The Chirality of Aggregated Yariv Reagents Correlates with Their AGP-Binding Ability.

Yariv reagents are glycosylated triphenylazo dyes that bind to arabinogalactan proteins (AGPs), proteoglycans found in plant cell walls that are integral for plant growth and development. Yariv reagents are widely utilized as imaging, purification, and quantification tools for AGPs and represent the only small molecule probe for interrogating AGP function. The ability of Yariv reagents to bind to AGPs is dependent on the structure of the terminal glycoside on the dye. The reason for this selectivity has not been understood until the present work. Using circular dichroism spectroscopy, we show that the Yariv reagents form supramolecular aggregates with helical chirality. More significantly, the ability of the Yariv reagent to bind AGPs is correlated with this helical chirality. This finding paves the way towards developing a more detailed understanding of the nature of the Yariv-AGP complex, and the design of AGP-binding reagents with higher affinities and selectivities.

Female pelvic medicine & reconstructive surgery (FPMRS) challenges on behalf of the collaborative research in pelvic surgery consortium (CoRPS): managing complicated cases series 7: can fibroids worsen incontinence?

This case presents the work-up and management of a patient with a fibroid uterus and urinary incontinence. Five international experts also provide their evaluation and approach to this case. According to the literature, there is uncertainty surrounding the relationship between fibroids and urinary incontinence. The experts emphasize patient counseling and a staged approach.

Development of Home Educational Materials for Families of Preterm Infants.

INTRODUCTION: Parent educational materials describing infant positioning for a home program are vital in supplementing NICU discharge instructions and promoting parent confidence. PURPOSE: To document the process of developing a brochure and DVD of a positioning program, using evidence-based practice and NICU expert feedback. METHODS: A trifold brochure and companion DVD were developed to demonstrate infant positioning to parents of premature infants for a home developmental program following NICU discharge. A standard process of development was followed for the brochure and DVD script and production. The process included review and comment by eight NICU professionals and several revisions. RESULTS: Content of the brochure and DVD and the process entailed in their development is described. Guidelines outlining the process for development of educational materials for families are provided. CONCLUSION: Creation of multimedia educational materials for parents of infants who are NICU graduates requires a multistep process to ensure usefulness and validity.

Review of the Assessment and Management of Perinatal Mood and Anxiety Disorders.

Perinatal mood and anxiety disorders (PMADs) are the most common complication of childbirth. When poorly controlled, they are associated with worse obstetric outcomes, such as higher rates of preterm birth and unplanned cesarean delivery. They are also associated with suicide, a leading cause of perinatal maternal death. This article provides an overview of evidence-based recommendations for screening, assessment, and management of PMADs, including suicide risk assessment and management and pharmacological and nonpharmacological treatment options compatible with pregnancy and lactation. Although specialized reproductive psychiatrists can provide expert guidance for the management of PMADs, their scarcity means that most patients will not have access to this expert care and instead will seek guidance from general psychiatrists. This article provides a clinical guide for generalists that is based on the best current evidence, including recently released treatment guidelines.

Maternal anxiety, depression and posttraumatic stress disorder (PTSD) after natural disasters: a systematic review.

OBJECTIVE: To measure the prevalence of maternal anxiety, depression and posttraumatic stress disorder (PTSD) in those exposed to natural disasters. METHODS: A literature search of the PubMed database and www.clinicaltrials.gov from January 1990 through June 2020 was conducted. A PRISMA review of the available literature regarding the incidence and prevalence of maternal anxiety, depression and posttraumatic stress disorder (PTSD) following natural disasters was performed. A natural disaster was defined as one of the following: pandemic, hurricane, earthquake and post-political conflict/displacement of people. Studies were selected that were population-based, prospective or retrospective. Case reports and case series were not used. The primary outcome was the prevalence of maternal anxiety, depression and PTSD in the post-disaster setting. Two independent extractors (I.F. & H.G.) assessed study quality using an adapted version of the Effective Public Health Practice Project Quality Assessment tool. Given the small number of studies that met inclusion criteria, all 22 studies were included, regardless of rating. Data were extracted and aggregate rates of depression, anxiety, and PTSD were calculated to provide synthesized rates of maternal mental health conditions among participants. RESULTS: Twenty-two studies met the inclusion criteria. A total of 8357 pregnant or birthing persons in the antepartum and postpartum periods were studied. The prevalence of post-pandemic anxiety, depression and PTSD were calculated to be 48.2%, 27.3%, and 22.9%. Post-earthquake depression and PTSD rates were 38.8% and 22.4%. The prevalence of post-hurricane anxiety, depression and PTSD were 17.4%, 22.5%, and 8.2%. The rates of post-political conflict anxiety, depression and PTSD were 48.8%, 31.6% and 18.5%. CONCLUSION: Given the high rates of anxiety, depression and PTSD among pregnant and birthing persons living through the challenges of natural disasters, obstetrician-gynecologists must be able to recognize this group of patients, and provide a greater degree of psychosocial support.

Eltrombopag use for refractory immune thrombocytopenia in pregnancy: A case report.

