Background The US Department of State estimates that there are between 4 and 27 million individuals worldwide in some form of modern slavery. Recent studies have demonstrated that 28% to 50% of trafficking victims in the United States encountered health care professionals while in captivity, but were not identified and recognized. This study aimed to determine whether an educational presentation increased emergency department (ED) providers' recognition of human trafficking (HT) victims and knowledge of resources to manage cases of HT. Methods The 20 largest San Francisco Bay Area EDs were randomized into intervention (10 EDs) or delayed intervention comparison groups (10 EDs) to receive a standardized educational presentation containing the following: background about HT, relevance of HT to health care, clinical signs in potential victims, and referral options for potential victims. Participants in the delayed intervention group completed a pretest in the period the immediate intervention group received the educational presentation, and all participants were assessed immediately before (pretest) and after (posttest) the intervention. The intervention effect was tested by comparing the pre–post change in the intervention group to the change in 2 pretests in the delayed intervention group adjusted for the effect of clustering within EDs. The 4 primary outcomes were importance of knowledge of HT to the participant's profession (5-point Likert scale), self-rated knowledge of HT (5-point Likert scale), knowledge of who to call for potential HT victims (yes/no), and suspecting that a patient was a victim of HT (yes/no). Findings There were 258 study participants from 14 EDs; 141 from 8 EDs in the intervention group and 117 from 7 EDs in the delayed intervention comparison group, of which 20 served as the delayed intervention comparison group. Participants in the intervention group reported greater increases in their level of knowledge about HT versus those in the delayed intervention comparison group (1.42 vs −0.15; adjusted difference = 1.57 [95% confidence interval, 1.02–2.12]; P < 0.001). Pretest ratings of the importance of knowledge about HT to the participant's profession were high in both groups and there was no intervention effect (0.31 vs 0.55; −0.24 [−0.90–0.42], P = 0.49). Knowing who to call for potential HT victims increased from 7.2% to 59% in the intervention group and was unchanged (15%) in the delayed intervention comparison group (61.4% [28.5%–94.4%]; P < 0.01). The proportion of participants who suspected their patient was a victim of HT increased from 17% to 38% in the intervention group and remained unchanged (10%) in the delayed intervention comparison group (20.9 [8.6%– 33.1%]; P < 0.01). Interpretation A brief educational intervention increased ED provider knowledge and self-reported recognition of HT victims.

No abstract

Introduction Gorham–Stout Disease (GSD) is a rare disorder of bony destruction due to lymphangiomatosis, and is often triggered by hormones. One complication of GSD is the development of chylothorax, which carries a high mortality rate. Very little experience has been published to guide management in GSD during pregnancy to optimize both fetal and maternal health. Case Study A 20-year-old woman with known GSD presented with shortness of breath at 18 weeks of pregnancy, due to bilateral chylothoraces which required daily drainage. To minimize chylous fluid formation, she was placed on bowel rest with total parenteral nutrition (limiting lipid intake) and received octreotide to decrease splanchnic blood flow and chylous fluid drainage. Treatment options were limited due to her pregnancy. Twice daily home chest tube drainage of a single lung cavity, total parenteral nutrition, octreotide, and albumin infusions allowed successful delivery of a healthy 37 weeks' gestation infant by cesarean delivery. Discussion This case illustrates the management of a rare clinical disease of bone resorption and lymphangiomatosis complicated by bilateral, refractory chylothoraces, triggered by pregnancy, in whom treatment options are limited, and the need for a multidisciplinary health care team to ensure successful maternal and fetal outcomes.

No abstract

OBJECTIVE: Chronic endometritis (CE) has been associated with recurrent pregnancy loss (RPL) and recurrent implantation failure. Incidence rates vary due to significant heterogeneity in biopsy timing and diagnostic criteria. Our group previously demonstrated that plasma cells are found in 59% of endometrial biopsies (EMBs) in the follicular phase compared to 18% in the luteal phase, which led us to question whether menstruation or hormonal changes in the follicular phase impact the diagnosis of CE. The purpose of this study was to assess the incidence and density of endometrial plasma cells in the early versus late follicular phase.DESIGN: This is a retrospective cohort study of patients undergoing EMB in the follicular phase at a single academic center.MATERIALS AND METHODS: EMBs performed between 2018 and 2020 were included. The early follicular phase was defined as the end of menses through day 8 of the menstrual cycle. The late follicular phase was defined as 9-14 days after menses. Patients with a prior CE diagnosis or abnormal uterine pathology were excluded. EMBs were assessed by gynecologic pathologists via H&E stain and CD138 immunohistochemistry. Plasma cell density was reported as rare (1-2 per slide), scattered (R 3 per slide), or clusters. Continuous variables were compared using t-tests, and categorical variables were compared with chi-square tests.RESULTS: Plasma cells were found in 74% of EMBs performed in the early follicular phase compared to 45% in the late follicular phase. Although the study was not powered to detect differences in plasma cell density, plasma cells were most commonly noted to be scattered (39%) in the early follicular and rare (18%) in the late follicular phase. See Table 1 for complete results.CONCLUSIONS: Our data demonstrate that plasma cells are more likely to be detected at higher densities in EMBs performed during the early compared to the late follicular phase. These findings may represent the influence of estrogen levels or menstruation on the endometrium. Further studies with larger cohorts are needed to establish the optimal timing of EMB and determine the clinical significance of low-density endometrial plasma cells.

No abstract

Background Assisted reproductive technologies (ART) and non-IVF fertility treatments (NIFT) are treatments for infertility. These technologies may have long-term health effects in children such as increased hypertension, glucose intolerance, and hypertriglyceridemia. Few studies have compared children born following ART and NIFT to those conceived spontaneously by subfertile couples. Objective Describe metabolic differences in children conceived by ART and NIFT compared to children conceived spontaneously by infertile couples. Methods Children conceived by parent(s) receiving infertility care at the University of California, San Francisco between 2000 and 2017 were invited to participate in the Developmental Epidemiological Study of Children born through Reproductive Technology (DESCRT). Serum metabolomic analyses were conducted using samples from 143 enrolled children (age range 4-12 years, 43% female) conceived using NIFT or ART (with fresh or frozen embryos with and without ICSI) and children conceived spontaneously by subfertile couples. Principal component analysis and multivariable regression were used to compare the distribution of metabolites between groups. Results There was no separation in metabolites based on treatment or sex. NIFT conceived children showed no differences compared to spontaneously conceived controls. Only spontaneously conceived children had different metabolomics profiles from children conceived from fresh ART, frozen ART, and all ICSI. Pantoate and propionylglycine levels were elevated in fresh ART compared to the spontaneous group (p &lt; 0.001). Propionylglycine levels were elevated in the ICSI (both fresh and frozen) versus spontaneous group (p &lt; 0.001). Finally, 5-oxoproline levels were decreased in frozen ART compared to the spontaneous group p &lt; 0.001) Conclusion NIFT conceived children did not show any metabolic differences with spontaneously conceived children. The metabolic differences between ART-conceived children and children conceived spontaneously were small but unlikely to be clinically significant but should be examined in future studies.

No abstract