Pregnancy and postpartum outcomes in a universally tested population for SARS-CoV-2 in New York City: a prospective cohort study.

OBJECTIVE: To describe differences in outcomes between pregnant women with and without coronavirus dsease 2019 (COVID-19). DESIGN: Prospective cohort study of pregnant women consecutively admitted for delivery, and universally tested via nasopharyngeal (NP) swab for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) using reverse transcription-polymerase chain reaction. All infants of mothers with COVID-19 underwent SARS-CoV-2 testing. SETTING: Three New York City hospitals. POPULATION: Pregnant women >20 weeks of gestation admitted for delivery. METHODS: Data were stratified by SARS-CoV-2 result and symptomatic status, and were summarised using parametric and nonparametric tests. MAIN OUTCOME MEASURES: Prevalence and outcomes of maternal COVID-19, obstetric outcomes, neonatal SARS-CoV-2, placental pathology. RESULTS: Of 675 women admitted for delivery, 10.4% were positive for SARS-CoV-2, of whom 78.6% were asymptomatic. We observed differences in sociodemographics and comorbidities among women with symptomatic COVID-10 versus asymptomatic COVID-19 versus no COVID-19. Caesarean delivery rates were 46.7% in symptomatic COVID-19, 45.5% in asymptomatic COVID-19 and 30.9% in women without COVID-19 (P = 0.044). Postpartum complications (fever, hypoxia, readmission) occurred in 12.9% of women with COVID-19 versus 4.5% of women without COVID-19 (P < 0.001). No woman required mechanical ventilation, and no maternal deaths occurred. Among 71 infants tested, none were positive for SARS-CoV-2. Placental pathology demonstrated increased frequency of fetal vascular malperfusion, indicative of thrombi in fetal vessels, in women with COVID-19 versus women without COVID-19 (48.3% versus 11.3%, P < 0.001). CONCLUSION: Among pregnant women with COVID-19 at delivery, we observed increased caesarean delivery rates and increased frequency of maternal complications in the postpartum period. Additionally, intraplacental thrombi may have maternal and fetal implications for COVID-19 remote from delivery. TWEETABLE ABSTRACT: COVID-19 at delivery: more caesarean deliveries, postpartum complications and intraplacental thrombi.

Evaluation of the Tekscan F-SCAN system for measurement of the kicking force in horses.

INTRODUCTION: The incidence of fractures after a kick, coupled with marked soft tissue trauma at the site of injury, suggests that the force of a kick from the hind limb of a horse is enormous. The goal of this study was to measure this force and to investigate whether the Tekscan F-SCAN in-shoe pressure measuring system is suitable for quantification of the impact strength of a kick from a horse. The system was tested in 6 horses that had undergone clinical examination and gait analysis. The sensor-shoe combination was attached to each hind foot and the horse was stimulated to kick against a wall. The F-SCAN system measured the maximum vertical and horizontal force (N), the main contact area (cm2) of the sole with the floor (stance phase limb) or wall (kicking limb) and the duration (sec) that the sole was in contact with the floor or wall. In addition, each kicking event was recorded with a video camera for subjective evaluation. The mean kicking force measured was lower than that recorded in horses trotting on a treadmill, where the forces exerted on one limb were similar to the horse's body weight. The results of this study indicate that the Tekscan F-SCAN system is not ideally suited to measure the force of a kick of a horse in vivo.

