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Fuchs A, Heiselman C, Fassler RP, Korgaonkar-Cherala C, Abuzeid O, Garretto D, Choi J, Avila C, Herrera K, Garry DJ. Ferritin in the nonanemic pregnant patient as a predictor of anemia at delivery. Am J Obstet Gynecol MFM 2024; 6:101375. [PMID: 38583713 DOI: 10.1016/j.ajogmf.2024.101375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 04/01/2024] [Accepted: 04/03/2024] [Indexed: 04/09/2024]
Affiliation(s)
- Anna Fuchs
- Department of Obstetrics and Gynecology and Reproductive Medicine, Renaissance School of Medicine at Stony Brook University, 101 Nicolls Road, HSC T9, Rm 030, Stony Brook, NY 11793
| | - Cassandra Heiselman
- Department of Obstetrics and Gynecology and Reproductive Medicine, Renaissance School of Medicine at Stony Brook University, 101 Nicolls Road, HSC T9, Rm 030, Stony Brook, NY 11793
| | - Richelle P Fassler
- Department of Obstetrics and Gynecology and Reproductive Medicine, Renaissance School of Medicine at Stony Brook University, 101 Nicolls Road, HSC T9, Rm 030, Stony Brook, NY 11793
| | - Chaitali Korgaonkar-Cherala
- Department of Obstetrics and Gynecology and Reproductive Medicine, Renaissance School of Medicine at Stony Brook University, 101 Nicolls Road, HSC T9, Rm 030, Stony Brook, NY 11793
| | - Omar Abuzeid
- Department of Obstetrics and Gynecology and Reproductive Medicine, Renaissance School of Medicine at Stony Brook University, 101 Nicolls Road, HSC T9, Rm 030, Stony Brook, NY 11793
| | - Diana Garretto
- Department of Obstetrics and Gynecology and Reproductive Medicine, Renaissance School of Medicine at Stony Brook University, 101 Nicolls Road, HSC T9, Rm 030, Stony Brook, NY 11793
| | - Jennifer Choi
- Department of Obstetrics and Gynecology and Reproductive Medicine, Renaissance School of Medicine at Stony Brook University, 101 Nicolls Road, HSC T9, Rm 030, Stony Brook, NY 11793
| | - Cecilia Avila
- Department of Obstetrics and Gynecology and Reproductive Medicine, Renaissance School of Medicine at Stony Brook University, 101 Nicolls Road, HSC T9, Rm 030, Stony Brook, NY 11793
| | - Kimberly Herrera
- Department of Obstetrics and Gynecology and Reproductive Medicine, Renaissance School of Medicine at Stony Brook University, 101 Nicolls Road, HSC T9, Rm 030, Stony Brook, NY 11793
| | - David J Garry
- Department of Obstetrics and Gynecology and Reproductive Medicine, Renaissance School of Medicine at Stony Brook University, 101 Nicolls Road, HSC T9, Rm 030, Stony Brook, NY 11793.
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Fields AT, Andraska EA, Kaltenmeier C, Matthay ZA, Herrera K, Nuñez-Garcia B, Jones CM, Wick KD, Liu S, Luo JH, Yu YP, Matthay MA, Hendrickson CM, Bainton RJ, Barrett TJ, Berger JS, Neal MD, Kornblith LZ. Effects of the circulating environment of COVID-19 on platelet and neutrophil behavior. Front Immunol 2023; 14:1130288. [PMID: 36999030 PMCID: PMC10043426 DOI: 10.3389/fimmu.2023.1130288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/23/2023] [Indexed: 04/01/2023] Open
Abstract
Introduction Thromboinflammatory complications are well described sequalae of Coronavirus Disease 2019 (COVID-19), and there is evidence of both hyperreactive platelet and inflammatory neutrophil biology that contributes to the thromoinflammatory milieu. It has been demonstrated in other thromboinflammatory diseases that the circulating environment may affect cellular behavior, but what role this environment exerts on platelets and neutrophils in COVID-19 remains unknown. We tested the hypotheses that 1) plasma from COVID-19 patients can induce a prothrombotic platelet functional phenotype, and 2) contents released from platelets (platelet releasate) from COVID-19 patients can induce a proinflammatory neutrophil phenotype. Methods We treated platelets with COVID-19 patient and disease control plasma, and measured their aggregation response to collagen and adhesion in a microfluidic parallel plate flow chamber coated with collagen and thromboplastin. We exposed healthy neutrophils to platelet releasate from COVID-19 patients and disease controls and measured neutrophil extracellular trap formation and performed RNA sequencing. Results We found that COVID-19 patient plasma promoted auto-aggregation, thereby reducing response to further stimulation ex-vivo. Neither disease condition increased the number of platelets adhered to a collagen and thromboplastin coated parallel plate flow chamber, but both markedly reduced platelet size. COVID-19 patient platelet releasate increased myeloperoxidasedeoxyribonucleic acid complexes and induced changes to neutrophil gene expression. Discussion Together these results suggest aspects of the soluble environment circulating platelets, and that the contents released from those neutrophil behavior independent of direct cellular contact.
