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Predictors of severe and critical disease in pregnant women with SARS-CoV-2

Limaye, Meghana A; Roman, Ashley S; Trostle, Megan E; Venkatesh, Pooja; Lantigua Martinez, Meralis; Brubaker, Sara G; Chervenak, Judith; Wei, Lili S; Sahani, Parita; Grossman, Tracy B; Meyer, Jessica A; Penfield, Christina A
BACKGROUND/OBJECTIVE/UNASSIGNED:SARS-CoV-2 continues to spread widely in the US and worldwide. Pregnant women are more likely to develop severe or critical illness than their non-pregnant counterparts. Known risk factors for severe and critical disease outside of pregnancy, such as asthma, diabetes, and obesity have not been well-studied in pregnancy. We aimed to determine which clinical and pregnancy-related factors were associated with severe and critical COVID illness in pregnancy. STUDY DESIGN/UNASSIGNED: < .05. Multivariable logistic regression was performed including variables that were significantly different between groups. RESULTS/UNASSIGNED:< .01). After adjustment, history of smoking remained significantly predictive of severe/critical disease [aOR 3.84 (95% CI, 1.25-11.82)]. CONCLUSION/UNASSIGNED:Pregnant women with a history of smoking, asthma, or other respiratory condition, and COVID-19 diagnosis in the second trimester of pregnancy were more likely to develop severe/critical disease. These findings may be useful in counseling women on their individual risk of developing the severe or critical disease in pregnancy and may help determine which women are good candidates for vaccination during pregnancy.
PMCID:8425435
PMID: 34470122
ISSN: 1476-4954
CID: 4999842

Overview on Adjuvant Vaginal Brachytherapy in Stage I to II Endometrial Carcinoma According to ESMO-ESGO-ESTRO Risk Classification: Long-Term Data from a Multi-Institutional Analysis in China [Meeting Abstract]

Wang, W; Zou, L; Wang, T; Liu, Z; He, J; Sun, X; Zhong, W; Zhao, F; LI, X; Li, S; Zhu, H; Ma, Z; Zhang, F; Hou, X; Wei, L; Hu, K
Purpose: This research aimed to perform an overview on adjuvant vaginal brachytherapy (VBT) in stage I to II endometrial carcinoma (EC) according to ESMO-ESGO-ESTRO risk group consensus in China from multi-institutional analysis.Materials and Methods: We retrospectively analyze patients with stage I to II EC at 13 institutions in China treated between 2003 and 2015. All patients underwent adjuvant radiotherapy and were divided into low-risk (LR), intermediate-risk (IR), high-intermediate risk (HIR) and high-risk (HR) groups according to ESMO-ESGO-ESTRO risk group consensus. XXResult(s): A total of 1048 cases were included. Stage I disease accounted for 85.9% of the cohort. Proportion of HR disease was 27.6%, HIR 17.7%, IR 27.7% and LR 27.1%. Patients received adjuvant VBT alone (n = 474), pelvic external beam radiotherapy (EBRT) alone (n = 116) or combined EBRT with VBT (n = 458). An increasing trend was found toward referrals for VBT alone. Historical data demonstrate that the clinical practice of adjuvant VBT alone increased significantly in the LR to HIR groups over the past 13 years. However, in the HR group, the proportion of VBT alone or as a boost after EBRT stayed stable in the corresponding period.All institutions commonly use High-dose-rate VBT prescribed to 0.5-cm depth from the vaginal surface with 14 and 17 different dose-fractionation schedules for VBT alone and VBT boost, respectively. The most common fractionation for VBT alone is 5 Gy in six fraction (407/474) and the most common fractionation for VBT as a boost after EBRT is 5 Gy in two fractions (178/458). Proximal 2-3 cm vagina was the most often irradiated vaginal target (61.3%). The most commonly used applicators were the multichannel vaginal cylinder (79.6%). The median follow-up time was 56 months. For LR to HIR patients, VBT alone achieved comparable survival to EBRT. Compared to EBRT, patients receiving VBT had significantly decreased incidence of grade 1-2 early and late gastrointestinal and urinary reactions, and the rate of grade 3-4 acute hematological toxicity. XXConclusion(s): There is remarkable heterogeneity among VBT dose-fractionation schedules. An increasing trend was found toward referrals for VBT alone. The clinical practice of adjuvant VBT alone increased significantly in LR to HIR groups over the past 13 years. In LR to HIR group, VBT alone achieved comparable survival to EBRT.XXCopyright
EMBASE:2013170982
ISSN: 1538-4721
CID: 4928502

