We conducted an epidemiologic investigation among survivors of an outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) infection in Jordan. A second-trimester stillbirth occurred during the course of an acute respiratory illness that was attributed to MERS-CoV on the basis of exposure history and positive results of MERS-CoV serologic testing. This is the first occurrence of stillbirth during an infection with MERS-CoV and may have bearing upon the surveillance and management of pregnant women in settings of unexplained respiratory illness potentially due to MERS-CoV. Future prospective investigations of MERS-CoV should ascertain pregnancy status and obtain further pregnancy-related data, including biological specimens for confirmatory testing.
Introduction Studies directly comparing preterm birth rates in women with and without severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection are limited. Our objective was to determine whether preterm birth was affected by SARS‐CoV‐2 infection within a large integrated health system in New York with a universal testing protocol. Material and methods This retrospective cohort study evaluated data from seven hospitals in New York City and Long Island between March 2020 and June 2021, incorporating both the first and second waves of the coronavirus disease 2019 (COVID‐19) pandemic in the USA. All patients with live singleton gestations who had SARS‐CoV‐2 polymerase chain reaction (PCR) testing at delivery were included. Deliveries before 20 weeks of gestation were excluded. The rate of preterm birth (before 37 weeks) was compared between patients with positive and negative SARS‐CoV‐2 test results. This analysis was performed separately for resolved prenatal infections and infections at delivery, with the latter group subdivided by symptom status. Multiple logistic regression analysis was used to examine the association between SARS‐CoV‐2 infection and preterm birth, adjusting for maternal age, race‐ethnicity, parity, history of preterm birth, body mass index, marital status, insurance type, medical co‐morbidities, month of delivery, and wave of pandemic. Results A total of 31 550 patients were included and 2473 (7.8%) had laboratory‐confirmed infection. Patients with symptomatic COVID‐19 at delivery were more likely to deliver preterm (19.0%; adjusted odds ratio 2.76, 95% CI 1.92–3.88) compared with women with asymptomatic infection (8.8%) or without infection (7.1%). Among preterm births associated with symptomatic infection, 72.5% were medically indicated compared with 44.1% among women without infection (p < 0.001). Risk of preterm birth in patients with resolved prenatal infection was unchanged when compared with women without infection. Among women with infection at delivery, preterm birth occurred more frequently during the second wave compared with the first wave (13.6% vs. 8.7%, respectively; p < 0.006). However, this was not significant on multiple regression analysis after adjusting for other explanatory variables. Conclusions Pregnant women with symptomatic COVID‐19 are more than twice as likely to have a preterm delivery than patients without infection. Asymptomatic infection and resolved prenatal infection are not associated with increased risk.
Background: Healthcare delivery is shifting to team-based care and physicians are increasingly relied upon to lead and participate in healthcare teams. Educational programs to foster the development of leadership qualities in medical students are needed to prepare future physicians for these roles. Objective: Evaluate the development of leadership attributes in medical students during their first 2 years of medical school while participating in leadership training integrated into a problem/case-based learning program utilizing the Leadership Traits Questionnaire assessment tool. Design: Ninety-eight students enrolled at Zucker School of Medicine participated in Patient-Centered Explorations in Active Reasoning, Learning and Synthesis (PEARLS), a hybrid problem/case-based learning program, during the first and second years of medical school. The Leadership Traits Questionnaire, designed to measure 14 distinct leadership traits, was utilized. It was administered to students, peers in students' PEARLS groups and their faculty facilitators. Participants completed questionnaires at three-time points during the study. Likert scale data obtained from the questionnaire was analyzed using a two-level Hierarchal Linear Model. Results: Complete data sets were available for 84 students. Four traits, including self-assured, persistent, determined, and outgoing, significantly increased over time by measurements of both peer and facilitator-rated assessments. Six additional traits significantly increased over time by measurement of facilitator-rated assessment. By contrast, a majority of student selfrated assessments trended downward during the study. Conclusions: Medical students demonstrated development of several important leadership traits during the first 2 years of medical school. This was accomplished while participating in the PEARLS program and without the addition of curricular time. Future work will examine the impact of third year clerkships on leadership traits.
The SARS-CoV-2 immunoglobulin G (IgG) antibodies increase approximately 2 to 3 weeks after viral infection. The time period for which these antibodies persist and how rapidly they decay have been the subject of several studies in nonpregnant patients, sometimes with differing results. 1e4 A study in pregnant women observed that the neutralizing antibody titers remained stable throughout gestation. 5 Our study evaluated the qualitative IgG antibody responses to SARS-CoV-2 infection longitudinally throughout pregnancy in an unselected cohort shortly after the peak of the outbreak in New York to determine the frequency of waning seropositivity. STUDY DESIGN:This retrospective cohort study evaluated all the patients who had first and second trimester biochemical screening to detect fetal aneuploidy between May 2020 and June 2020 at 3 hospitals within a large integrated health system in New York and subsequently had SARS-CoV-2 antibody testing during hospitalization for delivery. During the study period, the health system policy was to perform SARS-COV-2 polymerase chain reaction testing on all the hospitalized obstetrical patients and to offer, but not require, SARS-CoV-2 antibody testing. All the included patients were pregnant at the start of the COVID-19 pandemic and delivered before the availability of the SARS-CoV-2 vaccination. For each included patient, the dried blood specimens collected in the first trimester and the serum blood specimens collected in the second trimester were retrieved from storage at -20 C and were tested for SARS-CoV-2 IgG antibodies to the nucleocapsid protein using an enzymelinked immunosorbent assay (Gold
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