INTRODUCTION: La fréquence des fractures et les importants dégâts aux tissus mous consécutifs à des coups de pieds laissent à penser que la force de frappe transmise à cette occasion doit être très importante. Le but du présent travail était de mesurer cette force et de voir si le système F-Scan Tekscan est adapté pour quantifier la force de frappe d'un cheval. Après un examen clinique et orthopédique, le système a été utilisé sur 6 chevaux, en incluant le senseur dans une hipposandale et en stimulant ensuite le cheval pour qu'il rue contre une paroi. Le système F-Scan a mesuré lors de chaque coup de pied la force maximale verticale respectivement horizontale (N), la surface de contact (cm2) de la sole avec le sol (membre à l'appui) ou avec la paroi (membre donnant le coup) ainsi que la durée de contact avec le sol respectivement avec la paroi. Chaque coup de pied a simultanément été enregistré sur vidéo et le force du coup a été estimée subjectivement. Les forces mesurées étaient toutefois plus faibles que celles enregistrées chez des chevaux au trot sur un tapis roulant dans une étude précédente. Les forces exercées sur les membres étaient globalement égales au poids du cheval. Les résultats de notre étude laissent à penser que le système F-Scan Tekscan n'est pas idéal pour mesurer la force de frappe d'un cheval.

Evaluation of dietary and management risk factors for enterolithiasis among horses in California.

Enteroliths are intestinal calculi that result in intestinal obstruction and colic in horses. Equine enterolithiasis occurs worldwide, but the disease is particularly prevalent in some geographic locations, including California. The objectives of this study were to evaluate dietary and environmental risk factors for the disease. This was accomplished through a case-control study by comparing horses with colic from enterolithiasis presenting to the University of California, Davis VMTH, to horses with colic of other causes. Data were collected on 61 horses with enterolithiasis and 75 controls via evaluation of patient records and questionnaires completed by owners at the time of admission. Following multiple logistic regression analysis, the following factors were found to be significantly associated with enterolithiasis: feeding > or = 50% of the diet as alfalfa; feeding <50% of the diet as oat hay; feeding <50% of the diet as grass hay; and lack of daily access to pasture grazing.

Effect of emptying the vasculature before performing regional limb perfusion with amikacin in horses.

REASONS FOR PERFORMING STUDY: Emptying the vasculature with an Esmarch bandage before i.v. regional anaesthesia is commonly performed in human patients to prevent leakage of the solution under the tourniquet but there is no evidence for its efficacy in horses for antimicrobial i.v. regional limb perfusion (IV-RLP). OBJECTIVES: To determine the effect on synovial fluid concentration of amikacin of emptying the vasculature before performing IV-RLP. STUDY DESIGN: Crossover experiment. METHODS: Eight clinically healthy horses underwent 2 IV-RLP with amikacin in a randomised, crossover design. Horses received an IV-RLP with amikacin with or without exsanguination before applying a pneumatic tourniquet at the level of the forearm. Blood was collected from the jugular vein (before tourniquet removal) and synovial fluid from the radiocarpal and metacarpophalangeal joints (5 min after tourniquet removal and at 24 h) for amikacin determination. The procedure was video recorded to assess horse movement. RESULTS: There was no difference in amikacin concentrations in the plasma or synovial fluid from the radiocarpal joint between groups. There was a higher concentration of amikacin in the synovial fluid from the metacarpophalangeal joint immediately after tourniquet removal in the group with exsanguination of the limb prior to IV-RLP (mean ± s.d.: no exsanguination 49.7 ± 53.7 µg/ml, exsanguination 257.4 ± 149.7 µg/ml, P = 0.04). Horse movement did not differ significantly between groups. CONCLUSIONS: Emptying the vasculature with an Esmarch bandage before IV-RLP can improve amikacin concentrations in the metacarpophalangeal joint of horses with no effect on the levels of amikacin in the radiocarpal joint.

Evaluation of peritoneal fluid lactate as a marker of intestinal ischaemia in equine colic.

