Papers by Elizabeth Livingston
PubMed, Aug 1, 2002
In the US, transmission of HIV infection from pregnant women to their infants is now highly preve... more In the US, transmission of HIV infection from pregnant women to their infants is now highly preventable. HIV infection is sufficiently common to justify extension of HIV screening to all pregnant women. Once HIV infection is identified, the degree of immunocompromise may be ascertained through evaluation of CD4 cell number and HIV viral load levels. Use of antiretroviral medications can slow progression to AIDS or death, and prevent mother-to-child HIV transmission. Cesarean section plays a role in prevention of vertical HIV transmission in women with virus incompletely suppressed by medication. Simple, safe, and effective methods of preventing mother-to-child transmission are needed for the developing world.
Annals of Medicine, 1998
ABSTRACT In the US over one million persons are currently infected with the HIV, over half a mill... more ABSTRACT In the US over one million persons are currently infected with the HIV, over half a million have had AIDS, and over 300,000 have died from AIDS. Worldwide, it is estimated that more than 17 million people are currently infected with HIV, and over 1,200,000 cases of AIDS have been reported to the World Health Organization. By some estimates, up to 40% of patients with AIDS will ultimately develop some form of cancer. Non-Hodgkin's lymphoma, Kaposi's sarcoma and invasive cervical cancer have a higher incidence in persons with HIV infection and all three are AIDS-defining illnesses. In addition, several reports suggest that a number of other malignancies may occur at an increased incidence in persons with HIV infection, including squamous-cell carcinoma of the head, neck and anus, plasmacytoma, melanoma, small-cell lung cancer, basal-cell cancer, and germ-cell tumours. Clinicians should become familiar with HIV-related malignancies as their incidence is expected to further increase as more effective therapies for HIV and associated opportunistic infections allow patients to live longer in an advanced state of immunodeficiency. In the current article, we will review the clinical and therapeutic aspects of the most common AIDS-related malignancies including non-Hodgkin's and Hodgkin's lymphomas, Kaposi's sarcoma and anogenital epithelial neoplasias.
Antimicrobial Agents and Chemotherapy, Apr 1, 2015
We conducted an open-label, steady-state pharmacokinetic (PK) study of drug-drug interactions bet... more We conducted an open-label, steady-state pharmacokinetic (PK) study of drug-drug interactions between depot medroxyprogesterone acetate (DMPA) and twice-daily lopinavir (LPV) plus low-dose ritonavir (RTV) (LPV/r) among 24 HIV-infected women and compared the results to those for HIV-infected women receiving DMPA while on no antiretroviral therapy or on nucleosides only (n ؍ 14 subjects from the control arm of AIDS Clinical Trials Group [ACTG] study 5093). The objectives of the study were to address the effect of LPV/r on DMPA and to address the effect of DMPA on LPV/r therapy. PK parameters were estimated using noncompartmental analysis with between-group comparisons of medroxyprogesterone acetate (MPA) PKs and within-subject comparisons of LPV and RTV PKs before and 4 weeks after DMPA dosing. Plasma progesterone concentrations were measured every 2 weeks after DMPA dosing through week 12. Although the MPA area under the concentration-time curve and maximum concentration of drug in plasma were statistically significantly increased in the study women on LPV/r compared to those in the historical controls, these increases were not considered clinically significant. There were no changes in LPV or RTV exposure after DMPA. DMPA was well tolerated, and suppression of ovulation was maintained. (This study has been registered at ClinicalTrials.gov under registration no. NCT01296152.
Radiology, Jun 1, 1996
To assess the frequency of fetal gallbladder visualization through gestation and to determine the... more To assess the frequency of fetal gallbladder visualization through gestation and to determine the prognostic importance of nonvisualization. Demonstration of the gallbladder was prospectively attempted in 578 consecutive second- and third-trimester obstetric ultrasound examinations. Data regarding gallbladder visualization were stratified into subgroups on the basis of estimated gestational age. Postnatal follow-up was performed in 80 fetuses with nonvisualization of the gallbladder. The gallbladder was seen on 477 of 578 (82.5%) fetal sonograms. The likelihood of gallbladder visualization increased with advancing gestational age, reaching a plateau of approximately 95% between 24 and 32 weeks. After 32 weeks, the frequency of visualization declined. Seventy-five of the 80 fetuses with nonvisualized gallbladders who underwent follow-up had normal outcomes. Except for one fetus with trisomy 21, all fetuses with abnormalities had relatively minor, non-life threatening problems that did not involve the gallbladder or biliary tract. Most fetuses with nonvisualization of the gallbladder have normal outcomes. The rate of nonvisualization of the fetal gallbladder is sufficiently high to undermine the utility of gallbladder visualization as a screen for fetal abnormality.
