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Although over 100 million pregnant women worldwide are at risk of infection with SARS-CoV-2, little data exists on the impact of COVID-19 and related treatments on maternal/neonatal health.
Objectives
1) To quantify the prevalence of medication use in pregnancy to treat COVID-19; 2) To quantify and compare the risk of adverse pregnancy/neonatal outcomes in those with and without COVID-19.
Methods
In the Canadian Mother-Child population-based cohort (CAMCCO), two key sub-cohorts were identified using prospective data collection of medical services, prescription drugs, hospitalization archives data, and COVID-19 surveillance testing program (02/28/2020-2021). The first cohort included all pregnant women with at least one completed trimester of pregnancy during the study period regardless of pregnancy status (delivery, induced/planned or spontaneous abortion); this cohort was further stratified on COVID-19 status. The second cohort included all non-pregnant women (aged 15-45) with a positive COVID-19 test. COVID-19 infection in pregnant or non-pregnant women was assessed using COVID-19 test results or ICD-10CM codeU07.1 from hospital data. COVID-19 severity was categorized based on hospital admission. Women were considered exposed to COVID-19 medications if they filled at least one prescription for a medicine included in the WHO list in the 30 days pre- or 30 days post-COVID-19 positive test/diagnosis. Considering potential confounders, association between COVID-19 during pregnancy, treated vs not, and perinatal outcomes were quantified using log-binomial regression models.
Results
150,345 pregnant women (3,464 (2.3%) had COVID-19), and 112,073 non-pregnant women with COVID-19 diagnoses were included. Pregnant women with COVID-19 were more likely to have severe infections compared to non-pregnant women with COVID-19 (11.4% vs 1.6%, p< 0.001). The most frequent medications used in pregnancy to treat COVID-19 were antibacterials (13.96%), psychoanaleptics (7.35%), and medicines for obstructive airway disease (3.20%). In pregnancy COVID-19 was associated with spontaneous abortions (adjRR 1.76, 95%CI 1.3, 2.25), gestational diabetes (adjRR 1.52, 95%CI 1.18, 1.97), prematurity (adjRR 1.30, 95%CI 1.01, 1.67), NICU admissions (adjRR 1.32, 95%CI 1.10, 1.59); COVID-19 severity was increasing these risks but COVID-19 treatment with study medications reduced all risks.
Conclusions
Severity of COVID-19 was greater in pregnancy. Antibacterials, psychoanaleptics, and medicines for obstructive airway disease were the most used overall. Severe COVID-19 in pregnancy was associated with higher risks of adverse maternal, and neonatal outcomes.
We assessed factors associated with increased risk to loss of follow-up with infectious diseases staff in OPAT patients. Discharge to subacute healthcare facilities is strongly associated with loss to follow-up. We did not identify sociodemographic disparities. Poor communication between OPAT providers and subacute healthcare facilities remains a serious issue.
To characterize factors associated with increased risk of outpatient parenteral antimicrobial therapy (OPAT) complication.
Design:
Retrospective cohort study.
Setting:
Four hospitals within NYU Langone Health (NYULH).
Patients:
All patients aged ≥18 years with OPAT episodes who were admitted to an acute-care facility at NYULH between January 1, 2017, and December 31, 2020, who had an infectious diseases consultation during admission.
Results:
Overall, 8.45% of OPAT patients suffered a vascular complication and 6.04% suffered an antimicrobial complication. Among these patients, 19.95% had a 30-day readmission and 3.35% had OPAT-related readmission. Also, 1.58% of patients developed a catheter-related bloodstream infection (CRBSI). After adjusting for key confounders, we found that patients discharged to a subacute rehabilitation center (SARC) were more likely to develop a CRBSI (odds ratio [OR], 4.75; P = .005) and to be readmitted for OPAT complications (OR, 2.89; P = .002). Loss to follow-up with the infectious diseases service was associated with increased risks of CRBSI (OR, 3.78; P = .007) and 30-day readmission (OR, 2.59; P < .001).
