Obstetric outcomes of sars-cov-2 infection in asymptomatic pregnant women

Altres ajuts: Fondo Europeo de Desarrollo Regional (FEDER)Around two percent of asymptomatic women in labor test positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Spain. Families and care providers face childbirth with uncertainty. We determined if SARS-CoV-2 infection at delivery among asymptomatic mothers had different obstetric outcomes compared to negative patients. This was a multicenter prospective study based on universal antenatal screening for SARS-CoV-2 infection. A total of 42 hospitals tested women admitted for delivery using polymerase chain reaction, from March to May 2020. We included positive mothers and a sample of negative mothers asymptomatic throughout the antenatal period, with 6-week postpartum follow-up. Association between SARS-CoV-2 and obstetric outcomes was evaluated by multivariate logistic regression analyses. In total, 174 asymptomatic SARS-CoV-2 positive pregnancies were compared with 430 asymptomatic negative pregnancies. No differences were observed between both groups in key maternal and neonatal outcomes at delivery and follow-up, with the exception of prelabor rupture of membranes at term (adjusted odds ratio 1.88, 95% confidence interval 1.13-3.11; p = 0.015). Asymptomatic SARS-CoV-2 positive mothers have higher odds of prelabor rupture of membranes at term, without an increase in perinatal complications, compared to negative mothers. Pregnant women testing positive for SARS-CoV-2 at admission for delivery should be reassured by their healthcare workers in the absence of symptoms

Famílies botàniques de plantes medicinals

Facultat de Farmàcia, Universitat de Barcelona. Ensenyament: Grau de Farmàcia, Assignatura: Botànica Farmacèutica, Curs: 2013-2014, Coordinadors: Joan Simon, Cèsar Blanché i Maria Bosch.Els materials que aquí es presenten són els recull de 175 treballs d’una família botànica d’interès medicinal realitzats de manera individual. Els treballs han estat realitzat per la totalitat dels estudiants dels grups M-2 i M-3 de l’assignatura Botànica Farmacèutica durant els mesos d’abril i maig del curs 2013-14. Tots els treballs s’han dut a terme a través de la plataforma de GoogleDocs i han estat tutoritzats pel professor de l’assignatura i revisats i finalment co-avaluats entre els propis estudiants. L’objectiu principal de l’activitat ha estat fomentar l’aprenentatge autònom i col·laboratiu en Botànica farmacèutica

Serum 25-hydroxyvitamin D and cardiovascular disease risk factors in women with excessive weight gain during pregnancy and in their offspring at age 5-6 years

BACKGROUND/OBJECTIVE: Low 25-hydroxyvitamin D levels [25(OH)D] may increase the risk for cardiovascular disease (CVD). In pregnant women excessive weight gain and 25(OH)D deficiency are common complications and both could have deleterious consequences on their children. We aimed to study the relationship between serum 25(OH)D and CVD risk factors in pregnant women and in their offspring at school age. SUBJECTS/METHODS: Fasting serum 25(OH)D and its bioavailable fraction were quantified in 310 healthy pregnant women [with adequate (n = 113), insufficient (n = 113) and excessive (n = 84) weight gain]. A follow-up at 5-6 years was performed in sixty-six children born of these mothers. Lipids, insulin, glucose, and high-sensitivity C-reactive protein (hsCRP) were measured in all subjects. Children's carotid intima-media thickness (cIMT) together with visceral and intra-abdominal fat were measured by ultrasonography. RESULTS: Lower maternal 25(OH)D concentrations were associated with lower maternal age, and higher body mass index, triglycerides and hsCRP (all p < 0.05). In women with excessive weight gain during gestation, serum 25(OH)D concentrations showed independent associations with maternal hsCRP (β = -0.283 p = 0.03) and triglycerides (β = -0.436, p = 0.005). Maternal serum 25(OH)D concentrations were also independently associated with cIMT (β = -0.288, p = 0.04), visceral fat (β = -0.281, p = 0.01) and intra-abdominal fat (β = -0.248, p = 0.01) in their children at 5-6 years. CONCLUSIONS: Lower serum 25(OH)D concentrations were related to CVD risk factors in pregnant woman and in their offspring. The cardiometabolic consequences of low 25(OH)D concentrations during pregnancy could be aggravated by excessive weight gain during gestation.status: publishe

