TESTING PATTERNS FOR SYPHILIS AND OTHER SEXUALLY TRANSMITTED INFECTIONS IN PREGNANT WOMEN PRESENTING TO EMERGENCY DEPARTMENTS

Following an initial decrease in the incidence of congenital syphilis from 2008-2012, the rate of congenital syphilis rose by 38% across the United States between 2012-2014 (2). This trend followed a 22% rise in primary and secondary syphilis cases in women during the same period.(1) Vertical transmission of syphilis is a significant public health concern, contributing to stillbirth, infant mortality, and neurologic and skeletal morbidities in survivors. (2) The Centers for Disease Control and Prevention (CDC) recommends that all pregnant women be screened for sexually transmitted infections (STI) including HIV, syphilis, and hepatitis B at the first prenatal visit regardless of prior testing. The American College of Obstetricians and Gynecologists (ACOG) and the U.S. Preventive Services Task Force (USPSTF) also support similar recommendations. Yet, a CDC investigation into this epidemic revealed that 21% of women whose infants were diagnosed with congenital syphilis had no prenatal care, and of those who had at least one prenatal visit, 43% received no treatment for syphilis during pregnancy and 30% received inadequate treatment. (2, 3) Little is understood about factors associated with low STI screening during pregnancy in the US. In a 2014 study, Cha, et al. evaluated factors affecting the likelihood of STI screening in pregnant women in Guam. They found that the biggest barrier to STI testing was lack of prenatal care and insurance. Even women with access to prenatal care were not routinely screened for syphilis before 24 weeks’ gestation. Despite a 93.5% overall rate of screening for syphilis at any time during pregnancy, the authors found much lower screening 2 rates for other STIs, including 31% for HIV, 25.3% for chlamydia, and 25.7% for gonorrhea. (8) This suggests potential disparity in testing practices based on risk perception by providers or patients

Kynurenine pathway metabolites selectively associate with impaired associative memory function in depression

Activation of the kynurenine pathway (KP), an important downstream effect of inflammation, is a driver of depression and neurodegeneration. Damage from the end product of KP activation, quinolinic acid, may be responsible specifically for impairment in hippocampally mediated memory function, among its effects. We hypothesized that associative memory – the ability to recall relationships between items – would be sensitive to KP activation because it is heavily dependent on the hippocampus. We tested a sample of N ​= ​80 adults with unmedicated depression using a face-name task which assesses the ability to recognize, as well as to recall correct pairings, of faces and names. Plasma samples were analyzed for KP metabolites – tryptophan (TRP), kynurenine (KYN), quinolinic acid (QUIN) and kynurenic acid (KYNA). Using linear models we examined whether the KYN/TRP and QUIN/KYNA ratios predicted performance of recognition memory and associative memory, accounting for item type and the number of learning exposures to items (1 vs. 3). We found that for rearranged items viewed three times, associative memory performance was inversely related to the QUIN/KYNA ratio (p ​= ​0.01, p ​= ​0.001 adjusted for age, gender and race/ethnicity). Recognition memory was not associated with KP activation. The results support our hypothesis that KP activation most sensitively impacts hippocampally mediated memory function

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population.The aim of this study was to inform vaccination prioritization by modelling the impact of vaccination on elective inpatient surgery. The study found that patients aged at least 70 years needing elective surgery should be prioritized alongside other high-risk groups during early vaccination programmes. Once vaccines are rolled out to younger populations, prioritizing surgical patients is advantageous