Risk factors associated with adverse fetal outcomes in pregnancies affected by Coronavirus disease 2019 (COVID-19): a secondary analysis of the WAPM study on COVID-19.

Objectives To evaluate the strength of association between maternal and pregnancy characteristics and the risk of adverse perinatal outcomes in pregnancies with laboratory confirmed COVID-19. Methods Secondary analysis of a multinational, cohort study on all consecutive pregnant women with laboratory-confirmed COVID-19 from February 1, 2020 to April 30, 2020 from 73 centers from 22 different countries. A confirmed case of COVID-19 was defined as a positive result on real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of nasal and pharyngeal swab specimens. The primary outcome was a composite adverse fetal outcome, defined as the presence of either abortion (pregnancy loss before 22 weeks of gestations), stillbirth (intrauterine fetal death after 22 weeks of gestation), neonatal death (death of a live-born infant within the first 28 days of life), and perinatal death (either stillbirth or neonatal death). Logistic regression analysis was performed to evaluate parameters independently associated with the primary outcome. Logistic regression was reported as odds ratio (OR) with 95% confidence interval (CI). Results Mean gestational age at diagnosis was 30.6+/-9.5 weeks, with 8.0% of women being diagnosed in the first, 22.2% in the second and 69.8% in the third trimester of pregnancy. There were six miscarriage (2.3%), six intrauterine device (IUD) (2.3) and 5 (2.0%) neonatal deaths, with an overall rate of perinatal death of 4.2% (11/265), thus resulting into 17 cases experiencing and 226 not experiencing composite adverse fetal outcome. Neither stillbirths nor neonatal deaths had congenital anomalies found at antenatal or postnatal evaluation. Furthermore, none of the cases experiencing IUD had signs of impending demise at arterial or venous Doppler. Neonatal deaths were all considered as prematurity-related adverse events. Of the 250 live-born neonates, one (0.4%) was found positive at RT-PCR pharyngeal swabs performed after delivery. The mother was tested positive during the third trimester of pregnancy. The newborn was asymptomatic and had negative RT-PCR test after 14 days of life. At logistic regression analysis, gestational age at diagnosis (OR: 0.85, 95% CI 0.8-0.9 per week increase; pPeer reviewe

Maternal and perinatal outcomes of pregnant women with SARS-CoV-2 infection

Objectives To evaluate the maternal and perinatal outcomes of pregnancies affected by SARS-CoV-2 infection. Methods This was a multinational retrospective cohort study including women with a singleton pregnancy and laboratory-confirmed SARS-CoV-2 infection, conducted in 72 centers in 22 different countries in Europe, the USA, South America, Asia and Australia, between 1 February 2020 and 30 April 2020. Confirmed SARS-CoV-2 infection was defined as a positive result on real-time reverse-transcription polymerase chain reaction (RT-PCR) assay of nasopharyngeal swab specimens. The primary outcome was a composite measure of maternal mortality and morbidity, including admission to the intensive care unit (ICU), use of mechanical ventilation and death. Results In total, 388 women with a singleton pregnancy tested positive for SARS-CoV-2 on RT-PCR of a nasopharyngeal swab and were included in the study. Composite adverse maternal outcome was observed in 47/388 (12.1%) women; 43 (11.1%) women were admitted to the ICU, 36 (9.3%) required mechanical ventilation and three (0.8%) died. Of the 388 women included in the study, 122 (31.4%) were still pregnant at the time of data analysis. Among the other 266 women, six (19.4% of the 31 women with first-trimester infection) had miscarriage, three (1.1%) had termination of pregnancy, six (2.3%) had stillbirth and 251 (94.4%) delivered a liveborn infant. The rate of preterm birth before 37 weeks' gestation was 26.3% (70/266). Of the 251 liveborn infants, 69/251(27.5%) were admitted to the neonatal ICU, and there were five (2.0%) neonatal deaths. The overall rate of perinatal death was 4.1% (11/266). Only one (1/251, 0.4%) infant, born to a mother who tested positive during the third trimester, was found to be positive for SARS-CoV-2 on RT-PCR. Conclusions SARS-CoV-2 infection in pregnant women is associated with a 0.8% rate of maternal mortality, but an 11.1% rate of admission to the ICU. The risk of vertical transmission seems to be negligible. (C) 2020 International Society of Ultrasound in Obstetrics and Gynecology.Peer reviewe

Plan de Negocios Isy Bike: Libertad Sobre Ruedas

Este proyecto representa la oportunidad de incursionar en un area aun no explotada como es el trsalado interno en las universidades mediante bicicletas, esta modalidad de transporte es utilizada regularmente en universidades de europa y estados unidos principlamente. tiene como mision brindar un servicio eficiente de transporte ecologico con unidades en ioptimas condiciones, comprometidos con al seguridad integral, soporte tecnico y humano, grantizando la calidad del servicio. la vision que en los proximos 5 años se consolidaran en una empresa lider en la provision de servicio de transportacion con conciencia ecologica, a traves de altos standares de calidad y servicio.GuayaquilMagíster en Administración de Empresa

The Rule of 10: a simple 3D ultrasonographic method for the diagnosis of T-shaped uterus

