Risk factors for group B streptococcal disease in neonates of mothers with negative antenatal testing.

OBJECTIVE: The aim of this study was to identify risk factors for early-onset group B Streptococcus (EOGBS) disease in neonates of mothers with negative antenatal screening. STUDY DESIGN: We performed a retrospective cohort study of neonates born to mothers with negative antenatal GBS screening between 2002 and 2012. Our primary outcome was EOGBS infection. We used multivariable logistic regression to assess factors associated with EOGBS. RESULTS: EOGBS was confirmed in 492 of the 179 818 neonates that met the study inclusion criteria. Risk factors for EOGBS included black race (reference: white, odds ratio (OR) =1.81 (95% confidence interval: 1.43, 2.31)), maternal age <18 years (reference: >35 years, OR=2.63 (1.54, 4.51)) and maternal age 18 to 35 years (reference: >35 years, OR=1.94 (1.30, 2.88)). CONCLUSION: Maternal age <18 years and black race were the strongest predictors of EOGBS. Further research investigating contributors to the discordance between screening results and neonatal outcomes in these populations is needed.

Photocatalyst size controls electron and energy transfer: selectable E/Z isomer synthesis via C-F alkenylation.

Photocatalytic alkene synthesis can involve electron and energy transfer processes. The structure of the photocatalyst can be used to control the rate of the energy transfer, providing a mechanistic handle over the two processes. Jointly considering catalyst volume and emissive energy provides a highly sensitive strategy for predicting which mechanistic pathway will dominate. This model was developed en route to a photocatalytic Caryl-F alkenylation reaction of alkynes and highly-fluorinated arenes as partners. By judicious choice of photocatalyst, access to E- or Z-olefins was accomplished, even in the case of synthetically challenging trisubstituted alkenes. The generality and transferability of this model was tested by evaluating established photocatalytic reactions, resulting in shortened reaction times and access to complimentary Z-cinnamylamines in the photocatalytic [2 + 2] and C-H vinylation of amines, respectively. These results show that taking into account the size of the photocatalyst provides predictive ability and control in photochemical quenching events.

Complications of injectable testosterone undecanoate in routine clinical practice.

OBJECTIVE: Injectable testosterone undecanoate (TU) was marketed within the last decade, but its complications in routine clinical practice are not well defined. DESIGN AND METHODS: Prospective observational study of consecutive TU injections in an Andrology Clinic to estimate the incidence of i) immediate cough/syncope due to pulmonary oil microembolisation (POME), ii) post-injection haematoma and iii) the prevalence of secondary polycythaemia. RESULTS: In 3022 injections given to 347 patients over 3.5 years, POME was observed after 56 injections (66% mild, 19% severe; 40% with onset before injection completed) in 43 patients. The incidence of 19 (95% CI 14-24) per 1000 injections did not differ between three experienced nurse injectors, but recurrences were more frequent than by chance. No post-injection haematoma was reported including after 269 injections to men taking antiplatelet, anticoagulant or both drugs (upper 95% confidence limit 1%) with 56 not withholding drugs prior to TU administration (upper 95% confidence limit 5.4%). Mean haematocrit was 0.44±0.04 (s.d.) with 25 (7%) >0.50, 14 (4%) >0.52 and 3 (1%) >0.54. CONCLUSION: TU injections produce a low incidence of POME with injections by experienced nurses, but recurrence is more frequent than by chance. Post-injection haematoma was not observed even among men using anticoagulant and/or antiplatelet drugs, and polycythaemia was a minor problem rarely requiring treatment other than optimising inter-injection interval.

Assessing African medicinal plants for efficacy and safety: agricultural and storage practices.

The paper reviews an important but little researched area of ethnopharmacology, namely, the effect of cultivation and post-harvest storage practices on levels of biological activity in traditionally used medicinal plants. Changes in COX-1 inhibition and antibacterial activity, for example, occur at the onset of senescence and, in some species, are influenced by plant age. Plants in cultivation were also shown to have reduced anthelmintic and antibacterial activity while hypoxoside production was affected by nitrogen and phosphorous. Irrigation treatments, however, increased anthelmintic activity and, therefore, could be applied to medicinal plants cultivated in low rainfall areas. Pesticides have also been implicated in the regulation of plant growth and secondary metabolite production in cultivated medicinal plants, but residue levels have, so far, not been monitored. Post harvest storage of medicinal plants has been poorly researched in southern Africa. Available data indicates that antibacterial and anti-inflammatory activity changes following storage and is both species and temperature dependent. Similar trends were noted for materials that had been rapidly aged. Fatty acids with antibacterial activity are stable in dry specimens and, as such, may account for the fact that activity is unaffected by storage in certain instances.