A Modern Measles Outbreak: Understanding maternal immunity and impact on postpartum vaccination uptake

Hirschberg, Carly I; Limaye, Meghana; Roman, Ashley; Friedman, Steven; Lighter, Jennifer L; Deeb, Jessica; Schweizer, William; Wei, Lili; Mehta-Lee, Shilpi S
OBJECTIVE:In October 2018, a measles (rubeola) outbreak was identified in New York City (NYC) & Rockland County (RC) and a public health campaign and hospital policy changes were made to increase awareness of the importance of vaccination and increase vaccination rates. We describe the prevalence of rubeola immunity in pregnant women and the change in uptake of postpartum MMR vaccination before and during the measles outbreak. METHODS:A multi-pronged intervention was developed by the health system with the intent of raising awareness of the outbreak, identifying patients at risk of contracting measles during pregnancy, and limiting exposure of inpatients to the disease. This was a quality improvement study to assess the impact of the intervention and public health policy on the rates of documentation of rubeola immunity and rubeola vaccination rates in non-immune women. Women who delivered at NYU Langone Health prior to the outbreak (7/1/2016 to 7/1/2017) were compared to women who delivered during the outbreak (7/1/18 to 7/1/19). The primary outcome was acceptance of MMR vaccination in non-immune women during the postpartum period. Analysis was conducted using logistic regression and chi-square tests, and alpha was set at 0.05. RESULTS:19585 patients were analyzed. 9,162 women delivered prior to outbreak and 10,423 delivered during the outbreak. Of these, 2589 (13.2%) were documented as living in a high-risk ZIP code, which were areas at the epicenter of the measles outbreak. 14,731 women (75.2%) were tested for rubeola immunity and 3270 (22.2%) of those tested were not immune. In the year of the outbreak, a higher proportion of women had rubeola immunity documented with serum titers than in the year prior to the outbreak (81% vs. 69%, p<0.001). Inpatient compliance with postpartum MMR administration was greater during the outbreak than prior to it (76% vs 59%, p <.001) for patients from both low risk and high-risk ZIP codes. CONCLUSION/CONCLUSIONS:The NYC & RC measles outbreak, together with implementation of a health system wide education program and a change in public health policy led to an increase in the proportion of pregnant women being screened for rubeola immunity. It also led to an increase in uptake of the immediate postpartum MMR vaccine.
PMID: 33453442
ISSN: 2589-9333
CID: 4760102

Picking Up the Pieces: Healthcare Quality in a Post-COVID-19 World

Vinoya-Chung, Cjloe R; Jalon, Hillary S; Cho, Hyung J; Bajaj, Komal; Fleischman, Jean; Ickowicz, Marlee; Nassis, Electra; Wei, Lili S; Kaufman, Daran; Xavier, Geralda; Luong, Khoi; DeOcampo, Marilen; Conley, Georgia; Edwards, Darwin; Wei, Eric K
PMID: 32780582
ISSN: 2326-5108
CID: 4556252

1060: A modern measles outbreak: Understanding maternal immunity and impact on postpartum vaccination uptake [Meeting Abstract]

