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Background: COVID-19 pandemic has influenced health care delivery. We conducted an observational study to understand how obstetric medicine (ObM) physicians utilized home blood pressure monitoring (HBPM) to manage hypertension in pregnancy. Method(s): Pregnant participants with risk factors or diagnosis of hypertensive disorders of pregnancy (HDP) were enrolled, May 2020-December 2021, and provided with validated home blood pressure (BP) monitor. ObM physicians completed questionnaires to elicit how home BP readings were interpreted to manage HDP. Result(s): We enrolled 103 people: 44 antepartum patients (33.5 +/- 5 years, gestational age of 24 +/- 5 weeks);59 postpartum patients (35 +/- 6 years, enrolled 6 +/- 4 days post-partum). ObM physicians used range of home BP readings (70%) for management of HDP. Conclusion(s): HBPM to manage HDP is acceptable and can be used to manage hypertension during pregnancy. Further studies are needed to assess the generalizability of our findings and the safety of HBPM reliance alone in management of HDP.Copyright © The Author(s) 2023.
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Case Report: Since the beginning of the Coronavirus Disease 2019 (COVID-19) pandemic, there has been much work to understand the negative effects of SARS-CoV-2 on tissues expressing the Angiotensin Converting Enzyme-2 (ACE2) receptor, including the placenta. However, there is limited information regarding placental pathology findings in mothers with COVID-19 and the effects of SARS-CoV-2 on the placenta. The available research reports effects on the fetus ranging from minimal to intrauterine fetal demise. Case Description: A 4680g baby boy was born at 38+1 weeks of gestation to 36y old G4P1021 female via repeat cesarian section. The pregnancy was complicated by advanced maternal age, chronic hypertension with superimposed pre-eclampsia with severe features, BMI of 80, and SARS-CoV-2 infection. The mother had mild COVID-19 symptoms and did not require hospitalization or oxygen support. Prenatal ultrasounds were limited due to body habitus. At the time of delivery, there was clear amniotic fluid. Upon delivery the infant was cyanotic and limp and was brought to the warmer immediately. Non-invasive positive pressure ventilation was initiated at 5 minutes of life with improvement in infant color and oxygen saturation. He was then admitted to the Neonatal Intensive Care Unit (NICU). APGARs were 2, 3, 5, and 7 at 1, 5, 10, and 15 minutes respectively. Cord gases showed severe metabolic acidosis. The patient was diagnosed with hypoxic-ischemic encephalopathy (HIE) and therapeutic hypothermia was initiated. Both the NICU and obstetric teams were unable to identify a clear perinatal cause of HIE in this patient. Later, the placenta pathology report revealed a large placenta for estimated gestational age corresponding to the 75th percentile, villous parenchyma with focal chorangiosis and thrombi, with unremarkable fetal membrane and three vessel umbilical cord. The cause of HIE was then thought to be due to the placental thrombi likely caused by SARS-CoV-2 infection. Discussion(s): Fetal vascular malperfusion and fetal vascular thrombus have been noted as a common finding in the placentas of pregnant women who test positive for SARS-CoV-2. There are various causes of HIE, from maternal, placental and fetal factors. This patient had no clinically evident hypoxic event, but information was limited due to the lack of monitoring of the fetus in utero. Given the mother's SARS-CoV-2 infection and the placental pathology findings, it is likely that the cause of this patient's HIE was related to the effects on the placenta from SARS-CoV-2. Conclusion(s): As more information comes to light about the effects of SARS-CoV-2 on the placenta, it is important to consider a maternal SARS-CoV-2 infection during pregnancy as a cause of HIE in a newborn.
