Morbidly obese (Class III, body mass index [BMI] ≥ 40 kg m(-2)) women constitute 8% of reproductive-aged women and are an increasing proportion; however, their pregnancy risks have not yet been well understood. Hence, we performed meta-analyses following the MOOSE (Meta-Analysis of Observational Studies in Epidemiology) guideline, searching Medline and Embase from their inceptions. To examine graded relationships, we compared Class III obesity to Class I and I/II, and separately to normal weight. We found important effects on all three primary outcomes in morbidly obese women: preterm birth <37 weeks was 31% higher compared with Class I (relative risk [RR] 1.31 [1.19, 1.43]) and 20% higher than Class I/II (RR 1.20 [1.13, 1.27]), large-for-gestational age was higher (RR 1.37 [1.29, 1.45] and RR 1.30 [1.24, 1.36] compared with Class I and I/II, respectively), while small-for-gestational age was lower (RR 0.89 [0.84, 0.93] compared with Class I, with nearly identical reductions for Class I/II). Morbidly obese women have higher risks of preterm birth, large-for-gestational age and numerous other adverse maternal and infant health outcomes, relative to not only normal weight but also Class I or I/II obese women. These findings have important implications for screening and care of morbidly obese pregnant women, to try to decrease adverse outcomes.

Highlights We evaluated the impact of extended use and H 2 O 2 decontamination on N95 respirators. Extended N95 use and decontamination was associated with a rapid loss of fit test. User seal check overestimated user fit test. Single-use N95 respirator longevity may be shorter than previously reported.

The synthesis of dimethyl derivatives of 5.6.5 spiro bicyclic lactam Pro-Leu-Gly-NH(2) peptidomimetics was carried out to test the hypothesis that by placing methyl groups on the β-methylene carbon of the thiazolidine ring steric bulk would be introduced into the topological space that the β-methylene carbon is believed to occupy in the negative allosteric modulators of the dopamine D(2) receptor. With such a modification, a positive allosteric modulator would be converted into a negative allosteric modulator. This hypothesis was shown to be correct as 3a and 4a where found to be negative allosteric modulators, whereas their unmethylated derivatives were positive allosteric modulators of the dopamine D(2) receptor.

Multisystem Inflammatory Syndrome in Adults is a rare and life-threatening complication that follows natural COVID-19 infection, primarily affecting young unvaccinated adults. This complication is seldomly described following vaccination, which would have important implications for this population's vaccination timing and platform. COVID-19 vaccines are extremely effective; however, the risk of rare adverse events needs to be balanced with the vaccination benefits.

Aims: We characterize the epidemiology of Actinotignum schaalii within a large Canadian region after implementation of improved identification methods. Patients & methods: Positive cultures for A. schaalii from a centralized microbiology laboratory in Canada were analyzed. Clinical data were retrieved through administrative databases and chart reviews. Primary outcome was incidence of A. schaalii infections; secondary outcomes included mortality, hospital admission and length of stay. Results & conclusions: 86 unique isolates were studied, 37 bloodstream infections (BSI) and 49 non-BSIs. Patients with BSIs were older with more comorbidities, with urinary tract infections implicated as the most frequent source; skin abscesses caused the most non-BSIs. Hospitalization and 90-day mortality was higher in the BSI group. A. schaalii is an important community-acquired pathogen with the potential to cause invasive infections.

Q uebec was the epicentre of the COVID-19 health crisis in Canada between March and August 2020, accounting for more than half of Canada's cases and deaths. 1 As of Feb. 9, 2021, over 271 700 cases and 10 000 deaths attributed to COVID-19 occurred in Quebec, of which more than 50% of cases and 60% of deaths occurred in Montréal. 1 The first case of COVID-19 in Quebec was diagnosed on Feb. 27, 2020, in an international traveller. 2 Early transmission dynamics were driven by returning international travellers, many of whom were returning from school spring break. 2,3 By mid-April, however, numerous outbreaks occurred in public and private residential care facilities (RCFs). The residents of these institutions bore the greatest burden of the first wave of the pandemic, accounting for 70% of the deaths in Canada and Quebec, with a case fatality rate estimated to be 36% (range 20% to 42%). 2,4,5 Of the 59 845 patients with SARS-CoV-2 infection reported in Quebec between Mar. 1 and July 27, 2020, people living in RCFs represented a disproportionate burden of COVID-19, accounting for 23.4% of all patients, 43% of hospitalizations and 84.3% of deaths attributed to During the first wave of the pandemic, the incidence and mortality rates of COVID-19 peaked in Quebec in mid-May

Purpose of Review Point-of-care dengue diagnostics are unavailable in most settings; thus, diagnosis is clinical until more definitive microbiological testing -such as serology -is resulted. Thrombocytopenia and lymphopenia are common hallmarks of dengue fever; however, neutropenia is a prominent, yet less frequently reported trend. We aimed to identify hematological patterns that can assist frontline clinicians with diagnostic certainty of dengue. Dengue patients presenting to our unit via the Emergency Department were compared to those presenting with other febrile illness (OFI) diagnoses. Patient demographics, day of illness, and neutrophil, lymphocyte, and platelet counts from days 1 to 14 of illness were collected, where available. Analyses were stratified by day of illness. Recent Findings Eighteen patients were included in the dengue group and 151 in the OFI group. The frequency of thrombocytopenia, neutropenia, and lymphopenia was each significantly greater in the dengue cohort than in the OFI group (p < 0.0001). Mean nadir platelet, neutrophil, and lymphocyte counts were significantly lower in the dengue cohort compared to those with OFI (p < 0.001), and the likelihood of a dengue patient having the constellation of thrombocytopenia, neutropenia, and lymphopenia on a single CBC during acute illness was 30-fold higher than in the OFI group (p < 0.0001). Summary As dengue-specific diagnostic testing is often limited by insensitive early serologic diagnostics with prolonged turnaround time, the constellation of thrombocytopenia, neutropenia, and lymphopenia can guide the early diagnostic and treatment approach as well as follow-up of febrile returned travelers with suspected dengue.

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