La fuga dal “recinto”: la trincea e la follia,

Una delle eredità più terribili e sinistramente innovative della Grande Guerra è certamente costituita dallo shock post traumatico e dalla “follia di guerra”. La dura, terribile vita di trincea ha presto il sopravvento sulla retorica bellicista e sull’estetica della bella morte, consegnandoci una realtà nella quale progressivamente si afferma l’orrore che cresce nel fango, nelle ristrettezze e negli stenti della trincea fino a divenire, per alcuni, insopportabile e a prospettare la follia come unica via di fuga. Lo studio apre uno scorcio su questa realtà terribile attraverso le drammatiche - a volte tragiche - testimonianze dei militari al fronte: parole che raccontano una perdita di individualità e di dignità personale, una fangosa e sanguinosa contiguità del soldato con la quotidianità della morte che alimenta atti di insubordinazione, di diserzione, ma anche un crescente disagio che può sfociare nella follia. Subordinazione e abbrutimento sono amplificati dalla dimensione esistenziale del “recinto” della trincea: un enorme labirinto di angustia, paura, morte che segna il destino di una generazione e cambia la definitivamente l’idea stessa della guerra nel Novecento.La seconda parte del saggio illustra come la “nevrosi di guerra” faccia il suo ingresso, dopo un esordio assai difficile e contrastato, nei campi di battaglia. L’”isteria di guerra” diventa una realtà non più eludibile né censurabile, con la quale si dovranno misurare i comandi militari e, soprattutto, gli psichiatri italiani. Dalla nascita del Servizio neuropsichiatrico di guerra e dalla prima attività diagnostica e clinica, negli ospedali da campo e nelle retrovie, sui soldati affetti da patologie psichiatriche originate dalla guerra presto si evidenziano l’ampiezza del fenomeno e la sua gravità. Il fenomeno è nuovo e non stupisce che emergano anche carenze nelle terapie: non vi è traccia di psicoterapia, mentre trova scarsa applicazione anche la famigerata elettroterapia che incontrava grande favore presso i neurologi. Lo studio dà quindi contro dell’ampio dibattito che si sviluppò intorno alla “strana malattia”, coinvolgendo luminari e le principali riviste scientifiche. Abbandonata a fatica l’idea di una predisposizione ereditaria alla patologia mentale, e dovendosi peraltro superare la tentazione di liquidare il “folle di guerra” come vile o codardo, si fa strada lentamente - soprattutto dopo il disastro di Caporetto – l’idea che i disturbi psichici avvertiti da un sempre maggiore numero si soldati fosse da attribuire alle fatiche e agli orrori imposti dalla guerra. Al termine del conflitto prevale tuttavia ancora l’idea che quello che gli inglesi, dopo la catastrofe della Somme, avevano chiamato shell schock, il disturbo da stress post-traumatico, fosse comunque fenomeno transitorio e recuperabile, quando non frutto di simulazioneAmong the most awkward and ominously innovative heritages of WW1 there are the post traumatic shock and the "insanity of war". The fearful life on the trench has quickly overcome the wartime rhetoric and the aesthetics of the BELLA MORTE.The reality is the gradual acceptance of the horror of a life made of mud, of scarcity of food and equipment for some, and the escape to madness for the others. The essay focuses on the tragic, even dramatic witnesses of the soldiers at war: words telling of loss of human dignity and personal individuality. The everyday proximity to death leads to insubordination, to desertion, but also to a state of discomfort, or eventually of madness. Subordination and degradation are magnified by the sense on confinement of the trench, a labyrinth of anxiety, fear, death that marks the destiny of a generation and modifies the idea of the war in XX Century. The second part of the essay introduces the subject of "neurosis of the war" in the battlefields. The "hysteria of the war" is now unavoidable and cannot be silenced.It becomes a challenge that the military High Command and the psychiatrists have to face. The neuropsychiatric Service at war, that carried on diagnostic and clinic action in field hospitals and behind the front were brought to test the amplitude of the problem. It is a new issue, not yet carefully attended: psycotherapy is still unknown, nor the elettroschock, so much praised among neurologists, is widely practised. The essay records the wide discussion on the "weird disease" among the most eminent physicians and the leading scientific reviews . The belief of a hereditary pathology was gradually set aside, so was the risk of considering the "mad at war" a coward. The source of the psychiatric diseases was acknowledged in the atrocities suffered in the war. Nevertheless, at the end of the war, the opinion that the shell Schock, as the British called it after the debacle of the Somme, reappers. According to it, the post-traumatic disease was only a temporary phenomenon, if not mere dissimulation

