bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of hepatic fibrosis by elastography in patients with schistosomiasis mansoni
Authors: Lima Leila Maria Soares Tojal de Barros , Lacet Celina Maria Costa , Viana Mônica Salum Valverde Borsoi , da Costa Bernadete de Lourdes Novais , Parise Edison Roberto 
Published: April 2020

Abstract

Background
Periportal fibrosis is associated with the main complications of schistosomiasis mansoni. The usefulness of hepatic transient elastography (TE) in its evaluation remains to be clarified.

Methods
We conducted a cross-sectional study of schistosomal patients, where the measurements obtained by FibroScan TE were correlated with the degree of liver fibrosis according to the Niamey sonographic protocol, adopted as the gold standard, and its performance was calculated as the area under the receiver operating characteristics curve (AUROC).

Results
A total of 117 of 141 adult schistosomiasis patients from endemic areas were selected between May and August 2015. Applying the Niamey protocol, the patients were regrouped into absent fibrosis (A; 34.2%), mild to moderate fibrosis (MM; 27.4%) and intense fibrosis (I; 38.5%). The median of the TE values in the patients of group A was 4.7 kPa, the group MM 9.3 kPa and the group I 10.3 kPa. There was a difference in the TE values between the group A and the groups MM and I (p &lt; 0.05). The TE also presented strong and direct correlation with the clinical form (r ≥ 0.77). The AUROC value to define the presence of fibrosis was 0.92 and for significant fibrosis was 0.79, with cut-offs of 6.1 kPa and 8.9 kPa, respectively.

Conclusions
In this study, the TE was effective in the diagnosis of schistosomal fibrosis, being able to identify the advanced forms of the disease and thus predict the risk of clinical complications in endemic regions.
Identification of Cervical Human Papillomavirus by Self-Collection in Grenada [OP02-6B]
Authors: Manglardi Erin E. , Lendore Jessica , Balhotra Kimen , Bahadoor-Yetman Avi , Fields Paul J. , McGill Frances Mary 
Published: April 2020

INTRODUCTION:
Cervical cancer and Human Papillomavirus (HPV) screening with the Papanicolaou (Pap) smear/cervical cytology is widely accessible, however, it’s underutilized in developing countries worldwide. A self-sampling device evaluated in Grenada in 2017 was determined to be acceptable to women, and adequate in obtaining and evaluating cervical cells. Additionally, testing for Human Papillomavirus (HPV), the precursor for the development of cervical cancer, was performed.

METHODS:
Following IRB approval, women were recruited to the St. George’s University clinic in St. George’s, Grenada. Two cervical samples were obtained from each woman: one via the self-sampling device, and one by a physician. With informed consent, 101 women provided samples, of which the first isolate was tested for the presence of HPV DNA. If HPV was identified, it was further subtyped.

RESULTS:
HPV was detected in 49/101 (48%) samples: 25/50 (50%) from physician obtained samples and 24/51 (47%) via the self-sampling device. The difference in detection rates was not statistically significant. A total of 24 different genotypes were detected, and classified into low-risk, high-risk or mixed. Women with abnormal results were appropriately evaluated by close follow-up, colposcopy or biopsy.

CONCLUSION:
The self-screening device was adequate in obtaining cervical cells with co-testing for HPV. In a group of self-referred women living in Grenada, results showed additional HPV genotypes to the usual 6, 11, 16 & 18 commonly described in the literature. Self-sampling may be an effective method of identifying HPV in a developing country, conserving limited resources for further evaluation of women at risk.
Testicular Sperm Extraction Versus Ejaculated Sperm Use for Non-azoospermic Male Factor Infertility [OP02-7B]
Authors: Kim Tana , Rauchfuss-Kendall Lauren , Bleess Jessica , Shenoy Chandra 
Published: April 2020

INTRODUCTION:
Testicular sperm extraction (TESE) has traditionally been reserved for couples with azoospermia. However, recent data suggests TESE may be beneficial for men with abnormal semen parameters without azoospermia. The objective of this study was to compare in vitro fertilization (IVF) outcomes between TESE and ejaculated sperm (ES) for non-azoospermic male factor infertility.

METHODS:
Following IRB exemption, couples undergoing IVF for non-azoospermic male factor infertility with total motile sperm (TMS) <25 million motile/ejaculate from 1/2016 to 1/2019 were included. Men were grouped by whether TESE or ES was utilized for insemination. Couple characteristics and cycle outcomes were analyzed. Wilcoxon rank sum and Fisher exact tests were utilized as appropriate. Values are reported in medians.