REASONS FOR PERFORMING STUDY: The most common cause of death as a direct result of colic is acute circulatory failure secondary to intestinal ischaemia. Early and accurate recognition of ischaemic bowel is essential to decrease complications and increase survival. Blood to peritoneal lactate values have been evaluated as a prognostic indicator, but lactate values characterised by type of lesion have not been reported. HYPOTHESIS: Plasma and peritoneal lactate values are higher in horses with intestinal ischaemia secondary to a strangulating obstruction (ISSO). METHODS: Venous blood and peritoneal fluid were collected sequentially from 20 clinically healthy horses and 189 horses admitted for colic during a one-year period. Blood gas, pH, electrolyte (K+, Na+, Ca++, Cl-), glucose and lactate values were determined for blood and peritoneal fluid samples; other values recorded for peritoneal fluid included gross appearance, total protein and nucleated cell count. Information regarding diagnosis, treatment and outcome was retrieved from the medical records. RESULTS: Peritoneal and plasma levels of lactate were lower in control compared to clinical cases. Horses with ISSO had a higher peritoneal lactate value (8.45 mmol/l) than those with nonstrangulating obstruction (2.09 mmo/l). Factors with the strongest correlations with the presence of ISSO were changes in the gross appearance of the peritoneal fluid and values of peritoneal fluid chloride, pH and log10 lactate. CONCLUSIONS: Analysis of peritoneal fluid gross appearance, pH, lactate and chloride can be used for diagnosis of ISSO. POTENTIAL RELEVANCE: Peritoneal fluid lactate is a better predictor of ISSO than blood lactate and may aid in early detection of catastrophic peritoneal lesions such as intestinal strangulation and rupture.

Assessment of visual function in patients with age-related macular degeneration and low visual acuity.

The visual function of 100 eyes with low visual acuity of 100 patients with age-related macular degeneration was examined using measurements of visual acuity, peak contrast sensitivity, and the ability to read, to tell time, and to distinguish colors, products, and facial expressions. Visual acuity and peak contrast sensitivity were correlated (r = .62); however, a range of peak contrast sensitivities was observed at each level of acuity. When considered individually, visual acuity and peak contrast sensitivity were related to the ability to perform each of the tasks. When multivariate methods were applied, both visual acuity and peak contrast sensitivity contributed independently to the ability to read and tell time. Among patients with the same contrast sensitivity, visual acuity had little or no relationship to the ability to identify colors, products, and faces.

Combined sonographic-pathologic surveillance in elective first-trimester termination of pregnancy.

In this study, we attempted to develop a surveillance protocol for elective first-trimester termination to see whether unsuspected ectopic pregnancy could be detected earlier, and to identify those patients with unsuspected second-trimester pregnancies that could be terminated more safely in the hospital. Two hundred fifty consecutive patients requesting elective termination were studied prospectively. All were 12 weeks or less by last menstrual period, had positive urinary pregnancy tests, and had no history of vaginal bleeding. All patients had ultrasound screening before curettage. Immediately after curettage, a "modified" gross pathologic examination (3X magnification) was also performed on unstained curettage material. The sonographic, operative, and pathologic findings were all correlated. Such screening identified four patients with unruptured ectopic pregnancies, who were operated on the same day as the curettage. In addition, four patients, who were actually in the second trimester but had inaccurate dates, were identified and referred to hospital for appropriate methods of termination. We conclude that such surveillance may reduce morbidity in elective terminations and more rapidly identify unsuspected ectopic pregnancies.

Very early pregnancy detection with endovaginal ultrasound.

There are many situations in which the earliest possible detection of an intrauterine pregnancy would enhance clinical management. Current radioimmunoassays for hCG can detect pregnancy as early as eight to 12 days post-conception. The ability to document an intrauterine pregnancy with ultrasound has lagged behind by two to three weeks. New high-frequency endovaginal transducers offer the promise of narrowing this gap. This study was undertaken prospectively on 235 patients all amenorrheic for seven weeks or less and requesting either pregnancy testing or termination. All had endovaginal ultrasound scans. We obtained hCG levels when no sac was seen or when the sac was less than 1.0 cm (initial experience revealed that all sacs over 1.0 cm were associated with hCG levels over 6000 mIU/mL) (International Reference Preparation). Ultrasound findings were correlated with pathology specimens and/or hCG levels where appropriate. Results indicated that normal pregnancies can be imaged when: 1) The sac is greater than 0.4 cm; 2) hCG is greater than 1025 mIU/mL (International Reference Preparation); and 3) the uterus is normal with a homogeneous echo pattern. This was not true in three of our cases with diffuse myomatous changes or a coexisting intrauterine device.

