Anesthesia practices in the united states common to in vitro fertilization (IVF) centers

Purpose: Our purpose was to characterize and describe anesthesia practice in programs performing IVF in the United States. Methods: We used a telephone survey requiring respondents to be either the program director, a physician, or a nurse familiar with the practice. Two hundred seven (78%) Society of Assisted Reproductive Technology (SART) registered programs agreed to participate. Programs were divided by geographic region and type of practice (academic versus private). Results: Ninety-one private (68%) and 41 academic (56%) programs used personnel provided by the Department of Anesthesiology. Conscious sedation was performed most commonly (95%). The remaining 5% used primarily either general, regional, or local anesthesia. Typical recovery times were 90 to 120 min. Average costs of anesthetic administration were $300–$400 and were similar among groups except for the Eastern academic programs, with a higher mean cost of $543. Programs using personnel from anesthesiology reported higher costs compared to programs utilizing their own staff ($391±15 vs $157±11; P<0.05). Complications were infrequent (<10%); no hospitalizations or serious life-threatening incidents were reported. Conclusions: A large number of programs safely used their own trained personnel to deliver anesthesia, and realized a significant reduction in cost.     

Screening for gestational diabetes mellitus in adolescent pregnancies

Objective: Our purpose was to determine the incidence of gestational diabetes mellitus in an adolescent population and to determine the cost of screening. Study Design: A retrospective review of 509 adolescent pregnancies was performed. The incidence of gestational diabetes mellitus was determined and the cost of screening analyzed. Results: Five hundred nine adolescent pregnancies were screened for gestational diabetes mellitus with a 1-hour, 50 gm oral glucose challenge test. Twenty-three of the screens (4.5%) had positive results at a plasma glucose level of ≥140 mg/dl. Three-hour 100 gm oral glucose tolerance tests were performed on screen-positive women, six of whom were diagnosed with gestational diabetes mellitus, for an incidence of 1.18%. The cost per case diagnosed was $2733. Conclusions: The incidence of gestational diabetes mellitus in an adolescent population is low. The cost of universal screening may be prohibitive in this population. Large prospective studies are needed to better analyze outcome data and efficacy of screening in adolescent pregnancies. (Am J Obstet Gynecol 1998;178:1251-6.)     

Reasons for Teachers' Adaptation of Substance Use Prevention Curricula in Schools with Non-White Student Populations

In this study we investigate reasons why teachers adapt substance use prevention curricula in the nation's middle schools. We hypothesize that these reasons will be most salient in schools with racially and ethnically diverse student populations, for whom teachers may believe it appropriate to tailor their curricula. The study sample comprised a nationally representative sample of lead substance use prevention teachers in the nation's middle schools. Respondents answered questions concerning eight student problems or needs that constituted reasons why they might adapt their prevention lessons. Controlling for a variety of school and teacher characteristics, we found that teachers in high minority schools were more likely to adapt curricula in response to three of the eight characteristics presented: youth violence, limited English proficiency, and various racial/ethnic or cultural groups. We suggest that curriculum developers make a systematic effort to understand how teachers are adapting their curricula in high minority schools and incorporate these modifications, if found effective, into their curricula.     

State legislator gender and other characteristics associated with sponsorship of child health bills.

OBJECTIVE: To examine the characteristics of state legislators who introduce child health bills. METHODS: We conducted a cross-sectional analysis of all bills introduced in Colorado, Louisiana, and Michigan during the 1997-1998 legislative session. We identified the topic for each bill while blinded to legislator characteristics. The primary study outcome was whether the bill topic related to child health. We also categorized whether the bill was signed into law. We examined associations between the outcomes and characteristics of the sponsoring legislators (gender, political party, terms served, chairpersonship of committees, legislative chamber, membership in the legislature's Black Caucus). RESULTS: During 1997 and 1998, legislators in the 3 study states introduced 9833 bills (1234 in Colorado, 4905 in Louisiana, and 3694 in Michigan). Sixty-five bills (0.66%) related to child health issues. Child health bills comprised a significantly higher proportion of all legislation introduced by female legislators compared with male legislators (1.5% vs 0.5%, P <.001). Of bills introduced by Black Caucus members, 1.4% pertained to child health compared with 0.59% of bills introduced by nonmembers (P <.01). In contrast, 0.23% of bills introduced by committee chairpersons pertained to child health versus 0.96% of bills introduced by nonchair legislators (P <.001). These associations remained statistically significant in multivariate analyses controlling for state effects. Whether child health bills were signed into law was not associated with other legislator characteristics. CONCLUSIONS: This study offers valuable insights about the different roles of women, Black Caucus members, and committee chairpersons in the state legislative process regarding children's health.     

Marked abnormal quadruple screen in a patient with severe preeclampsia at 20 weeks with a triploid fetus.

Severe preeclampsia rarely occurs prior to 20 weeks of gestation except in pregnancies with triploidy. The patient reported herein is a 29-year-old primigravida who developed severe preeclampsia at 20 weeks of gestation. Evaluation of the pregnancy demonstrated a markedly abnormal quadruple screen. Amniocentesis demonstrated a fetus with triploidy, despite a normal appearance.     

Repurposing povidone-iodine to reduce the risk of SARS-CoV-2 infection and transmission: a narrative review

BackgroundAccumulating data suggest antiviral effects of povidone-iodine against the Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. This narrative review aims to examine the antiviral mechanisms of povidone-iodine, efficacy of povidone-iodine against the SARS-CoV-2 virus, and safety of povidone-iodine to human epithelial cells and thyroid function.MethodsWe searched the electronic databases PubMed, Embase, Cochrane Library, ClinicalTrials.gov and World Health Organization’s International Clinical Trials Registry Platform for articles containing the keywords “povidone-iodine”, “SARS-CoV-2” and “COVID-19” from database inception till 3 June 2021.ResultsDespite in vitro data supporting the anti-SARS-CoV-2 effects of povidone-iodine, findings from clinical studies revealed differences in treatment response depending on study settings (healthy vs. hospitalized individuals), treatment target (nasal vs. oral vs. pharynx), method of administration (oral rinse vs. gargle vs. throat spray) and choice of samples used to measure study endpoints (nasopharyngeal vs. saliva). One large-scale clinical trial demonstrated reduction in the incidence of SARS-CoV-2 infection among participants who administered povidone-iodine 3 times daily during an active outbreak. Povidone-iodine is also used to disinfect the oro-pharyngeal space prior to dental or otolaryngology procedures. Although existing data suggest minimal impact of povidone-iodine on thyroid function, high-quality safety data are presently lacking.ConclusionsPovidone-iodine application to the oropharyngeal space could complement existing non-pharmacological interventions to reduce SARS-CoV-2 infection especially in high exposure settings.

Key messages

• Accumulating data suggest antiviral effects of povidone-iodine against the SARS-CoV-2 virus.
• Findings from clinical studies reveal differences in treatment response depending on study settings, treatment target, method of administration and choice of samples used to measure study endpoints. One large-scale clinical trial observed reduction in the incidence of SARS-CoV-2 infection among participants who administered povidone-iodine 3 times daily during an active outbreak.
• Povidone-iodine application to the oropharyngeal space could complement existing non-pharmacological interventions to reduce SARS-CoV-2 infection especially in high exposure settings.