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SARS-CoV-2 is known to impact multiple organ systems, with growing data to suggest the potential for placental infection and resultant pathology. Understanding how maternal COVID-19 disease can affect placental histopathology has been limited by small study cohorts with mild disease, review by multiple pathologists, and potential confounding by maternal-fetal comorbidities that can also influence placental findings. This study aims to identify pathologic placental findings associated with COVID-19 disease and severity, as well as to distinguish them from changes related to coexisting maternal-fetal comorbidities.This is an observational study of 61 pregnant women with confirmed SARS-CoV-2 infection who delivered and had a placental histological evaluation at NYU Langone Health between March 19, 2020 and June 30, 2020. Primary outcomes were the prevalence of placental histopathologic features and their association with maternal-fetal comorbidities and severity of COVID-19 related hypoxia. Analysis was performed using Fisher's exact test andSixty-one placentas were included in the study cohort, 71% from pregnancies complicated by at least one maternal-fetal comorbidity. Twenty-five percent of placentas were small for gestational age and 77% exhibited at least one feature of maternal vascular malperfusion. None of the histopathologic features in the examined placentas were associated with the presence of any specific maternal-fetal comorbidity. Thirteen percent of the cohort required maternal respiratory support for COVID-19 related hypoxia. Villous trophoblast necrosis was associated with maternal supplemental oxygen requirement (67In pregnancies complicated by COVID-19 disease, there was a high prevalence of placental histopathologic changes identified, particularly features of maternal vascular malperfusion, which could not be attributed solely to the presence of maternal-fetal comorbidities. The significantly increased prevalence of villous trophoblast necrosis in women needing respiratory support suggests a connection to the severity of COVID-19 illness.

ObjectivesEstablishing the rate of post-vaccination cardiac myocarditis in the 12-15 and 16-17-year-old population in the context of their COVID-19 hospitalization risk is critical for developing a vaccination recommendation framework that balances harms with benefits for this patient demographic.Design, Setting and ParticipantsUsing the Vaccine Adverse Event Reporting System (VAERS), this retrospective epidemiological assessment reviewed reports filed between January 1, 2021, and June 18, 2021, among adolescents ages 12-17 who received mRNA vaccination against COVID-19. Symptom search criteria included the words chest pain, myocarditis, pericarditis and myopericarditis to identify children with evidence of cardiac injury. The word troponin was a required element in the laboratory findings. Inclusion criteria were aligned with the CDC working case definition for probable myocarditis. Stratified cardiac adverse event (CAE) rates were reported for age, sex and vaccination dose number. A harm-benefit analysis was conducted using existing literature on COVID-19-related hospitalization risks in this demographic.Main outcome measures1) Stratified rates of mRNA vaccine-related myocarditis in adolescents age 12-15 and 16-17; and 2) harm-benefit analysis of vaccine-related CAEs in relation to COVID-19 hospitalization risk.ResultsA total of 253 CAEs were identified. Rates per million following dose 2 among males were 162.2 (ages 12-15) and 93.0 (ages 16-17); among females, rates were 13.0 and 12.5 per million, respectively. For boys 12-15 without medical comorbidities receiving their second mRNA vaccination dose, the rate of CAE is 2.6 to 4.3 times higher than their 120-day COVID-19 hospitalization risk even at times of peak incidence such as during the delta wave (7-day hospitalizations 2.1/100k population). For boys 16-17 without medical comorbidities, the rate of CAE is 1.5 to 2.5 times higher at times of high weekly COVID-19 hospitalization.ConclusionsPost-vaccination CAE rate was highest in young boys aged 12-15 following dose two. For boys 12-17 without medical comorbidities, the likelihood of post vaccination dose two CAE is 162.2 and 93.0/million respectively. This incidence exceeds their expected 120-day COVID-19 hospitalization rate at both moderate and high COVID-19 hospitalization incidence. Further research into the severity and long-term sequelae of post-vaccination CAE is warranted. Quantification of the benefits of the second vaccination dose and vaccination in addition to natural immunity in this demographic may be indicated to minimize harm.