BACKGROUND: Immune thrombocytopenic purpura (ITP) is a rare autoimmune disorder that involves platelet destruction in the spleen. Eltrombopag (Promacta®), a thrombopoietin agonist, has been used in non-pregnant patients to manage ITP, but few cases of its use in pregnancy have been reported. CASE PRESENTATION: We present a case of a pregnant patient at 26 weeks of gestation with severe refractory ITP. After first-line therapies failed, the patient was treated with the drug eltrombopag. The patient had no response to initial therapy, and the fetus developed supraventricular tachycardia (SVT). This resolved with maternal digoxin but the patient elected to stop the eltrombopag. The patient refused further experimental and second-line treatments, and after a multidisciplinary meeting a decision was made to deliver by cesarean section at 30 weeks of gestation due to severe refractory ITP and allow other therapies to be tried postpartum. Preeclampsia and neonatal atrial flutter were encountered in the postpartum period but both mother and baby had good outcomes. CONCLUSION: Refractory ITP in pregnancy is not well studied. Eltrombobag could have maternal and fetal side-effects but a multidisciplinary approach to management leads to favorable maternal and fetal outcomes.

The effect of music on anxiety in women undergoing cesarean delivery: a systematic review and meta-analysis.

OBJECTIVE: This study aimed to evaluate the effect of music on anxiety in patients undergoing cesarean delivery. DATA SOURCES: An electronic search of PubMed, CINAHL, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials was performed from inception to November 2020. STUDY ELIGIBILITY CRITERIA: Eligibility criteria included all randomized controlled trials of pregnant women undergoing cesarean delivery who were randomized to either the music intervention or control. Studies needed to measure preoperative, intraoperative, or postoperative anxiety via a visual analog scale, State-Trait Anxiety Inventory, or Zung Self-Rating Anxiety Scale, for inclusion. The primary outcome was intraoperative anxiety during cesarean delivery. Secondary outcomes included preoperative and postoperative anxiety, postoperative pain, postoperative opioid requirements, blood pressure, and heart rate. STUDY APPRAISAL AND SYNTHESIS METHODS: The methodologic quality of the included studies was evaluated using the Cochrane Handbook for Systematic Reviews of Interventions. A meta-analysis was performed using the random-effects model of DerSimonian and Laird to produce a summary of treatment effects in terms of mean difference with 95% confidence intervals. A prespecified subgroup analysis of patients undergoing a scheduled or an unscheduled cesarean delivery was carried out for the main outcomes. RESULTS: Of the 1296 studies screened, 15 met the inclusion criteria (n=613 music group vs n=748 controls). Three trials (n=217 music group vs n=215 controls) reported on intraoperative anxiety specifically. Among studies using a visual analog scale for anxiety assessment, women in the intervention group had lower intraoperative anxiety levels than the controls (mean difference, -0.54; 95% confidence interval, -0.87 to -0.20; I2=0%; n=2 studies). One trial used the State-Trait Anxiety Inventory and 1 trial used the Zung Self-Rating Anxiety Scale for intraoperative anxiety assessment. In both of these studies, music exposure was associated with lower anxiety levels when compared with the controls (State-Trait Anxiety Inventory: mean difference, -2.80; 95% confidence interval, -4.57 to -1.03; Zung Self-Rating Anxiety Scale: mean difference, -4.80; 95% confidence interval, -7.08 to -2.52). In the subgroup analyses, the same relationship persisted when the cesarean delivery was unscheduled and when the music was selected by the patient or by the study team. The effect of music on preoperative and postoperative anxiety varied depending on which anxiety assessment tool was used. Music was also associated with decreased opioid use (mean difference, -0.87; 95% confidence interval, -1.55 to -0.19; I2=0%). CONCLUSION: In patients undergoing a cesarean delivery, music is associated with decreased intraoperative anxiety.

Hands-and-knees posturing and fetal occiput anterior position: a systematic review and meta-analysis.