RESULTS:
The analysis included 36 men who utilized ES and 23 men who utilized TESE. The median female age was 32 while the median male age was 35 with ES and 37 with TESE. TMS (6.1 vs 3.9 million motile/ejaculate, P=.46), motility (40% vs 30%, P=.07), and strict morphology (2.5% vs 1.0%, P=.15) were similar between ES and TESE. The total mature oocytes retrieved was similar between the groups but compared to ES, TESE was associated with 20% decrease in fertilization (80.6% vs 60.0%, P=.02) and half the number of blastocyst embryos (4 vs 2 embryos, P=.02). Although not statistically significant, TESE also had >10% decrease in live birth (48.5% vs 36.8%, P=.56).

CONCLUSION:
TESE is associated with lower fertilization and blastocyst embryos as well as decreased live birth rates compared to ES use for non-azoospermic male factor infertility.
Use of Medicaid Coverage for Abortion Is Associated With Improved Abortion Access [OP03-3C]
Authors: McDonnell Jill , Vinekar Kavita 
Published: April 2020

INTRODUCTION:
Low income women disproportionately face barriers to abortion access. It remains unknown whether Medicaid coverage for abortion improves abortion access measures.

METHODS:
We performed a secondary analysis of the 2014 Guttmacher Abortion Patient Survey. Respondents were included if they selected “Medicaid” as their primary insurance. The exposure was self-report of using Medicaid to pay for the abortion. NARAL state legislative classifications and patient demographics were used as covariates. Chi-square testing and t-tests for unequal variance were used for categorical and continuous variables, respectively. Multivariate regression was performed for the primary outcome of >7 days wait time between decision for abortion and abortion appointment. All statistical analysis was performed in StataSE v15. This study was IRB exempt.

RESULTS:
Of 2,549 respondents on Medicaid, 1,482 had Medicaid coverage for their abortions and 1,067 did not. Patients with Medicaid coverage had their abortions at an earlier gestational age (8.61 vs. 8.94 weeks, P=.02). Patients using Medicaid for abortion had shorter mean wait times (3.84 vs. 4.37 days, P=.01), traveled less time (32.15 vs. 48.63 minutes, P<.0001) and shorter distances (28.62 vs. 42.91 miles, P=.0003) for their abortions, and were less likely to cross state lines (0.81% vs 7.97%, P < .0001). Patients with Medicaid coverage for abortion were less likely to wait >7 days (83.14% vs. 86.97%, P=.008), which remained true in multivariate regression with OR 0.71 (CI 0.51-0.99).

CONCLUSION:
Utilization of Medicaid coverage for abortion is associated with increased abortion access, as evidenced by decreased wait times, earlier gestational ages, and decreased travel measures.
Impact of Nurse Driven EMR Pathway for Treatment of Severe Hypertension in Pregnancy [OP03-5C]
Authors: Martin Courtney , Johns Kim , Yao Ruofan , Balli Kevin , Pappas James 
Published: April 2020

INTRODUCTION:
The use of care pathways via EMR is emerging technology to standardize patient care. The objectives of this study was to build and assess the effect of a care pathway in the management of severe hypertension in pregnancy.

METHODS:
A nurse driven care pathway and warning system was designed and implemented in the EMR inpatient environment. The pathway protocolizes the initial management of severe hypertension in pregnancy based on ACOG guidelines. The care pathway utilizes patient vital signs, intravenous access, patient medical history, and ACOG algorithms for initial antihypertensive therapy, to make a first line recommendation that the nurse administers. Information regarding compliance with ACOG guidelines was collected for 12 months before and after the pathway was launched. The data examined was the time from the second severe range blood pressure to administration of the pathway recommended antihypertensive agent. The primary endpoint was to improve compliance with the ACOG guidelines in the management of severe hypertension. The primary outcome of interest is the difference in the compliance rate before and after the implementation of the care pathway.

RESULTS:
49% (623/1272) of patients received meds within 30 minutes of the second severe range blood pressure in the initial 12 months versus 64% (895/1394) in the 12 months after launch of the pathway (p=.0000).

