Changes in attitudes, beliefs, and experiences related to pregnancy during graduate medical education training from 2005 to 2021

Today, 50% of medical students are women, and residency and fellowship training years overlap with peak times for starting families. The authors describe attitudes toward pregnancy during residency and fellowship and report pregnancy rates and complications for female residents and resident partners across several decades. A web-based survey was emailed to 1,057 residents in 2005 (period 1) and 1,860 residents in 2021 (period 2). Anonymous surveys were sent to all trainees including pregnant trainees, affected co-trainees and trainee partners. Resident attitudes and pregnancy characteristics were compared between groups using the chi-square (χ2) test for categorical variables and the Kruskal-Wallis test for ordinal variables. A total of 442 residents (41.8%) responded to the 2005 survey, and 525 (28.2%) responded to the 2021 survey. Most residents who covered for a pregnant resident had positive feelings about covering for their colleagues during both time periods, although more positive attitudes were present during the period 2. Only about 10% of residents received compensation for their coverage during both time periods. Among residents with a pregnancy during training (i.e., themselves or partners), most characterized having a baby in training as “somewhat difficult” or “very difficult” at both time periods. Pregnancy complication rates were 33% and 44% for training years 2005 and 2021. As medical education evolves, training programs should be proactive in creating structured support systems for pregnant residents and resident partners to minimize adverse maternal and fetal outcomes and to improve training programs. Future studies are needed to elucidate the causality of higher-than-expected pregnancy complication rates

Benthic macroinvertebrate community structure and distribution in the Ayeyarwady continental shelf, Andaman Sea

272-278Quantitative assessment of macrofaunal community of Ayeyarwady continental shelf, Andaman Sea was studied during the coastal resource survey during April-May 2002. About 27 major taxa were identified. Abundance of fauna was in the order of polychaeta (34.2%), crustacean (25.7), mollusca (4.2%) and echinodermata (4.5%), forams 30.3% and other groups 1.1%. Faunal density ranged from 59 to 6027/m2 and the wet weight biomass from 0.01 to 43.47 g/m2. Funa was dominated by polychaeta with 100% prevalence. Faunal composition differed along the depth gradient of habitat heterogeneity. Macrofaunal abundance during this study was within the range reported for shelf water of Burma and Andaman Sea but were higher than those from the South China Sea. Major shift in the quantitative distribution and spatial heterogeneity was due to several environmental factors

Acquired Factor VIII Inhibitor: A Single Institution Experience With 62 Patients

Abstract Background Acquired Factor VIII inhibitor or autoimmune hemophilia A (AHA), has an estimated incidence of up to 1.5 cases per million/year and may result in severe hemorrhagic complications and death. Approximately 50% of cases have an underlying condition such as malignancies, autoimmune disorders and post-partum state. AHA should be suspected in any patient presenting with unexplained bleeding and an inhibited aPTT. Management consists of maintaining hemostasis and elimination of the inhibitor, however management is not standardized. We present 62 cases of AHA managed at Mayo Clinic Rochester, over the course of 36 years. We also analyzed whether aPTT at presentation correlated with the strength of inhibition measured by Bethesda Titer. Methods After IRB approval, medical records of patients with AHA were reviewed and all clinical data collected. Cumulative incidence of death was estimated by Kaplan-Meier analysis. Spearman correlation was used to calculate relation of APTT to Bethesda titer. Results Between 1976 and 2012, we identified 62 patients (male: 35), with a median age at diagnosis of AHA 69 years (mean 64, range 20-86). Clinical presentation consisted of extensive ecchymoses (n=40, 64%) in majority of cases. 29/62 (47%) patients had at least 1 identifiable predisposing condition with 12/62 (19%) patients with an underlying malignancy and 16/62 (26%) with underlying autoimmune conditions. Median Bethesda titer was 29 (range 1 to 1178). Bethesda titer was not related to the number or duration of hospitalizations. Most (69%) patients had at least one hospitalization and 12 (19%) had more than one hospitalization for bleeding complication. Inpatient therapy for bleeding consisted most commonly of FEIBA in 21 pts (34%) and rFVIIa in 6 pts (10%). Prednisone was the most common immunosuppressant used in 54 (87%) patients while Rituximab was used in 11 (18%) patients. Of 32 patients with available follow up labs most (69%) achieved remission. There was no difference in remission rates between patients treated or not treated with Rituximab (p=0.1735). Conclusion Acquired Hemophilia A is a rare condition with very heterogenous presentation. It affects mostly older male patients who present with ecchymoses and elevated APTT. The degree of APTT prolongation at the time of diagnosis does not correlate with the strength of the Bethesda titer and should not guide choice of therapy in a patient presenting with an acute bleed. Rituximab use in the 11 patients treated at Mayo did not seem to influence remission rates or survival. Disclosures: No relevant conflicts of interest to declare. </jats:sec