Chestnut's Obstetric Anesthesia: Principles and Practice, 2009
Evidence report/technology assessment (Summary), 2002
The review evaluated the benefits and risks of different strategies for the management of prolong... more The review evaluated the benefits and risks of different strategies for the management of prolonged pregnancy in order to avoid adverse perinatal and maternal outcomes.
Ultrasound in Obstetrics and Gynecology, 2008
A 33-year-old woman, gravida 2 para 2, was refferd to our institution at 35 weeks' gestation, bec... more A 33-year-old woman, gravida 2 para 2, was refferd to our institution at 35 weeks' gestation, because of polyhydramnios. Ultarasound examination revealed mild polyhydramnios (amniotic fluid index:25) and juxtaposition of the descending aorta and inferior vena cava. Fetal echocardiography demonstrated a common atrioventricular valve, double outlet right ventricle, pulmonary stenosis. Four pulmonary veins drained to a confluence behind the left atrium arising a vertical vein passed through the diaphragma and then connected to portal vein. On pulsed Doppler examination, the pulmonary veins and vertical vein showed continuous, mildly pulsatile flow. All these features were suggestive of right atrial isomserism with total anomalous pulmonary venous connection to the portal vein. Absence of the ductus venosus without liver bypass was suspected by meticulous color flow mapping of the portal circulation in various planes. A female infant was delivered weighing 2810g with Apgar scores of 8 and 8 at 1 and 5 minutes, respectively. Postnatal echocardiography confirmed the prenatal findings. On pulsed Doppler examination, the vertical vein showed non-pulsatile continuous flow. The infant underwent open heart surgery and the pulmonary confluence was connected to the left atrium. But she died at the second day because of cardiac failure. We speculate absence of the ductus venosus without liver bypass might worsend the prognosis of the infant with total anomalous pulmonary venous connection to the portal vein.
Journal of Ultrasound in Medicine, Oct 1, 2001
This study compares transperineal and endovaginal ultrasonography of the gravid cervix to evaluat... more This study compares transperineal and endovaginal ultrasonography of the gravid cervix to evaluate image quality and assess for a systematic difference in cervical lengths measured by the 2 techniques. Methods. Transperineal and endovaginal ultrasonography of the cervix was performed on 64 pregnant women. Two physicians reviewed the images and rated the relative diagnostic value of the techniques for assessing the cervix and for evaluating for placenta previa. Cervical length was measured prospectively in both techniques. Data were analyzed to determine if there is a systematic difference in length using the 2 approaches and if length differences are dependent on gestational age. Results. There was a strong reviewer preference for endovaginal ultrasonographic images over transperineal images for both assessing the cervix (P < .001) and evaluating for placenta previa (P < .001). Despite this, transperineal and endovaginal ultrasonographic images were frequently rated as similar in diagnostic quality by both reviewers for depicting the cervix (35.9% of patients) and evaluating for placenta previa (57.8% of patients). The mean length of the cervix was slightly shorter at transperineal ultrasonography (28.4 mm) than at endovaginal ultrasonography (30.1 mm). When cervical lengths were subdivided by gestational age, however, a significant length discrepancy was found only in the 14-to 20-week gestational age range. In this age range, mean cervical length at transperineal ultrasonography (28.6 mm) averaged 5.5 mm less than at endovaginal ultrasonography (34.1 mm). Conclusions. Both transperineal and endovaginal ultrasonography can provide satisfactory images of the cervix, but endovaginal images are frequently superior to transperineal images. Endovaginal ultrasonography should be considered the optimal method for imaging the cervix in most situations. Transabdominal or transperineal ultrasonography can also be used, but if the cervix is not adequately depicted from these perspectives, endovaginal ultrasonography is indicated. Transperineal measurements of cervical length can be significantly shorter than endovaginal measurements, particularly before 20 weeks; therefore, short cervical lengths documented at transperineal ultrasonography before 20 weeks should be confirmed by endovaginal ultrasonography.
American Journal of Obstetrics and Gynecology, 2017
administration with a meal or soft foods, and the impact of high doses of secnidazole on cardiac ... more administration with a meal or soft foods, and the impact of high doses of secnidazole on cardiac safety. SYM-1219 was administered in either applesauce, yogurt, or pudding, followed by 240 mL of water. Serial blood samples were collected to determine secnidazole plasma concentrations and PK parameters for each treatment group are reported. Safety assessments, ECGs, and vital signs were performed during each study. An in vitro metabolism program, including CYP metabolism, inhibition, and induction, substrate and inhibition potential for transporters, and the potential for secnidazole to inhibit ethanol metabolism was performed. RESULTS: A single 2-g oral dose of SYM-1219 achieves an average maximum plasma secnidazole concentration (Cmax) of 35.7 to 46.3 mg/mL approximately 2 to 3 hours after dosing (Tmax). Exposure, as assessed by area under the plasma-concentration time curve (AUC), increases linearly with dose. Secnidazole has a prolonged terminal elimination half-life (t1/2) of w1...
