Professionally responsible coronavirus disease 2019 vaccination counseling of obstetrical and gynecologic patients

© 2021 Elsevier Inc. The development of coronavirus disease 2019 vaccines in the current and planned clinical trials is essential for the success of a public health response. This paper focuses on how physicians should implement the results of these clinical trials when counseling patients who are pregnant, planning to become pregnant, breastfeeding or planning to breastfeed about vaccines with government authorization for clinical use. Determining the most effective approach to counsel patients about coronavirus disease 2019 vaccination is challenging. We address the professionally responsible counseling of 3 groups of patients—those who are pregnant, those planning to become pregnant, and those breastfeeding or planning to breastfeed. We begin with an evidence-based account of the following 5 major challenges: the limited evidence base, the documented increased risk for severe disease among pregnant coronavirus disease 2019-infected patients, conflicting guidance from government agencies and professional associations, false information about coronavirus disease 2019 vaccines, and maternal mistrust and vaccine hesitancy. We subsequently provide evidence-based, ethically justified, practical guidance for meeting these challenges in the professionally responsible counseling of patients about coronavirus disease 2019 vaccination. To guide the professionally responsible counseling of patients who are pregnant, planning to become pregnant, and breastfeeding or planning to breastfeed, we explain how obstetrician-gynecologists should evaluate the current clinical information, why a recommendation of coronavirus disease 2019 vaccination should be made, and how this assessment should be presented to patients during the informed consent process with the goal of empowering them to make informed decisions. We also present a proactive account of how to respond when patients refuse the recommended vaccination, including the elements of the legal obligation of informed refusal and the ethical obligation to ask patients to reconsider. During this process, the physician should be alert to vaccine hesitancy, ask patients to express their hesitation and reasons for it, and respectfully address them. In contrast to the conflicting guidance from government agencies and professional associations, evidence-based professional ethics in obstetrics and gynecology provides unequivocal and clear guidance: Physicians should recommend coronavirus disease 2019 vaccination to patients who are pregnant, planning to become pregnant, and breastfeeding or planning to breastfeed. To prevent widening of the health inequities, build trust in the health benefits of vaccination, and encourage coronavirus disease 2019 vaccine and treatment uptake, in addition to recommending coronavirus disease 2019 vaccinations, physicians should engage with communities to tailor strategies to overcome mistrust and deliver evidence-based information, robust educational campaigns, and novel approaches to immunization

Does the human placenta express the canonical cell entry mediators for SARSCoV-2?

The pandemic of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has affected more than 10 million people, including pregnant women. To date, no consistent evidence for the vertical transmission of SARS-CoV-2 exists. The novel coronavirus canonically utilizes the angiotensin-converting enzyme 2 (ACE2) receptor and the serine protease TMPRSS2 for cell entry. Herein, building upon our previous single-cell study (Pique-Regi et al., 2019), another study, and new single-cell/nuclei RNA-sequencing data, we investigated the expression of ACE2 and TMPRSS2 throughout pregnancy in the placenta as well as in third-trimester chorioamniotic membranes. We report that co-transcription of ACE2 and TMPRSS2 is negligible in the placenta, thus not a likely path of vertical transmission for SARS-CoV-2. By contrast, receptors for Zika virus and cytomegalovirus, which cause congenital infections, are highly expressed by placental cell types. These data show that the placenta minimally expresses the canonical cell-entry mediators for SARS-CoV-2

Palynostratigraphy of the Mesozoic continental clastics in western and southeastern Libya

Abundant and diverse terrestrial palynomorphs recovered from 287 samples from 55 wells and outcrop material in the Mesozoic continental sequence of western and southeastern Libya have been used to establish palynological zonations, reconstruct paleogeography and depositional environments, and to delineate regional unconformities. Two miospore suites and six palynological assemblage zones include 365 distinct taxa. Thirty-five new palynomorph species and two genera are described and illustrated. Critical palynomorph types are systematically described, compared to other species, and documented stratigraphically. Middle Triassic conifer pollen and spores recovered from a cored section of the Al Aziziyah Formation are separated into two discrete suites. On the basis of new appearances of diagnostic species, Suite I is assigned to the early Ladinian, and Suite II is assigned to the late Ladinian. Palynological analysis of outcrop material and several boreholes permits the establishment of three palynozones within the Jurassic-Lower Cretaceous sediments of western Libya. Palynomorph assemblages of these biozones range in age from the Callovian (Middle Jurassic) to the Berriasian (Early Cretaceous). Spore and pollen assemblages from subsurface Kiklah Formation (Albian) are often associated with dinoflagellates and allow recognition of three distinct assemblage zones. Zone III, which is late Albian in age, is further separated into two subzones on the basis of appearance of characteristic species. Paleogeographic distribution of palynomorphs is analysed to assess the previously proposed dates and boundaries, and to interpret the continental to marginal marine depositional system characteristic of the Jurassic-Early Cretaceous sequence in northwestern Libya. The Nubian Sandstone facies in the As Sarir region and in the Murzuq Basin, traditionally considered of Jurassic-Cretaceous age, are divided on the basis of pollen and spores into four assemblage zones. Environments of deposition and paleogeography of these facies are interpreted in the light of new findings. Palynomorph assemblages indicate that Nubian Sandstone in western Libya was deposited by braided streams, flowing from the southern highlands. Application of local biostratigraphy for species-level comparisons with coeval microfloras from other parts of Northern Gondwana, particularly North Africa, Gabon Basin, and Brazil, confirms extension of the West African-South American (WASA) Province into North Africa. Sparse Laurasian palynomorphs may indicate that the West African-South American/Boreal floral boundary crossed into North Africa. Developed regional correlations and palynostratigraphy are used to test hypotheses on paleogeography, place and time of origin, and adaptive radiation of the early angiosperms. The new data are used to improve knowledge on the first appearance of specific microfloras and the geographic and geologic conditions of the African craton during the Mesozoic. Palynostratigraphic data support the concept that initial angiosperm evolution took place in semiarid environment of the tropical and subtropical regions before migration poleward. Occurrence of small smooth tricolpate pollen in the Aptian and Albian sediments of Libya and Egypt supports the pseudoanthial theory, and suggests that wind-pollination was well-established, at least, as early as the Aptian. However, coexistence of these psilate species with large coarsely sculptured insect-pollinated pollen add credibility to the idea that angiosperms are polyphyletic in origin