PubMed Health⌕ Search

Biomedical subjects

J M Ernest

Publications and source records attributed to J M Ernest.

At least 19 recordsLinked to original sources
PubMed1998

Chlamydia in pregnancy: a randomized trial of azithromycin and erythromycin.

OBJECTIVE: To determine side effect profiles and cure rates of azithromycin compared with erythromycin in the treatment of chlamydial cervicitis complicating pregnancy. METHODS: Pregnant patients with positive DNA antigen assays for Chlamydia trachomatis were randomized to either azithromycin, 1 g oral slurry in a single dose, or erythromycin, 500 mg every 6 hours for 7 days. Repeat assays were planned for 3 weeks after therapy. Side effects, compliance, and treatment efficacy were assessed. RESULTS: One hundred six women were enrolled, and eighty-five women completed the protocol. Significantly fewer gastrointestinal side effects were noted in the azithromycin group than in the erythromycin group (11.9% versus 58.1%, P < or = .01). Enhanced compliance was noted with azithromycin, because it was given in a single observed dose. Similar treatment efficacy was noted between azithromycin and erythromycin (88.1% versus 93.0%, P > .05). CONCLUSION: Compared with erythromycin, azithromycin is associated with significantly fewer gastrointestinal side effects in pregnancy. This association, along with the ease of administration and similar efficacy, suggests that azithromycin should be considered for the initial treatment of chlamydial cervicitis in pregnancy.

Adult↗
PubMed1996

Meconium-stained amniotic fluid-associated infectious morbidity: a randomized, double-blind trial of ampicillin-sulbactam prophylaxis.

OBJECTIVE: To evaluate the efficacy of intrapartum prophylactic administration of ampicillin-sulbactam in reducing intraamniotic infection and postpartum endometritis in patients with meconium-stained amniotic fluid (AF). METHODS: Patients with intrapartum meconium-stained AF were randomized to receive either ampicillin-sulbactam or normal saline (placebo) intravenously at the time of diagnosis of meconium and every 6 hours until delivery. The outcomes of the two groups were compared with respect to intra-amniotic infection and postpartum endometritis. RESULTS: During the study period, 332 patients with meconium-stained AF were approached for participation, and 120 patients met inclusion criteria and were enrolled. Patient demographics, labor, and delivery characteristics were similar. Ampicillin-sulbactam reduced the incidence of intra-amniotic infection from 23.3 to 6.7%, (P = .02; relative risk [RR] 0.48, 95% confidence interval [CI] 0.22-0.98). The incidence of postpartum endometritis was also reduced, but the difference was statistically nonsignificant (8.3 versus 16.7%, P = .16; RR 0.64, 95% CI 0.30-1.33). CONCLUSION: Prophylactic intravenous ampicillin-sulbactam significantly reduces intra-amniotic infection in patients with meconium-stained AF.

Adult↗
PubMed1995

Intrapartum hepatitis B screening.

OBJECTIVE: The purpose of this study was to determine the prevalence of acute hepatitis B in intrapartum patients and to describe the birth-to-administration interval of the hepatitis B vaccine and immune globulin in hepatitis B surface antigen-positive patients detected by intrapartum screening. STUDY DESIGN: Hepatitis B screening was performed on 8712 laboring patients admitted to Forsyth Memorial Hospital in Winston-Salem, North Carolina, between July 1, 1992, and Jan. 31, 1994. RESULTS: Fourteen laboring patients had positive results for hepatitis B surface antigen (prevalence 0.16%), and two of the 14 had a profile consistent with acute disease. The average interval from birth to administration of the hepatitis B immune globulin and hepatitis B virus vaccine was 18.6 hours (range 3.9 to 31.0 hours) for hepatitis B virus-infected patients whose hepatitis B surface antigen status was unknown before labor. CONCLUSION: Intrapartum screening allows for diagnosis of the asymptomatic patient with acute hepatitis B virus infection whose hepatitis B surface antigen status was unknown before labor who would not have received hepatitis B immune globulin had only early prenatal screening been performed.

Acute Disease↗
PubMed1995

Fetal fibronectin, interleukin-6, and C-reactive protein are useful in establishing prognostic subcategories of idiopathic preterm labor.