Purpose To investigate and propose a new simple tridimensional (3D) ultrasonographic method to diagnose a T-shaped uterus (Class U1a). Methods A multicenter non-experimental case-control diagnostic accuracy study was conducted between January 2018 and December 2019, including 50 women (cases) diagnosed with T-shaped uterus (U1a class) and 50 women with a "normal uterus" (controls). All the enrolled women underwent 3D ultrasound, drawing four lines and recording the length of three of them as follow: draw and measure the interostial line (R0); draw from the midpoint of R0 a perpendicular line length 20 mm; draw and measure in the uterine cavity a line parallel to R0 at 10 mm below R0 (R10) and a second line parallel to R0 at 20 mm below R0 (R20). The diagnostic performance of all sonographic parameters statistically significantly different between T-shaped and normal uteri was estimated using the receiver operator characteristic (ROC) curve analysis. Results R10 and R20 were statistically significantly shorter in the T-shaped than the normal uterus. R10 reported the highest diagnostic accuracy with an area under the ROC curve of 0.973 (95% CI 0.940-1.000). R10 length maximizing the Youden's J statistic was 10.5 mm. Assuming R10 length equal to or shorter than 10 mm as the cut off value for defining a woman as having a T-shaped uterus, the new ultrasonographic method following the proposed protocol (R0, R10, and R20) reported sensitivity for T-shaped uterus of 91.1% (95% CI 0.78-0.97%) and a specificity of 100% (95% CI 0.89-100%). The positive likelihood ratio was higher than 30, and the negative likelihood ratio was 0.09 (95% CI 0.04-0.26). Conclusions Measuring the length of the intracavitary line parallel to the interostial line at 10 mm from it and using a length <= of 10 mm as cut off value (the "Rule of 10") appears a simple and accurate 3D ultrasonographic method for the diagnosis of a T-shaped uterus

Surface evolution of the Anhur region on comet 67P/Churyumov-Gerasimenko from high-resolution OSIRIS images

International audienceThe southern hemisphere of comet 67P/Churyumov-Gerasimenko (67P) became observable by the Rosetta mission in March 2015, a few months before cometary southern vernal equinox. The Anhur region in the southern part of the comet’s larger lobe was found to be highly eroded, enriched in volatiles, and highly active. We analyze high-resolution images of the Anhur region pre- and post-perihelion acquired by the OSIRIS imaging system on board the Rosetta mission. The Narrow Angle Camera is particularly useful for studying the evolution in Anhur in terms of morphological changes and color variations.Radiance factor images processed by the OSIRIS pipeline were coregistered, reprojected onto the 3D shape model of the comet, and corrected for the illumination conditions.We find a number of morphological changes in the Anhur region that are related to formation of new scarps; removal of dust coatings; localized resurfacing in some areas, including boulders displacements; and vanishing structures, which implies localized mass loss that we estimate to be higher than 50 million kg. The strongest changes took place in and nearby the Anhur canyon-like structure, where significant dust cover was removed, an entire structure vanished, and many boulders were rearranged. All such changes are potentially associated with one of the most intense outbursts registered by Rosetta during its observations, which occurred one day before perihelion passage. Moreover, in the niche at the foot of a new observed scarp, we also see evidence of water ice exposure that persisted for at least six months. The abundance of water ice, evaluated from a linear mixing model, is relatively high (>20%). Our results confirm that the Anhur region is volatile-rich and probably is the area on 67P with the most pristine exposures near perihelion

On the nucleus structure and activity of comet 67P/Churyumov-Gerasimenko

Images from the OSIRIS scientific imaging system onboard Rosetta show that the nucleus of 67P/Churyumov-Gerasimenko consists of two lobes connected by a short neck. The nucleus has a bulk density less than half that of water. Activity at a distance from the Sun of >3 astronomical units is predominantly from the neck, where jets have been seen consistently. The nucleus rotates about the principal axis of momentum. The surface morphology suggests that the removal of larger volumes of material, possibly via explosive release of subsurface pressure or via creation of overhangs by sublimation, may be a major mass loss process. The shape raises the question of whether the two lobes represent a contact binary formed 4.5 billion years ago, or a single body where a gap has evolved via mass loss

Rosetta/OSIRIS observations of 67P nucleus during the April 2016 flyby: high-resolution spectrophotometry

23 pages, 14 figures, 5 tablesInternational audienceFrom August 2014 to September 2016, the Rosetta spacecraft followed comet 67P/Churyumov–Gerasimenko along its orbit. After the comet passed perihelion, Rosetta performed a flyby manoeuvre over the Imhotep–Khepry transition in April 2016. The OSIRIS/Narrow-Angle-Camera (NAC) acquired 112 observations with mainly three broadband filters (centered at 480, 649, and 743 nm) at a resolution of up to 0.53 m/px and for phase angles between 0.095° and 62°.We have investigated the morphological and spectrophotometrical properties of this area using the OSIRIS/NAC high-resolution observations. We assembled the observations into coregistered color cubes. Using a 3D shape model, we produced the illumination conditions and georeference for each observation. We mapped the observations of the transition to investigate its geomorphology. Observations were photometrically corrected using the Lommel–Seeliger disk law. Spectrophotometric analyses were performed on the coregistered color cubes. These data were used to estimate the local phase reddening.The Imhotep–Khepry transition hosts numerous and varied types of terrains and features. We observe an association between a feature’s nature, its reflectance, and its spectral slopes. Fine material deposits exhibit an average reflectance and spectral slope, while terrains with diamictons, consolidated material, degraded outcrops, or features such as somber boulders present a lower-than-average reflectance and higher-than-average spectral slope. Bright surfaces present here a spectral behavior consistent with terrains enriched in water-ice. We find a phase-reddening slope of 0.064 ± 0.001%/100 nm/° at 2.7 au outbound, similar to the one obtained at 2.3 au inbound during the February 2015 flyby.Identified as the source region of multiple jets and a host of water-ice material, the Imhotep–Khepry transition appeared in April 2016, close to the frost line, to further harbor several potential locations with exposed water-ice material among its numerous different morphological terrain units