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Background: Increasing availability of highly effective cystic fibrosis (CF) transmembrane conductance regulator (CFTR) modulator therapy (HEMT) has improved the quality of life and long-term prognosis for many people with CF. Thus, more people with CF are considering parenthood. Almost all menwith CF (MwCF) are infertile because of congenital bilateral absence of the vas deferens (CBAVD). Based on CF animal models, CBAVD occurs early in gestation and is unlikely to be reversible using HEMT, but assisted reproductive techniques (ARTs) can enable MwCF to father children using the sperm in their testes. Animal reproductive models suggest no HEMT teratogenicity, and the amount of exposure of the fetus to HEMT via absorption of seminal fluid through the vaginal wall is predicted to be negligible, although to ensure no sperm exposure to HEMT, the life span of sperm would require MwCF to discontinue CFTR modulators for approximately 3 months before ART. Because abrupt discontinuation of CFTR modulators may result in health decline, MwCF and their providers must consider all potential risks. There are no published data in MwCF regarding use of HEMT during conception and partner pregnancy. Method(s): Beginning in August 2021, CF center staff in the United States, United Kingdom, and Australia completed a two-page anonymous questionnaire regarding MwCF who used CFTR modulators during ART (sperm retrieval and in vitro fertilization) or natural conception with subsequent partner pregnancy. Result(s): Providers have submitted 34 surveys for MwCF on CFTR modulators whose partner became pregnant after use of ART (n = 32) or natural conception (n = 2). The median age of the samplewas 32 (range 24- 43). Fifteen were homozygous for F508del, median percentage predicted forced expiratory volume in 1 second was 76% (range (22-111%), and median body mass index was 24 kg/m2 (range 18.5-32.1). Twenty-three were taking elexacaftor/tezacaftor/ivacaftor. The median time that MwCF were taking CFTR modulators before partner conception was 18 months (range 0-82). One newly diagnosed man initiated HEMT after sperm retrieval. Four MwCF stopped CFTR modulators before sperm retrieval, one of whom experienced pulmonary decline. None of the 19 MwCF whose condom use during pregnancy was known used condoms. Fetal complications in partners of MwCF included three first-trimester miscarriages, two* COVID, two breech presentation, two* vaginal bleeding, and one vasa previa. None of the complications were deemed definitively related to use of CFTR modulators. One MwCF experienced testicular infection after sperm retrieval#. Postpartum complications included three# infants with hypoxemia requiring neonatal intensive care unit stay, three maternal blood loss, one forceps delivery, and one caesarean section. No congenital anomalies were reported for any infant. (*/# overlap). Conclusion(s): Use of CFTR modulator therapy during partner conception and pregnancy in 34 MwCF has not resulted in higher-than-expected miscarriage rates or congenital anomalies. Providers should consider the risk to the health of MwCF combined with the lack of teratogenicity in animal reproductive models and limited safety data in the human fetus before discontinuing CFTR modulators before ART or natural partner conception. Survey collection is ongoing;results will be updated for presentationCopyright © 2022, European Cystic Fibrosis Society. All rights reserved
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Purpose of Study: The regional NICU is an essential healthcare resource for families of newborns with serious life-threatening illnesses. Mechanical ventilation, cardiovascular therapies, therapeutic hypothermia, and neonatal surgeries are common life-sustaining interventions. Our NICU serves an underprivileged population in a resource poor environment and several ethical questions frequently emerge when facing extremes of innovative therapies. The pandemic and rapidly changing institutional protocols accentuated challenges faced by frontline NICU teams caring for newborns at risk for devastating illnesses and death. Concurrently, evolving paradigms in neonatal ethics required urgent and high quality palliative care in a background of racial and socioeconomic inequities, restrictive visitation policies, and limited healthcare resources. The purpose of this study was to ensure that neonates and their families receive ethically sound care, timely referrals for innovative therapies, and specialized palliative care in the strained and uncertain environment of the COVID-19 pandemic. Methods Used: The key steps consisted of structured and impromptu discussion forums for specialized palliative care and medical ethics, perinatal case conferences and pediatrics grand rounds on virtual platforms, educational webinars for interdisciplinary teams, and improved electronic communication. Online collaboration and innovative combinations of in-person and virtual meetings were utilized for urgently Incorporating clinical updates. Summary of Results: 1. A neonate with severe HIE and postnatally diagnosed congenital diaphragmatic hernia required emergent ECMO center referral. NICU providers utilized a structured bioethics and palliative care framework for providing family support and discussing the prognostication challenges of acute illnesses. 2. Many important bioethical questions emerged while caring for infants with life-threatening chromosomal abnormalities. Ethical tension was addressed by teaching tools, quality of life and pediatrics ethics conversations, mitigation of moral distress, contemporary clinical and surgical experience, community engagement, and family perspectives. 3. Ethical conflicts are central in the decision to resuscitate neonates born between 22 and 23 weeks of gestation. To provide urgent prenatal consultations and attend high risk deliveries, we collaborated across geographically distant healthcare systems, unified management strategies and analyzed outcomes data. 4. NEC in several extremely preterm babies had devastating outcomes and the team respected each family's voice with compassionate, shared decision-making for both curative care surgeries and palliative care. Conclusion(s): The new workflows, telephone and video conferences, and redirection to telehealth based family meetings did not change important outcomes during the pandemic. Advocacy and education for integrating bioethics and palliative care were vital facets of neonatal critical care in a resource poor and ever-changing pandemic environment.