Purpose To determine the prevalence of strabismus among Danish adults and to find the frequency of history of strabismus and strabismus surgery. Furthermore, to evaluate the prevalence of strabismus-associated amblyopia among participants with strabismus and to relate the results to the current national vision screening programme. Methods In total, 3785 adults in the Danish Rural Eye Study underwent an interview regarding eye health, visual acuity measurement, Hirschberg test and retinal photography. Participants were categorized into groups based on their birth date in relation to the introduction of the national vision screening programme. Results In total, the prevalence of strabismus was 1.1% (41/3785; 95% CI: 0.8-1.5); no differences were found in relation to gender or screening status. The prevalence of exotropia (XT) was 0.3% (12/3785; 95% CI: 0.2-0.6) and of esotropia (ET) 0.8% (29/3785; 95% CI: 0.5-1.1), resulting in an XT:ET ratio of 1:2.7. A history of strabismus was present in 4.6% (174/3785; 95% CI: 4.0-5.3), and a history of strabismus surgery was present in 0.8% (32/3785; 95% CI: 0.6-1.2) of the participants. Among participants with manifest strabismus, 24% had strabismus-associated amblyopia. Conclusion In this first European population-based study of strabismus prevalence in adults, the prevalence was similar to three out of five previous studies using cover test. The use of Hirschberg test may have led to an underestimation of the true prevalence. The prevalence was neither related to screening status nor gender. Our results are the first to display a predominance of ET among Caucasian Scandinavian adults.

Despite the growing number of patients worldwide with metabolism-related chronic diseases, medical biochemistry education is commonly perceived as focusing on recall of facts irrelevant for patient care. The authors suggest that this focus on rote memorization of pathways creates excessive cognitive load that may interfere with learners’ development of an integrated understanding of metabolic regulation and dysregulation. This cognitive load can be minimized by providing appropriate references during learning and assessment. Biochemistry educators collaborated to develop a medically relevant pathways of human metabolism map (MetMap) that is now being used at many medical schools as a nationally standardized resource during learning and assessments. To assess impact, students from three medical schools were surveyed about its benefits and disadvantages. Responses were obtained from 481 students (84%) and were examined using thematic analysis. Five main themes emerged as perceived benefits of using the MetMap: (1) aids visual and mental organization, (2) promotes deep learning and applied understanding, (3) decreases emphasis on memorization, (4) reduces anxiety on exams, and (5) aids recall. Perceived disadvantages were (1) fear of underpreparation for licensing exams, (2) overwhelming nature of the map, and (3) reduced motivation for and time spent studying. Results affirm that students’ perceive use of the MetMap promotes focus on broader metabolic concepts and deep versus surface learning, supporting a shift in cognitive load toward desired goals. Although the long-term impact on learning needs to be further studied, the use of the MetMap represents a step toward open-reference exams that reflect “real-world” practice.

Purpose: To examine the frequency and causes of visual impairment (VI) in a select population of Danish adults.Methods: A total of 3843 adults aged 20-94 years from the Danish General Suburban Population Study (GESUS) were included in the population-based, cross-sectional ophthalmological study, Danish Rural Eye Study (DRES). All DRES participants received a comprehensive general health examination preceding their eye examination, including measurement of best-corrected visual acuity (BCVA) for each eye, bilateral 45° retinal fundus photographs and further ophthalmological examination where indicated.Results: Overall, 3826 of 3843 participants (99.6%) had bilateral visual acuity measurements. The overall frequency of VI (BCVA 50 years and 3.7% (95% CI 2.1-6.5%; n = 11) in participants >80 years. The primary causes of VI in the better-seeing eye were age-related macular degeneration (AMD) in 46.7% (7/15) and cataract in 26.7% (4/15). A total of 43.3% (n = 115) of participants >80 years were pseudophakic in one or both eyes. The frequency of diabetes (HbA 1c ≥48 mmol/mol or self-reported diagnosis) was 5.9% (n = 227), including 1.3% (n = 51) newly diagnosed in the GESUS. Of participants determined to have VI due to exudative AMD, 50% had received anti-vascular endothelial growth factor (VEGF) treatment.Conclusion: We report a relatively low frequency of VI among Danish adults over 59 years of age compared with that observed 10-15 years ago, which is both consistent with other recent Scandinavian studies and reflective of our relatively healthy and mobile population sample.

