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Vaccination is considered the most promising approach for addressing the COVID-19 pandemic. However, even vaccinated people remain at risk. In this study, we examined the association between levels of vaccination and clinical outcomes in hospitalized patients. We conducted a retrospective review of adults hospitalized with COVID-19 infection. Of 484 patients, fully vaccinated (OR = 0.49, p = 0.001) and updated patients (OR = 0.46, p = 0.004) had significantly lower probability of critical severity compared to unvaccinated. Vaccination status is significantly related with 30-day mortality (p = 0.005) but not significantly associated with need for respiratory support or ICU stay. Mean length of stay (LOS) of 6.6 days among boosted patients is significantly lower than patients with no vaccination status (10.7 d, p < 0.001). Our study findings provide real-world evidence of the benefit of booster vaccinations against critical infection and death as well as shortcomings in ICU stay, length of stay or need for ventilatory support.
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Coronavirus disease 2019 (COVID-19) has had significant impacts on mothers and neonates. In this report, we present four unique cases of COVID-19 infections in pregnancy and its effects on the mother, fetus, and placenta. Four mothers presented to the hospital during their pregnancy. Each had tested COVID-19-positive 1-29 days prior to admission. Gestational age ranged from 16 weeks six days to 36 weeks six days. Three of the four cases resulted in fetal demise or infant expiration. The common finding among all four cases was pathologic changes in the placenta. Most of the placentas were small for gestational age and had extensive villous infarction. There was also histiocytic intervillositis with villous necrosis and perivillous fibrin deposition. The placentas demonstrated positive staining of syncytiotrophoblasts for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike S1 subunit protein. SARS-CoV-2 RNA was detected in tissue samples of two of the fetuses demonstrating vertical transmission. A higher incidence of severe COVID-19 disease course has been observed in pregnant women. Prior to the SARS-CoV-2 pandemic, chorionic histiocytic intervillositis of the placenta was rarely seen, and mostly of unknown etiology. The increase in placental fibrin levels results in decreased maternal placenta blood flow ensuing hypoxic stress in the fetus. Intrauterine hypoxia has been associated with alterations in brain structure and function resulting in defects in motor skills, cerebral palsy, decreased brain weight, schizophrenia, and other forms of cognitive impairment.
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Introduction: Prolactinomas resulting in pituitary apoplexy are an uncommon obstetrical complication. The hemorrhage can cause compression and necrosis of the pituitary gland as well as the optic chiasm, necessitating surgical intervention. Case: A 35-year-old woman, G0, presented for an infertility consult with a prior diagnosis of polycystic ovarian syndrome. Evaluation for oligomenorrhea found an elevated prolactin level of 69.76 ng/mL, an elevated DHEA-S of 524, and HgbA1c of 5.7%. The patient denied visual or neurological symptoms. Infertility treatment was started, and magnetic resonance imaging (MRI) of the brain was recommended; however, the patient forewent imaging. Within a few months, she was pregnant. At 27 weeks of gestation, the patient developed sudden visual field loss to the right eye and presented to her optometrist. MRI of the pituitary identified a sellar mass with suprasellar extension, consistent with a recently hemorrhaged pituitary macroadenoma or pituitary apoplexy with displacement of the optic chiasm. Due to the risks of permanent optic nerve damage, the patient underwent endoscopic endonasal transsphenoidal hypophysectomy with intraoperative fetal monitoring at 30 weeks 1 day of gestation. At 39 weeks of gestation a cesarean section was performed due to the recent procedure. Her delivery and postpartum period were without complications. Discussion: Pituitary apoplexy presenting in pregnancy is a rare and potentially life-threatening disorder due to an acute ischemic infarction or hemorrhage of the pituitary gland. Surgical management of the pituitary gland in pregnancy is rarely recommended, except in cases of severe visual disturbance and uncontrolled Cushing's disease.
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Type 2 scleredema on the background of monoclonal gammopathy of undetermined significance (MGUS) is a rare and progressive connective tissue disorder with very few cases reported to date. It is characterized by chronic and diffuse induration of the skin that begins in the upper back and neck and progresses proximally to distally, involving the shoulders, trunk, and arms; the hands are usually spared. Here, we present an unusual case of long-standing scleredema that progressed to involve the hands and fingers. This case was further complicated by new-onset Raynaud's phenomenon, splenomegaly, lymphadenopathy, the development of a plasmacytoma, and eventual progression to multiple myeloma. We highlight the differential diagnoses for his complex presentation, the workup that was completed, and current treatment options.
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Understanding the mechanisms behind critical thermal maxima (CTmax; the high body temperature at which neuromuscular coordination is lost) of organisms is central to understanding ectotherm thermal tolerance. Body size is an often overlooked variable that may affect interpretation of CTmax, and consequently, how CTmax is used to evaluate mechanistic hypotheses of thermal tolerance. We tested the hypothesis that body size affects CTmax and its interpretation in two experimental contexts. First, in four Sceloporus species, we examined how inter- and intraspecific variation in body size affected CTmax at normoxic and experimentally induced hypoxic conditions, and cloacal heating rate under normoxic conditions. Negative relationships between body size and CTmax were exaggerated in larger species, and hypoxia-related reductions in CTmax were unaffected by body size. Smaller individuals had faster cloacal heating rates and higher CTmax, and variation in cloacal heating rate affected CTmax in the largest species. Second, we examined how body size interacted with the location of body temperature measurements (i.e., cloaca vs. brain) in Sceloporus occidentalis, then compared this in living and deceased lizards. Brain temperatures were consistently lower than cloacal temperatures. Smaller lizards had larger brain-cloacal temperature differences than larger lizards, due to a slower cloacal heating rate in large lizards. Both live and dead lizards had lower brain than cloacal temperatures, suggesting living lizards do not actively maintain lower brain temperatures when they cannot pant. Thermal inertia influences CTmax data in complex ways, and body size should therefore be considered in studies involving CTmax data on species with variable sizes.