Assessing African medicinal plants for efficacy and safety: pharmacological screening and toxicology.

This paper reviews progress in establishing the scientific rationale for and safety of traditional medicine use in Africa. Selected plants were screened for antibacterial, antifungal, anthelmintic, anti-amoebic, antischistosomal, antimalarial, anti-inflammatory and antioxidant activity, as well as psychotropic and neurotropic activity using appropriate in vitro tests. Isolation of active compounds, in almost all cases, provided scientific validation for the use of the plants in traditional medicine. Although plants used medicinally are widely assumed to be safe, many are potentially toxic. Where poisoning from traditional medicines has been reported, it is usually because the plants used have been misidentified in the form in which they are sold, or incorrectly prepared and administered by inadequately trained personnel. The issue of quality control may, in the interim, be addressed using chromatographic techniques.

Alkaloid production in Crinum moorei cultures.

The alkaloids cherylline (1), crinamidine (2), crinine (3), epibuphanisine (4), lycorine (5), powelline (6), undulatine (7), 1-epideacetylbowdensine (8), and 3-O-acetylhamayne (9) were identified in the in vitro propagated bulblets of Crinum moorei. In addition, crinine, powelline, and undulatine were detected in the solidified Murashige and Skoog (MS) medium. The identity of the alkaloids was confirmed by comparing retention times and mass spectra with known samples. Light, as well as benzyladenine (BA) and charcoal supplementation of the tissue culture medium, influenced the levels of specific alkaloids in both the bulblets and media.

Assessment of osteoporosis using standard radiographs of the wrist.

BACKGROUND: This study evaluated the ability of the orthopaedic surgeon to radiographically assess bone density in the wrist with sufficient accuracy to determine which patients require treatment for osteoporosis. METHODS: Thirty-eight patients with unilateral distal radius fractures, 30 of whom were female, were included in this study. The mean age was 55 years (range 45 to 82). Standard radiographs of the fractured and normal wrists were taken. Dual energy x-ray absorptiometry was performed on the normal distal radius of all patients within 1 week of their injury. The radiographs were viewed in blinded randomized fashion on two separate occasions by three orthopaedic surgeons and once by a fourth. The participants were required to determine the presence of osteoporosis. Visual analog scales (VAS) were used to evaluate (1) porosity, (2) cortical thickness, (3) trabecular thickness, and (4) the number of trabeculae in the ultradistal radius. RESULTS: Intraobserver agreement assessing osteoporosis averaged 81% (kappa of 0.5393). VAS assessment was unreliable for all four parameters. Radiographic determination of osteoporosis had a specificity of 61% and a sensitivity of 61% using x-rays of the uninjured wrist. CONCLUSION: We conclude that orthopaedic surgeons cannot predict with sufficient accuracy using plain x-rays whether a patient is significantly osteoporotic.

Crinum species in traditional and modern medicine.

Crinums are large, showy plants with umbels of lily-like flowers. They are found in tropical and subtropical regions throughout the world, where, for centuries, they have been used traditionally to cure ailments and diseases. Sometimes they are prescribed for the same medicinal purpose. This would suggest that they contain a common ingredient. Phytochemical analysis has recently yielded a vast array of compounds, including more than 150 different alkaloids. These are of the Amaryllidaceae type, whose most noted effects are: analgesic, anticholinergic, antitumour and antiviral. Even though much has been reported on the medicinal properties of Crinum, only an estimated 20% of the species worldwide are represented in these analyses, as reviewed in this paper.

Benign calcaneal bone cyst and pathologic fracture--surgical treatment with injectable calcium-phosphate bone cement (Norian): a case report.

Solitary calcaneal bone cysts are uncommon. Usually they measure 1/3 to 1/2 of the calcaneal length. Symptomatic calcaneal bone cysts are generally treated with open debridement and autologous bone grafting. We report a case of a patient with a displaced intra-articular calcaneal fracture who presents with a large benign calcaneal bone cyst. This patient was treated with debridement and filling of defect with injectable calcium-phosphate bone cement (Norian) and open reduction and internal fixation of the calcaneal fracture.