Tubal sterilization by bipolar laparoscopy: report of 232 cases.

Two hundred thirty-two interval bipolar laparoscopic tubal sterilizations were performed in a university-affiliated community teaching hospital over a 3-year period. Advanced laparoscopy equipment, properly trained laparoscopists, and a system of delineated operating privileges were used; the complication rate was 0.8%. There was 1 intraoperative complication, and 1 postoperative complication that manifested itself on postoperative day 3. Neither complication was related to the electrocauterization. The cauterized segments of fallopian tube were intentionally transected in 195 (84%) of the patients. The equipment and methodology employed are discussed with comparison of bipolar electrocautery to mechanical nonelectric methods of laparoscopic sterilization, ie, bands and clips. The authors' preference for bipolar electrocautery tubal sterilization, using single-segment cauterization with tubal transection, is discussed.

PIP: 232 interval bipolar laparoscopic tubal sterilizations were performed in a university-affiliated community teaching hospital over a 3-year period. Advanced laparoscopy equipment, properly trained laparoscopists, and a system of delineated operating privileges were used; the complication rate was .8%. There was 1 intraoperative complication and 1 postoperative complication that manifested itself on postoperative day 3. Neither complication was related to the electrocauterization. The cauterized segments of fallopian tube were intentionally transected in 195 (84%) of the patients. The equipment and methodology employed are discussed with comparison of bipolar electrocautery to mechanical nonelectric methods of laparoscopic sterilization, i.e., bands and clips. The authors' preference for bipolar electrocautery tubal sterilization, using single-segment cauterization with tubal transection, is discussed.

Estimation of nongravid uterine volume based on a nomogram of gravid uterine volume: its value in gynecologic uterine abnormalities.

To facilitate accurate and standard methods of reporting pathologic uterine corpus enlargement, we constructed a nomogram using the gravid uterine corpus volumes from five to 20 weeks' gestation in 186 patients. The volume was calculated by measuring the maximum length and anteroposterior and transverse diameters of the uterine corpus, and using the formula for the volume of a prolate ellipsoid: V = 0.52 X (L X AP X T). Clinicians can use the nomogram for better understanding in assessing uterine volume.

The postmenopausal cystic adnexal mass: the potential role of ultrasound in conservative management.

Often ovarian cancer does not present clinically until the advanced stages. In the past, the presence of any cystic adnexal enlargement in postmenopausal women was an indication for surgical exploration. The ultrasound scans of 42 postmenopausal women with simple adnexal cysts were reviewed. We included only patients who were available for follow-up and who had cysts that were less than or equal to 5 cm in maximum diameter, unilocular (ie, without septations or solid components), and without ascites. Of these patients, 26 underwent prompt surgical exploration. All exhibited benign histopathology. In 16 patients, serial sonographic surveillance was performed every 3-6 months. Two of these patients had exploratory laparotomy at 6 and 9 months of observation; the first operation, for increasing size and septation, demonstrated a cystadenofibroma, and the second, for increasing pain, demonstrated a degenerating myoma. The remaining 14 patients were followed from 10-73 months without any change in size or character of the cyst. Small (less than 5 cm), unilocular postmenopausal cysts had a low incidence of malignant disease (0%) in this series of 28 surgical specimens. Therefore, serial ultrasound follow-up without surgical intervention may play a role in the clinical management of such patients.

A comparison of career-entry administrative competencies with skills required in practice: implications for continuing education.