CONCLUSION:
Implementation of a nurse driven, care pathway for hypertension in pregnancy reduces time to administration of antihypertensive therapy. Using EMR systems to standardize care is a novel way to provide safety infrastructure in hospitals for pregnant women.
The Relationship Between Social Deprivation and Preterm Birth [OP03-7C]
Authors: DeHority Rebecca L. , Coyne Kathryn D. , Bevan Graham H. , Lappen Justin R. 
Published: April 2020

INTRODUCTION:
The United States has the highest preterm birth (PTB) rate amongst developed countries, and within the country significant geographic variability exists. Socioeconomic factors and stress are associated with the risk of PTB, however this association has not been characterized using the Social Deprivation Index (SDI), a validated national socioeconomic index. Our objective was to assess the relationship between the SDI and PTB using county-level data.

METHODS:
Using CDC Natality data from 2007-2018 we identified PTBs (20-36 weeks) in counties with populations greater than 100,000. The 2015 SDI measures and score components were extracted. Linear regression was used to assess the relationship between SDI score, its components, and PTB. The SDI score was log transformed for normalcy.

RESULTS:
A total of 37,722,326 births were analyzed, with 4,379,950 PTB in 580 counties. The median percent PTB was 11.4%. Using simple linear regression, SDI score significantly correlated with PTB (β=.0024, R2=.17, p < .001). In a secondary multiple linear regression analysis, the following components of SDI were independently significantly associated with PTB: income below the federal poverty level (1), African American race (2), and education level (3) (β1=.46, β2= .73, β3= .34, R2=.47, p < .001).

CONCLUSION:
The SDI and several of its components predict county variance in PTB. This publically available data could be used to inform resource allocation for PTB prevention.
Contraceptive Efficacy and Safety of 52 mg LNG-IUS for up to Eight Years: Year 6 Data From the Mirena Extension Trial [OP04-1D]
Authors: Jensen Jeffrey T. , Kroll Robin , Lynen Richard F. , Schulze Andrea , Lukkari-Lax Eeva 
Published: April 2020

INTRODUCTION:
The Mirena Extension Trial (MET) is a multicenter, open-label, single group study being conducted in the USA investigating contraceptive efficacy and safety of 52 mg LNG-IUS (Mirena®) during extended use for up to 8 years, with analyses planned at the end of Year 6, 7 and 8.

METHODS:
We recruited and screened current users of 52 mg LNG-IUS, ≤35 years of age, after a minimum of 4 years and 6 months of use. Eligible consenting participants underwent a baseline visit 0 to 14 days before the end of Year 5. Institutional review board approval was obtained for all centers. The primary aim was to assess contraceptive efficacy (Pearl Index, PI) for up to 8 years of use. We present the results of the Year 6 analysis.

RESULTS:
Most of the 362 participants starting Year 6 completed and entered Year 7; 14 were lost to follow up and 40 discontinued. At baseline, 11.3% of women were between 18 and 25 years of age (mean=29.4 years [±3.1]). Around half (47.2%) were nulliparous. During Year 6, one pregnancy occurred for a Year 6 PI of 0.35 (CI 95% 0.01, 1.95). This pregnancy was of undetermined location, occurred with 52 mg LNG-IUS in situ and resolved without intervention. Overall, participants reported high levels of satisfaction (92.6% very satisfied, 6.4% somewhat satisfied). Treatment-emergent adverse events were reported in 166 patients, with 27 considered related to 52 mg LNG-IUS.

CONCLUSION:
52 mg LNG-IUS maintains high contraceptive efficacy during Year 6 with a favorable safety profile. Satisfaction also remains high.
Polygenic Risk Score for the Non-Invasive Prediction of Surgical Endometriosis [OP04-3D]
Authors: Ward Kenneth 
Published: April 2020

INTRODUCTION:
Endometriosis commonly causes infertility, dysmenorrhea, dyspareunia, dyschezia, chronic pelvic pain, and other gynecologic symptoms. Unfortunately, history, physical exam, pelvic ultrasound, and even the “gold standard” of laparoscopic visualization/histology have limitations with regard to diagnostic sensitivity and specificity. The objective of this study is development of a predictive DNA test for endometriosis.

METHODS:
Using IRB approved protocols, endometriosis associated markers were discovered using genome wide association studies (GWAS) involving 5,571 women with surgically confirmed endometriosis and 21,971 controls and whole exome sequencing (WES) of 2,904 affected women. Allele frequencies for WES markers were compared to published data [55,860 non-Finnish European in gnomAD database (Broad Institute)]. An additive prediction model was created using 71 GWAS markers combined into a single risk term using logistic regression and 550 low-frequency exome variants individually weighted using observed odds ratios. The predictive algorithm was validated using independent cohorts (1,458 Caucasian endometriosis patients and 758 population controls).