Semitubular blade plate fixation in proximal humeral fractures: a biomechanical study in a cadaveric model.

This study was undertaken to compare the fixation of the semitubular blade plate with that of the AO T plate. Cadaveric humeri (n=12 pairs) from an elderly population (41 to 89 years) had either a blade plate (n=12) or a T plate (n=12) fixed to them, subsequent to which a transverse osteotomy was performed. Mechanical testing in tension was performed in 1 series (n=5, blade plate; n=5, T plate) by applying a single maximal load to failure and in a second series (n=7, blade plate; n=7, T plate) by applying submaximal cyclic loading before failure was induced. Results showed that the fixation provided by the semitubular blade plate was significantly better (P < .05) than that of the T plate in those specimens subjected to submaximal cyclic loading before failure (series 2). This latter testing method contains some component of the clinical situation compared with monotonic distraction to failure. Based on these results plus favorable clinical results reported in the literature, the semitubular blade plate is possibly a better alternative to the T plate in the management of proximal humeral fractures that require open reduction and internal fixation.

Inverse association of H2O2-producing lactobacilli and vaginal Escherichia coli colonization in women with recurrent urinary tract infections.

Women with recurrent urinary tract infection (UTI) often demonstrate persistent vaginal colonization with Escherichia coli. Since strains of lactobacilli that produce hydrogen peroxide inhibit the growth of E. coli, the absence of these strains may predispose to E. coli colonization and to UTI. To test this hypothesis, vaginal introital cultures were obtained from 140 women, 65 with recurrent UTI (case-patients) and 75 without (controls). Vaginal E. coli colonization was significantly more frequent in case-patients than controls (35% vs. 11%; P < .001) and in women without H2O2-positive lactobacilli than in women with (odds ratio [OR], 4.0; P = .01). Spermicide use was associated with greater risk of vaginal E. coli colonization (OR, 12.5; P < .001) and with absence of H2O2-positive lactobacilli (OR, 2.9; P = .04). The inverse association between H2O2-positive lactobacilli and vaginal E. coli colonization remained in case-patients after controlling for spermicide use (OR, 6.5; P = .02). Thus, absence of H2O2-positive lactobacilli may be important in the pathogenesis of recurrent UTI by facilitating E. coli introital colonization.

Urovirulence determinants in Escherichia coli strains causing prostatitis.

To define the urovirulence properties of Escherichia coli strains producing prostatitis, E. coli strains isolated from men with acute (7 strains) or chronic (23) prostatitis were compared with E. coli isolates from women with pyelonephritis (30), acute cystitis (60), or complicated urinary tract infection (UTI; 30). Strains from prostatitis patients were significantly more likely to express hemolysin than were strains causing complicated UTI (73% vs. 43%; P = .02) and more often demonstrated hybridization with the cytotoxic necrotizing factor-1 (CNF-1) probe (63%) than did strains from women (44%-48%). P fimbrial expression was highest among pyelonephritis (73%) and prostatitis strains (53%) and lowest among E. coli from women with complicated UTI (23%) and cystitis (30%; P < .05, prostatitis strains vs. either of the latter 2 groups). Results suggest that E. coli strains producing prostatitis generally possess urovirulence profiles similar to those of strains from women with acute uncomplicated pyelonephritis and that hemolysin and CNF-1 are especially prevalent in prostatitis strains.

Comparative evaluation of bone suture anchor to bone tunnel fixation of tibialis anterior tendon in cadaveric cuboid bone: a biomechanical investigation.

A multiphase biomechanical study was performed using human tibialis anterior tendons and cuboid bones, comparing the fixation of the tendon to the bone using bone anchors and bone tunnels. Twenty-six specimens were tested for ultimate load to failure comparing Mitek Superanchor fixation with no. 1 and no. 5 braided polyethelyne suture to bone tunnel fixation. Mitek Superanchor with no. 5 suture failed at 223 N, compared with Mitek Superanchor with no. 1 suture at 134 N and bone tunnel at 143 N (P = 0.033). Mitek with no. 1 suture versus bone tunnel was not significantly different. The Mitek with no. 5 suture failed at the tendon/suture interface (75%), the Mitek with no. 1 suture failed at the suture/anchor interface (56%), and bone tunnel fixation failed most commonly by fracture of the tunnel (76%). This study is the first biomechanical analysis of the pullout strengths of bone tunnels or suture anchors in the cuboid bone. We have shown that the suture anchor has a pullout strength comparable or superior to a conventional bone tunnel in an in vitro situation. We believe it is a viable alternative to fixation of the tibialis anterior tendon to the cuboid when there is insufficient tendon length or failure of the bone tunnel.