Dietitians, advancing in practice, are often required to fill expanding administrative roles without the benefit of additional formal preparation. A study was conducted to compare career-entry administrative competence with competence needed for current practice. The survey instrument contained 59 generic administrative competency statements categorized under the headings of organization and administration; leadership and supervision; personnel management; space, equipment, and materials management; communications; financial management; and quality assurance of services. The questionnaire was sent to the 138 administrative dietitians practicing in Nebraska. Completed questionnaires were returned from 50 dietitians, a 35% response rate. Results of a Student t-test analysis indicated a statistically significant difference between the two competency levels for each major category of administrative skills. The data support the need for multiple continuing education opportunities for dietitians to develop skills needed for their expanding managerial responsibilities.

Deoxygenated and alkylated furanoses: Thorpe-Ingold effects on tautomeric equilibria and rates of anomerization.

2-Deoxy-D-glycero-tetrose, 3-deoxy-DL-glycero-tetrose, 3-deoxy-3,3-di-C-methyl-DL-glycero-tetrose, 3-C-methyl-DL-erythrose, 3-C-methyl-DL-threose, 2-deoxy-5-O-methyl-D-erythro-pentose and 3-deoxy-5-O-methyl-D-erythro-pentose have been prepared, in some cases with 13C-substitution at the anomeric carbon, and characterized by 1H-(300 and 620 MHz) and 13C-n.m.r. (75 MHz) spectroscopy. The proportions of cyclic (alpha and beta furanoses) and acyclic (aldehyde and hydrate) forms were determined in aqueous (2H2O) solution, and ring-opening (kopen) and ring-closing (kclose) rate constants were measured by 1H and 13C saturation-transfer n.m.r. spectroscopy at p2H 5.0 (acetate buffer) and 60 degrees. The degree of furanose ring substitution was found to significantly affect both the thermodynamics and kinetics of furanose anomerization. Increased substitution enhances the proportion of cyclic forms in solution by stimulating furanose kclose. In contrast, furanose kopen was less affected by the degree of substitution; however, kinetic studies of 2-deoxyfuranose anomerization implicate furanose ring conformation as a potential determinant of kopen.

Synthesis and n.m.r.-spectral analysis of unenriched and [1-13C]-enriched 5-deoxypentoses and 5-O-methylpentoses.

Chemical methods are described for preparing unenriched and [1-13C]-enriched 5-deoxy- and 5-O-methyl-pentoses in the D or L configuration. The 1H-n.m.r. spectra of these compounds have been interpreted, and the 13C-n.m.r. spectra assigned with the aid of 2-D 13C-1H chemical-shift correlation spectroscopy. Tautomeric forms (furanoses, hydrate, and aldehyde) in solution in 2H2O have been quantified with the aid of [1-13C]-enriched derivatives. Spectra of 5-deoxypentoses, 5-O-methylpentoses, and methyl pentofuranosides have been compared, in order to assess the effect of 5-C-deoxygenation and 5-O-methylation on chemical shifts and coupling constants (1H-1H, 13C-1H, and 13C-13C) and on the pentofuranose conformations.

Furanose ring anomerization: a kinetic study of the 5-deoxypentoses and 5-O-methylpentoses.

The anomerization of 5-deoxy-L-pentoses (1-4) and 5-O-methyl-D-pentoses (5-8) in aqueous solution has been studied by 13C saturation-transfer n.m.r. (s.t.-n.m.r.) spectroscopy, using compounds substituted with 13C at the anomeric carbon atom. Unidirectional rate-constants of ring-opening (k open) and ring-closing (k close) have been obtained for these compounds under identical solution conditions (50mM acetate buffer, pH 4.0 at 60 degrees), and have been compared to those measured for the D-tetroses (9 and 10) and the four D-pentose 5-phosphates (11-14). Based on these comparisons, several correlations between furanose structure and reactivity have been revealed, and models have been proposed to explain the observed kinetic behavior of compounds (1-10). The effect of exocyclic structure on acid-catalyzed rate-constants was also examined by comparing the behavior of 5-deoxy-L-(1-13C)-lyxose and 5-O-methyl-D-(1-13C)lyxose. Some consideration has been given to identifying the factors (enthalpic and entropic) that may play roles in determining the effect of structure on anomerization reactivity.