Mehta-Lee, S; Limaye, M; Hirschberg, C; Wei, L; Deeb, J; Schweizer, W; Roman, A
Objective: In October 2018 a measles (rubeola) outbreak was identified in New York City (NYC) & Rockland County (RC). A public health emergency was declared with a focus on increasing MMR (measles, mumps, and rubella) vaccination uptake. Childhood MMR vaccination is 97% effective but antibody titers decrease over time. Screening for immunity has not been a routine part of prenatal care. NYU Langone Health created a communication and prevention program at the start of the outbreak and non-immune women were encouraged to take the MMR vaccination postpartum during hospitalization. We aimed to describe the prevalence of rubeola immunity in pregnant women and the change in uptake of postpartum MMR vaccination before and during the measles outbreak.
Study Design: This was a retrospective cohort, quality improvement study. The control group was women who delivered at NYU Langone Health prior to the outbreak (PO) from 7/1/2016 to 7/1/2017. The study group was women who delivered during the outbreak (DO) from 7/1/18 to 7/1/19. Primary outcome was acceptance of MMR vaccination in non-immune women during the postpartum period. Serologic evidence of rubeola immunity was defined based on lab reference values. Statistical analysis was done using chi-square and T-test.
Result(s): 19585 patients were analyzed. 9,162 women delivered PO and 10,423 delivered DO. Of these, 2589 (13.2%) were documented as living in a high-risk ZIP code. 14,731 women (75.2%) were tested for rubeola immunity and 3270 (22.2%) of those tested were not immune. In the year DO, a higher proportion of women had rubeola immunity documented with serum titers than in the year PO (81% vs. 69%, p< 0.001). Inpatient compliance with postpartum MMR administration was greater DO than PO (100% v. 88.2%, p< 0.001).
Conclusion(s): The NYC & RC measles outbreak, together with implementation of a health system wide education program and a change in public health policy led to an increase in the proportion of pregnant women being screened for measles immunity. It also led to an increase in uptake of the immediate postpartum MMR vaccine. [Formula presented]
Copyright
EMBASE:2004455396
ISSN: 1097-6868
CID: 4260892

Addressing practical concerns surrounding fertility preservation in patients with Turner syndrome [Editorial]

Blakemore, Jennifer K; Wei, Lili S; Quinn, Gwendolyn P
PMID: 31371047
ISSN: 1556-5653
CID: 4015422

CEA in breast ductal secretions as a promising biomarker for the diagnosis of breast cancer: a systematic review and meta-analysis

Tang, Shifu; Zhou, Fang; Sun, Yifan; Wei, Lili; Zhu, Shengbo; Yang, Renqi; Huang, Yiyong; Yang, Jianqing
PURPOSE/OBJECTIVE:Other studies have shown that levels of carcinoembryonic antigen (CEA) in breast ductal secretions (BDS) differ significantly between breast cancer (BC) patients and healthy individuals, providing direct evidence for CEA in BDS as a promising biomarker for BC. This meta-analysis was designed to assess the potential diagnostic value of CEA in BDS. METHODS:Relevant articles were retrieved from Embase, Pubmed, and the Cochrane Library. Sensitivity, specificity, and diagnostic odds ratio (DOR) of CEA in BDS for diagnosing BC were pooled using random effects models. SROC and the area under the curve (AUC) were used to estimate overall diagnostic performance. RESULTS:This meta-analysis comprised five studies with a total of 340 BC patients and 448 healthy controls. For CEA in BDS, the pooled sensitivity, specificity, and DOR to diagnose BC were 58 % [95 % confidence interval (CI): 52-63 %], 87 % (95 % CI: 84-90 %), and 7.07 (95 % CI: 3.10-16.12), respectively. Moreover, the AUC of CEA in the diagnosis of BC was 0.8570. CONCLUSIONS:CEA in BDS is a promising biomarker in the diagnosis of BC and should be evaluated as a standard screening tool upon verification of our results in a larger study population.
PMID: 26898373
ISSN: 1880-4233
CID: 3215172

High-visfatin levels in women with polycystic ovary syndrome: evidence from a meta-analysis

Sun, Yifan; Wu, Zhitong; Wei, Lili; Liu, Chunming; Zhu, Shengbo; Tang, Shifu
OBJECTIVE:Previous studies regarding visfatin levels in women with polycystic ovary syndrome (PCOS) showed conflicting results. To evaluate the visfatin levels in PCOS, a meta-analysis was performed. METHODS:A comprehensive literature search of eligible studies in Embase, Pubmed and the Cochrane Library was undertaken through November 2014. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated to estimate the strength of the association. RESULTS:A total of 1341 subjects (695 cases and 646 controls) were included in this meta-analysis. The pooled analysis results indicated that the visfatin levels were significantly higher in PCOS patients than that of controls (SMD = 1.19, 95% CI 0.77-1.60, p = 0.000). The results from stratified analysis and univariate analysis suggested that high-visfatin levels were not related to body mass index (BMI), insulin resistance (IR) and total testosterone ratio. Significant heterogeneity was observed in all analysis. CONCLUSION/CONCLUSIONS:Our results indicate that high-circulating visfatin level is an intrinsic characteristic of PCOS, which suggests visfatin could be a potential biomarker for PCOS.
PMID: 26422683
ISSN: 1473-0766
CID: 3215162