Conclusions:
Discharge to an SARC is strongly associated with increased risks of readmission for OPAT-related complications and CRBSI. Loss to follow-up with the infectious diseases service is strongly associated with increased risk of readmission and CRBSI. CRBSI prevention during SARC admission is a critically needed public health intervention. Further work must be done for patients undergoing OPAT to improve their follow-up retention with the infectious diseases service.
Mental health regional differences during pregnancy through the COVID-19 pandemic is understudied.
Objectives
We aimed to quantify the impact of the COVID-19 pandemic on maternal mental health during pregnancy.
Methods
A cohort study with a web-based recruitment strategy and electronic data collection was initiated in 06/2020. Although Canadian women, >18 years were primarily targeted, pregnant women worldwide were eligible. The current analysis includes data on women enrolled 06/2020-11/2020. Self-reported data included mental health measures (Edinburgh Perinatal Depression Scale (EPDS), Generalized Anxiety Disorders (GAD-7)), stress. We compared maternal mental health stratifying on country/continents of residence, and identified determinants of mental health using multivariable regression models.
Results
Of 2,109 pregnant women recruited, 1,932 were from Canada, 48 the United States (US), 73 Europe, 35 Africa, and 21 Asia/Oceania. Mean depressive symptom scores were lower in Canada (EPDS 8.2, SD 5.2) compared to the US (EPDS 10.5, SD 4.8) and Europe (EPDS 10.4, SD 6.5) (p<0.05), regardless of being infected or not. Maternal anxiety, stress, decreased income and access to health care due to the pandemic were increasing maternal depression. The prevalence of severe anxiety was similar across country/continents. Maternal depression, stress, and earlier recruitment during the pandemic (June/July) were associated with increased maternal anxiety.
Conclusions
In this first international study on the impact of the COVID-19 pandemic, CONCEPTION has shown significant country/continent-specific variations in depressive symptoms during pregnancy, whereas severe anxiety was similar regardless of place of residence. Strategies are needed to reduce COVID-19’s mental health burden in pregnancy.
Female sex workers (FSWs) are at high risk of mental health problems and suicide risk. Few longitudinal studies have examined risk factors for poor mental health among FSWs.
Methods
Maisha Fiti is a longitudinal study among FSWs randomly selected from Sex Worker Outreach Programme clinics across Nairobi. Behavioural-biological survey data were collected at baseline (n = 1003, June–December 2019), midline (n = 366) (Jan–March 2020) and endline (n = 877) (June 2020–Jan 2021). Women reporting mental health problems were offered counselling services. Multivariable mixed logistic regression models were used to examine factors associated with mental health problems and suicidal behaviours.
Results
There was a decline in the proportion of women reporting any mental health problem (depression and/or anxiety and/or PTSD) (baseline: 29.9%, midline: 13.3%, endline: 11.8%). There was strong evidence that any mental health problem was associated with recent hunger (aOR 1.99; 95% CI 1.37–2.88) and recent violence from non-intimate partners (2.23; 95% CI 1.55–3.19). Recent suicidal behaviour prevalence was similar across survey rounds (baseline: 10.2%; midline: 10.2%; endline: 10.4%), and was associated with recent violence from non-intimate partners (aOR 1.96; 95% CI 1.31–2.95), recent hunger (aOR 1.69; 95% CI 1.15–2.47) and having an additional employment to sex work (aOR 1.50; 95% CI 1.00–2.23).
Conclusions
Our study found a decline in mental health problems but high levels of persistent suicidal behaviours among FSWs. Syndemic risk factors including food insecurity and violence were longitudinally associated with mental health problems and recent suicidal behaviours. There is a need for accessible mental health services for FSWs, alongside structural interventions addressing poverty and violence.
Adverse childhood experiences (ACEs), poverty, violence and harmful alcohol/substance are associated with poor mental health outcomes in the general population. These risks are likely to be exacerbated among Female Sex Workers (FSWs), however there are few studies examining risks factors for mental health problems among FSWs. We examine the prevalence and correlates of common mental health problems including suicidal behaviour among FSWs in Kenya.