DL-apiose substituted with stable isotopes: synthesis, n.m.r.-spectral analysis, and furanose anomerization.

The branched-chain pentose DL-apiose has been synthesized in good yield by a new and simple chemical method that can be adapted to prepare (1-13C)-, (2-13C)-, (1-2H)- and/or (2-2H)-enriched derivatives. N.m.r. spectra (1H- and 13C-) have been interpreted with the aid of selective (13C)- and (2H)-enrichment, and 2D and 13C[13C]-n.m.r. spectra. The solution composition of DL-(1-13C)apiose in 2H2O, determined by 13C-n.m.r. spectroscopy, has been found to differ from that determined previously by 1H-n.m.r. spectroscopy. Several 13C-1H and 13C-13C couplings have been measured and interpreted in terms of apiofuranose ring conformation. Ring-opening rate-constants of the four apiofuranoses [3-C-(hydroxymethyl)-alpha- and -beta-D-erythrofuranose, and 3-C-(hydroxymethyl)-alpha- and -beta-L-threofuranose] have been determined by 13C-saturation-transfer n.m.r. spectroscopy, and compared to those obtained previously for the structurally related tetrofuranoses.

An analysis of inservice education practices for hospital laboratory personnel.

Inservice education is a form of continuing professional education provided by the health care employer at the worksite. The purposes of this study were to describe current inservice practices in clinical laboratories and to explore laboratory managers' perceptions of the job impact and cost-worthiness of specific inservice education activities. A written survey was mailed to 237 hospitals in Ohio to gather data. Results of the study (61% usable return) were analyzed using descriptive statistics. Notable findings include: Most laboratories do not have an inservice budget; most important for cost worthiness and job impact are new employee orientation, policy and procedure discussions, and instruction on instrumentation. The report discusses ratings of several inservice activities in terms of their value for improving employees' knowledge, skills, and attitudes.

Ratio of gestational sac volume to crown-rump length in early pregnancy.

The sine qua non of fetal well-being in the first trimester is considered to be the presence of fetal cardiac activity. Despite fetal viability, some pregnancies might have a sac that is too large or small for the gestational age, even in the first trimester. As a first step in evaluating this hypothesis, a nomogram was constructed for the ratio of normal sac volume to crown-rump length.

The role of thermography in the management of equine lameness.

Equine thermography has increased in popularity recently because of improvements in thermal cameras and advances in image-processing software. The basic principle of thermography involves the transformation of surface heat from an object into a pictorial representation. The colour gradients generated reflect differences in the emitted heat. Variations from normal can be used to detect lameness or regions of inflammation in horses. Units can be so sensitive that flexor tendon injuries can be detected before the horse develops clinical lameness. Thermography has been used to evaluate several different clinical syndromes not only in the diagnosis of inflammation but also to monitor the progression of healing. Thermography has important applications in research for the detection of illegal performance-enhancing procedures at athletic events.

Surgical treatment for colic in the foal (67 cases): 1980-1992.

Sixty-seven foals age < 150 days underwent a ventral celiotomy for colic. Of the 67 foals, 51 foals (82%) recovered from anaesthesia and 42 (63%) were subsequently released from the hospital. Three (6%) of the 51 foals were subjected to a repeat celiotomy. Long term follow-up was available on 36 foals. Twenty-nine (57%) of the 51 foals recovered from anaesthesia, were alive at least 2 years following surgery. Adhesions were identified in 8 (17%) of the foals which recovered from general anaesthesia but were subsequently subjected to euthanasia due to recurrent colic. Strangulating lesions were associated with a lower survival rate. Nineteen per cent of foals with strangulating intestinal lesions survived > 2 years following surgery, compared to 69% of foals with nonstrangulating lesions. The age of foals on admission had a significant effect on survival. Only 10% of foals less than 14 days of age survived, compared to 45.8% of foals between age 15 and 150 days.