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Vaccination is essential to manage the COVID-19 pandemic. Vaccination significantly protects against severe COVID-19, hospitalization and death;it also protects against symptomatic infection and reduces the risk of transmission to other people. Protection against the new SARS-CoV-2 variants may be lower, but protection against severe course and death remains high. Two mRNA vaccines (BNT162b2 and mRNA-1273) and two vector vaccines (AZD1222 and Ad26.COV2.S) are currently available in the Czech Republic. Vaccination of persons over 60 years of age and immunocompromised persons, who are demonstrably at the highest risk of a serious course of the disease, is of the utmost importance. In order to achieve adequate vaccination coverage, it is necessary to motivate other groups of people to be vaccinated, including children over 12 years of age and young adults. Vaccination is also recommended in preg-nant women in the 2nd and 3rd trimesters and in breastfeeding women. For selected groups of vaccines, a third dose of vaccination is recommended (additional third dose 4 weeks after the second dose or a booster dose 8 to 12 months after the second dose). The side effects are usually mild, with serious complications (including anaphylaxis, thrombocytopenia with thrombosis syndrome, myocardi-tis, Guillain-Barre syndrome and capillary leak syndrome) being rare.Copyright © 2021, Trios spol. s.r.o.. All rights reserved.
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Background: With the emergence of the coronavirus 2019 (COVID-19) pandemic, it was essential to determine the impact of this disease on pregnant women and neonatal outcomes. In this study, we present a series of nine cases of pregnant women with COVID-19 disease requiring intensive care unit (ICU) admission. Method(s): We retrospectively collected clinical data of pregnant women with COVID-19 disease admitted to ICU between September 2020 and September 2021. Result(s): Most common presenting symptom was cough. Two patients had no respiratory symptoms at presentation. Five of the nine patients required invasive mechanical ventilation. Seven patients required caesarean section, four of whom delivered preterm. There were no maternal or neonatal deaths. Conclusion(s): Although maternal and neonatal outcomes reported in our study are encouraging, it is imperative to emphasize the importance of an individualized, multidisciplinary approach, and good healthcare infrastructure for optimal management of this group of patients.Copyright © The Author(s) 2023.
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Maternal antibiotics administration (MAA) is among the widely used therapeutic approaches in pregnancy. Although published evidence demonstrates that infants exposed to antibiotics immediately after birth have altered recognition memory responses at one month of age, very little is known about in utero effects of antibiotics on the neuronal function and behavior of children after birth. Therefore, this study aimed to evaluate the impact of MAA at different periods of pregnancy on memory decline and brain structural alterations in young mouse offspring after their first month of life. To study the effects of MAA on 4-week-old offspring, pregnant C57BL/6J mouse dams (2–3-month-old;n=4/group) were exposed to a cocktail of amoxicillin (205 mg/kg/day) and azithromycin (51 mg/kg/day) in sterile drinking water (daily/1 week) during either the 2nd or 3rd week of pregnancy and stopped after delivery. A control group of pregnant dams was exposed to sterile drinking water alone during all three weeks of pregnancy. Then, the -week-old offspring mice were first evaluated for behavioral changes. Using the Morris water maze assay, we revealed that exposure of pregnant mice to antibiotics at the 2nd and 3rd weeks of pregnancy significantly altered spatial reference memory and learning skills in their offspring compared to those delivered from the control group of dams. In contrast, no significant difference in long-term associative memory was detected between offspring groups using the novel object recognition test. Then, we histologically evaluated brain samples from the same offspring individuals using conventional immunofluorescence and electron microscopy assays. To our knowledge, we observed a reduction in the density of the hippocampal CA1 pyramidal neurons and hypomyelination in the corpus callosum in groups of mice in utero exposed to antibiotics at the 2nd and 3rd weeks of gestation. In addition, offspring exposed to antibiotics at the 2nd or 3rd week of gestation demonstrated a decreased astrocyte cell surface area and astrocyte territories or depletion of neurogenesis in the dentate gyrus and hippocampal synaptic loss, respectively. Altogether, this study shows that MAA at different times of pregnancy can pathologically alter cognitive behavior and brain development in offspring at an early age after weaning.