OBJECTIVE: Our purpose was to evaluate fetal fibronectin, interleukin-6, and C-reactive protein from patients with preterm labor to establish prognostic subcategories. STUDY DESIGN: Thirty-seven patients with preterm labor had cervical fetal fibronectin and plasma C-reactive protein sampled. Eighteen of these patients had amniotic fluid interleukin-6 levels measured. Outcome variables were (1) delivery before 34 weeks and (2) delivery within 48 hours. RESULTS: Detectable cervical fetal fibronectin identified 89% of patients who were delivered before 34 weeks' gestation. Interleukin-6 > 1500 pg/ml identified 88% of patients who were delivered within 48 hours. C-reactive protein > 1.5 mg/dl correlated with elevated interleukin-6 levels (p < 0.001). CONCLUSIONS: Three subcategories of idiopathic preterm labor were evident: (1) fetal fibronectin nondetectable (37% likely to be delivered before 34 weeks), (2) fetal fibronectin detectable but interleukin-6 < 1500 pg/ml (79% likely to be delivered before 34 weeks but 85% with > 48 hours' latency), and (3) fetal fibronectin present and interleukin-6 > 1500 pg/ml (91% likely to be delivered with < 48 hours' latency).

Amniotic Fluid↗
PubMed1995

Rewarding medical student teaching.

Scholarship in academic medicine includes the discovery of new knowledge as well as the integration, application, and teaching of existing knowledge. Although all components are vital, the rewards for each may vary considerably. Many medical educators have recommended that the teaching of medical students be given the same level of esteem traditionally awarded to research and patient care, and that the same level of excellence must be expected from teachers as from researchers and clinicians. Common facets of three successful reward systems in place include documenting quality as well as quantity; rewarding all excellent teachers, not just "the best"; and publicizing the rewards to students, peers, and administrators.

Education, Medical, Undergraduate↗
PubMed1994

Etiology of low-birthweight birth: a population-based study.

BACKGROUND: Preterm and low-birthweight births remain the major correlates of infant mortality in the United States. The recognition that these births result from varying proximal etiologies is essential to the development of preventive strategies specific to each etiologic group. METHODS: Using vital statistics data tapes provided by the North Carolina Center for Health and Environmental Statistics, mothers in 20 counties who delivered infants with birthweights between 1 pound and 5 pounds, 8 ounces were identified. Maternal hospital records of 4,754 women were reviewed for data about prenatal and intrapartal events. Two perinatologists classified births into four proximal etiology groups: term-lowbirthweight, medically indicated preterm birth, preterm premature rupture of membranes, and idiopathic preterm birth. Information from birth certificate and hospital records was merged to provide an expanded data set. RESULTS: Race, age, education, and marital status are associated with different patterns of proximal etiology. Rates were higher for all etiologies in black women and in young women; however, the absolute number of LBW births was highest among white women. Idiopathic preterm birth was highest in black women and decreased as age increased; medical indications for preterm birth increased with increasing age. CONCLUSIONS: Classification of LBW births by etiologic group provides insights of value to both clinicians and researchers. Studies in which LBW and/or preterm birth are the outcome variables will be enhanced by identifying etiology. Multiple preventive strategies should address varying etiologic groups.

Adolescent↗
PubMed1994

Race differences in infant mortality from endogenous causes: a population-based study in North Carolina.

This study examines the associations between race, birth weight, and mortality from endogenous causes for all singleton births born in 1984-1987 in a 20-county region of North Carolina. A more detailed analysis of preterm low birth weight infants examines these associations according to the proximate medical causes (medical etiology) of the preterm birth. Overall, black infants were found to have approximately twice the mortality risk of white infants. Most of the excess black mortality risk is explained by the larger proportion of black infants born at lower birth weights. The pattern of race differences in infant mortality by birth weight generally replicates the results of earlier studies, but the relative risk ratios within specific birth weight categories are smaller than previously reported. Among preterm low birth weight infants, the association between race and endogenous mortality differs within categories of medical etiology. The mortality risk is the same for black and white infants born preterm due to premature rupture of the membranes (PROM), lower for black infants born preterm due to medical problems, and higher for black infants born preterm due to idiopathic premature labor (IPL).

Adult↗
PubMed1994

Low amniotic fluid glucose levels are a specific but not a sensitive marker for subclinical intrauterine infections in patients in preterm labor with intact membranes.