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Affiliation(s)
- Alexander T. Fields
- Department of Surgery, University of California, San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
| | - Elizabeth A. Andraska
- Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Christof Kaltenmeier
- Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Zachary A. Matthay
- Department of Surgery, University of California, San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
| | - Kimberly Herrera
- Department of Surgery, University of California, San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
| | - Brenda Nuñez-Garcia
- Department of Surgery, University of California, San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
| | - Chayse M. Jones
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Katherine D. Wick
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
- Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA, United States
| | - Silvia Liu
- Department of Pathology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jian-Hua Luo
- Department of Pathology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Yan-Ping Yu
- Department of Pathology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Michael A. Matthay
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
- Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA, United States
| | - Carolyn M. Hendrickson
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Roland J. Bainton
- Department of Anesthesia and Perioperative Care, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Tessa J. Barrett
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University (NYU) Grossman School of Medicine, New York, NY, United States
| | - Jeffrey S. Berger
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University (NYU) Grossman School of Medicine, New York, NY, United States
- New York University (NYU) Center for the Prevention of Cardiovascular Disease, New York University (NYU) Langone Health, New York, NY, United States
- Division of Vascular Surgery, Department of Surgery, New York University (NYU) Grossman School of Medicine, New York, NY, United States
| | - Matthew D. Neal
- Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Lucy Z. Kornblith
- Department of Surgery, University of California, San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
- *Correspondence: Lucy Z. Kornblith,
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Stewart L, Korgaonkar-Cherala C, Parikh B, Shinder E, Heiselman C, Herrera K, Garretto D, Garry D. COVID pandemic effect on prenatal care utilization in women with OUD. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Fuchs A, Heiselman C, Fassler R, Korgaonkar-Cherala C, Abuzeid O, Garretto D, Choi J, Avila C, Herrera K, Garry D. Early Pregnancy Serum Ferritin in the Non-Anemic Patient as a Predictor of Anemia at Delivery. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Matthay ZA, Fields AT, Wick KD, Jones C, Lane HC, Herrera K, Nuñez-Garcia B, Gennatas E, Hendrickson CM, Kornblith AE, Matthay MA, Kornblith LZ. Association of SARS-CoV-2 nucleocapsid viral antigen and the receptor for advanced glycation end products with development of severe disease in patients presenting to the emergency department with COVID-19. Front Immunol 2023; 14:1130821. [PMID: 37026003 PMCID: PMC10070743 DOI: 10.3389/fimmu.2023.1130821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/07/2023] [Indexed: 04/08/2023] Open
Abstract
Introduction There remains a need to better identify patients at highest risk for developing severe Coronavirus Disease 2019 (COVID-19) as additional waves of the pandemic continue to impact hospital systems. We sought to characterize the association of receptor for advanced glycation end products (RAGE), SARS-CoV-2 nucleocapsid viral antigen, and a panel of thromboinflammatory biomarkers with development of severe disease in patients presenting to the emergency department with symptomatic COVID-19. Methods Blood samples were collected on arrival from 77 patients with symptomatic COVID-19, and plasma levels of thromboinflammatory biomarkers were measured. Results Differences in biomarkers between those who did and did not develop severe disease or death 7 days after presentation were analyzed. After adjustment for multiple comparisons, RAGE, SARS-CoV-2 nucleocapsid viral antigen, interleukin (IL)-6, IL-10 and tumor necrosis factor receptor (TNFR)-1 were significantly elevated in the group who developed severe disease (all p<0.05). In a multivariable regression model, RAGE and SARS-CoV-2 nucleocapsid viral antigen remained significant risk factors for development of severe disease (both p<0.05), and each had sensitivity and specificity >80% on cut-point analysis. Discussion Elevated RAGE and SARS-CoV-2 nucleocapsid viral antigen on emergency department presentation are strongly associated with development of severe disease at 7 days. These findings are of clinical relevance for patient prognostication and triage as hospital systems continue to be overwhelmed. Further studies are warranted to determine the feasibility and utility of point-of care measurements of these biomarkers in the emergency department setting to improve patient prognostication and triage.
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Affiliation(s)
- Zachary A. Matthay
- Department of Surgery, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, United States
- *Correspondence: Zachary A. Matthay,
| | - Alexander T. Fields
- Department of Surgery, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, United States
| | - Katherine D. Wick
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
- Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA, United States
| | - Chayse Jones
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
- Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA, United States
| | - H. Clifford Lane
- Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Kimberly Herrera
- Department of Surgery, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, United States
| | - Brenda Nuñez-Garcia
- Department of Surgery, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, United States
| | - Efstathios Gennatas
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, United States
| | - Carolyn M. Hendrickson
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Aaron E. Kornblith
- Department of Emergency Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, United States
| | - Michael A. Matthay
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
- Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA, United States
| | - Lucy Z. Kornblith
- Department of Surgery, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, United States
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Parikh B, Shinder E, Pattanaik R, Herrera K, Garretto D, Garry D, Heiselman C. Wild type through Omicron: Maternal outcomes across COVID-19 waves. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Abuzeid O, Abdelrahman A, LaChance J, Herrera K, Garry D, Abuzeid M. O-058 Obstetric outcomes of twin gestation after In-Vitro Fertilization and Embryo Transfer (IVT-ET) treatment in patients who underwent hysteroscopic septoplasty for subseptate uterus. Hum Reprod 2022. [DOI: 10.1093/humrep/deac104.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Is there an associated increased risk of preterm birth (PTB) in patients who underwent hysteroscopic septoplasty for subseptate uterus (SSU) with twin gestation through IVF-ET?
Summary answer
This study suggests an increased risk of PTB in patients, who underwent hysteroscopic septoplasty for SSU, and subsequently conceived twins after IVF-ET treatment.
What is known already
In general, the incidence of PTB is higher after IVF-ET treatment. In addition, Müllerian uterine anomalies, such as unicornuate uterus, are considered risk factors for PTB, even with singleton pregnancy. Furthermore, historical data suggest that some patients with uterine anomaly may have cervical incompetence. Twin gestation is associated with PTB in approximately 50% of cases. It is assumed that the obstetric outcome of twin gestation after successful septoplasty should be no different from those with normal uterine cavity. The impact of previous septoplasty for SSU on the obstetric outcomes of twin gestation after IVF-ET treatment has not been adequately studied.
Study design, size, duration
This retrospective cohort study included 377 fertility patients who received treatment between 2006-2019. The study group included 162 patients who underwent hysteroscopic septoplasty for SSU and subsequently conceived dichorionic-diamniotic (DI-DI) twins after IVF-ET treatment (Group 1). The control group included 215 patients who had normal endometrial cavity on hysteroscopy (#109) or Transvaginal 3D ultrasound scan with saline sonohysterogram (#106) and subsequently conceived DI-DI twins after IVF-ET treatment (Group 2).
Participants/materials, setting, methods
This study was conducted at an infertility clinic affiliated with an academic hospital. Demographic, clinical, and obstetric outcome data were collected for both groups and compared using appropriate statistical methods. PTB, severe PTB, extreme PTB, and peri-viable birth were defined as < 37 weeks, <32 weeks, <28 weeks and between 20 weeks-25 weeks 6 days gestation respectively.
Main results and the role of chance
There was no significant difference in mean age, BMI and infertility duration or in the incidence of smoking, primary infertility, tubal factors and unexplained infertility between the two groups. There was significantly lower mean baseline FSH levels (p < 0.01), lower incidence of male infertility (p < 0.001) and higher incidence of ovulatory disorders (p < 0.001) and endometriosis (p < 0.05) in Group 1 compared to Group 2. As expected, there was past history of lower parity rate (p < 0.01) and higher miscarriage rate (p < 0.001) in Group 1 compared to Group 2 prior to septum division. There was significantly higher incidence of PTB (72.8% vs 56.3%, p < 0.01), severe PTB (20.3% vs 8.2%, p < 0.01), extreme PTB (8.3% vs 3.9%, p < 0.05), and peri-viable birth (6.3% vs 1.9%, p < 0.05) in Group 1 compared to Group 2. There was no significant difference in cesarean section rate (82.8% vs 87.5%, p = 0.349) between Group1 and Group 2 respectively. There was significantly lower gestational age at birth in weeks (34.0 + 4.0 vs 35.6 + 3.0, p < 0.001), birth weight of the first newborn (2180.5 + 717.9 vs 2436.4 + 606.6, p < 0.001), and the second newborn (2235.2 + 674.2 vs 2398.0 + 537.9, p < 0.05) in grams in Group 1 compared to Group 2.
Limitations, reasons for caution
Our study has limitations being retrospective in nature. Data on cervical length measurements via ultrasound, if performed, was not available. However, recall bias was prevented by retrieving data from that submitted to the Society of Assisted Reproductive Technology. Additionally, procedural variation was reduced as this was a single-center study.