Significant visual impairment occurs in a small percentage of ultramarathon participants and is thought to be due to corneal edema. Yet, the usual effects of prolonged exercise on the eye have not been previously reported. Eight study volunteers who completed the 161-km Western States Endurance Run underwent pre-race and post-race binocular and monocular visual acuity, intraocular pressure, and corneal thickness measurements. None was symptomatic with visual impairment during the race and they demonstrated no changes from pre-race to post-race in visual acuity (p = 0.11–0.95 for right, left and combined), intraocular pressure (p = 0.11–0.43 for the both eyes) and corneal thickness (p = 0.30–0.99 for both eyes at three corneal areas). We conclude that there is no evidence that ultramarathon running has an acute effect on eye function or physiology when the runner has no symptoms or findings of visual impairment.

Objective The purpose of this study was to investigate the characteristics under which ultramarathon-associated visual impairment occurs and to seek to identify its physiological basis and risk factors. Methods Through an online questionnaire, distributed worldwide, we obtained information from 173 self-identified ultramarathon runners who had experienced visual impairment during an ultramarathon. We attempted to characterize this vision impairment—its symptoms, duration, and the conditions under which it occurs. Select characteristics were compared with a reference group of 412 registrants of the 161-km Western States Endurance Run. Results Ultramarathon-associated visual impairment was typically characterized as painless clouding of vision that resolved either during (13.5%) or after racing within a median of 3.5 hours (range 0 to 48 hours) upon cessation of running. The mean (±SD) distance at which vision impairment occurred was 73 ± 40 km, and the 161-km distance was the most frequent race distance (46.8%) in which visual impairment occurred. Visual impairment was often recurrent, with respondents reporting having it develop during a median of 2 races. Respondents with a history of refractive surgery had more episodes than those without such history (median 3.5 vs 2 episodes, P = .010). Compared with the reference group, runners with visual impairment were nearly twice as likely (23.7% vs 12.1%, P Conclusions Ultramarathon-associated visual impairment typically presents as a painless clouding of vision that is self-limited but tends to recur in certain runners. Risk appears higher among those with a history of refractive surgery, which is relevant for ultramarathon runners who are considering, or who have a history of, refractive surgery.

Purpose To determine the prevalence of amblyopia in Denmark before and after the initiation of the Danish national preschool vision screening programme. Methods In a population-based cross-sectional study, 3826 participants of the Danish General Suburban Population Study (GESUS) aged 20 years and older from a Danish rural municipality received a complete general health examination and an ophthalmological interview and examination. This study included a comprehensive ophthalmologic interview, measurement of best corrected visual acuity (BCVA) in each eye, Hirschberg's test for strabismus and two 45-degree retinal fundus photographs of each eye. A complete ophthalmologic examination was performed when indicated. Results The prevalence of monocular visual impairment (MVI) was 4.26% (95% CI, 3.66–4.95, n = 163). Amblyopia was the most common cause, accounting for 33%. The prevalence of amblyopia was 1.44% (95% CI, 1.01–1.81, n = 55), being higher among non-preschool vision screened persons compared to those who were offered (estimated 95% attendance) preschool vision screening (1.78%, n = 41, 95% CI 1.24–2.33 versus 0.44%, n = 2, 95% CI, 0.12–1.60, p = 0.024). The leading cause of amblyopia was anisometropia (45.5%, 25/55). Conclusions Amblyopia was the most common cause of MVI. Following the initiation of the Danish national preschool vision screening programme, which has an approximate attendance rate of 95%, the prevalence of amblyopia decreased by fourfold.

Background RESTORE (Randomized Evaluation of Sedation Titration for Respiratory Failure) was a cluster randomized clinical trial evaluating a sedation strategy in children 2 weeks to

Twenty-four women with children 5 years old or younger were interviewed regarding their experiences in losing weight during the postpartum period. Phenomenological interviews were conducted according to Husserl’s perspective. Women who participated in the study revealed the issues related to postpartum weight loss: weight struggles, exercise, breast-feeding, eating, and pregnancy contributions to weight gain. The overall theme that resulted from these in-depth interviews was that women struggle to balance their successes and setbacks in losing weight during the postpartum period.

This study used the MMPI-2 to explore the personalities of yellow-belt and black-belt martial artists. A total of 40 participants completed the MMPI-2 and a demographic questionnaire. Black-belt females tended to be less defensive than were other martial artists, but also displayed more paranoia and more anger than average. Females of both ranks reported a higher degree of anxiety and health concerns than did males in the study, and black-belt females also reported more family problems than did other groups. Finally, black belts in general reported more health concerns than did yellow belts.

