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Objectives: Pre-trauma center care is a critical component in severe pediatric traumatic brain injury (TBI). For geographically large trauma catchment areas, optimizing increased intracranial pressure (ICP) management may potentially improve outcomes. This retrospective study examined ICP management in nontrauma centers and during interfacility transport to the trauma center., Methods: Charts from a pediatric level I trauma center were reviewed for admissions between 2008 and 2013. Patients with a Glasgow Coma Scale score of 8 or less, head Abbreviated Injury Scale score of 3 or higher, and requiring intubation at a nontrauma center were included. Exclusion criteria included head injury secondary to drowning, stroke, obstetrical complications, asphyxia, and afflicted head trauma (younger than 5 years). Trauma center charts contained coalesced data from first responders, nontrauma centers, and transport., Results: Twenty-five patients (74%) had increased ICP upon admission at trauma center, 48% experienced ICPs greater than 20 cm H2O within 12 hours of admission, 12% required an urgent craniotomy, and 16% had herniation syndromes on neuroimaging. Pre-trauma center ICP management included osmotherapy and head-of-bed elevation. Sixty-four percent of patients with increased ICP at trauma center admission received pre-trauma center ICP management., Conclusions: Early increased ICP is a common presentation of severe pediatric TBI during pre-trauma center management. However, what constitutes optimal care remains unknown. Given the difficulties of diagnosing early increased ICP in this setting, prophylactic raising ICP-lowering strategies may be considered.

Objective: To characterize the natural history of bacterial vaginosis in pregnancy and to assess the efficacy of short courses of oral metronidazole therapy for long-term suppression of bacterial vaginosis flora., Methods: This was a randomized, double-blind, placebo-controlled study of two 2-day courses of metronidazole (400 mg twice daily) in pregnant women with bacterial vaginosis (by Gram stain) and/or heavy growth of Gardnerella vaginalis. The first course was given at 24 weeks' gestation and a second course at 29 weeks if the follow-up vaginal swab grew G vaginalis. Follow-up swabs were performed at 28, 32, and 36 weeks' gestation., Results: On the basis of their G vaginalis colonization, 196 women were enrolled, and 137 were evaluable for efficacy, including 66 with bacterial vaginosis. The microbial ecology of bacterial vaginosis in 36 women in the placebo group was relatively stable, with 72% persistence at 28 weeks and 57% at 32 weeks' gestation. Metronidazole effectively suppressed bacterial vaginosis for 4 weeks after the first course in 76%, compared with 28% in the placebo group, and had a cumulative efficacy of 87% compared to 44% 4 weeks after the second course (odds ratio 0.12, 95% confidence interval 0.03-0.5)., Conclusions: The microbial ecology of bacterial vaginosis in pregnant women is relatively stable. Long-term suppression of bacterial vaginosis flora for 2-3 months can be achieved by short courses of metronidazole therapy in 87% of women in mid-pregnancy. Because bacterial vaginosis has been associated with an increased risk of preterm labor, these findings provide the foundation for an intervention study of women with bacterial vaginosis in pregnancy.

A non-competitive enzyme immunoassay (EIA) was developed to detect IgG antibody to the recently-described species Chlamydia pneumoniae strain TWAR. Purified elementary bodies of the organism were used as capture antigen. Cross-reacting antibody to Chlamydia trachomatis was detected in the assay by running a parallel EIA for IgG antibody to C. trachomatis. The C. pneumoniae assay was validated by comparing the results on 60 selected sera with those obtained with the microimmunofluorescence test. The comparison indicated that the EIA had a sensitivity of 88%, specificity of 100% and overall correlation with micro-immunofluorescence of 93%. The assay was applied to 352 sera from 3 populations within Australasia in a limited survey to determine the extent of exposure to this organism. Prevalence rates of up to 55% were found, suggesting that a significant amount of respiratory disease in the region may be due to C. pneumoniae strain TWAR.

The effect of brief exposure of staphylococci to penicillin upon susceptibility to leukocidal activity was studied. Antibiotic pretreated staphylococci were incubated with normal human leukocytes and viability of the bacteria was determined. Penicillin pretreated staphylococci were more susceptible to killing by leukocytes than untreated control bacteria. The extent of sensitization varied between different strains of staphylococci. When staphylococci were exposed simultaneously to leukocytes and penicillin, the bacteria were protected from the lethal action of penicillin. This study demonstrates that phagocytosed staphylococci are protected from penicillin, but prior exposure to the antibiotic increases their susceptibility to the activity of leukocytes.

An antibody class capture (ACC) enzyme-linked immunosorbent assay (ELISA) utilizing an F(ab)2 conjugate was established and its specificity and reproducibility were determined. The test was further validated by comparing its results with those obtained by 2 overseas reference laboratories which used the indirect immunofluorescence antibody test (IIFT) for Toxoplasma-specific IgM. It was found that the F(ab)2ACC-ELISA was not affected by the presence of rheumatoid and antinuclear factor in serum, that it was reproducible (coefficients of variation less than 10.0%), and that it compared well with tests currently used overseas. ELISA was then used to test for the presence of Toxoplasma-specific IgM in cord blood sera. The results obtained to date are consistent with the hypothesis that the prevalence of congenital toxoplasmosis in the population of Adelaide is less than 1/2,000.