Wider implications of the findings
Our study suggests that twin gestation after IVF-ET in patients who underwent successful hysteroscopic septoplasty for SSU may increase the likelihood of PTB. Such patients may require increased surveillance with ultrasound cervical length and signs for preterm labor. Future research should focus on measures to reduce PTB in such patients.
Trial registration number
Not Applicable
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Affiliation(s)
- O Abuzeid
- Renaissance School of Medicine at Stony Brook University, Maternal Fetal Medicine , Nesconset, U.S.A
| | - A Abdelrahman
- St. Joseph Mercy Oakland Hospital, Maternal Fetal Medicine , Pontiac, U.S.A
| | - J LaChance
- Hurley Medical Center/Michigan State University, Department of Research , Flint, U.S.A
| | - K Herrera
- Renaissance School of Medicine at Stony Brook University, Department of Obstetrics and Gynecology , Stony Brook , U.S.A
| | - D Garry
- Renaissance School of Medicine at Stony Brook University, Department of Obstetrics and Gynecology , Stony Brook , U.S.A
| | - M Abuzeid
- Department of Obstetrics and Gynecology- Hurley Medical Center/Michigan State University, Division of Reproductive Endocrinology and Infertility , Rochester, U.S.A
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Hidrobo-Chavez J, Ramírez-Villacís DX, Barriga-Medina N, Herrera K, León-Reyes A. First Report of Neopestalotiopsis mesopotamica Causing Root and Crown Rot on Strawberry in Ecuador. Plant Dis 2022; 106:1066. [PMID: 34546776 DOI: 10.1094/pdis-06-21-1278-pdn] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- J Hidrobo-Chavez
- Laboratorio de Biotecnología Agrícola y de Alimentos, Colegio de Ciencias e Ingenierías-Agronomía, Universidad San Francisco de Quito USFQ, Campus Cumbayá, Quito 170901, Ecuador
| | - D X Ramírez-Villacís
- Laboratorio de Biotecnología Agrícola y de Alimentos, Colegio de Ciencias e Ingenierías-Agronomía, Universidad San Francisco de Quito USFQ, Campus Cumbayá, Quito 170901, Ecuador
| | - N Barriga-Medina
- Laboratorio de Biotecnología Agrícola y de Alimentos, Colegio de Ciencias e Ingenierías-Agronomía, Universidad San Francisco de Quito USFQ, Campus Cumbayá, Quito 170901, Ecuador
| | - K Herrera
- Laboratorio de Biotecnología Agrícola y de Alimentos, Colegio de Ciencias e Ingenierías-Agronomía, Universidad San Francisco de Quito USFQ, Campus Cumbayá, Quito 170901, Ecuador
| | - A León-Reyes
- Laboratorio de Biotecnología Agrícola y de Alimentos, Colegio de Ciencias e Ingenierías-Agronomía, Universidad San Francisco de Quito USFQ, Campus Cumbayá, Quito 170901, Ecuador
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Noureddine LR, Parikh B, Saliba E, Lo Monaco G, Herrera K, Heiselman C. How Comprehensive Are Websites of Maternal Fetal Medicine Programs for Prospective Fellows? Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Noureddine LR, Fuchs A, Heiligenstein MA, Fassler R, Abuzeid O, Korgaonkar-Cherala C, Iovino N, Herrera K, Garry D, Garretto D, Heiselman C. Predictors of Positive Edinburgh Postnatal Depression Scale in Opioid Use Disorder. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Heiselman C, Fuchs A, Heiligenstein MA, Noureddine LR, Fassler R, Abuzeid O, Korgaonkar-Cherala C, Iovino N, Herrera K, Garretto D, Garry D. Discordance between maternal and newborn drug screening at delivery. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Preis H, Djurić PM, Ajirak M, Mane V, Garry DJ, Garretto D, Herrera K, Heiselman C, Marci L. Missingness patterns in a comprehensive instrument identifying psychosocial and substance use risk in antenatal care. J Reprod Infant Psychol 2021:1-15. [PMID: 34787528 DOI: 10.1080/02646838.2021.2004302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Psychosocial vulnerabilities (e.g. inadequate social support, financial insecurity, stress) and substance use elevate risks for adverse perinatal outcomes and maternal mental health morbidities. However, various barriers, including paucity of validated, simple and usable comprehensive instruments, impede execution of the recommendations to screen for such vulnerabilities in the first antenatal care visit. The current study presents findings from a newly implemented self-report tool created to overcome screening barriers in outpatient antenatal clinics. METHODS This was a retrospective chart-review of 904 women who completed the Profile for Maternal & Obstetric Treatment Effectiveness (PROMOTE) during their first antenatal visit between June and December 2019. The PROMOTE includes the 4-item NIDA Quick Screen and 15 additional items that each assess a different psychosocial vulnerability. Statistical analysis included evaluation of missing data, and exploration of missing data patterns using univariate correlations and hierarchical clustering. RESULTS Three quarters of women (70.0%) had no missing items. In the entire sample, all but four PROMOTE items (opioid use, planned pregnancy, educational level, and financial state) had < 5% missing values, suggesting good acceptability and feasibility. Several respondent-related characteristics such as lower education, less family support, and greater stress were associated with greater likelihood of missing items. Instrument-related characteristics associated with missing values were completing the PROMOTE in Spanish or question positioning at the end of the instrument. CONCLUSIONS AND IMPLICATIONS Conducting a comprehensive screening of theoretically and clinically meaningful vulnerabilities in an outpatient setting is feasible. Study findings will inform modifications of the PROMOTE and subsequent digitisation.
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Affiliation(s)
- Heidi Preis
- Department of Psychology, Stony Brook University Stony Brook, New York, USA
| | - Petar M Djurić
- Department of Electrical and Computer Engineering, Stony Brook University, Stony Brook, New York USA
| | - Marzieh Ajirak
- Department of Electrical and Computer Engineering, Stony Brook University, Stony Brook, New York USA
| | - Vibha Mane
- Department of Electrical and Computer Engineering, Stony Brook University, Stony Brook, New York USA
| | - David J Garry
- Department of Obstetrics, Gynecology and Reproductive Medicine, Renaissance School of Medicine, Stony Brook University Stony Brook, New York, USA
| | - Diana Garretto
- Department of Obstetrics, Gynecology and Reproductive Medicine, Renaissance School of Medicine, Stony Brook University Stony Brook, New York, USA
| | - Kimberly Herrera
- Department of Obstetrics, Gynecology and Reproductive Medicine, Renaissance School of Medicine, Stony Brook University Stony Brook, New York, USA
| | - Cassandra Heiselman
- Department of Obstetrics, Gynecology and Reproductive Medicine, Renaissance School of Medicine, Stony Brook University Stony Brook, New York, USA
| | - Lobel Marci
- Department of Psychology, Stony Brook University Stony Brook, New York, USA
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Abuzeid O, Heiselman C, Fuchs A, La Chance J, Herrera K, Garry D, Abuzeid M. P-746 Obstetric outcomes of singleton birth after hysteroscopic division of septate uterus. Hum Reprod 2021. [DOI: 10.1093/humrep/deab128.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
The aim of this study is to determine the obstetric outcomes in patients with a singleton birth after hysteroscopic division of septate uterus.