We studied two large Mycobacterium tuberculosis genotype clusters associated with recent outbreaks in homeless persons to determine factors associated with these tuberculosis (TB) strains. Isolates from all culture-positive TB cases diagnosed from 1 January 2001 to 31 December 2004 were genotyped. Patients whose isolates had identical restriction fragment length polymorphism patterns and spoligotypes were considered clustered. Health department records were reviewed and reinterviews attempted for clustered cases. Patients with the Cs30 and BEs75 strains were compared to other genotypically clustered cases and to each other. The two largest genotype clusters among homeless persons were the Cs30 strain ( n = 105) and the BEs75 strain ( n = 47). Fifty-one (49%) patients with the Cs30 strain and 28 (60%) with the BEs75 strain were homeless. Compared to patients with the BEs75 strain, patients with the Cs30 strain were less likely to be respiratory acid-fast bacillus smear positive (51% versus 72%). Furthermore, patients with the BEs75 strain were more likely to be HIV infected (74% versus 42%), which suggests that most patients with this strain advanced to disease after recent infection. Cases in clusters of strains that have been circulating in the community over a long time period, such as the Cs30 strain, require additional investigation to determine whether clustering is a result of recent transmission or reactivation of remote infection.

At age 46, Francisco de Goya (1746-1828) suffered from a severe illness that lasted several months. It caused loss of vision and hearing, tinnitus, disorientation, weakness, abdominal distress, and general malaise. After a few months he recuperated but was left deaf forever. In addition to the physical effects, his emotional health and artwork were affected. The precise cause of this illness has long been debated. One early, but unlikely, hypothesis was that he had syphilis. Later conjectures have included Vogt-Koyanagi-Harada disease and lead toxicity. Cogan's syndrome and vasculitis are additional possibilities, although neither is likely to have been Goya's diagnosis. An infectious disease such as meningitis, encephalitis, or malaria is far more likely. Quinine toxicity (cinchonism) may have complicated the illness.

Urinary incontinence (UI) is a disorder receiving little attention from clinical health psychologists. This paper establishes the importance of addressing the issue of UI within the clinical and research practices of clinical health psychologists. Over 10 million Americans suffer from loss of bladder control. Incontinence affects over half of older individuals in long-term care institutions, about one-third of hospitalized elderly, and up to 30% of Americans over the age of 60 living at home. Because of social stigma and misconceptions attached to urinary incontinence, it is estimated that less than half of those affected see a physician about their condition. Since UI is generally associated with medical, social, psychological, and economic consequences, a multidisciplinary perspective is important because these factors are integral in the selection of appropriate treatment. Definitions of UI, its incidence and costs, and brief reviews of treatment and management techniques are presented. Psychological sequelae and treatments are presented as a foundation for developing further treatment and research approaches. Guidelines for collaboration and consultation by clinical health psychologists with medical professionals in the area of UI are also discussed.

In the present state of knowledge of epidemic hepatitis, this disease can be defined only in descriptive terms, since the infectious agent has not yet been isolated and identified. The disease is transmissible to human beings by oral or parenteral inoculation with a filter-passing agent, presumably a virus,1but in contrast to spirochetal jaundice and yellow fever experimental infection of animals has never been accomplished. It is characterized clinically by evidence of hepatic dysfunction and pathologically by inflammatory and degenerative changes in the hepatic parenchyma. It ordinarily runs a benign, self-limited course of two to three weeks' duration, but symptoms may persist for months, with or without acute recrudescences. Although the mortality is low, death may occur at any stage. On clinical and pathologic grounds it is indistinguishable from the endemic, sporadic disease known for many years as catarrhal jaundice, from homologous serum jaundice and from at least certain