Method
Maisha Fiti is a longitudinal study among FSWs randomly selected from Sex Worker Outreach Programme (SWOP) clinics across Nairobi. Baseline data were collected from June-December 2019. Mental health problems were assessed using the Patient Health Questionnaire (PHQ-9) for depression, the Generalised Anxiety Disorder tool (GAD-7) for anxiety, and the Harvard Trauma Questionnaire (HTQ-17) for Post-Traumatic Stress Disorder (PTSD). Recent suicidal behaviour was defined as reported suicide attempt or suicidal ideation in the past 30 days. Other measurement tools included the WHO Adverse Childhood Experiences (ACE) score, WHO Violence Against Women questionnaire, and the WHO ASSIST tool (to measure harmful alcohol/substance use in the past 3 months). Descriptive statistics and multivariable logistic regression were conducted in Stata 16.1.
Result
Of 1039 eligible FSWs, 1003 FSWs took part in the study (response rate: 96%) with a mean age of 33.7 years. The prevalence of moderate/severe depression was 23.2% (95%CI: 20.7–25.9%), moderate/severe anxiety 11.0% (95%CI: 9.3–13.1%), PTSD 14.0% (95% CI: 12.2–16.5%) and recent suicidal behaviour 10.2% (95%CI: 8.5–12.2%) (2.6% suicide attempt; 10.0% suicidal ideation). Among women with any mental health problem 63.0% also had a harmful alcohol/substance use problem. One in four women (25%; 95%CI: 22.5–27.8%) had depression and/or anxiety and this was independently associated with higher ACE scores, hunger (skipped a meal in last week due to financial difficulties), death of a child, perceived sex work stigma and recent sexual/physical violence. PTSD was associated with higher ACE scores, hunger, increased STI prevalence (chlamydia trachomatis) and recent violence. Recent suicidal behaviour was associated with higher ACE scores, low literacy, hunger, and recent violence. Mental health problems and suicidal behaviour were less prevalent among women reporting social support.
Conclusion
The high burden of mental problems among FSWs indicates a need for accessible services tailored for FSWs alongside broader structural interventions addressing poverty, harmful alcohol/substance use and violence. High rates of ACEs among this population indicates the need to consider early childhood and family interventions to prevent poor mental health outcomes.
Funding: Medical Research Council and the UK Department of International Development
This paper reports on an ultra-wideband low-noise distributed amplifier (LNDA) in a transferred-substrate InP double heterojunction bipolar transistor (DHBT) technology which exhibits a uniform low-noise characteristic over a large frequency range. To obtain very high bandwidth, a distributed architecture has been chosen with cascode unit gain cells. Each unit cell consists of two cascode-connected transistors with 500 nm emitter length and ft/fmax of ~360/492 GHz, respectively. Due to optimum line-impedance matching, low common-base transistor capacitance, and low collector-current operation, the circuit exhibits a low-noise figure (NF) over a broad frequency range. A 3-dB bandwidth from 40 to 185 GHz is measured, with an NF of 8 dB within the frequency range between 75 and 105 GHz. Moreover, this circuit demonstrates the widest 3-dB bandwidth operation among all reported single-stage amplifiers with a cascode configuration. Additionally, this work has proposed that the noise sources of the InP DHBTs are largely uncorrelated. As a result, a reliable prediction can be done for the NF of ultra-wideband circuits beyond the frequency range of the measurement equipment.
