Jesus R. Alvarez

Septic Pelvic Thrombophlebitis: Diagnosis and Management

Septic pelvic thrombophlebitis (SPT) was initially diagnosed and described in the late 1800s. The entity had a high incidence and mortality during this period of time, and a surgical therapeutic approach was the treatment of choice. Since then, the diagnosis, incidence, and management of the entity evolved. This evolution followed the development of newer diagnostic tools such as computed tomography (CT), magnetic resonance imaging (MRI), and a better understanding of the pathophysiology of the disease. The treatment of SPT has had significant changes as well, from a surgical approach at the end of the 19th century to a medical approach after the 1960s. By using an adequate broad-spectrum antibiotic therapy, mortality has decreased. However, controversy in the management of this entity remains even till today.

Asymptomatic Bacteriuria in Pregestational Diabetic Pregnancies and the Role of Group B Streptococcus

We sought to determine if gravidas with pregestational diabetes mellitus (DM) are at increased risk for asymptomatic bacteriuria (ASB) compared with nondiabetic gravidas. This is a retrospective case-control study of 150 pregnant patients with pregestational DM and 294 nondiabetic controls. Rates of ASB and any colony count of group B streptococcus (GBS) bacteriuria were reviewed. The incidence of ASB among pregestational diabetics was higher compared with nondiabetic gravidas (18% versus 8.2%, odds ratio [OR] 2.47, 95% confidence interval [CI] 1.37 to 4.45). GBS was the most common organism in diabetic gravidas (26%). There was no difference in incidence of ASB recurrence (OR 1.26, 95% CI 0.37 to 4.36), but antibiotic resistance was higher in the control group (OR 0.28, 95% CI 0.09 to 0.91). Diabetic gravidas with ASB or any level of GBS bacteriuria had higher hemoglobin A (1c) values compared with diabetics without ASB (8.31 +/- 1.89 versus 7.31 +/- 1.84, P = 0.0035). Our results demonstrate that gravidas with DM are at increased risk of ASB including GBS bacteriuria compared with non-diabetic gravidas.

Glutaric aciduria type II and narcolepsy in pregnancy.

BACKGROUND: Glutaric aciduria type II is a rare disorder affecting the metabolism of fatty acid oxidation and several mitochondrial dehydrogenase enzymes. Narcolepsy and cataplexy is a disorder affecting sleep cycles and rapid eye movement activity. There is little information on outcome or management for either disorder in pregnancy. CASE: This is a case of a 16-year-old with glutaric aciduria type II and narcolepsy with cataplexy, treated with L-carnitine, riboflavin, fluoxetine, and modafinil during pregnancy. Intrapartum management included intravenous carnitine administration, and the patient underwent cesarean delivery at term without complication. CONCLUSION: This inborn error of metabolism and sleep disorder can be effectively treated during pregnancy with nutritional supplementation and stimulants. Because of the risk of cataplexy during labor, cesarean delivery is recommended to minimize the patient’s risk.

Preterm premature rupture of membranes in pregnancies complicated by human immunodeficiency virus infection: A single center's five-year experience

Objective. The objective of this study was to describe one centers five-year experience of the management of human immunodeficiency virus (HIV) positive gravidas with preterm premature rupture of the membranes (PPROM) not in labor at ≤34 weeks of gestation. Methods. This is a retrospective chart review of all HIV positive gravidas with PPROM at ≤34 weeks of gestation, who delivered between December 1, 2000 and December 31, 2005. Results. We identified 228 HIV positive gravidas of whom 19 had PPROM at ≤34 weeks of gestation. Mother-to-child transmission occurred in two of 18 surviving neonates as confirmed by a follow-up visit at six months of age. No mother-to-child transmission occurred in the 10 neonates of mothers who received antenatal highly active antiretroviral therapy and intrapartum zidovudine. Eleven neonates were delivered between 30 and 33 weeks of gestation. In this group, five of 11 gravidas received antenatal corticosteroids. The mean neonatal hospital stay was 31 days with or without prophylactic treatment of the mothers with antenatal corticosteroids. Conclusions. In this study of HIV positive patients with PPROM, the mother-to-child transmission rate of HIV did not seem to be related to the duration of rupture of membranes prior to delivery.

An Unusual Case of Urinary Tract Infection in a Pregnant Woman With Photobacterium damsela

We describe a case of a urinary tract infection with an unusual pathogen, Photobacterium damsela, in a pregnant female. This pathogen has been described as having a virulent life threatening nature, so a detailed history and prompt treatment is needed.