The association between SARS-CoV-2 infection and preterm delivery: a prospective study with a multivariable analysis.

To determine whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, the cause of COVID-19 disease) exposure in pregnancy, compared to non-exposure, is associated with infection-related obstetric morbidity. We conducted a multicentre prospective study in pregnancy based on a universal antenatal screening program for SARS-CoV-2 infection. Throughout Spain 45 hospitals tested all women at admission on delivery ward using polymerase-chain-reaction (PCR) for COVID-19 since late March 2020. The cohort of positive mothers and the concurrent sample of negative mothers was followed up until 6-weeks post-partum. Multivariable logistic regression analysis, adjusting for known confounding variables, determined the adjusted odds ratio (aOR) with 95% confidence intervals (95% CI) of the association of SARS-CoV-2 infection and obstetric outcomes. Preterm delivery (primary), premature rupture of membranes and neonatal intensive care unit admissions. Among 1009 screened pregnancies, 246 were SARS-CoV-2 positive. Compared to negative mothers (763 cases), SARS-CoV-2 infection increased the odds of preterm birth (34 vs 51, 13.8% vs 6.7%, aOR 2.12, 95% CI 1.32-3.36, p = 0.002); iatrogenic preterm delivery was more frequent in infected women (4.9% vs 1.3%, p = 0.001), while the occurrence of spontaneous preterm deliveries was statistically similar (6.1% vs 4.7%). An increased risk of premature rupture of membranes at term (39 vs 75, 15.8% vs 9.8%, aOR 1.70, 95% CI 1.11-2.57, p = 0.013) and neonatal intensive care unit admissions (23 vs 18, 9.3% vs 2.4%, aOR 4.62, 95% CI 2.43-8.94, p  This prospective multicentre study demonstrated that pregnant women infected with SARS-CoV-2 have more infection-related obstetric morbidity. This hypothesis merits evaluation of a causal association in further research

The impact of the COVID-19 pandemic on Sexually Transmitted Infections surveillance data : incidence drop or artefact?