Summary answer
The data suggest excellent obstetric outcomes for singleton gestation after hysteroscopic division of a septate uterus reaching either the internal or the external cervical os.
What is known already
Septate uterus is a rare Müllerian anomaly with major impact on reproductive outcomes, particularly with a septum over 10mm. Controversy still exists over the need for surgical correction of the septum due to conflicting data on outcomes, particularly in women with histories of good obstetric outcomes and incidental septum findings. Placental location in relation to the septum may account for such conflicting reports. Most data on reproductive outcomes after hysteroscopic surgical correction combine both septate and subseptate uteri. There is limited published data on obstetric outcomes after hysteroscopic surgical correction of septate uteri, especially septate uteri reaching the external os.
Study design, size, duration
This retrospective cohort study included 107 patients with infertility and/or recurrent pregnancy loss (RPL) who received treatment between 2002 -2019. The study group included 24 patients with a singleton birth after hysteroscopic correction of septate uterus (Class Va; ASRM classification) that was diagnosed on trans-vaginal 3D ultrasound. The control group included 83 patients with a singleton birth who had normal endometrial cavity on hysteroscopy during the same period of time, before starting treatment.
Participants/materials, setting, methods
This study was conducted at an infertility clinic affiliated with a teaching hospital. In the study group the septum reached the internal or the external cervical os in 14 and 10 patients respectively. After hysteroscopic correction, all patients were offered various infertility treatments depending on the underlying etiology. The inclusion criterion in this study was to have a singleton birth after hysteroscopy. Demographic and clinical data and obstetric outcomes were compared between the two groups.
Main results and the role of chance
There was no significant difference in mean age, infertility duration, infertility type and incidence of male infertility or ovulatory disorders between the two groups. There was a significantly higher BMI (0.048), and a higher incidence of history of miscarriage (P=0.002) and history of RPL (P=0.017) in the study group. There was significant lower incidence of tubal factors infertility (P=0.005) and endometriosis (P=0.03) in the study group, therefore there was higher incidence of spontaneous conception (70.8% vs 19.3%; P=0.000) and lower incidence of conception with IVF-ET (20.8% vs 66.3%; P=0.000) in the study group compared to the control group respectively. There was significantly higher incidence of prophylactic cervical cerclage (17.4% vs 0%; P=0.000), and delivery by CS (69.6% vs 41.2%; P=0.019) and lower incidence of vaginal delivery (30.4% vs 58.8%; P=0.019), in the study group compared to the control group. There was no significant difference in gestational age in weeks (38.3 + 1.8 vs 38.6 + 2.0), newborn birth weight in grams (3173.9 + 630.0 vs 3202.1 + 555.6), incidence of premature birth (12.5% vs 12.2%), or other obstetric complications (25% vs 17.6%) between the study and the control groups respectively. For premature births, mean gestational age was 34.3 + 0.47 and 34.6 + 1.2 weeks in the study and control groups respectively.
Limitations, reasons for caution
A retrospective study has its own inherent bias. Furthermore, the small sample size is explained by the fact that a septate uterus is a rare anomaly leading to difficulties finding cases and organizing a prospective study to achieve a larger sample size. A multicenter prospective study is needed.
Wider implications of the findings
Regardless of whether the septum reached the internal or external os, there were excellent obstetric outcomes in singleton gestations after hysteroscopic correction of septate uteri. There was no increased risk with septate uteri involving the cervix. Hysteroscopic surgical correction should be the treatment of choice for patients with septate uteri.
Trial registration number
Not Applicable
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Affiliation(s)
- O Abuzeid
- Renaissance School of Medicine at Stony Brook University, Maternal Fetal Medicine, Nesconset, U.S.A
| | - C Heiselman
- Renaissance School of Medicine at Stony Brook University, Maternal Fetal Medicine, Stony Brook, U.S.A
| | - A Fuchs
- Renaissance School of Medicine at Stony Brook University, Maternal Fetal Medicine, Stony Brook, U.S.A
| | - J La Chance
- Hurley Medical Center/Michigan State University- College of Human Medicine, Department of Research, Flint, U.S.A
| | - K Herrera
- Renaissance School of Medicine at Stony Brook University, Maternal Fetal Medicine, Stony Brook, U.S.A
| | - D Garry
- Renaissance School of Medicine at Stony Brook University, Maternal Fetal Medicine, Stony Brook, U.S.A
| | - M Abuzeid
- - Department of Obstetrics and Gynecology- Hurley Medical Center/Michigan State University- College of Human Medicine, Division of Reproductive Endocrinology and Infertility, Flint, U.S.A
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Abuzeid O, Heiselman C, Fuchs A, Chance JL, Herrera K, Garry D, Abuzeid M. P–746 Obstetric outcomes of singleton birth after hysteroscopic division of septate uterus. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study question
The aim of this study is to determine the obstetric outcomes in patients with a singleton birth after hysteroscopic division of septate uterus.
Summary answer
The data suggest excellent obstetric outcomes for singleton gestation after hysteroscopic division of a septate uterus reaching either the internal or the external cervical os.
What is known already
Septate uterus is a rare Müllerian anomaly with major impact on reproductive outcomes, particularly with a septum over 10mm. Controversy still exists over the need for surgical correction of the septum due to conflicting data on outcomes, particularly in women with histories of good obstetric outcomes and incidental septum findings. Placental location in relation to the septum may account for such conflicting reports. Most data on reproductive outcomes after hysteroscopic surgical correction combine both septate and subseptate uteri. There is limited published data on obstetric outcomes after hysteroscopic surgical correction of septate uteri, especially septate uteri reaching the external os.
Study design, size, duration
This retrospective cohort study included 107 patients with infertility and/or recurrent pregnancy loss (RPL) who received treatment between 2002 –2019. The study group included 24 patients with a singleton birth after hysteroscopic correction of septate uterus (Class Va; ASRM classification) that was diagnosed on trans-vaginal 3D ultrasound. The control group included 83 patients with a singleton birth who had normal endometrial cavity on hysteroscopy during the same period of time, before starting treatment.
Participants/materials, setting, methods
This study was conducted at an infertility clinic affiliated with a teaching hospital. In the study group the septum reached the internal or the external cervical os in 14 and 10 patients respectively. After hysteroscopic correction, all patients were offered various infertility treatments depending on the underlying etiology. The inclusion criterion in this study was to have a singleton birth after hysteroscopy. Demographic and clinical data and obstetric outcomes were compared between the two groups.