Hemagglutination, adherence, and surface properties of vaginal Lactobacillus species.

To address the poorly understood mechanisms through which lactobacilli adhere to vaginal epithelial cells (VECs), 65 wild type lactobacilli isolated from the vaginal flora of young women and 3 American Type Culture Collection Lactobacillus strains were studied. Group I isolates (n = 56) hemagglutinated sheep, rabbit, and human red blood cells (RBCs) and adhered poorly to VECs. In contrast, all 4 group II strains hemagglutinated sheep and human but not rabbit RBCs, adhered in large numbers to VECs, and were identical in five phenotypic tests and DNA-DNA hybridization. Eight other strains (group III) hemagglutinated all RBC types studied, adhered avidly to VECs, and had identical protein and hybridization patterns but showed heterogeneous enzyme activities. Although most wild type lactobacilli from the vaginal flora of young women adhered poorly to VECs, selected isolates (groups II and III) adhered in large numbers, demonstrated specific and reproducible hemagglutination patterns, and may have specific mechanisms of attachment to VECs.

Effect of secretor status on vaginal and rectal colonization with fimbriated Escherichia coli in women with and without recurrent urinary tract infection.

The prevalence and duration of rectal and vaginal colonization with P- and F-fimbriated Escherichia coli and the relationship of colonization with these strains to blood group secretor status was investigated. Rectal and vaginal E. coli isolates were prospectively collected twice monthly for 6 months from 20 young women with and 20 without a history of recurrent urinary tract infection (UTI). Rectal and vaginal colonization with P- and/or F-fimbriated E. coli was highly prevalent. Nonsecretors who developed UTI during the study period were significantly more likely to be colonized rectally with F-fimbriated E. coli than were the infected secretors (56% vs. 27%; P = .042) or uninfected nonsecretors (56% vs. 31%; P = .046). Persistent vaginal and rectal E. coli colonization with fimbriated organisms occurred commonly in the study patients but was not often temporally associated with the development of UTI. Results suggest that nonsecretors are more susceptible than secretors to colonization with F adhesin-bearing E. coli isolates.

Redefining the anatomy of the anterior tibialis tendon.

The observation that, when performing a split anterior tibialis tendon transfer, a twist develops as the distal segment is brought into position on the lateral side of the foot led to our hypothesis that, as a consequence of foot rotation during embryologic development, rotation of the tendon of the anterior tibialis muscle also occurs and can be seen in the adult. Ten unembalmed human lower extremities were examined with regard to the macrostructure of the anterior tibialis tendon. In all 10 specimens, the fibers rotated through 90 degrees from the musculotendinous junction to the insertion on the first cuneiform and metatarsal. The tendon was then split, releasing the first metatarsal insertion in five specimens and the first cuneiform insertion in five. Lateral transfer of the first metatarsal-released group produced a crossing over proximally of the tendon as the fibers came from the medial side of the musculotendinous junction. Lateral transfer of the first cuneiform-released group produced no crossing over proximally as the fibers came from the lateral side of the musculotendinous junction. During a split anterior tibialis tendon transfer, release of the cuneiform insertion will avoid the proximal twisting seen with first metatarsal release and allows for a more direct line of pull of the muscle on the tendon.

Multidirectional radiocarpal dislocation without fracture: a case report.

The first reported case of posttraumatic multidirectional instability of the radiocarpal joint is described with a review of the relevant literature. A 31-year-old man sustained a palmar radiocarpal dislocation that also dislocated dorsally with gentle provocation and showed ulnar translation and a dorsal intercalated segmental instability pattern after closed reduction. Treatment consisted of open reduction and internal fixation with 11 weeks of immobilization. Follow-up at 32 months showed excellent clinical and radiographic results. Multidirectional instabilities of the radiocarpal joint can occur with radiocarpal dislocation, and one must look for them when planning treatment. Anatomic realignment of the bones and joints is recommended to allow soft tissue healing and prevention of secondary ligamentous laxity.