RESULTS:
The mean polygenic risk score was 1.2 in population controls and 2.9 in endometriosis patients (p<10-16). The calculated Area Under the Curve (AUC) of predictor was excellent (0.88), even though endometriosis was not excluded in population controls (10% may have endometriosis).

CONCLUSION:
Predictive DNA testing may help to reduce the under-diagnosis and delayed diagnosis documented for endometriosis today. Blood, saliva, or other cell/tissue samples can be tested using this assay. DNA tests also have the potential to provide insights regarding molecular pathways involved, likely treatment responses, malignant potential, and other disease characteristics unavailable from histology.
Relugolix Combination Improves Quality of Life in Phase 3 Studies of Symptomatic Uterine Fibroids [OP04-4D]
Authors: Lukes Andrea S. , Poindexter Alfred , Villarroel Claudio , Li Yulan , Hunsche Elke , Stewart Elizabeth A. 
Published: April 2020

INTRODUCTION:
In the two phase 3 LIBERTY Institutional Review Board-approved studies, relugolix combination therapy (Relugolix-CT; once-daily relugolix 40 mg, estradiol 1.0 mg, and norethindrone acetate 0.5 mg) significantly improved heavy menstrual bleeding (HMB) and pain associated with uterine fibroids (UF). Impact of Relugolix-CT treatment on quality of life (QoL) was assessed using the validated Uterine Fibroid Symptom (UFS)-QoL questionnaire.

METHODS:
Changes from baseline to Week 24 in UFS-QoL symptom severity (SS) and health-related (HR) QoL scale scores (range 0 to 100), and HR-QoL subscale scores were assessed. Higher SS scores reflect more severe symptoms; conversely, higher HR-QoL scores indicate better QoL. Least-squares mean changes in SS and HR-QoL were compared between Relugolix-CT and placebo, by LIBERTY study, using a mixed-effects model, with treatment, visit, region, baseline menstrual blood loss volume, and treatment by visit interaction as fixed effects.

RESULTS:
At Week 24, SS improved significantly from baseline (both studies: nominal P<.0001) with Relugolix-CT vs placebo (decreases were, respectively, from 55.1 to 23.4 and from 60.3 to 49.2 [LIBERTY-1]; from 59.1 to 21.7 and from 59.2 to 45.1 [LIBERTY-2]). HR-QoL improved significantly from baseline (both studies: nominal P<.0001) with Relugolix-CT vs placebo (increases were from 37.2 to 74.0 and from 33.5 to 44.9 [LIBERTY-1]; from 38.9 to 78.7 and from 37.3 to 51.0 [LIBERTY-2]). Similar results were observed between groups in all HR-QoL subscales.

CONCLUSION:
Over 24 weeks, Relugolix-CT significantly improved HMB and pain associated with UF, with corresponding significant improvements in patient-reported SS, and HR-QoL total and subscale scores.
The Antiretroviral Pregnancy Registry: 30 Years of Monitoring for Congenital Anomalies [OP04-6D]
Authors: Albano Jessica , Scheuerle Angela , Beckerman Karen , Mofenson Lynne , Vannappagari Vani 
Published: April 2020

INTRODUCTION:
Antiretroviral (ARV) treatment saves lives and prevents vertical transmission of HIV. The Antiretroviral Pregnancy Registry (APR) began prospectively monitoring prenatal ARV use for potential teratogenicity in 1989 and depends on voluntary registration of ARV exposed pregnancies (www.APRegistry.com).

METHODS:
The APR is an IRB approved, prospective exposure-registration cohort study with data from 70 countries. Prevalence of congenital anomalies (CAs) are estimated and compared to internal and external comparison groups. Twenty-two ARVs have sufficient 1st trimester exposures to detect at least a 2-fold increase in risk of CAs overall, of which 11 can detect a 1.5-fold increase.

RESULTS:
Of the 20,759 pregnancies prospectively enrolled through 31 July 2019, reported outcomes include 19,642 live births (LB) with ARV exposure at any time during pregnancy and 554 CAs. Prevalence of CAs was 2.8% (95% CI 2.6-3.1) overall, 2.8% (95% CI 2.5-3.1) among 1st trimester exposures and 2.8% (95% CI 2.5-3.2) among 2nd/3rd trimester exposures to ARVs (prevalence ratio 1.00 [95% CI 0.85-1.18]).