Main results and the role of chance
There was no significant difference in mean age, infertility duration, infertility type and incidence of male infertility or ovulatory disorders between the two groups. There was a significantly higher BMI (0.048), and a higher incidence of history of miscarriage (P = 0.002) and history of RPL (P = 0.017) in the study group. There was significant lower incidence of tubal factors infertility (P = 0.005) and endometriosis (P = 0.03) in the study group, therefore there was higher incidence of spontaneous conception (70.8% vs 19.3%; P = 0.000) and lower incidence of conception with IVF-ET (20.8% vs 66.3%; P = 0.000) in the study group compared to the control group respectively. There was significantly higher incidence of prophylactic cervical cerclage (17.4% vs 0%; P = 0.000), and delivery by CS (69.6% vs 41.2%; P = 0.019) and lower incidence of vaginal delivery (30.4% vs 58.8%; P = 0.019), in the study group compared to the control group. There was no significant difference in gestational age in weeks (38.3 + 1.8 vs 38.6 + 2.0), newborn birth weight in grams (3173.9 + 630.0 vs 3202.1 + 555.6), incidence of premature birth (12.5% vs 12.2%), or other obstetric complications (25% vs 17.6%) between the study and the control groups respectively. For premature births, mean gestational age was 34.3 + 0.47 and 34.6 + 1.2 weeks in the study and control groups respectively.
Limitations, reasons for caution
A retrospective study has its own inherent bias. Furthermore, the small sample size is explained by the fact that a septate uterus is a rare anomaly leading to difficulties finding cases and organizing a prospective study to achieve a larger sample size. A multicenter prospective study is needed.
Wider implications of the findings: Regardless of whether the septum reached the internal or external os, there were excellent obstetric outcomes in singleton gestations after hysteroscopic correction of septate uteri. There was no increased risk with septate uteri involving the cervix. Hysteroscopic surgical correction should be the treatment of choice for patients with septate uteri.
Trial registration number
Not applicable
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Affiliation(s)
- O Abuzeid
- Renaissance School of Medicine at Stony Brook University, Maternal Fetal Medicine, Nesconset, USA
| | - C Heiselman
- Renaissance School of Medicine at Stony Brook University, Maternal Fetal Medicine, Stony Brook, USA
| | - A Fuchs
- Renaissance School of Medicine at Stony Brook University, Maternal Fetal Medicine, Stony Brook, USA
| | - J L Chance
- Hurley Medical Center/Michigan State University- College of Human Medicine, Department of Research, Flint, USA
| | - K Herrera
- Renaissance School of Medicine at Stony Brook University, Maternal Fetal Medicine, Stony Brook, USA
| | - D Garry
- Renaissance School of Medicine at Stony Brook University, Maternal Fetal Medicine, Stony Brook, USA
| | - M Abuzeid
- - Department of Obstetrics and Gynecology- Hurley Medical Center/Michigan State University- College of Human Medicine, Division of Reproductive Endocrinology and Infertility, Flint, USA
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Fuchs A, Harris L, Huber A, Heiligenstein M, Heiselman C, Herrera K, Garretto D. A case of severe SARS-CoV-2 infection with negative nasopharyngeal PCR in pregnancy. Case Reports in Perinatal Medicine 2021. [DOI: 10.1515/crpm-2020-0075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Objectives
SARS-CoV-2 remains a pressing issue for our obstetric community during the current pandemic. We present a case of a 22-year-old nulliparous woman 31 weeks pregnant, with significant clinical SARS-CoV-2 disease, in the setting of negative nasopharyngeal PCR testing but positive IgG antibodies.
Case presentation
This was a 22-year-old patient 31 weeks pregnant who presented with fever, tachycardia, and subsequently preterm premature rupture of membranes (PPROM) and pulmonary emboli with multifocal pneumonia. The patient underwent three negative SARS-CoV-2 tests via nasopharyngeal PCR testing during her hospital stay as well as a negative workup for fever. After a cesarean section for worsening maternal status after 7 days of hospitalization, the patient was admitted for worsening clinical status to the SICU. At the time of SICU admission patient was found to have serum IgG positive antibodies and was managed with intubation, antibiotics, and anticoagulation. Patient eventually left hospital against medical advice on hospital day 16 on oral antibiotics but was found to be recovering well at later outpatient follow up.
Conclusions
Diagnosis of SARS-CoV-2 remains a complicated picture in the setting of testing limitations. This case highlights an antepartum clinical presentation of severe SARS-CoV-2 and recommends a high clinical suspicion for diagnosis of SARS-CoV-2 and initiation of treatment in the pregnant population, even in the presence of negative nasopharyngeal PCR testing.
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Affiliation(s)
- Anna Fuchs
- Department of Obstetrics & Gynecology and Reproductive Medicine , Renaissance School of Medicine at Stony Brook University , Stony Brook , NY , USA
| | - Lauren Harris
- Department of Obstetrics & Gynecology and Reproductive Medicine , Renaissance School of Medicine at Stony Brook University , Stony Brook , NY , USA
| | - Ashley Huber
- Department of Obstetrics & Gynecology and Reproductive Medicine , Renaissance School of Medicine at Stony Brook University , Stony Brook , NY , USA
| | - Mia Heiligenstein
- Department of Obstetrics & Gynecology and Reproductive Medicine , Renaissance School of Medicine at Stony Brook University , Stony Brook , NY , USA
| | - Cassandra Heiselman
- Department of Obstetrics & Gynecology and Reproductive Medicine , Renaissance School of Medicine at Stony Brook University , Stony Brook , NY , USA
| | - Kimberly Herrera
- Department of Obstetrics & Gynecology and Reproductive Medicine , Renaissance School of Medicine at Stony Brook University , Stony Brook , NY , USA
| | - Diana Garretto
- Department of Obstetrics & Gynecology and Reproductive Medicine , Renaissance School of Medicine at Stony Brook University , Stony Brook , NY , USA
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Monardes H, Herrera K, Vargas J, Steinfort K, Zaror C, Abarca J. Root Anatomy and Canal Configuration of Maxillary Premolars: A Cone-beam Computed Tomography Study. INT J MORPHOL 2021. [DOI: 10.4067/s0717-95022021000200463] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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DiNobile C, Fuchs A, Herrera K. A case of newly diagnosed autoimmune diabetes in pregnancy presenting after acute onset of diabetic ketoacidosis. Case Reports in Perinatal Medicine 2021. [DOI: 10.1515/crpm-2020-0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Objectives
We present a case of immune-mediated diabetes mellitus, diagnosed in pregnancy upon presentation with diabetic ketoacidosis, found to have normal glucose control postpartum.
Case presentation
A 28-year-old medically uncomplicated G1P0 presented in diabetic ketoacidosis at 28.2 weeks gestation. Workup for pancreatic autoantibodies revealed indeterminate anti-islet cell antibodies and positive anti-glutamic acid antibodies. She was stabilized with intravenous fluids and insulin, and transitioned to long and short acting subcutaneous insulin. Her insulin requirements decreased over the course of her pregnancy. Spontaneous vaginal delivery occurred at 37 weeks. Her postpartum glucose control was normal without re-initiation of insulin.
Conclusions
The diagnosis of diabetic ketoacidosis during pregnancy should prompt further investigation into an underlying diagnosis of immune mediated diabetes. These patients should be followed closely in the postpartum period.