OBJECTIVE: Persistent occiput posterior and occiput transverse positions are associated with adverse maternal and neonatal outcomes. The objective of this study was to assess if the use of hands-and-knees posturing increased the rate of occiput anterior position immediately after posturing during the second stage of labor or at the time of birth. DATA SOURCES: An electronic search of PubMed, EMBASE, Clinicaltrials.gov, and Cochrane Central Register of Controlled Trials was performed from inception to September 2020. STUDY ELIGIBILITY CRITERIA: Eligibility criteria included all randomized controlled trials of singleton gestations at ≥36 weeks' gestation that were randomized to either the hands-and-knees posture group or control group. The primary outcome was a composite of occiput anterior positioning during the second stage of labor or at birth. Individual components of the composite were assessed as secondary outcomes. Additional secondary outcomes were a change to occiput anterior position immediately after the intervention, use of regional anesthesia, duration of labor, mode of delivery, third- or fourth-degree perineal laceration, neonatal birthweight, and Apgar score less than 7 at 5 minutes. METHODS: The methodological quality of all the included studies was evaluated using the Cochrane Handbook for Systematic Reviews of Interventions. A meta-analysis was performed using the random effects model of DerSimmonian and Laird to produce a summary of the treatment effects in terms of relative risk or mean difference with 95% confidence intervals. RESULTS: Of the 1079 studies screened, 5 met the inclusion criteria (n=1727 hands-and-knees posture vs n=1641 controls). When compared with the control group, patients who adopted the hands-and-knees posture had the same rate of occiput anterior positioning in the second stage of labor or at birth (81.2% vs 81.2%; relative risk, 1.03; 95% confidence interval, 0.92-1.14), as well as immediately after the intervention (34.1% vs 18.0%; relative risk, 1.60; 95% confidence interval, 0.88-2.90). On the basis of the post hoc subgroup analysis of patients with an ultrasound-diagnosed malposition before posturing, there was a higher rate of occiput anterior positioning immediately after the intervention (17.0% vs 10.3%; relative risk, 1.63; 95% confidence interval, 1.06-2.52), but this relationship did not persist at delivery. The remainder of the subgroup analyses and secondary outcomes were not significant. CONCLUSION: Adopting a hands-and-knees posture does not increase the rate of occiput anterior positioning at time of delivery.

Are Household Expenditures on Food Groups Associated with Children's Future Heights in Ethiopia, India, Peru, and Vietnam?

Household expenditure surveys, routinely conducted in low-and middle-income countries (LMICs), usually include questions pertaining to recent household expenditures on key food groups. When child anthropometrics are also available, such expenditure data can provide insights into household food purchasing patterns that are associated with subsequent child growth measures. We used data from 6993 children, born around 2001, from Ethiopia, India, Peru, and Vietnam, from the Young Lives younger cohort. We compared associations between two weeks of household food expenditures (in PPP-Purchasing Power Parity adjusted dollars) on food groups and child height-for-age-Z score (HAZ) at subsequent time points to assess longitudinal associations. Total food expenditures, rural/urban residence, maternal and paternal schooling, and child sex were included in our adjusted models because they may affect the relations between household food group expenditures and future child HAZ. In Ethiopia, India, and Peru every extra PPP$ spent on fats was associated with 0.02-0.07 higher future HAZ. In Vietnam every extra PPP$ spent on starches, was significantly associated with a 0.01 lower future HAZ. Across countries, different patterns of food expenditure and procurement may be differentially critical for predicting child HAZ. Our results demonstrate how expenditures on specific food groups can be associated with children's linear growth. This study provides additional evidence of the utility of longitudinal household food expenditure data in understanding child nutritional status.

Can Nonsterile Gloves for Dermatologic Procedures Be Cost-Effective without Compromising Infection Rates?

Over the last decade, studies have compared the use of sterile gloves (SGs) versus nonsterile gloves (NSGs) on surgical site infection (SSI) rates in Mohs micrographic surgery (MMS). In this study, we sought to determine SSI rates before and after employment of NSGs for dermatologic procedures. Infection data were collected from January 2009 to December 2015 on 7365 tumors treated with MMS and 1620 tumors treated by surgical excision. For MMS procedures using chlorhexidine as the antiseptic, the SSI rate with SGs was 3.39% compared to 3.06% with NSGs. For surgical excisions, the SSI rate was 3.02% with SGs and 4.17% with NSG. Using NSGs for MMS tumor resection and reconstruction can provide cost savings without adversely affecting SSI rates, and could also be considered in dermatologic procedures, including electrodessication and curettage and surgical excisions.

Initial Experience with Telemedicine at a Single Institution.

INTRODUCTION: Several studies have documented the efficacy of and patient satisfaction with video visits in place of face-to-face encounters. We evaluated patient satisfaction by diagnosis and determined whether specific urological diagnoses are more amenable to being managed via remote encounters. A secondary objective was to evaluate patient satisfaction according to patient age and distance from the clinic. METHODS: We conducted a retrospective review of 611 consecutive telemedicine encounters at an urban academic urology practice between October 2015 and December 2016. Patients rated their provider and the videoconference platform on a Likert scale of 1 to 5. Spearman's correlation coefficient was used to correlate age and distance with satisfaction. ANOVA testing was used to determine significant difference in patient satisfaction based on diagnosis. RESULTS: A total of 289 patients (47.2%) completed the survey. Mean patient age was 54.4 years (range 18 to 89) and mean patient distance to the practice was 44.6 miles (range 0.4 to 327.0). Mean patient-provider satisfaction rating was 4.94 (SD 0.32) and mean system satisfaction was 4.63 (SD 0.97). Significant negative correlation was found between age and patient-system satisfaction (CC -0.15, p=0.025) with no significant correlation between satisfaction and distance. ANOVA testing revealed no significant difference in system satisfaction or provider satisfaction across primary diagnoses. CONCLUSIONS: Video visits can be used across a wide variety of diagnoses with high patient satisfaction regardless of distance from a facility. Patient satisfaction with their provider is high regardless of diagnosis but satisfaction with system use may be more variable.