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Background: COVID-19 vaccine booster uptake remains low and preventable COVID-19 deaths continue to occur, making access to oral antivirals for those most at risk of severe COVID-19 outcomes essential. Method(s): We estimated age and gender adjusted prevalence ratios of oral nirmatrelvir-ritonavir (NMV/r) uptake by sociodemographics, clinical characteristics, and prescription eligibility (based on age, underlying medical conditions, body mass index, physical inactivity, pregnancy, or smokers), among participants in a large U.S. national prospective cohort who were infected with SARS-CoV-2 between December 2021 and October 2022. Among participants who reported NMV/r uptake, we also described the proportion who reported (1) taking NMV/r as directed and (2) NMV/r was helpful for reducing COVID-19 symptoms. Result(s): Among 1,594 participants with a SARS-CoV-2 infection as of October 2022, 1,356 were eligible for NMV/r prescription;of whom 209 (15.4% [95%CI:13.5-17.3]) reported receiving NMV/r. NMV/r uptake increased from 2.2% (95%CI:1.0-3.4) between December 2021 and March 2022 to 16.5% (95% CI:13.0-20.0) between April and July 2022 and 28.6% (95%CI:24.4-32.8) between August and October 2022, respectively. Participants >=65 years of age reported the highest uptake of NMV/r (30.2% [95%CI:22.2-38.2]). Black non-Hispanic participants (7.2% [95%CI:2.4-12.0]) and those in the lowest income group (10.6% [95%CI:7.3-13.8]) had lower uptake than white non-Hispanic (15.8% [95%CI:13.6-18.0]) and high-income individuals (18.4% [95%CI:15.2-21.7]), respectively. Participants with type 2 diabetes had greater uptake (28.8% [95%CI:20.4-37.3]), compared to those without it (12.4% [95%CI:4.8-20.0]). Among a subset of 278 participants who had a prior SARSCoV-2 infection, those who had a history of long COVID reported greater uptake (22.0% [95%CI:13.9-30.1]) for a subsequent SARS-CoV-2 infection than those without a history of long COVID (7.9% [95%CI:3.9-11.8]). Among all participants who were prescribed NMV/r (N=216), 89% (95%CI:85-93) reported that they took NMV/r as directed and 63% (95%CI:57-70) stated NMV/r was helpful for reducing COVID-19 symptoms. Conclusion(s): Uptake of NMV/r increased over time coinciding with national efforts to increase awareness and access. However, most individuals who were eligible for NMV/r did not receive it. Lower NMV/r uptake among racial/ethnic minorities and individuals with lower household income suggests a need to improve awareness and address barriers to uptake in these populations.
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Backgrounds: Rare cases of COVID-19 vertical transmission are reported, even though abnormal findings on placenta histopathology are frequently reported on SARS-CoV-2 infected pregnancies. However, no publications report the impact of COVID-19 infection on the placental apoptotic index. Apoptosis is a physiological process of cell regeneration. SARS-CoV-2 infection during pregnancy may disturb the respiration system, causing hypoxia, thus altering placental perfusion. COVID-19 infection also increases inflammatory mediators, producing reactive oxygen species and affecting placenta tissue in viremia cases. These processes can cause caspase cleavage, resulting in programmed cell death and apoptosis. This study aims to know whether COVID-19 infection with various degrees of symptoms affects placental apoptosis. Methods: This is a retrospective, cross sectional study. We conduct a study on 34 placenta blocks of COVID-19 pregnancy and 31 placenta blocks of non-COVID-19 pregnancy. The PCR of nasopharyngeal swabs performed on third-trimester patients in Dr. Soetomo Hospital meets the inclusion and exclusion criteria. Those placenta samples were processed into slides and painted with a TUNEL assay kit. Slides are then examined and rated for apoptotic index. Results: The majority of these patients are multiparous women. Sixty-five patients were included in the study, 2 died, and 63 others lived. Comparison between COVID-19 positive and non-COVID-19 placental apoptotic index shows a significant difference between both groups (p=0.001). Conclusion: From this study, we can conclude that there is a significant difference in the apoptotic index of the placenta between COVID-19-positive and negative pregnancies. © 2023, Sanglah General Hospital. All rights reserved.