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Affiliation(s)
- Charissa DiNobile
- Department of Obstetrics & Gynecology and Reproductive Medicine , Renaissance School of Medicine, Stony Brook University , Stony Brook , NY , USA
| | - Anna Fuchs
- Department of Obstetrics & Gynecology and Reproductive Medicine , Renaissance School of Medicine, Stony Brook University , Stony Brook , NY , USA
| | - Kimberly Herrera
- Department of Obstetrics & Gynecology and Reproductive Medicine , Renaissance School of Medicine, Stony Brook University , Stony Brook , NY , USA
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Milone GF, Tiwari M, McInerney H, Franz B, Potkin K, Persad MD, Herrera K. 864 Does implementation of a video module improve patient knowledge about gestational weight gain? Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Persad MD, Staszewski C, Khan F, Adeyeye A, Franz B, Ly V, Day M, Varghese E, Shridevi P, Perseleni T, Huettemann T, Kaplan C, Herrera K, Garry D, Garretto D. 230 Does antepartum vitamin D3 supplementation prevent gestational diabetes mellitus? Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Heiselman C, Fuchs A, Abuzeid O, Heiligenstein M, Iovino N, Huber A, Gorman M, Sha S, Herrera K, Garretto D, Noureddine LR, Choi J, Garry D. 1022 Opioid maintenance therapy prescription by obstetricians and postpartum visit compliance. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.1047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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21
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Milone GF, Tiwari M, McInerney H, Franz B, Potkin K, Persad MD, Herrera K. 832 Does BMI influence the impact of an educational video module on gestational weight gain? Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Persad MD, Staszewski C, Khan F, Adeyeye A, Franz B, Ly V, Day M, Varghese E, Shridevi P, Huettemann T, Kaplan C, Herrera K, Garry D, Garretto D. 145 To determine if Vitamin D prophylaxis decreases the incidence of maternal and neonatal infection. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Milone GF, Tiwari M, McInerney H, Franz B, Potkin K, Persad MD, Herrera K. 835 Does use of a gestational weight gain video module decrease postpartum weight retention? Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Persad MD, Staszewski C, Khan F, Adeyeye A, Day M, Ly V, Shridevi P, Perseleni T, Herrera K, Garry D, Garretto D. 143 Does vitamin d prophylaxis prevent adverse neonatal outcomes? Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
Abstract
Objectives
Infective endoplastitis/endocarditis (IE) due to a cardiac implant is an extremely rare event during pregnancy. Management and prognosis is not well known in this population.
Case presentation
A 29-year-old woman, gravida 1 para 0, at 19 3/7 weeks gestation with an Amplatzer septal occluder presented to the hospital with fever. A transesophageal echocardiogram demonstrated cardiac vegetations. She subsequently underwent cardiopulmonary bypass surgery with fetal monitoring to remove the device and eventually went on to deliver a full-term infant.
Conclusions
IE should be on the differential in patients with cardiac device. Multidisciplinary efforts enable prompt initiation of treatment after weighing the risks and benefits to both mother and fetus. Lastly, the fetal status can be utilized to assess for hemodynamic status of the mother.
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Affiliation(s)
- Sara Kim
- Stony Brook University Hospital , Stony Brook , NY , USA
| | | | - Diana Garretto
- Stony Brook University Hospital , Stony Brook , NY , USA
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Preis H, Garry DJ, Herrera K, Garretto DJ, Lobel M. Improving Assessment, Treatment, and Understanding of Pregnant Women With Opioid Use Disorder: The Importance of Life Context. ACTA ACUST UNITED AC 2020. [DOI: 10.1080/23293691.2020.1780395] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Heidi Preis
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
| | - David J. Garry
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York, USA
| | - Kimberly Herrera
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York, USA
| | - Diana J. Garretto
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York, USA
| | - Marci Lobel
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
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Dinglas C, Afsar N, Cochrane E, Davis J, Kim S, Akerman M, Wells M, Chavez M, Herrera K, Heo H, Vintzileos A. First-trimester maternal serum alpha fetoprotein is associated with ischemic placental disease. Am J Obstet Gynecol 2020; 222:499.e1-499.e6. [PMID: 31794723 DOI: 10.1016/j.ajog.2019.11.1264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 10/20/2019] [Accepted: 11/25/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND While elevated second-trimester maternal serum alpha fetoprotein has been associated with adverse pregnancy outcomes, the utility of first-trimester maternal serum alpha fetoprotein in predicting these outcomes is limited. Some laboratories have been including maternal serum alpha fetoprotein as part of the first-trimester analyte screening for aneuploidy and preeclampsia, offering its potential utility in predicting pregnancy outcomes. OBJECTIVE Our primary objective was to determine the association between elevated first-trimester maternal serum alpha fetoprotein and preeclampsia as well as ischemic placental disease (a composite of preeclampsia, fetal growth restriction, and/or placental abruption). Secondary outcomes included early-onset preeclampsia requiring delivery at <34 weeks gestation, fetal growth restriction, placental abruption, preterm delivery, fetal demise, and spontaneous abortion. STUDY DESIGN An institutional review board-approved multisite retrospective cohort study was performed including all patients with first-trimester maternal serum alpha fetoprotein as part of routine first-trimester aneuploidy screening from April 2015 through January 2017. Pregnancies with multiple gestations, known structural or chromosomal abnormalities, known malignancy, and incomplete delivery records were excluded. Delivery records were reviewed for baseline characteristics and adverse pregnancy outcomes. The optimal cutoff point for first-trimester maternal serum alpha fetoprotein to predict these outcomes was assessed, and an elevated maternal serum alpha fetoprotein was considered >2.0 multiple of the median. A Fisher exact test and odds ratios were used to determine the association between elevated first-trimester maternal serum alpha fetoprotein and adverse pregnancy outcomes. Spearman correlation coefficient assessed the relationship between first- and second-trimester maternal serum alpha fetoprotein. RESULTS Of 1478 patients with first-trimester maternal serum alpha fetoprotein, 1280 had complete records available for review (86.6%). There was no association demonstrated between elevated first-trimester maternal serum alpha fetoprotein (>2.0 multiple of the median) and the primary outcome, overall preeclampsia (5.8% vs 4.6%, odds ratio, 1.29, 95% confidence interval, 0.58-2.91). However, there was an increased incidence of ischemic placental disease, 15.8% vs 7.7% (odds ratio, 2.26, 95% confidence interval, 1.33-3.87) in those with an elevated alpha fetoprotein. Also, elevated first-trimester maternal serum alpha fetoprotein was associated with a higher incidence of fetal growth restriction (7.5% vs 2.3%, odds ratio, 3.40, 95% confidence interval, 1.56-7.42) and preterm birth (18.3% vs 10.3%, odds ratio, 1.95, 95% confidence interval, 1.18-3.21). Also, a positive correlation between first- and second-trimester maternal serum alpha fetoprotein was demonstrated (rho = 0.46, P < .0001). CONCLUSION Elevated first-trimester maternal serum alpha fetoprotein is associated with ischemic placental disease, fetal growth restriction, and preterm birth. This suggests that elevated maternal serum alpha fetoprotein may help to identify high risk pregnancies as early as the first trimester of pregnancy. Future studies are necessary to determine whether the addition of first-trimester maternal serum alpha fetoprotein to existing algorithms can improve the early detection of ischemic placental disease.