American Journal of Obstetrics and Gynecology, 2017
administration with a meal or soft foods, and the impact of high doses of secnidazole on cardiac ... more administration with a meal or soft foods, and the impact of high doses of secnidazole on cardiac safety. SYM-1219 was administered in either applesauce, yogurt, or pudding, followed by 240 mL of water. Serial blood samples were collected to determine secnidazole plasma concentrations and PK parameters for each treatment group are reported. Safety assessments, ECGs, and vital signs were performed during each study. An in vitro metabolism program, including CYP metabolism, inhibition, and induction, substrate and inhibition potential for transporters, and the potential for secnidazole to inhibit ethanol metabolism was performed. RESULTS: A single 2-g oral dose of SYM-1219 achieves an average maximum plasma secnidazole concentration (Cmax) of 35.7 to 46.3 mg/mL approximately 2 to 3 hours after dosing (Tmax). Exposure, as assessed by area under the plasma-concentration time curve (AUC), increases linearly with dose. Secnidazole has a prolonged terminal elimination half-life (t1/2) of w1...
Journal of Clinical Microbiology, 1999
We examined the patterns of strain relatedness among pathogenic yeasts from within and among grou... more We examined the patterns of strain relatedness among pathogenic yeasts from within and among groups of women to determine whether there were significant associations between genotype and host condition or body site. A total of 80 yeast strains were isolated, identified, and genotyped from 49 female volunteers, who were placed in three groups: (i) 19 women with AIDS, (ii) 11 pregnant women without human immunodeficiency virus (HIV) infection, and (iii) 19 women who were neither pregnant nor infected with HIV. Seven yeast species were recovered, including 59 isolates of Candida albicans , 9 isolates of Candida parapsilosis , 5 isolates of Candida krusei , 3 isolates of Candida glabrata , 2 isolates of Saccharomyces cerevisiae , and 1 isolate each of Candida tropicalis and Candida lusitaniae . Seventy unique genotypes were identified by PCR fingerprinting with the M13 core sequence and by random amplified polymorphic DNA analysis. Of the nine shared genotypes, isolates from three diffe...
American Journal of Obstetrics and Gynecology, 2021
Medscape women's health, 1997
The fact that zidovudine therapy can prevent perinatal transmission of HIV infection strongly sup... more The fact that zidovudine therapy can prevent perinatal transmission of HIV infection strongly supports the need to screen for HIV during pregnancy. Controversy continues to revolve around which testing strategy offers the benefits of zidovudine to the greatest number of infants while still allowing the mother some degree of autonomy in making her own health care decisions. Screening based on patient-reported risk factors has repeatedly been shown to exclude many seropositive women. Voluntary testing has had inconsistent results, and mandatory testing may discourage women from getting the prenatal care they need. Despite the controversy, HIV testing and education should be recommended to all pregnant women. Counseling should be geared to the educational level of the patient, and risk-factor reduction is an important component of counseling. Health care providers must be prepared to address the social as well as the medical ramifications of a diagnosis of HIV infection for both the mo...
Southern Medical Journal, 1997
Obstetrics & Gynecology, 2010
Journal of Women's Health, 2007
Objective: To provide an overview of the epidemiology, etiology, pathogenesis, diagnosis, and man... more Objective: To provide an overview of the epidemiology, etiology, pathogenesis, diagnosis, and management of intrahepatic cholestasis of pregnancy. Methods: We searched the Medline and PubMed database using the key words intrahepatic cholestasis of pregnancy, obstetric cholestasis, diagnosis, management, and complications. Results: Intrahepatic cholestasis of pregnancy, or obstetric cholestasis, is a liver condition that develops during pregnancy. It is associated with increased perinatal morbidity and mortality. Pruritus and risk of postpartum hemorrhage are the main causes of maternal morbidity. Intrahepatic cholestasis of pregnancy is a diagnosis of exclusion. The current management policies depend on regular fetal and maternal monitoring and delivery at fetal maturity. The analysis of the quality of previous studies provided in this review highlights the areas of deficiency in evidence-based knowledge of this subject. Conclusions: More research is required into the etiology, pathogenesis, and monitoring modalities that can specifically predict fetal outcome in intrahepatic cholestasis of pregnancy. Clinical trials are required to identify the most suitable drugs for treatment.
Annals of Emergency Medicine, 1992
American Journal of Obstetrics and Gynecology, 2007
Uploads
Papers by Elizabeth Livingston