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Introduction: COVID-19 coagulopathy is associated with poor prognosis and a state of coexisting 'hypercoagulopathy' (HyperC) and hypofibrinolysis, only detected by viscoelastic tests (VET). VET technology has been useful in areas where conventional tests are inadequate, such as screening for HyperC, thrombotic risk assessment and systemic anticoagulants' effect. We aim to characterize the evolution profile of coagulopathy in patients with COVID-19 infection during their intensive care unit (ICU) stay. Method(s): Consecutive recruitment of adult COVID-19 patients admitted to our hospital's ICU, during a 6 months period. Patients with thrombosis in the previous 3 months, pregnancy, under hormone therapy, and congenital coagulopathies were excluded. VET were executed every 5 days, at discharge and in complications and all of them were under low weight molecular heparin (LMWH) therapy. Group 1 (G1), n = 24-less than 10 days in ICU and group 2 (G2), n = 16-more than 10 days in ICU. In G1 there was 1 death (day 3) and in G2 there were 5 deaths (between days 15 and 42). We focused current analysis on VET-Rotem parameters (see Fig. 1). Result(s): Prognostic scores APACHE II, SAPS II and SOFA were higher in G2, but surprisingly G1 patients are more obese. G2 patients had shorter aPTT and lower platelets. The variables CT-HepTem and MCF Extem-MCF-Fib-Tem present a greater difference between groups, but no statistical significance. We observed an initial correlation between basophils number (which is lower) on CT Intem and CT Hep-Tem, lost as progression to cure, probably due to cytoplasm heparin granules. As expected, VET were in accordance with HyperC: short CTs, increased MCFs, and decreased lysis. Conclusion(s): We expected to guide/adjust LMWH dosage, using Rotem profiles, however these were not corrected by LMWH, used transversally, and remained unchanged in all patients during their stay in ICU.
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Objective: To determine the frequency of contraceptive usage, the social barriers affecting their use, and the frequency of unplanned pregnancies during the COVID-19 pandemic Methodology: This is a prospective cross-sectional study carried out at the Department of Obstetrics and Gynaecology, Fazaia Ruth Pfau Medical College & PAF Hospitals from July 2020 to September 2020. All women of reproductive age attending the outpatient department were consecutively included. A pre-structured questionnaire was used for the purpose of collection of data. We obtained information regarding the use of contraception before and during the COVID-19 pandemic and the contraception methods used by these women. Furthermore, reasons for discontinuing contraception amongst those women who were using it earlier. The occurrence of pregnancy during pandemic was also noted. Results: Of the 350 women, 306 (87.4%) women practiced contraception before and 288 (82.3%) practiced it during the lockdown. Of 306 women practicing contraception before the lockdown, 265 (86.6%) continued practicing during the lockdown as well. Condom 145 (50.3%) and withdrawal method 116 (40.3%) were the most used methods amongst the 288 women practicing contraception during the lockdown. The noticeable increase in the number of those using withdrawal method was due to the lack of consultation following the fear of getting COVID (17 women, 41.5%) and no access to the clinic (14 women, 34.1%). These were the most common reasons for not using contraception, amongst the 41 women practicing contraception before the pandemic. Pregnancies were reported by 93 (26.6%) women out of whom 75 (80.6%) reported these to have been unplanned. Conclusion: The COVID pandemic has largely affected the utilization of contraceptives among women who were already practicing different contraceptive methods. Moreover, unplanned pregnancies are increasingly reported by women.
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Background: Adolescent girls and young women are the epicenter of the global HIV epidemic and in need of multilevel interventions to improve their health outcomes. Method(s): FANMI, a randomized-controlled trial, evaluated the effectiveness of community-based cohort HIV care versus standard of care (SOC) among adolescent and young adults living with HIV (AYALH) in Haiti. Females, 16-24 years who were newly diagnosed with HIV at clinic or community HIV testing sites, or defaulted >6 months from care, were randomized 1:1 to FANMI vs SOC. FANMI was designed to improve convenience, social support and stigma by grouping AYALH in cohorts of 6-10 peers to attend monthly HIV care sessions in a community center with integrated clinical care, group counseling, and social activities led by the same provider. National guideline changes during the study included switching participants to dolutegravir regimens and expanding SOC visits to 6 months. The primary outcome was 12-month retention defined as any visit 9-15 months from enrollment. Secondary outcomes included viral suppression (< 1000 copies/ml), risk behaviors, and acceptability using interviews. Result(s): 120 AYALH enrolled (60 per arm) between May 2018-January 2021. Median age was 21, 91% were newly diagnosed, and median CD4 count was 591 cells/mm3 (IQR 399-788). A total of 78.3% (47/60) FANMI participants vs 85.0% (51/60) in SOC achieved the primary outcome (unadjusted RR=0.92 95%CI 0.78-1.09, p=0.35). Excluding 9 participants who never attended a FANMI/SOC visit after enrollment, 12-month retention was 88.7% (47/53) in FANMI vs 87.9% (51/58) in SOC (RR =1.01 95%CI 0.88-1.15, p=0.90). Participants who presented for HIV testing vs community testing and achieved the primary outcome: 95% vs 70% (FANMI) and 83% vs 88% (SOC). Viral suppression among those retained at 12 months: 44.6% (21/47) in FANMI and 37.3% (19/51) in SOC (RR 1.20 95% CI 0.74-1.9, p=0.45). There were no differences in pregnancy and risk behaviors. Providers preferred FANMI reporting increased time for counseling and peer support. FANMI participants reported high acceptability, decreased stigma, and increased social support with no confidentiality breaches. Limitations included interrupted study operations during the COVID-19 pandemic. Conclusion(s): FANMI was not more effective for AYALH in Haiti but was preferred by providers and highly acceptable to participants. It offers promise as a complementary program for high-risk AYALH in low-income settings facing barriers to clinic-based care.