A double-blind, controlled trial was performed to assess the effect of a short intraoperative course of Cefoxitin, a new broad spectrum cephamycin antibiotic, on the incidence of septic complications following elective colonic and rectal surgery. In addition to a two-day preoperative bowel preparation, patients entered in the study received a short course of either Cefoxitin (three 2g intravenous bolus doses at two-hour intervals, the first before skin incision) or a matching placebo. Thirty-two patients received Cefoxitin and 33 patients received the placebo. Postoperative abdominal wound infections developed in one (3%) of the Cefoxitin-treated patients and nine (27%) of the placebo-treated patients. This difference is statistically significant (p = 0.01). Septic complications remote from the abdominal wound, e.g. intra-abdominal abscesses, occurred in both Cefoxitin-treated and placebo-treated patients, but numbers were too small for meaningful analysis. The study shows that even a very short peroperative course of Cefoxitin is highly effective in reducing postoperative abdominal wound infections after elective colorectal surgery.

Feces of 115 stray or unwanted cats were screened for Toxoplasma oocysts by sucrose density centrifugation and inoculation into mice. None of the feces examined contained detectable levels of viable oocysts. Using a laboratory infected cat, the sensitivity of this detection technique was found to be about 250 oocysts/g of feces by microscopic analysis and about 2 oocysts by mouse inoculation. Samples of pork and lamb chops bought from suburban butcher shops were screened for Toxoplasma cysts by pepsin digestion and mouse inoculation. One of the 30 pork and none of the 30 lamb chops contained viable cysts. Experimental studies determined that the sensitivity of this method of detection was about 1 cyst/100 g of tissue. The relative likelihood of each route of Toxoplasma infection for members of an urban community in a developed country is discussed.

Viral immunofluorescence tests were performed with commercial antisera on 1046 specimens of respiratory, conjunctival corneal and dermal origin to compare the diagnostic effectiveness of direct examination by immunofluorescence with culture. The fluorescence assays were found to be highly sensitive for respiratory syncytial and measles virus in nasopharyngeal aspirates from children, but less satisfactory for other respiratory viruses. The test detected 38% of the adenovirus positives from conjunctival specimens and 67% of the combined herpes simplex virus positives from the latter 3 groups. Despite the reduced sensitivity of fluorescence for some viruses, a case is presented for more widespread use of fluorescence in routine microbiology laboratories because of its simplicity, speed and cost-effectiveness compared with culture which is labour-intensive and time consuming.

Commercial kits of fluorescein-labelled monoclonal antibody against Chlamydia trachomatis have been evaluated (1) as an alternative to Giemsa staining for detection of chlamydia inclusions in cell culture and (2) for direct detection of chlamydia in conjunctival, urethral and cervical smears. The inclusion-detection kit (Micro Trak Culture Confirmation Test) was tested on 270 cultures and was found to be highly sensitive, detecting all 16 Giemsa-positive specimens plus an additional 3 that were negative by Giemsa. It was also superior to Giemsa-staining in terms of simplicity of use, ease of detection, and readability with toxic specimens. The direct detection kit (Micro Trak Direct Specimen Test) gave results which agreed with the culture result for all 33 genital tract specimens and for 32 of 34 conjunctival specimens tested in parallel. The kit is considered to be a valuable test for diagnosis of chlamydial infection by laboratories lacking adequate tissue-culture facilities.

We evaluated the use of the D-xylose absorption test as a marker of intestinal mucosal damage following single-dose oral food challenges in infants suspected of food-protein-induced-enterocolitis. The absorption tests were performed before any challenge, and again after each of four separate food challenges. The response to challenge was judged by five objective criteria (diarrhea, polymorphonuclear leukocytosis, fecal blood, leukocytes, and eosinophils). A significant decrease in the group mean for serum xylose was seen following positive challenges. The 1-h serum xylose level prior to any challenge was 42 +/- 9.5, following negative challenges it was 46 +/- 15, and following positive challenges it was 28 +/- 4.4. However, there was not a good individual correlation between the challenge response and xylose absorption, so intrasubject variability of the xylose absorption test was examined in six infants who had at least three tests performed before a positive challenge response was encountered. The average standard deviation for these repeated tests was 8.2 mg/dl, and the coefficient of variability was 12.6%. This would suggest that, in utilizing this test to assess mucosal damage following oral food challenges or gluten reintroduction, a decrease of 16 mg/dl from the prechallenge values would have to be seen before the difference would exceed two standard deviations. This degree of change was not seen in any patient following a single oral food challenge.