SummaryIncreased plasma levels of β-thromboglobulin (βTG) and fibrinopeptide A (FPA), markers of platelet release and thrombin generation respectively, were measured in normal women, women taking oral contraceptives, normal pregnancy and pregnant women with hypertension or pre-eclampsia. No significant increases in βTG or FPA were found in women taking oral contraceptives. Significantly increased concentrations of βTG, but not FPA, were found in normal pregnant women in the second and third trimester of pregnancy when compared with nonpregnant age-matched controls. In eleven women with pregnancy hypertension and thirteen women with pre-eclampsia significantly elevated levels of both βTG and FPA were found when compared with age, parity and gestation-matched pregnant controls. Although the mean value for both βTG and FPA in the group with pre-eclampsia was higher than the group with pregnancy hypertension, the difference was not statistically significant. These findings provide additional evidence that pre-eclampsia and pregnancy hypertension are associated with activation of the coagulation system and the platelet release reaction.

This study indicates that psychotic symptoms not fulfilling criteria for schizophrenia or a psychotic mood disorder are unreliable predictors of a syndromal psychotic disorder outcome at 2 years. Long-term studies of PsyNOS and BrPsy are needed to clarify where these disorders fall in the developmental course of schizophrenia.

Objective To examine predictors of diagnostic and symptomatic outcome in adolescents with either psychotic disorder not otherwise specified (PsyNOS) or brief psychotic disorder (BrPsy) followed in a schizophrenia prodrome program. Methods As part of a naturalistic study of adolescents considered at clinical high risk for schizophrenia, 26 youth (mean age: 15.9±2.6 years, 65.4% male) with subsyndromal psychosis and diagnosed with PsyNOS or BrPsy were evaluated for predictors of diagnostic and symptomatic outcome after at least 6 (mean: 22.8±19.4) months follow-up. Results Progression to schizophrenia, schizoaffective disorder or psychotic bipolar disorder (n=10, 38.5%), was predicted by fulfilling criteria for schizotypal personality disorder at baseline (p=0.046). Development of schizophrenia/schizoaffective disorder (n=7, 27.0%) was associated with worse executive functioning (p=0.029) and absence of anxiety disorders (p=0.027). Conversely, progression to bipolar disorder (n=4, 15.4%), with (n=3, 11.5%) or without (n=1, 3.8%) psychosis, was associated with the presence of anxiety disorders (p=0.014). Remission of any subsyndromal and attenuated positive or negative symptoms (n=5, 19.4%) was predicted by Hispanic ethnicity (p=0.0047), an initial diagnosis of BrPsy (p=0.014), longer duration of antidepressant treatment (p=0.035), and better attention at baseline (p=0.042). Conclusions Results from this preliminary study suggest that patients with PsyNOS, BrPsy or schizotypal personality disorder features in adolescence should be followed as separate risk groups in prodrome studies of schizophrenia and bipolar disorder. Executive function deficits and absence of anxiety disorders may be risk markers for schizophrenia, while presence of anxiety disorders may be linked to bipolar disorder risk. After achieving full remission, patients with sudden onset of psychosis and brief episodes could once be given the option of careful, supervised treatment discontinuation. The potential salutary effect of antidepressants during the psychotic prodrome and presence of characteristics differentiating patients at risk for schizophrenia or bipolar disorder should be investigated further.

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Objectives: World Health Organization recommends exclusive breastfeeding (EBF) for 6 months after birth. However, problems with the baby failing to latch properly are common in the postpartum period contributing to breastfeeding cessation. The aim of the study was to evaluate the utility of LATCH score to predict EBF and weight gain at 6 weeks postpartum along with an optimum LATCH score cutoff. Patients and Methods: This prospective cohort study was conducted in India. Ninety-three mother-infant dyads at term gestation were enrolled. Two LATCH score assessments were done by a lactation consultant: first within 24 hours of birth and second at discharge. Mothers with low LATCH scores were counselled before discharge. EBF rate and weight gain velocity were analyzed at 6 weeks. Results: LATCH score ≥6 at discharge has the highest sensitivity (92.1%) and specificity (66.7%) for predicting EBF at 6 weeks postpartum (RR, 95% CI; 5.63 [4.32–12.65], P = 0.0003). Receiver operating characteristic (ROC) of LATCH score at discharge and EBF at 6 weeks had an area under the curve of 0.785 with a cutoff ≥5.5, showing the highest sensitivity of 93.6% with a false-positive rate of 30.1%. LATCH score >6 at discharge was significantly associated with higher EBF rate (RR, 95% CI; 0.61 [0.39–0.94]) and appropriate weight gain (≥ 20 grams/day) at 6 weeks of age (RR, 95% CI; 0.44 [0.25–0.75]). After counselling, the LATCH score significantly improved at discharge in mothers (n = 62) with an initial score <6 (P < 0.001). Conclusion: LATCH score is a simple tool to identify mothers who require breastfeeding support and counselling before discharge from the hospital to prevent early breastfeeding cessation.

We conducted a case-control study to evaluate severe physical abuse of the elderly treated in two Chicago area Level I trauma centers. This report details whether physicians are adequately reporting cases of abuse to Adult Protective Services (APS), and assesses 1 year. The failure to report two-thirds of the cases and the substantially higher risk of death during the first year after hospitalization indicates the need for improved identification, reporting, and intervention. It is important that clinicians understand the complexity of elder abuse in order to better identify suspected victims and report these cases to professionals in APS.

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The data revealed faster and more successful IO catheter placement than reported for CVCs, few complications and high user satisfaction. For simple placements, cost savings for IO access vs. CVCs was $195/procedure. If 20% of the 3.5 million CVCs placed annually were replaced with IO catheters, cost savings could approach $650 million/year. We conclude that IO access in place of CVCs delivers high value in terms of being a safe, fast and effective mode of vascular access for patients in the hospital setting, with potentially substantial cost savings. These data indicate that IO access is a cost effective and viable alternative to problematic CVC lines.