Characterization of two plasmids from Campylobacter jejuni isolates that carry the aphA-7 kanamycin resistance determinant.

Two small plasmids of 11.5 and 9.5 kb, each carrying an aphA-7 kanamycin phosphotransferase gene, were studied. The MICs of kanamycin for the two human Campylobacter jejuni isolates harboring the plasmids were 10,000 and 5,000 micrograms/ml, while the MICs of amikacin were 32 and 8 micrograms/ml, respectively. The MICs of gentamicin and tobramycin were less than or equal to 2 micrograms/ml for both isolates. The restriction endonuclease maps of the plasmids were similar, with the larger plasmid showing two discrete regions of additional DNA. When the aphA-7 gene from each plasmid was cloned into pBR322, the aphA-7 gene expressed the kanamycin resistance phenotype in Escherichia coli. For transformants containing the cloned aphA-7 gene, kanamycin MICs were greater than or equal to 128 micrograms/ml. The aphA-7 gene was also subcloned from the plasmid pFKT4420 into the E. coli-Streptococcus shuttle vector pDL278 and was transformed into Streptococcus gordonii Challis. For streptococcal transformants containing the novel plasmid, kanamycin MICs were 4,000 micrograms/ml. In the presence of a tetracycline resistance plasmid, both small plasmids could be mobilized during conjugal matings to Campylobacter coli recipients.

Nonoxynol-9: differential antibacterial activity and enhancement of bacterial adherence to vaginal epithelial cells.

The antibacterial activity and adherence-enhancing effects of nonoxynol-9 were evaluated against vaginal and uropathogenic bacteria. Nonoxynol-9 was markedly less active against the 43 uropathogenic bacterial and yeast strains tested (MIC90, greater than 32%) than against the 26 Gardnerella vaginalis strains (MIC90, less than or equal to 0.015%) and the 53 Lactobacillus strains (MIC90, 8%) tested. Hydrogen peroxide-producing strains of Lactobacillus were more susceptible to nonoxynol-9 (MIC90, 4%) than nonproducers (MIC90, 16%). Two Escherichia coli strains that expressed type 1 fimbriae and three vaginal strains of lactobacilli adhered in significantly higher numbers to vaginal epithelial cells preincubated with 5% nonoxynol-9 than to control cells preincubated with PBS. Spermicides may provide a selective advantage in colonizing the vagina with nonoxynol-9-resistant uropathogens such as E. coli, perhaps via a reduction in vaginal lactobacilli (especially hydrogen peroxide-producing strains) and through enhancement of adherence of E. coli to epithelial cells.

Experimental infection of pig-tailed macaques (Macaca nemestrina) with Campylobacter cinaedi and Campylobacter fennelliae.

Campylobacter cinaedi and C. fennelliae have been associated with proctocolitis, bacteremia, and asymptomatic rectal infection, primarily in homosexual men. To more directly assess the pathogenic role of these organisms, we studied their disease-producing potential in 12- to 25-day-old pig-tailed macaques (Macaca nemestrina). Four infant monkeys were challenged with 10(8) to 10(9) C. cinaedi, three were challenged with C. fennelliae, two were challenged with C. jejuni, and one received no microorganisms. Watery or loose stools without associated fever or fecal leukocytes developed 3 to 7 days postinoculation in all of the animals given C. cinaedi, C. fennelliae, and C. jejuni, but not in the control animal. Stool cultures were simultaneously positive and remained so in the animals challenged with C. cinaedi or C. fennelliae for 3 weeks after inoculation despite the resolution of clinical illness. All of the animals challenged with C. cinaedi and C. fennelliae became bacteremic, and three had clinical evidence of septicemia. Histopathologic evaluation of rectal biopsies (five animals) and necropsy (one animal) showed no evidence of mucosal disruption. Specific immunoglobulin M and immunoglobulin G antibody responses occurred in all of the animals challenged with C. cinaedi and C. fennelliae, as determined by enzyme-linked immunosorbent assay and immunoblotting. We conclude that C. cinaedi and C. fennelliae consistently produce a diarrheal illness accompanied by bacteremia and followed by prolonged gastrointestinal colonization in M. nemestrina.