RESUMEN
BACKGROUND: Reports of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have focused on pregnant women hospitalized due to moderate to severe coronavirus disease 2019 (COVID-19) or asymptomatic women diagnosed through universal screening at the time of obstetric admission. Many pregnant women who have symptomatic SARS-CoV-2 infection may not meet criteria for hospitalization; however, whether and how these women can be managed safely in outpatient setting is not well described. METHODS: We sought to describe the time to symptom and viral clearance and to identify predictors of hospitalization to better understand the safety of monitoring pregnant patients with symptomatic COVID-19 in the outpatient setting. We performed a retrospective cohort study of pregnant patients with symptomatic, confirmed COVID-19 illness at a large, academic medical center. Patients had systematic telehealth follow up by a clinician team to assess for symptoms, provide virtual prenatal care, and arrange in-person visits when appropriate in a dedicated outpatient center. Data were collected via chart abstraction. RESULTS: Of 180 pregnant patients presenting with symptoms and undergoing reverse-transcription polymerase chain reaction (RT-PCR) testing, 67 patients with confirmed COVID-19 infection were identified during the study period. Nineteen (28%) required acute care given worsening of COVID-19 symptoms, and 95% of these were directed to this acute care setting due to symptom severity telehealth evaluation. Nine women (13%) were admitted to the hospital given worsening symptoms, 3 required intensive care unit care, 2 required ventilatory support, and 2 required delivery. Women with the presenting symptoms of fever, cough, shortness of breath, chest pain, or nausea and vomiting were more likely to require admission. The median duration from initial positive test to RT-PCR viral clearance was 26 days. Disease progression, time to viral clearance, and duration of symptoms did not vary significantly by trimester of infection. CONCLUSIONS: Management of the majority of pregnant women with symptomatic COVID-19 illness can be accomplished in the outpatient setting with intensive and protocol-driven monitoring for symptom progression.
RESUMEN
In recent years there has been interest in possible differential behavioral functions of the core and shell subregions of the nucleus accumbens. The present study compared the effects of accumbens core and shell injections of (+)-amphetamine on turning behavior in rats; the turning effects of the selective D2 antagonist (-)-eticlopride injected into the shell were also tested. Rats (n = 28) were implanted unilaterally with guide cannulae and subsequently tested for turning in seven 20-min sessions. Amphetamine (10.0 and 20.0 microg but not 5.0 microg/ 0.5 microl) elicited contralateral turning following injection into the shell, while the same doses into the core had no effect. In animals given systemic amphetamine (2.0 mg/kg), eticlopride (10.0 but not 1.0 or 0.1 microg/0.5 microl) injected into the shell region of the accumbens produced ipsilateral turning. These results suggest that the accumbens shell, but not the core, is a critical site for turning behavior.