CONCLUSION:
The APR has not detected a significant difference in overall CA prevalence compared to two population based surveillance systems: 2.72/100 LB (95% CI 2.68-2.76) Metropolitan Atlanta Congenital Defects Program (MACDP) and 4.17/100 LB (95% CI 4.15-4.19) Texas Birth Defects Registry (TBDR). Two ARVs, didanosine and nelfinavir, have modest statistically significant increased prevalence compared to MACDP but not TBDR. The APR independent Advisory Committee concludes, “The Registry finds no apparent increases in frequency of specific defects with first trimester exposures and no pattern to suggest a common cause; however, potential limitations of registries should be recognized.”
Duration of Intrapartum Antibiotic Prophylaxis for Group B Streptococcus [06A]
Authors: Cate Jennifer , Lee Illuzzi Jessica , Cayton Colby 
Published: April 2020

INTRODUCTION:
Intrapartum vertical transmission of group B streptococcus (GBS) occurs in approximately 50% of vaginal births without antibiotic prophylaxis. This prospective cohort study aimed to determine if <4 hours duration of intrapartum antibiotic prophylaxis (IAP) before delivery reduces GBS vertical transmission rates.

METHODS:
1354 GBS positive parturients presented to Yale New Haven Hospital between 10/1/2009 and 3/28/2012. Of eligible patients ≥37 weeks with singleton gestations in labor (n=1111), 316 were invited after IRB approval to participate and 240 completed the study. Maternal characteristics, labor course, delivery and neonatal outcomes were obtained. Of 240 maternal-infant dyads, 69 received <4 hours of IAP and 158 received ≥4 hours. Nine did not receive IAP. Infant oropharyngeal and rectal swabs were collected after 24 hours to detect mucosal GBS colonization.

RESULTS:
Rates of GBS transmission were equivalent in those receiving less than and greater than 4 hours of prophylaxis before delivery, respectively (1.5 vs 1.2%; P=1.0). No significant differences in GBS transmission were observed between those with and without risk factors for early neonatal GBS disease. No cases of GBS vertical transmission occurred in those who received IAP prior to membrane rupture versus 3 (3.9%) cases of transmission (P=.036) among those who received IAP after membrane rupture.

CONCLUSION:
GBS vertical transmission rates among individuals who received IAP <4 hours were equivalent to those receiving IAP ≥4 hours before delivery. Antibiotic prophylaxis duration may be less relevant than membrane rupture timing in vertical transmission and deserves further exploration to optimize newborn monitoring protocols after delivery in maternal GBS colonization.
Expedited Partner Therapy for Trichomoniasis: Prevalence and Provision at LA County Hospitals [09A]
Authors: Chang Emily , Nguyen Brian T. , Mitchell Evelyn , Jeffrey Nicholas , Long Minica 
Published: April 2020

INTRODUCTION:
Trichomoniasis is the most common, non-viral sexually transmitted infection (STI) worldwide. Cases are frequently asymptomatic in men and men traditionally are not screened, possibly contributing to high rates of reinfection among women. Expedited partner therapy (EPT) is a proposed solution that provides empiric STI treatment for an infected female patient's male partner without requiring a separate healthcare visit. EPT is legal in California and commonly given for gonorrhea and chlamydia; however, EPT provision for trichomonas is inconsistent, thereby warranting further study.

METHODS:
Institutional Review Board approval was obtained. Patients testing positive for trichomonas were identified from electronic medical records within the LA County hospital network, from 1/2015 to 6/2017. Documentation of partner treatment discussion and EPT provision was identified, along with potential associated factors, e.g. patient demographics and medical specialization. Descriptive statistics and bivariate comparisons were used to describe potential associations.

RESULTS:
Of 326 female patients testing positive for trichomonas, 34.5% identified as black, 33.2% as Hispanic/Latina. Only 57.9% of patients received some form of partner counseling; only 13.3% were offered EPT. Emergency medicine providers diagnosed trichomoniasis most frequently (51.8%), but only 38.6% offered verbal partner counseling and only 6.6% offered EPT. Family medicine providers were most likely to offer verbal partner counseling (66.7%, P<.01); gynecologists were most likely to offer EPT (25.5%, P<.01).

CONCLUSION:
Patients with trichomoniasis were not routinely offered EPT nor counseled about partner treatment in this population. Healthcare providers, regardless of specialty, should be reminded to recommend the screening and treatment of male partners and/or provide EPT directly.