Two-dimensional (2D) materials are very promising with respect to their integration into optoelectronic devices. Monolayer tungsten diselenide (WSe2) is a direct-gap semiconductor with a bandgap of ∼1.6eV, and is therefore a complement to other two-dimensional materials such as graphene, a gapless semimetal, and boron nitride, an insulator. The direct bandgap distinguishes monolayer WSe2 from its bulk and bilayer counterparts, which are both indirect gap materials with smaller bandgaps. This sizable direct bandgap in a two-dimensional layered material enables a host of new optical and electronic devices. In this work, a comprehensive analysis of the effect of optical excitation on the transport properties in few-layer WSe2 is studied. Monolayer WSe2 flakes from natural WSe2 crystals were transferred onto Si/SiO2 (270nm) substrates by mechanical exfoliation. The flakes were observed under an optical microscope. A FET based on mechanically exfoliated WSe2 was fabricated using photolithography with Molybdenum as metal contact and Silicon as back gate and the electronic properties were measured in a wide range of temperatures. The mobility of our device was found to be 0.2 cm /V-S at room temperature. The schottky barrier height was found to decrease from 80 meV to 25 meV as the gate voltage increases.
Climate change is expected to affect optimum agricultural management practices for autumn-sown wheat, especially those related to sowing date and nitrogen (N) fertilization. To assess the direction and quantity of these changes for an important production region in eastern Austria, the agricultural production systems simulator was parameterized, evaluated and subsequently used to predict yield production and grain protein content under current and future conditions. Besides a baseline climate (BL, 1981–2010), climate change scenarios for the period 2035–65 were derived from three Global Circulation Models (GCMs), namely CGMR, IPCM4 and MPEH5, with two emission scenarios, A1B and B1. Crop management scenarios included a combination of three sowing dates (20 September, 20 October, 20 November) with four N fertilizer application rates (60, 120, 160, 200 kg/ha). Each management scenario was run for 100 years of stochastically generated daily weather data. The model satisfactorily simulated productivity as well as water and N use of autumn- and spring-sown wheat crops grown under different N supply levels in the 2010/11 and 2011/12 experimental seasons. Simulated wheat yields under climate change scenarios varied substantially among the three GCMs. While wheat yields for the CGMR model increased slightly above the BL scenario, under IPCM4 projections they were reduced by 29 and 32% with low or high emissions, respectively. Wheat protein appears to increase with highest increments in the climate scenarios causing the largest reductions in grain yield (IPCM4 and MPEH-A1B). Under future climatic conditions, maximum wheat yields were predicted for early sowing (September 20) with 160 kg N/ha applied at earlier dates than the current practice.
Vitamin D has an important role in calcium homeostasis and is known to have various health-promoting effects. Moreover, potential interactions between vitamin D and physical activity have been suggested. This study aims to investigate the relationship between 25-hydroxyvitamin D (25(OH)D) and exercise capacity quantified by cardiopulmonary exercise testing (CPET). For this, 1377 participants from the Study of Health in Pomerania (SHIP-1) and 750 participants from the independent SHIP-TREND cohort were investigated. Standardised incremental exercise tests on a cycle ergometer were performed to assess exercise capacity by VO2 at anaerobic threshold, peakVO2, O2 pulse and peak power output. Serum 25(OH)D levels were measured by an automated chemiluminescence immunoassay. In SHIP-1, 25(OH)D levels were positively associated with all considered parameters of cardiopulmonary exercise capacity. Subjects with high 25(OH)D levels (4th quartile) showed an up to 25 % higher exercise capacity compared with subjects with low 25(OH)D levels (1st quartile). All associations were replicated in the independent SHIP-TREND cohort and were independent of age, sex, season and other interfering factors. In conclusion, significant positive associations between 25(OH)D and parameters of CPET were detected in two large cohorts of healthy adults.
Younger patients, aged below 45 years, usually lack the conventional risk factors of stroke whereas infections, especially in developing countries, may play a role. There have been many reports in the last decade about the association of Chlamydia pneumoniae (C.pneumoniae) and atherosclerosis involving cerebral vessels.
Objective:
To investigate the seroprevalence of C.pneumoniae IgG and IgA antibodies in patients aged below 45 years with acute ischemic stroke.