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Davis J, Heiselman C, Cochrane E, Staszewski C, Gruttadauria M, Fuchs A, Fung J, Dayton S, Garry D, Herrera K, Garretto D. 678: Comparison of Opioid Maintenance Therapy (OMT) on prenatal and postnatal growth effects. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.11.692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Heiselman C, Pastore LM, Milone G, Davis J, Dinglas C, Persad MD, Garretto D, Herrera K. 1152: How do distress levels affect women’s decision-making for invasive prenatal genetic testing? Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.11.1164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Persad MD, Staszewski CL, Khan F, Chiu F, Perseleni T, Demishev M, Garry D, Herrera K, Garretto DJ. 562: Does antepartum vitamin D3 supplementation prevent preterm birth? Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2018.11.584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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31
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Persad MD, Staszewski CL, Khan F, Chiu F, Perseleni T, Demishev M, Garry D, Herrera K, Garretto DJ. 1011: What is the optimal maternal Vitamin D level for the prediction of adverse maternal outcomes? Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2018.11.1035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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32
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Ly V, Persad MD, Herrera K, Garry D, Garretto D. Does Buprenorphine Decrease the Risk of Neonatal Abstinence Syndrome in Mothers with Opioid use Disorder? [26N]. Obstet Gynecol 2018. [DOI: 10.1097/01.aog.0000533122.79665.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Persad MD, Ly V, Herrera K, Demishev M, Quirk JG, Garry D, Garretto D. 197: Does vitamin D prophylaxsis in pregnancy decrease the risk of adverse maternal outcomes? Am J Obstet Gynecol 2018. [DOI: 10.1016/j.ajog.2017.10.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Herrera K, Bernasko J, Garry D, Vahanian S, Kaplan C. Vertical transmission of Zika virus (ZIKV) in early pregnancy: two cases, two different courses. Case Reports in Perinatal Medicine 2016. [DOI: 10.1515/crpm-2016-0027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AbstractBackground:Vertical Zika virus (ZIKV) transmission is actively being studied. Prior cases of ZIKV in pregnancy have suggested an association with infection and adverse fetal outcomes. We describe two cases of maternal illness and their respective pregnancy courses.Case 1: A 30-year-old Hispanic female presented with rash, fatigue, and chills after noticing mosquito bites in Honduras. Fetal anatomy appeared normal on ultrasound at 16 and 17 weeks. ZIKV RNA reverse-transcriptase-polymerase-chain-reaction (RT-PCR) was identified in her serum and amniotic fluid. She opted for pregnancy termination. Fetal serum and tissue analysis confirmed ZIKV infection.Case 2: A 28-year-old Hispanic female presented with rash, fever, and fatigue after sexual intercourse. Her ZIKV serum RNA RT-PCR was positive and amniotic fluid was negative. Fetal anatomy appeared normal at 20 and 22 weeks and her pregnancy remains ongoing.Conclusion:The effects of maternal ZIKV infection in early pregnancy can vary.
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Affiliation(s)
- Kimberly Herrera
- Stony Brook Medicine – Obstetrics, Gynecology, and Reproductive Medicine, Health Sciences Tower Level 9, Room 030, Stony Brook, NY 11794-8091, United States of America
| | - James Bernasko
- Stony Brook Medicine – Obstetrics, Gynecology, and Reproductive Medicine, Stony Brook, NY, United States of America
| | - David Garry
- Stony Brook Medicine – Obstetrics, Gynecology, and Reproductive Medicine, Stony Brook, NY, United States of America
| | - Sevan Vahanian
- Stony Brook Medicine – Obstetrics, Gynecology, and Reproductive Medicine, Stony Brook, NY, United States of America
| | - Cynthia Kaplan
- Stony Brook Medicine – Department of Pathology, Stony Brook, NY United States of America
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35
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Bimson B, Morris S, Rosenn B, Murphy E, Herrera K, Schwartz R, Brustman L. 617: Are there regional differences in the management of gestational diabetes? Am J Obstet Gynecol 2015. [DOI: 10.1016/j.ajog.2014.10.823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Herrera K, Rosenn B, Foroutan J, Bimson B, Al Ibraheemi Z, Brustman L. 649: A randomized controlled trial of insulin detemir versus insulin NPH for the treatment of pregnant women with gestational diabetes and type 2 diabetes. Am J Obstet Gynecol 2015. [DOI: 10.1016/j.ajog.2014.10.855] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Herrera K, Brustman L, Foroutan J, Scarpelli S, Murphy E, Francis A, Rosenn B. The importance of fasting blood glucose in screening for gestational diabetes. J Matern Fetal Neonatal Med 2014; 28:825-8. [PMID: 24939625 DOI: 10.3109/14767058.2014.935322] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To determine how well an isolated abnormal fasting blood glucose (FBG) value on the 1-step, 75-g, 2-hour glucose tolerance test (GTT) indicates significant gestational diabetes (GDM). METHODS Retrospective cohort study, January 2011 to May 2012. Patients diagnosed by the 1-step method were assigned by their abnormal results to the isolated fasting (FBG), isolated 1-hour (1HBG), isolated 2-hour (2HBG), or multiple-value (≥2BG) group. Characteristics and outcomes were compared using ANOVA, Kruskal--Wallis, and Chi-squared tests. RESULTS 324 patients were included. Compared to other groups, the FBG group (N = 23) had the highest incidence of requiring medical therapy (78.26%), mean body mass index (29.40 ± 6.20 kg/m(2)), and percentage of Black plus Hispanic women (60.87%). CONCLUSIONS Seven percent of women were diagnosed with GDM by an isolated abnormal fasting BG and have significant disease. This group should not be missed; therefore, fasting BG should be integrated into all GDM screening.
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Affiliation(s)
- Kimberly Herrera
- Department of Obstetrics & Gynecology, St. Luke's-Roosevelt Hospital Center , New York , USA
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Suffecool K, Rosenn BM, Kam S, Mushi J, Foroutan J, Herrera K. Labor induction in nulliparous women with an unfavorable cervix: double balloon catheter versus dinoprostone. J Perinat Med 2014; 42:213-8. [PMID: 24096438 DOI: 10.1515/jpm-2013-0152] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 08/29/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We sought to compare the efficacy of the double-balloon catheter and dinoprostone for induction of labor among nulliparous women with an unfavorable cervix. STUDY DESIGN Nulliparous women with a Bishop score <6 were randomized to receive a 10-mg intra-vaginal dinoprostone insert or a double-balloon catheter. Primary outcome was time to delivery. Statistical analyses were performed by intention to treat using the chi-square, Fisher's exact, and Student's t-test, as appropriate. RESULTS The mean induction-to-delivery time was shorter in the double-balloon group as compared to the dinoprostone group (17.9±5.8 vs. 26.3±9.7 h) as was the time from induction to vaginal delivery (19.13±5 vs. 24.45±8.7 h, respectively). More women in the catheter group were delivered within 24 h compared to the dinoprostone group (87.1% vs. 47.4%). Approximately 50% of women in both groups delivered by cesarean section. CONCLUSION Induction of labor with the double-balloon catheter in nulliparous women with an unfavorable cervix is associated with a shorter time to delivery compared to dinoprostone.
