidal antibody titre. Among women for whom sera were available this agent caused 50% (14/28) of all fevers and 71% (5/7) of the higher fevers. Absence or low titre (< 1:8) of antibody against M. hominis was the strongest single predictor of otherwise unexplained fever (16/40 patients with low antibody titre were febrile vs 7/50 with high antibody titre, p < 0.01). Among women with absent or low antibody titres, both rise in titre of antibody to this organism and lochial colonisation by it were significantly associated with fever (p < 0.001, p < 0.025, respectively). Standard microbiological and clinical techniques identified probable causes in only 18% (5/28) of all fevers and 29% (2/7) of higher fevers. Patients who had postpartum infection caused by M. hominis remained in hospital 31% longer than the non-infected patients (4.57 vs 3.49 days, p < 0.001). Low antibody to and lochial colonisation with M. hominis occurred together in 17% of patients, who accounted for 71% of all higher fevers. Since these risk factors for postpartum fever can be identified before delivery, prophylactic measures applied selectively to women with these risk factors may prevent a large proportion of postpartum fevers and the excess hospital stay associated with them.

Reduction of alcohol consumption during pregnancy with benefits to the newborn.

Among a group of 69 pregnant women who drank heavily, 25 reduced alcohol consumption before the third trimester. Infants born to these women showed less growth retardation than did infants born to 44 women who continued to drink heavily throughout the pregnancy. Analysis of other risk factors showed little effect on outcome when third trimester drinking patterns were held constant, Identification and counseling of heavy-drinking pregnent women should provide benefits for both the mother and her newborn.