Background. We conducted a pharmacokinetic study of antimycobacterial drugs involving a cohort of patients with pulmonary tuberculosis (TB) in Gaborone, Botswana, to assess the prevalence of and risk factors for low drug concentrations in serum. Methods. Adults participated if they had a history of cough 2 weeks, had abnormal chest radiograph findings, consented to testing for human immunodeficiency virus (HIV), had sputum cultures positive for Mycobacterium tuberculosis, and were receiving antituberculous therapy for 17 days. Observed maximum serum concentrations were compared with published normal ranges. Results. Of 91 patients enrolled, 89 (98%) were outpatients, and 59 (68%) of 87 patients tested had HIV infection. The following numbers of patients had low serum concentrations of the following drugs: isoniazid, 27 (30%) of 90; rifampin, 71 (78%) of 91; ethambutol, 37 (41%) of 91; and pyrazinamide, 1 (1%) of 91. Low serum concentrations of both isoniazid and rifampin occurred in 23 (26%) of 90 patients. Low serum concentrations of rifampin were found in both HIV-infected and non‐HIV-infected patients, and such patients were less likely to have 14 weeks of symptoms, more likely to have lymphadenopathy, and more likely to have low serum albumin levels ( for all). The associations with noncavitary pulmonary disease ( ) and HIV infection ( P ! .05 P p .12 P p ) did not reach statistical significance. Delayed absorption was most common with ethambutol, followed by .07 rifampin. Conclusions. These data, predominantly from HIV-infected patients with TB, suggest that low isoniazid, rifampin, and ethambutol concentrations are common in Botswana. In contrast, pyrazinamide usually is well absorbed.

Aims: We investigated whether reduced anxiety predicted improved drinking outcomes over and above age of onset and ondansetron treatment among alcoholics enrolled in a clinical trial. Methods: Study design was a 2 (early onset alcoholics versus late onset alcoholics) × 4 (placebo and ondansetron 1, 4 and 16 μg/kg twice daily) factorial randomized clinical trial during which all participants received weekly group cognitive behavioural therapy. Using weighted least squares regression, we examined the effects of ondansetron dose, age of onset, pre-treatment drinking and anxiety level (measured by Profile of Mood States) on end-state drinking behaviour. Our previous studies have demonstrated that ondansetron dose, age of onset and pre-treatment drinking influence end-state drinking behaviour. Results and conclusions: The present study added to our previous knowledge, indicating that when change in anxiety level was included as a predictor of end-state drinking, it also accounted for a significant proportion of the variance. Those who experienced decreases in anxiety during the treatment reported fewer drinks per day at their last visit compared with those who reported increases in anxiety.

Human neutrophils or HL60 cells express P2U receptors and respond to micromolar concentrations of ATP, adenosine 5'-O-(thiotriphosphate) (ATPgammaS), or UTP with immediate increases in intracellular Ca2+ through activation of phosphoinositide phospholipase C (Cowen, D. S., Lazarus, H. M., Shurin, S. B., Stoll, S. E., and Dubyak, G. R. (1989) J. Clin. Invest. 83, 1651-1660). P2U agonists reportedly induce limited enzyme secretion and enhance the respiratory burst in response to chemotactic factors. We demonstrate here that P2U agonists are chemotactic for neutrophils or differentiated HL60 cells. Rhodamine phalloidin staining indicates that ATPgammaS treatment induces actin polymerization and shape changes similar to those seen when these cells are treated with chemotactic peptide fMet-Leu-Phe. Although undifferentiated HL60 cells fail to mount a rise in Ca2+ when challenged with fMet-Leu-Phe, they increase Ca2+ in response to P2U agonists. However, functional expression of phospholipase C-coupled receptors is not sufficient for chemotaxis since HL60 cell migration in response to these agonists or to fMet-Leu-Phe occurs only after exposure to differentiating agents such as BT2cAMP. In addition to the well known G protein-linked receptors for lipid or peptide chemotactic factors, neutrophils apparently also can utilize G protein-linked purino/pyrimidino receptors to recognize nucleotides as chemoattractants. High concentrations of ATP and UTP generated at sites of platelet aggregation and tissue injury could thus be important mediators of inflammation.

PROLIFERATION of fibroblasts resulting in the development of abnormal fibrous tissue in the lung is a common sequel of many types of injury to the pulmonary parenchyma. In fact, few lungs of adult individuals are found free from foci of fibrosis postmortem. The term “pulmonary fibrosis,” however, is rarely used as a diagnosis when the etiology of the fibrous reaction is obvious, as in fibroid phthisis, lipoid pneumonia, or silicosis, nor is it commonly applied to localized scars such as healed infarcts, but is reserved for examples of multifocal or generalized involvement of the lungs, the origin of which is dubious or unknown. It is the pathology of this latter group which is the subject of the present paper. Upon review of a series of 6,000 postmortem examinations performed in the pathology laboratory of the Massachusetts General Hospital, it was found that an anatomic diagnosis of pulmonary fibrosis corresponding to the limited definition given above had been made on only 59 occasions. In 36 the lesion...