OBJECTIVE: The purpose of this study was to evaluate the ability of a low amniotic fluid glucose level, as defined by previously published thresholds, to identify a subclinical intrauterine infection in women in preterm labor with intact membranes. STUDY DESIGN: Amniotic fluid glucose levels, amniotic fluid cultures, and placental histologic characteristics were determined in women with preterm labor (n = 55) and in preterm controls (n = 58). These amniotic fluid glucose levels were compared between women with and without intrauterine infection using the Mann-Whitney U test. The sensitivity, specificity, and positive and negative predictive values for the identification of an intrauterine infection were determined with four different previously published amniotic fluid glucose threshold levels and the threshold from receiver-operator characteristic curve analysis of the study data. RESULTS: The median amniotic fluid glucose level was significantly lower in patients with positive amniotic fluid cultures (intraamniotic infection group) but was not lower in the group of patients with only histologic chorioamnionitis (extra-amniotic infection group), compared with noninfected controls. The sensitivity of a low amniotic fluid glucose level to detect both types of intrauterine infection ranged from 41% to 55%, depending on the threshold used. The specificity of a low amniotic fluid glucose level to detect an intrauterine infection ranged from 94% to 100%, the positive predictive value ranged from 86% to 100%, and the negative predictive value ranged from 70% to 80% with the same thresholds. CONCLUSION: Low amniotic fluid glucose levels are a specific but not a sensitive marker for either intraamniotic or extra-amniotic intrauterine infections in patients with preterm labor.

Amniotic Fluid↗
PubMed1994

A prospective, randomized, placebo-controlled trial of penicillin in preterm premature rupture of membranes.

OBJECTIVE: Preterm premature rupture of the fetal membranes is common and frequently results in infectious complications. A prospective, randomized, controlled trial of penicillin versus placebo in preterm premature rupture of membranes is reported. The aim of the study was to determine if prophylactic antibiotics after preterm premature rupture of membranes would reduce infectious complications in the mother or neonate. STUDY DESIGN: Patients with preterm premature rupture of membranes between 21 and 37 weeks' gestation were randomized into a penicillin group that received 1 million units of benzylpenicillin intravenously every 4 hours followed by 250 mg of potassium phenoxymethyl penicillin (Pen-Vee K, Wyeth-Ayerst) orally twice daily or a placebo group before delivery. Latency period, infectious complications, and neonatal outcomes were studied. RESULTS: Patients with preterm premature rupture of membranes who received prophylactic penicillin had fewer infectious complications, including intraamniotic infection and postpartum endometritis (4 vs 11, p < 0.03), without adverse effects on the mother or fetus. CONCLUSION: Prophylactic penicillin in patients with preterm premature rupture of membranes reduces maternal infectious complications without adversely affecting the mother or newborn.

Chorioamnionitis↗
PubMed1993

Amniotic fluid interleukin-6 levels correlate with histologic chorioamnionitis and amniotic fluid cultures in patients in premature labor with intact membranes.

OBJECTIVES: Our purpose was (1) to determine the frequency of intraamniotic and extraamniotic intrauterine infection in patients with premature labor and intact membranes and (2) to determine if intrauterine infection is associated with elevated amniotic fluid interleukin-6 levels. STUDY DESIGN: Amniocentesis was performed on 57 patients in preterm labor and 201 controls at various gestational ages without labor and at term with labor. The amniotic fluid was evaluated with gram stain, cultures, and an enzyme-linked immunosorbent assay specific for interleukin-6. Placentas from study patients (n = 52) and term controls (n = 120) were analyzed. RESULTS: The frequency of positive amniotic fluid cultures (intraamniotic intrauterine infection) was 10 of 57 (18%) in the preterm labor group and zero of 201 for controls. Histologic chorioamnionitis (extraamniotic intrauterine infection) was present in 21 of 24 (88%) of patients in preterm labor that failed tocolysis and 28 of 120 (23%) of term laboring controls. An amniotic fluid interleukin-6 level of > or = 600 pg/ml was 100% sensitive and 89% specific (positive predictive value 85%, negative predictive value 100%) for the identification of intrauterine infection. CONCLUSION: Interleukin-6 is a sensitive and specific marker for the identification of both intraamniotic and extraamniotic intrauterine infection in patients in preterm labor with intact membranes.

Adult↗
PubMed1993

Incidence of perceived and actual face shield contamination during vaginal and cesarean delivery.