Methods:
This study was done at a tertiary care hospital in South India between January 2004 and December 2006 where we recruited consecutive patients aged less than 45years with acute ischemic stroke. Age and sex matched controls were recruited from the outpatient department with non stroke diagnosis. All stroke patients underwent CT (Computerized Tomography), MRI (Magnetic Resonance Image), MRA (Magnetic Resonance Angiography), Transthoracic Echocardiography and Carotid Doppler for stroke sub group diagnosis. We measured C.pneumoniae antibodies IgG and IgA by microimmunofluorescence technique in all patients and controls.
Results:
A total of 120 patients and 120 controls were studied over a period of two years. We found C.pneumoniae antibodies in 29.1% (35/120) stroke patients and in 12.5% (15/120) control subjects (p=0.002). C.pneumoniae IgG antibodies were found in 27.5 % (33/120) of stroke patients and 12.5% (15/120) of controls (p=0.006). IgAantibodies were observed in 5 % (6/120) of strokes and none in control group (p=0.03). After adjustment of all risk factors C.pneumoniae IgG seropositivity showed odds ratio of 2.6; 95% Confidence Interval 1.2-5.6.
Conclusions:
C.pneumoniae IgG antibodies were found to be associated with ischemic stroke in young.
Objective: To report the autosomal dominant inheritance of the Jervell and Lange-Nielsen syndrome in a highly inbred family, the initiation of Torsades de Pointes, and the natural history of the syndrome based on a 16-year follow-up of the kindred. Method: A family tree was constructed that included 66 blood relatives from three successive generations. Electrocardiograms were obtained from 59 living members including the proband, four members from a nuclear family, and 54 from the extended family. Evoked response audiometry was recorded for the proband and the nuclear family. All 59 family members were followed up regularly for 16 years. Results: A total of 24 living members were affected – QTc: 480–680 ms. The proband had long QTc, bilateral high-tone sensorineural deafness, recurrent syncope, and Torsades de Pointes. The asymptomatic father had long QTc and unilateral high-tone sensorineural deafness that involved specifically the left ear. One asymptomatic sibling of the proband had long QTc and normal hearing. The mother and another sibling were asymptomatic; QTc and hearing were normal in both. A total of 21 affected members from the extended family had only long QTc, and all were asymptomatic. There were three congenitally deaf first cousins who had recurrent syncope and adrenergic-triggered sudden death. In all, seven of 10 parents had consanguineous marriage to a first cousin. Each affected offspring had at least one affected parent. The severely symptomatic proband who received only β-blocker therapy and the 23 affected members without antiadrenergic therapy, all remained asymptomatic throughout the 16-year follow-up period. Conclusion: Jervell and Lange-Nielsen syndrome was inherited as autosomal dominant in this kindred. The majority of the affected members had a mild phenotype. The severity of auditory and cardiac phenotypes corresponded.
A field experiment was conducted for 3 years to study the effect of Rhizobium inoculation, mulch and N and P fertilizers on soya bean. The application of wheat straw mulch helped greatly in lowering the maximum soil temperature but failed to increase the yield, particularly on the fields where soya bean was raised for the first time. Seed inoculation gave significantly greater yield than control (no inoculation and no mulching). The combination of mulch and seed inoculation, on average, produced 0·76, 0·43 and 0·84 t/ha more grain than inoculation alone in 1976, 1977 and 1978 respectively. A basal dose of 15 kg N/ha increased the yield when seed was inoculated but no mulch applied whereas the dressing of N did not prove beneficial when mulching was combined with inoculation. The grain yield, however, increased up to 180 kg N/ha in the case of mulch alone and control treatments. The response of soya bean to phosphorus application was inconsistent.
The habit of growth of pigeon-pea cultivars was greatly affected by environmental changes. The effect was greatest in the highest yielding cultivar, Pant A2, for the characters plant width, number of pods/main branch, number of pods/plant, grain yield and plant weight. In the late-sown crop the ‘vegetative sink’ was affected more than the ‘generative sink’. T21 was the outstanding yielder under late-sown conditions. It is suggested that a rotation of mungbean–pigeon pea–wheat can be grown in 1 year, with profitable returns.