Quantitative distribution of meiobenthos in the Gulf of Martaban, Myanmar Coast, north-east Andaman Sea

189-197Quantitative distribution of meiofauna in the depth range 20 to 1000 m of the Gulf of Martaban, Andaman Sea was studied from 46 stations during a synaptic survey carried out in April-May 2002 of ORV Sagar Kanya Cruise SK175. Fauna was dominated by three taxa: free living nematodes (80%) benthic copepods (5.9%) and foraminiferans (2.8%). Other groups together contributed more than copepods in total abundance. Total density ranged between 40 and 612/10 cm2 and dry weight biomass from 0.21 to 0.428 mg/10 cm2 in different sediment type and depth zone. Numerical abundance of meiofauna was high in fine silty clay and low in sandy bottom. Formation of three main clusters suggests the influence of dominant sediment texture of clayey sand sand silt clay, silty-clay clayey-silt, and sandy substratum. Fauna was contagiously distributed except at few stations where the distribution was regular. Meiofauna of the present study were similar to those of Andaman Sea and Bay of Bengal and the density changes appears to be related to hydrographic condition and sediment characteristics of the region

Pregnancy and birth outcomes after SARS-CoV-2 vaccination in pregnancy

ABSTRACTBackgroundSARS-CoV-2 infection during pregnancy is associated with significant maternal morbidity and increased rates of preterm birth. For this reason, COVID-19 vaccine administration in pregnancy has been endorsed by multiple professional societies including ACOG and SMFM despite exclusion of pregnant women from initial clinical trials of vaccine safety and efficacy. However, to date little data exists regarding outcomes after COVID-19 vaccination of pregnant patients.Study DesignA comprehensive vaccine registry was combined with a delivery database for an integrated healthcare system to create a delivery cohort including vaccinated patients. Maternal sociodemographic data were examined univariately for factors associated with COVID-19 vaccination. Pregnancy and birth outcomes were analyzed, including a composite measure of maternal and neonatal pregnancy complications, the Adverse Outcome Index.ResultsOf 2002 patients in the delivery cohort, 140 (7.0%) received a COVID-19 vaccination during pregnancy and 212 (10.6%) experienced a COVID-19 infection during pregnancy. The median gestational age at first vaccination was 32 weeks (range 13 6/7-40 4/7), and patients vaccinated during pregnancy were less likely than unvaccinated patients to experience COVID-19 infection prior to delivery (1.4% (2/140) vs. 11.3% (210/1862)) P&lt;0.001No maternal COVID-19 infections occurred after vaccination during pregnancy.Factors significantly associated with increased likelihood of vaccination included older age, higher level of maternal education, lower pre-pregnancy BMI, and use of infertility treatment for the current pregnancy. Tobacco or other substance use, Hispanic ethnicity, and higher gravidity were associated with a lower likelihood of vaccination. No significant difference in the composite adverse outcome (5.0% (7/140) vs. 4.9% (91/1862) P=0.95) or other maternal or neonatal complications, including thromboembolic events and preterm birth, was observed in vaccinated mothers compared to unvaccinated patients.ConclusionsVaccinated pregnant women in this birth cohort were less likely to experience COVID-19 infection compared to unvaccinated pregnant patients, and COVID-19 vaccination during pregnancy was not associated with increased pregnancy or delivery complications. Significant sociodemographic disparities in vaccine uptake and/or access were observed among pregnant patients, and future efforts should focus on outreach to low-uptake populations.</jats:sec