Altres ajuts: Fundacion Alfonso Martin Escudero and the Medical Research Council (grant numbers MR/K501256/1, MR/N013468/1).Background: Before the COVID-19 pandemic, Sexually transmitted infections (STIs) were increasing in Europe, and Spain and Catalonia were not an exception. Catalonia has been one of the regions with the highest number of COVID-19 confirmed cases in Spain. The objective of this study was to estimate the magnitude of the decline, due to the COVID-19 pandemic, in the number of STI confirmed cases in Catalonia during the lockdown and de-escalation phases. Methods: Interrupted time series analysis was performed to estimate the magnitude of decline in the number of STI reported confirmed cases - chlamydia, gonorrhoea, syphilis, and lymphogranuloma venereum- in Catalonia since lockdown with historical data, from March 13th to August 1st 2020, comparing the observed with the expected values. Results: We found that since the start of COVID-19 pandemic the number of STI reported cases was 51% less than expected, reaching an average of 56% during lockdown (50% and 45% during de-escalation and new normality) with a maximum decrease of 72% for chlamydia and minimum of 22% for syphilis. Our results indicate that fewer STIs were reported in females, people living in more deprived areas, people with no previous STI episodes during the last three years, and in the HIV negative. Conclusions: The STI notification sharp decline was maintained almost five months after lockdown started, well into the new normality. This fact can hardly be explained without significant underdiagnosis and underreporting. There is an urgent need to strengthen STI/HIV diagnostic programs and services, as well as surveillance, as the pandemic could be concealing the real size of the already described re-emergence of STIs in most of the European countries

Absolute risk and predictors of the growth of acute spontaneous intracerebral haemorrhage : a systematic review and meta-analysis of individual patient data

Altres ajuts: UK Medical Research Council and British Heart Foundation.Intracerebral haemorrhage growth is associated with poor clinical outcome and is a therapeutic target for improving outcome. We aimed to determine the absolute risk and predictors of intracerebral haemorrhage growth, develop and validate prediction models, and evaluate the added value of CT angiography. In a systematic review of OVID MEDLINE-with additional hand-searching of relevant studies' bibliographies- from Jan 1, 1970, to Dec 31, 2015, we identified observational cohorts and randomised trials with repeat scanning protocols that included at least ten patients with acute intracerebral haemorrhage. We sought individual patient-level data from corresponding authors for patients aged 18 years or older with data available from brain imaging initially done 0·5-24 h and repeated fewer than 6 days after symptom onset, who had baseline intracerebral haemorrhage volume of less than 150 mL, and did not undergo acute treatment that might reduce intracerebral haemorrhage volume. We estimated the absolute risk and predictors of the primary outcome of intracerebral haemorrhage growth (defined as >6 mL increase in intracerebral haemorrhage volume on repeat imaging) using multivariable logistic regression models in development and validation cohorts in four subgroups of patients, using a hierarchical approach: patients not taking anticoagulant therapy at intracerebral haemorrhage onset (who constituted the largest subgroup), patients taking anticoagulant therapy at intracerebral haemorrhage onset, patients from cohorts that included at least some patients taking anticoagulant therapy at intracerebral haemorrhage onset, and patients for whom both information about anticoagulant therapy at intracerebral haemorrhage onset and spot sign on acute CT angiography were known. Of 4191 studies identified, 77 were eligible for inclusion. Overall, 36 (47%) cohorts provided data on 5435 eligible patients. 5076 of these patients were not taking anticoagulant therapy at symptom onset (median age 67 years, IQR 56-76), of whom 1009 (20%) had intracerebral haemorrhage growth. Multivariable models of patients with data on antiplatelet therapy use, data on anticoagulant therapy use, and assessment of CT angiography spot sign at symptom onset showed that time from symptom onset to baseline imaging (odds ratio 0·50, 95% CI 0·36-0·70; p<0·0001), intracerebral haemorrhage volume on baseline imaging (7·18, 4·46-11·60; p<0·0001), antiplatelet use (1·68, 1·06-2·66; p=0·026), and anticoagulant use (3·48, 1·96-6·16; p<0·0001) were independent predictors of intracerebral haemorrhage growth (C-index 0·78, 95% CI 0·75-0·82). Addition of CT angiography spot sign (odds ratio 4·46, 95% CI 2·95-6·75; p<0·0001) to the model increased the C-index by 0·05 (95% CI 0·03-0·07). In this large patient-level meta-analysis, models using four or five predictors had acceptable to good discrimination. These models could inform the location and frequency of observations on patients in clinical practice, explain treatment effects in prior randomised trials, and guide the design of future trials. UK Medical Research Council and British Heart Foundation