Field investigations were undertaken during the winters of 1971–6 to study the grain yield responses of lentil cultivars to seed inoculation with single and mixtures of Rhizobium strains. An effective symbiosis and consequent increase in the grain yield was associated with the efficacy of the strain. Inoculation with a superior strain produced 23–32 % more grain than no inoculation on loamy-sand soil and 46–90% more on sandy-loam soil.
In separate studies comprising inoculation and nitrogen treatments, the seed treated with an effective Rhizobium strain gave on average 43% more yield than no inoculation and the application of 25 kg N/ha alone gave the same yield as inoculation. Rhizobium inoculation plus 20 kg N/ha was the best combination for maximum yield under both loamy-sand and sandy-loam soils.
It has been observed that there is an appreciable from the beginning of flowering till its completion percentage of flower shedding in pulse crops but and the total number of flowers shed was calculated, reliable data are lacking. Preliminary studies were, At maturity, the number of full-size pods per plant therefore, vindertaken to collect information on the was counted and the percentage of flowers shed extent of flower shedding in some kharif (rainy was calculated, season) pulses.
Optimality conditions via subdifferentiability and generalised Charnes-Cooper transformation are obtained for a continuous-time nonlinear fractional programming problem. Perturbation functions play a key role in the development. A dual problem is presented and certain duality results are obtained.
We have determined the sequence and genomic organization of the genes encoding the cone visual pigment of the platypus (Ornithorhynchus anatinus) and the echidna (Tachyglossus aculeatus), and inferred their spectral properties and evolutionary pathways. We prepared platypus and echidna retinal RNA and used primers of the middle-wave-sensitive (MWS), long-wave-sensitive (LWS), and short-wave sensitive (SWS1) pigments corresponding to coding sequences that are highly conserved among mammals; to PCR amplify the corresponding pigment sequences. Amplification from the retinal RNA revealed the expression of LWS pigment mRNA that is homologous in sequence and spectral properties to the primate LWS visual pigments. However, we were unable to amplify the mammalian SWS1 pigment from these two species, indicating this gene was lost prior to the echidna-platypus divergence (∼21 MYA). Subsequently, when the platypus genome sequence became available, we found an LWS pigment gene in a conserved genomic arrangement that resembles the primate pigment, but, surprisingly we found an adjacent (∼20 kb) SWS2 pigment gene within this conserved genomic arrangement. We obtained the same result after sequencing the echidna genes. The encoded SWS2 pigment is predicted to have a wavelength of maximal absorption of about 440 nm, and is paralogous to SWS pigments typically found in reptiles, birds, and fish but not in mammals. This study suggests the locus control region (LCR) has played an important role in the conservation of photo receptor gene arrays and the control of their spatial and temporal expression in the retina in all mammals. In conclusion, a duplication event of an ancestral cone visual pigment gene, followed by sequence divergence and selection gave rise to the LWS and SWS2 visual pigments. So far, the echidna and platypus are the only mammals that share the gene structure of the LWS-SWS2 pigment gene complex with reptiles, birds and fishes.
Acute respiratory failure is a common reason for admission to critical care. This chapter focuses on acute respiratory failure as a consequence of primary lung or chest wall disease, examining the assessment and specific medical management of these conditions. Acute conditions, such as asthma and community-acquired pneumonia, have clear criteria for referral to critical care; however, admission of patients limited by chronic respiratory disease may not be straightforward.
Primary respiratory conditions in those with previously normal lungs
Clinical assessment of community acquired pneumonia involves recognizing treatable coexisting complications and comorbidities, including parapneumonic effusion or empyema, which should be drained. Detailed microbiological investigations should be performed, including blood and sputum/tracheal aspirate for culture and sensitivities (preferably before starting antibiotic treatment) and urine for both pneumococcal and legionella antigen. In addition, sputum should be examined by Gram stain and direct immunofluorescence for viral pathogens. Additional investigations for severe community acquired pneumonia include paired viral and atypical serology. The incidence of Staphylococcus aureus and Legionella pneumophila is increased in severe pneumonia, and a history of influenza symptoms and foreign travel should be sought.