Background Gestational helminth infections are correlated to adverse outcomes including maternal anemia; as such, treatment is recommended. However, little published high-quality data exist around the efficacy, safety, and tolerability of anti-helminthics in pregnancy. We therefore conducted a systematic review and synthesized the available data on maternal outcomes following gestational treatment of intestinal nematodes to help guide clinical decision-making. Methods Five electronic databases were searched for studies reporting the efficacy, safety, or tolerability of anti-helminthic drugs for gestational treatment of intestinal nematodes. Studies were systematically screened, followed by data extraction. Trial quality was assessed using the GRADE approach. We conducted a narrative synthesis followed by meta-analyses using random-effects models as appropriate. Data were summarized using qualitative and quantitative measures for specific parasitic infections as well as efficacy and safety of anti-parasitic agents. Outcomes of interest included: maternal anemia, minor adverse outcomes, pregnancy loss, pre-mature delivery, prevalence of infection, and cure rate. Results 23 studies were included. Gestational treatment with albendazole had cure rates up to 90% for hookworm and Ascaris, but only 50% for Trichuris. Mebendazole had an overall cure rate of ≤70% for Ascaris, hookworm, and Trichuris. Pooled relative risk reduction of hookworm prevalence at delivery with albendazole compared to placebo was 90% (95%CI 0.09-0.15, n=2, I2=0%). Rate of pregnancy loss and hemoglobin concentration did not differ between albendazole or mebendazole versus placebo, and rates of pre-term delivery were similar in albendazole-treated pregnant women versus controls. Ivermectin demonstrated a cure rate of 29% for hookworm and 56% for Trichuris in pregnant women. No serious adverse events were attributable to any drug studied. Conclusions With increased international travel and migration of vulnerable populations, practitioners will encounter nematode infections in pregnant patients. Our analysis supports that albendazole in pregnancy has high cure rates for STHs and is safe for the mother.

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A non-pregnant Canadian woman returning from India presented with a 1-week history of jaundice and malaise. Subsequently, she developed fulminant hepatic failure caused by hepatitis E virus (HEV). HEV can cause fulminant hepatic failure, most commonly in pregnant women and those with chronic liver disease; however, all travellers are at risk.

Background Mechanical ventilation of patients with COVID-19 is associated with high mortality. Understanding risk factors for developing mechanical ventilation may allow for more targeted monitoring and therapeutics that may improve outcomes. Methods We performed a retrospective case series of all patients admitted within thirty days of a positive Sars CoV-2 test to an integrated health system near Chicago, Illinois between March 12 and May 31, 2020. Covariates evaluated included demographics, symptoms on admission, vital signs, medications, comorbidities, census tract data and social history. Univariable analysis was performed and variables with an alpha of 0.05 or less were included in multivariable regression modeling to identify factors associated with mechanical ventilation. The area under the curve (AUC) was used to assess performance of the model. Results Of 990 patients admitted with COVID-19 12.6% (125) were mechanically ventilated. The median age was 68 (interquartile range 55–82), 48.4% (479) were female and 49.6% (491) were Caucasian. Independent factors associated with mechanical ventilation included female sex (Adjusted OR [AOR] 0.621, Confidence Interval [CI] 0.427–0.903; p=0.0363), body mass index (BMI) (AOR 1.035, CI 1.011–1.060; p=0.0175), percent of english speaking population within patient’s census tract (AOR 0.989, CI 0.979–0.998; p=0.0454), respiratory rate (AOR 1.054, CI 1.027–1.083; p=0.0011), oxygen saturation (AOR 0.922, CI 0.901–0.943; p< 0.0001), cerebrovascular accident (CVA) (AOR 0.176, CI 0.051–0.605; p=0.0207) and hematologic malignancy (AOR 3.668, CI 1.403–9.590; p=0.0261). AUC of the model was 0.8 (0.75–0.84). Characteristics of patients admitted with COVID-19 Multivariable logistic regression to identify risk factors associated with mechanical ventilation Conclusion Risk factors associated with mechanical ventilation included male gender, elevated BMI, census tract with lower percentage of english speakers, increased respiratory rate, low oxygen saturation, hematologic malignancy and not having a CVA. We suspect that history of CVA may have been associated with overall patient debility in which aggressive measures such as intubation were not deemed appropriate. Identifying patients with risk factors associated with mechanical ventilation may allow for early and targeted interventions to improve outcomes. Disclosures All Authors: No reported disclosures