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Background: The COVID-19 pandemic affected numerous global industry sectors. Impacts on pre-existing randomised clinical trials, however, have largely been unaddressed. The Perth-based Preterm Birth Prevention Study (PTBPS), a trial assessing a new microbial DNA test and treatment regimen for prevention of preterm birth, was plunged into uncertainty two years into recruitment, and had to rapidly adapt to a constantly changing environment to survive. Method(s): Recruitment was moved from patient-facing to telephone and internet. Study information was included in antenatal mailouts in place of antenatal visits. Sample collection predominantly occurred off-site, in many cases from participant's homes. Where necessary, study medications were delivered to participants. Additional funding was sought and additional study sites were added. Result(s): COVID-19 associated restrictions and later, dissemination of COVID-19 into the Western Australian community, badly impacted study recruitment. Financial burden was high;the initial national lockdown alone cost the project $71 590. Two philanthropic donations and a state government grant allowed trial continuation, ensuring a sufficiently powered interim data analysis will occur at the end of 2023. Using a combination of adaptive recruitment methods (e-recruitment and off-site participant consultations), combined with two additional study sites, trial recruitment continued throughout the majority of the pandemic, albeit at a greatly diminished rate. Conclusion(s): The PTBPS was one of many NHMRC-funded clinical trials impacted by the COVID-19 pandemic. Unlike many others, it was fortunate enough to continue operating during times of uncertainty through a combination of philanthropic and state government generosity and protocol changes to match the dynamic clinical environment.
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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19). The course of COVID-19 in pregnant women, which continues to spread rapidly worldwide, on which many studies and researches are ongoing and has many unknowns, is also controversial. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.
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Objective: The primary objective was to assess the difference in rates of hypoglycemia (blood glucose (BG) <=70 mG/dL) when using reduced-dose (5 units) vs. standard-dose (10 units) of IV regular insulin for hyperkalemia treatment in renal insufficiency. Secondary objectives include the efficacy of insulin dose on potassium reduction and evaluating the difference in rates of severe hypoglycemia (BG <=54 mG/dL) between the groups. Method(s): This was a retrospective chart review of patients with renal insufficiency treated with IV regular insulin for hyperkalemia at a tertiary care teaching hospital from June 2020 to June 2021, with institutional review board approval. Inclusion criteria encompassed patients aged 18 years and older with elevated baseline potassium (>=5.5 mEq/L), estimated glomerular filtration rate < 30 mL/min/1.73m2, end stage renal disease, or presence of acute kidney injury, having received either 5 or 10 units of IV regular insulin for hyperkalemia, and had documented glucose and potassium levels after insulin administration. Patients who were pregnant, had diabetic ketoacidosis, or a baseline BG <=70 mG/dL were excluded. Data collection included patient demographics, diabetes history, relevant labs at time of elevated potassium, doses of insulin and dextrose administered for hyperkalemia treatment, presence of coronavirus-19 infection, glucose levels within 6 hours and first potassium level within 24 hours following insulin administration, concurrent use of potassium-lowering agents, insulin outside of hyperkalemia treatment, or steroids, and mortality. Result(s): Out of 409 patients included, 92 were in the 10-unit group and 317 in the 5-unit group. The rate of hypoglycemia in the 5-unit arm vs. the 10-unit arm was 6.9% vs. 8.7% (p=0.649), respectively. The rate of severe hypoglycemia between the 5-unit arm and the 10-unit arm was 3.2% vs 5.4% (p=0.682), respectively. The percent normalization of potassium was not statistically different between the 5-unit group and the 10-unit group (59% vs. 68%;p=0.115), with the same mean reduction in potassium from baseline (0.8 mEq/L (p=0.947)). Administration of concurrent treatments for hyperkalemia was similar between the groups, with dialysis being the only one with statistical significance in normalization of potassium. Patient characteristics that could have an impact on risk of hypoglycemia were studied and analyzed, including pre-treatment BG, history of diabetes mellitus, insulin naive, and patient weight. In patients with hypoglycemia (n=30) vs. those without hypoglycemia (n=379), there was a significantly different mean pre-treatment BG (113 mG/dL vs. 178 mG/dL, p<0.001). Discussion/Conclusion: There was no significant difference in rates of hypoglycemia and severe hypoglycemia between the 5-unit vs. 10-unit groups. There was no significant change in potassium normalization between the two insulin doses. Because of the small number of hypoglycemia events, larger studies are needed to better understand if 5 units of regular insulin is a safer option for the treatment of hyperkalemia in renal insufficiency.Copyright © 2023