OBJECTIVE: The purpose of this study was to determine the rate of potential contamination or splashes to the face of obstetricians during vaginal and cesarean delivery. STUDY DESIGN: Clear plastic face shields were worn during 50 consecutive vaginal and 50 consecutive cesarean deliveries. The face shields were then analyzed for evidence of contamination, and rates of contamination were compared. RESULTS: The contamination rate of the face shields was 50% during cesarean deliveries and 32% during vaginal deliveries. Ninety-two percent of the contaminated face shields were undetected by physicians at the time of cesarean delivery and 50% were undetected at the time of the vaginal delivery. CONCLUSIONS: Obstetricians commonly receive blood or amniotic fluid splashes to the face during deliveries and should wear protective eyeglasses or face shields during all deliveries to minimize the risk of exposure to potentially infectious blood and body fluids.

Amniotic Fluid↗
PubMed1992

A comparison of risk assessment models for term and preterm low birthweight.

BACKGROUND: Most epidemiological research dealing with the assessment of risk for low birthweight has focused on all low birthweight births. Studies that have attempted to distinguish between term and preterm low birthweights have tended to examine preterm low birthweight, since the risk of perinatal mortality and morbidity is greatest for this group of infants. METHOD: This study uses data from 25,408 singleton births in a 20-county region in North Carolina to identify and compare risk factors for term and preterm low birthweights, and also examines the usefulness of separate multivariate risk assessment systems for term and preterm low birthweights that could be used in the clinical setting. RESULTS: Risk factors that overlap as significant predictors of both types of low birthweight include race, no previous live births, smoking, weight under 100 lb, and previous preterm or low birthweight birth. Age also is a significant predictor of both types of low birthweight, but in opposite directions. Younger age is associated with reduced risk of term low birthweight and increased risk of pattern low birthweight. CONCLUSION: Comparison of all risk factors indicates that different multivariate models are needed to understand the epidemiology of preterm and term low birthweights. In terms of clinical value, a general risk assessment model that combines all low birthweight births is as effective as the separate models.

Adolescent↗
PubMed1992

Long-term outcome in fetal hydrops from parvovirus B19 infection.

Parvovirus B19 infection in the fetus is associated with anemia and hydrops and can result in fetal death. Fetal transfusion has been used in an attempt to improve outcome; however, it is associated with its own perinatal morbidity. We report two cases of fetal parvovirus B19 infection that were confirmed by polymerase chain reaction for parvovirus B19 deoxyribonucleic acid in umbilical cord blood. Ultrasonographic signs of compromise were observed at 30 and 24 weeks of gestation. Both fetuses were hydropic and one fetus was also anemic. Serial sonograms demonstrated that the hydrops resolved spontaneously over 3 to 5 weeks after diagnosis. One infant was delivered at 32 weeks of gestation as a result of idiopathic preterm labor. The other infant was delivered at term. Both infants appeared relatively normal at birth and have developed normally in the first year of life. Thus fetal hydrops in association with parvovirus B19 infection does not always lead to poor long-term outcome. A conservative approach without in utero therapy may be appropriate for the management of some of these fetuses.

Adult↗
PubMed1992

Topical antifungal agents.

Current knowledge of fungal cell architecture and biochemistry allows limited understanding of the mode of action of presently available topical antifungal agents. Nystatin, first introduced in the 1950s for treatment of vulvovaginal candidiasis, has been surpassed by the imidazoles and triazoles as the first choice of treatment for vulvovaginal candidiasis. The lack of clear superiority of any one azole agent or dosing regimen leads some authors to recommend a short course of therapy (1-3 days) for acute uncomplicated candidal vaginitis using factors including anatomic distribution of inflammation and patient preference (such as previous hypersensitivity or allergic reaction to the agent, the cost of the agent, and the preferred vehicle for administration of the agent) to choose the specific antifungal agent (see Table 1). Recurrent cases or treatment during pregnancy may require longer therapy (6-14 days), again using an agent chosen because of these factors. Although theoretic risks may exist, actual harm to the fetus or pregnancy has not been demonstrated with the use of the topical azoles during any trimester of pregnancy. The development of antimycotic resistance need not be considered in infrequent and occasional episodes of candidal vaginitis, and it is rarely a cause of treatment failure even in chronic or recurrent cases.

Administration, Topical↗
PubMed1991

Appropriateness of intrapartum fetal heart rate management and risk of cerebral palsy.

Cerebral palsy affects 2 in 1000 infants in the United States, and the intrapartum period is frequently scrutinized as the etiologic source. In a matched group of 49 infants with cerebral palsy at 1 year of age and 49 controls, no difference in the incidence of inappropriate intrapartum fetal heart rate pattern management was detected. This supports the conclusions of others that the intrapartum period is an infrequent source of cerebral palsy.

Apgar Score↗