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Foroutan J, Rosenn B, Herrera K, Bimson B, Scarpelli S, Brustman L. 248: Is there a benefit from using the one-step method for the diagnosis of gestational diabetes in obese women? Am J Obstet Gynecol 2014. [DOI: 10.1016/j.ajog.2013.10.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Herrera K, Lewis D, Foroutan J, King L, Bimson B, Mozier E. 179: The utility of maternal serum analyte screening in the era of cell-free fetal DNA (cffDNA). Am J Obstet Gynecol 2014. [DOI: 10.1016/j.ajog.2013.10.212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Feenstra H, Dunn T, Lewis D, Herrera K, Foroutan J, Calabio R, Batey A, Wang E, Gebbia JA. Complexity of noninvasive prenatal screening and diagnostic testing for an unbalanced translocation involving chromosomes 5 and 18. Prenat Diagn 2013; 34:195-8. [DOI: 10.1002/pd.4270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Revised: 10/14/2013] [Accepted: 11/03/2013] [Indexed: 11/05/2022]
Affiliation(s)
- H. Feenstra
- Division of Genetics; Roosevelt Hospital; New York NY USA
| | - T. Dunn
- CytoGenX Medical Genetic Laboratories; Stony Brook NY USA
| | - D. Lewis
- Department of Obstetrics and Gynecology; Roosevelt Hospital; New York NY USA
| | - K. Herrera
- Department of Obstetrics and Gynecology; Roosevelt Hospital; New York NY USA
| | - J. Foroutan
- Department of Obstetrics and Gynecology; Roosevelt Hospital; New York NY USA
| | - R. Calabio
- Department of Pediatrics; Roosevelt Hospital; New York NY USA
| | - A. Batey
- Ariosa Diagnostics; San Jose CA USA
| | - E. Wang
- Ariosa Diagnostics; San Jose CA USA
| | - J. A. Gebbia
- CytoGenX Medical Genetic Laboratories; Stony Brook NY USA
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Foroutan J, Rosenn B, Suffecool K, Herrera K, Fuchs A, Scarpelli S, Brustman L. 264: The one-step method for screening and diagnosis of gestational diabetes: is it really better? Am J Obstet Gynecol 2013. [DOI: 10.1016/j.ajog.2012.10.429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Foroutan J, Rosenn B, Suffecool K, Herrera K, Scarpelli S, Brustman L. 263: Glycemic control in gestational diabetes: it's all a matter of timing. Am J Obstet Gynecol 2013. [DOI: 10.1016/j.ajog.2012.10.428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Maio V, Jutkowitz E, Herrera K, Abouzaid S, Negri G, Del Canale S. Appropriate medication prescribing in elderly patients: how knowledgeable are primary care physicians? A survey study in Parma, Italy. J Clin Pharm Ther 2010; 36:468-80. [PMID: 21729112 DOI: 10.1111/j.1365-2710.2010.01195.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Increasing attention is being paid to inappropriate medication prescribing for the elderly. A growing body of studies have detected a prevalence of inappropriate prescribing ranging from 12% to 40% worldwide, including Regione Emilia-Romagna, Italy. To improve quality of prescribing, a multi-phase pilot project in the Local Health Unit (LHU) of Parma, Regione Emilia-Romagna, was established. This phase aimed to assess primary care physicians' knowledge of appropriate prescribing in elderly patients. METHODS In total, 155 primary care physicians (51% of the total), convened by the LHU of Parma for an educational session, were asked to complete anonymously a 19-item paper survey. Knowledge of inappropriate medication use in the elderly was assessed using seven clinical vignettes based on the 2002 Beers Criteria. Topics tested included hypertension, osteoarthritis, arrhythmias, insomnia and depression. Data regarding physician's perceived barriers to appropriate prescribing for elderly patients were also collected. To evaluate the relationship between physician knowledge scores and physician characteristics, physicians were classified as having a 'low score' (three or below) or a 'high score' (six or more) with respect to their knowledge of prescribing for the elderly. RESULTS AND DISCUSSION All physicians completed the survey. Most physicians (88%) felt confident in their ability to prescribe appropriate medications for the elderly. Thirty-nine physicians (25%) received a 'high score' compared to 26 (17%) who received a 'low score'. 'Lower score' respondents had been in practice for a longer time (P < 0·05) than 'higher score' respondents. Perceived barriers to appropriate prescribing included potential drug interactions (79% of respondents) and the large number of medications a patient is already taking (75%). WHAT IS NEW AND CONCLUSION The study results show an unsatisfactory knowledge of appropriate prescribing among primary care physicians in the LHU of Parma, especially among older physicians. Educational strategies tailored to primary care physicians should be establish to enhance knowledge in this area and improve quality of prescribing.
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Affiliation(s)
- V Maio
- Jefferson School of Population Health, Thomas Jefferson University, Philadelphia, PA 19017, USA.
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Louis DZ, Robeson M, Herrera K, Maio V, Gonnella JS, Richardson D, Grilli R. Who is most likely to require a higher level of care: predicting risk of hospitalization. BMC Health Serv Res 2010. [PMCID: PMC2950295 DOI: 10.1186/1472-6963-10-s2-a2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Galbács G, Jedlinszki N, Herrera K, Omenetto N, Smith BW, Winefordner JD. A study of ablation, spatial, and temporal characteristics of laser-induced plasmas generated by multiple collinear pulses. Appl Spectrosc 2010; 64:161-172. [PMID: 20149277 DOI: 10.1366/000370210790619609] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Multi-pulse laser-induced breakdown spectroscopy (LIBS) in the collinear pulse configuration with time-integrating detection was performed on metallic samples in ambient air in an effort to clarify the contributing processes responsible for the signal enhancement observed in comparison with single-pulse excitation. Complementary experiments were also carried out on another LIBS setup using detection by an imaging spectrograph with high time resolution. The effects of laser bursts consisting of up to seven ns-range pulses from Nd-doped solid-state lasers operating at their fundamental wavelength and separated by 8.5-50 micros time gaps was studied. The ablation and emission characteristics of the generated plasmas were investigated using light profilometry, microscopy, plasma imaging, emission distribution mapping, time-resolved line emission monitoring, and plasma temperature calculations. The experimental data suggest that the two contributing processes mainly responsible for the signal enhancement effect are the plume reheating caused by the sequential laser pulses and, more dominantly, the increased material ablation attributed to the lower breakdown threshold for the preheated (molten) sample surface and/or the reduced background gas pressure behind the shockwave of preceding pulses.
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Affiliation(s)
- G Galbács
- University of Szeged, Department of Inorganic and Analytical Chemistry, Dóm tér 7, H-6720 Szeged, Hungary.
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