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Objective: In this study, we aimed to retrospectively assess the change in weight before and after the COVID-19 mandatory lockdown in Colombia among adults who received nutritional and healthy lifestyle recommendations at weight loss and wellness clinics by telehealth. The primary objective was to describe and compare the mean weight reduction measured at the baseline and by the end of the lockdown. Secondary objectives include describing and comparing body fat percentage, muscle mass percentage, and BMI measured at the baseline and by the end of the lockdown. Method(s): One hundred and seventy-two middle-aged (18-68 years old) women and men received online nutritional and healthy lifestyle advice during the COVID-19 lockdown in Colombia. Weight, fat (%), muscle mass (%), and BMI were assessed before and after the lockdown. We included baseline measurements taken before the lockdown from March 1st to June 20th, 2020, and post-lockdown measurements from August 31st to October 20th, 2020. Exclusion criteria included pregnancy or breastfeeding women, acutely decompensated diabetes, hypertension, CKD, Hypothyroidism or taking any of the obesity treatment medications approved in Colombia, including liraglutide, semaglutide or orlistat. A retrospective analysis was completed to compare the change in mean body anthropometrics. Shapiro Wilk test was used to assess for normality. Paired T Test and Wilcoxon sign test were used to compare the distribution of body anthropometrics before and after the lockdown. IRB approval was obtained before exporting and analyzing the collection of data. Result(s): Out of 205 subjects and after a review of exclusion criteria, 172 subjects were included in the data analysis. 90.1% (155) were women. 52.3% (135) had overweight or obesity. After the COVID-19 lockdown, the mean weight loss reduction was 8.79 kg (SD +/- 5.45, p<0.0001), corresponding to an 11.4% weight loss reduction. The mean fat mass percentage loss was 2.89 % (SD +/- 2.64, p<0.0001), and the mean BMI presented a reduction of 3.16 (SD +/- 1.96, p <0.0001). The mean muscle percentage loss was 0.10% (SD +/- 2.67, p 0.482). Discussion/Conclusion: Subjects receiving telehealth nutritional advice in Colombia during the COVID-19 lockdown had significant clinical and statistical weight, BMI, and fat loss reduction. Muscle mass was preserved;however, this mean change was not statistically significant. Physical inactivity during the lockdown period was a potential contributor to a nonsignificant mean muscle mass change. The subjects in this study were highly motivated to virtually attend weight loss and wellness clinics and to improve body anthropometrics by optimizing lifestyle changes. Telehealth weight loss strategies should always be considered when in-person patient interaction is not available.Copyright © 2023
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Interest in perinatal mental distress has been increasing in recent years. Data from international literature show that almost 25% of women of the general population in perinatal period (pregnancy and post partum) suffer from under diagnosed affective and anxiety disorders. These data make the need for early and adequate interventions in this field dramatically evident. The Multicentric Observatory for Perinatal Depression (OMDP) is an observatory born from the cooperation of Tor Vergata and Sapienza Perinatal Mental Health Services, which now oversees the participation of several universities and territorial structures located in central, southern and northern Italy. The purpose of the Multicentric Observatory for Perinatal Depression (OMDP), is to conduct an extensive and precocious screening program for perinatal depression with a uniform and standardized criterion for all the Italian Centres participating, starting from the first trimester of pregnancy to 1 year after delivery, to create in the future a prophylactic and therapeutic network, offering the most effective and the safest therapeutic pathways. Pandemic Covid-19 has dramatically changed perinatal assistance and the activity of OMDP, which now is starting again with the screening program, and adding telepsychiatry to traditional visits and evaluation. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022. All rights reserved.
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Background: Recent studies describe increasing rates of cannabis use among pregnant women. Gestational cannabis use has been associated with adverse neonatal outcomes and maternal reports of domestic violence. Domestic violence reportedly increased in Australia during the COVID-19 pandemic. We examined trends and outcomes of gestational cannabis use before and during the COVID-19 pandemic and sought associations with domestic violence. Method(s): The study population comprised women who attended the antenatal clinic and childbirth between 1 January 2019 and 31 December 2021 at an Australian tertiary hospital. Maternal socio-demographic, pregnancy progress and neonatal outcomes were recorded from the clinical records. We sought associations between maternal cannabis use and self-reported domestic violence during the study period, and the relationship with pregnancy outcomes. Result(s): Cannabis use was reported by 165/10,263 (1.6%) pregnant women. Cannabis use remained consistent during the study period, but reports of domestic violence increased from 2.9% pre-COVID to 6.7% during the COVID-19 pandemic. During the pandemic, women with gestational cannabis use were more likely to be young (40% <25 years vs. 11.8% .25 years), underweight (3.5% vs. 2.4%) and reported more domestic violence (33.0% vs. 6.3%), compared with non-users. The most common co-consumed substances by cannabis-users were tobacco (63.5%), alcohol (13.9%) and amphetamines (9.6%). Gestational cannabis use was associated with smaller neonates (median birth weight 2900 vs. 3330 g), higher preterm births (33% vs. 8.6%) and increased stillbirths (1.7% vs. 0.4%) Conclusion(s): Although domestic violence increased, gestational cannabis use remained constant during the COVID-19 pandemic and was associated with worse neonatal outcomes.
ABSTRACT
Background: Monash Health implemented a new telehealth-integrated antenatal care schedule in March 2020, in response to the COVID-19 pandemic. Given ever-increasing healthcare costs, new interventions must be evaluated to ensure value for money. Method(s): We conducted a retrospective comparative cost analysis from the health service and patient perspective. Women with a singleton pregnancy who received antenatal care and gave birth at Monash Health from 1 January 2018 to 22 March 2020 (pre-telehealth) and 20 April 2020 to 31 December 2021 (post-telehealth) were included. We generated propensity score matched pre- and post-telehealth cohorts, balancing baseline characteristics and comorbidities. We assigned costs for all episodes of care at Monash Health and calculated the average cost per birth in each cohort. Travel costs were estimated using the average travel distance and time. Result(s): Matched pre- and post-telehealth cohorts (both n = 13 534) were generated from the pre-telehealth ( n = 18 628) and post-telehealth ( n = 14 137) populations. We found an AU$122 increase per birth, for a total cost of AU$12 069 per birth post-telehealth. This was mainly driven by an AU$188 per birth increase in outpatient costs, associated with an extra half an appointment per birth, but offset by an AU$99 per birth decrease in patient travel costs. Differences in clinical outcomes are described in Table 1. Conclusion(s): Telehealth-integrated antenatal care enabled the health service to provide safe, ongoing care for more complex pregnancies during the pandemic for only a minimal cost increase. The results highlight the need for more research into obstetric telehealth, including more comprehensive valuations of benefits and costs to all stakeholders.
ABSTRACT
Background: Coronavirus disease-2019 (COVID-19) has rapidly disseminated worldwide, with a wide variety of clinical manifestations ranging from mild respiratory symptoms to severe pneumonia. Since then, there have been over 62300396 cases of COVID-19 infections worldwide, with 6550033 deaths. Coronavirus disease has presented the world to uncertainty and clinical dilemma with developing and constantly changing management guidelines and protocols. In the backdrop of this pandemic, it thus becomes crucial to study the effects of the infection on pregnancy, childbirth, and the postpartum period. In this study, we analyzed experiences of breastfeeding mothers during the COVID-19 pandemic, specifically concerning how COVID-positive status affected their infant's feeding decisions. Objective(s): To study anxiety, fear and depression associated with breastfeeding in coronavirus disease (COVID)-positive mothers. Method(s): The following DASS scale was used to measure depression anxiety, and stress of coronavirus disease-2019 (COVID-19) among postpartum women along with a self-made breastfeeding questionnaire to assess the association with breastfeeding. Result(s): Among the total of 77 respondents, 13% showed symptoms of depression, 16% anxiety and 9% stress. The breastfeeding questionnaire suggested that most women are afraid of transmitting the infection to their newborns and they lack the knowledge about the importance of breast milk in warding off other infections. Also, women found it difficult to take care of their newborns on their own. Conclusion(s): With this study, we could determine the effects of this pandemic on anxiety depression, and stress levels of COVID infection in postpartum women. It clearly showed that being COVID positive created, affected, and exacerbated mental health issues for mothers. So, there is an urgent need to provide emotional and psychosocial support to this group of the population during the crisis. Otherwise, the adverse outcome is possible involving both mother and newborn.