General Public's Information-Seeking Patterns of Topics Related to Obesity: Google Trends Analysis.

BACKGROUND: Obesity is a major public health challenge, and recent literature sheds light on the concept of "normalization" of obesity. OBJECTIVE: We aimed to study the worldwide pattern of web-based information seeking by public on obesity and on its related terms and topics using Google Trends. METHODS: We compared the relative frequency of obesity-related search terms and topics between 2004 and 2019 on Google Trends. The mean relative interest scores for these terms over the 4-year quartiles were compared. RESULTS: The mean relative interest score of the search term "obesity" consistently decreased with time in all four quartiles (2004-2019), whereas the relative interest scores of the search topics "weight loss" and "abdominal obesity" increased. The topic "weight loss" was popular during the month of January, and its median relative interest score for January was higher than that for other months for the entire study period (P<.001). The relative interest score for the search term "obese" decreased over time, whereas those scores for the terms "body positivity" and "self-love" increased after 2013. CONCLUSIONS: Despite a worldwide increase in the prevalence of obesity, its popularity as an internet search term diminished over time. The reason for peaks in months should be explored and applied to the awareness campaigns for better effectiveness. These patterns suggest normalization of obesity in society and a rise of public curiosity about image-related obesity rather than its medical implications and harm.

Evaluation of genotoxic and modulatory effects of Nyctanthes arbor-tristis calyx extract and the isolated crocin in Ames' assay.

Flowers of the plant Nyctanthes arbor-tristis (NAT) are widely used in the traditional medicinal systems of several Asian countries. In the present study, potential genotoxicity and modulatory effects of ethanolic extract of NAT flower calyx (NAT FCE) and crocin, a carotenoid principle were evaluated employing standard Salmonella assay. Experiments evaluating the genotoxic potential of NAT FCE and crocin, with and without the S9-activation in TA 98, TA 100 and TA 102 showed a lack of increase in revertant mutants. Evaluation of modulatory effects of NAT FCE and crocin, without the S9, showed significant decrease in the number of 4-nitro-o-phenylenediamine-, sodium azide- and ethyl methanesulfonate-induced revertants. However, with S9, NAT FCE and crocin moderately increased the 2-aminoanthracene-induced revertants in TA 98; they moderately decreased revertants in TA 100 and TA 102. Both NAT FCE and crocin have been shown to be non-genotoxic and to be able to modulate responses of standard mutagens.

Acceptance and compliance with postpartum human papillomavirus vaccination.

OBJECTIVE: Despite the efficacy of vaccines against human papillomavirus (HPV), vaccination rates remain low in many countries. We estimated the acceptability and satisfaction of HPV vaccination in postpartum women. METHODS: Postpartum women aged 18-26 years were offered the quadrivalent HPV vaccine. Women were vaccinated during hospitalization after delivery, at the 6-week postpartum visit, and at a third dedicated vaccination visit. The primary outcome was completion of all three vaccinations. Secondary outcomes included the influence of knowledge and attitudes of HPV, decisional conflict, and satisfaction. RESULTS: A total of 150 women were enrolled. Overall, seven (4.7%) women did not receive any doses of the vaccine, 62 (41.3%) received one dose, 35 (23.3%) received two doses, and 46 (30.7%) completed the series and received all three doses of the vaccine. Knowledge of HPV and HPV-related disease, attitudes about HPV, and decisional conflict were not associated with completion of the vaccine series (P>.05). The vaccine was well tolerated with few side effects. The majority of women reported a high degree of satisfaction with postpartum vaccination; 97.2% thought vaccination was worthwhile, 98.6% thought postpartum vaccination was convenient, and 99.3% were happy they participated. Furthermore, 50.4% of women reported that they would not have otherwise asked about vaccination. After vaccination, only 17.5% said they would have rather made a separate trip for vaccination. CONCLUSION: A strategy of postpartum HPV vaccination is convenient and associated with a high degree of patient satisfaction. LEVEL OF EVIDENCE: II.

Scientific evidence underlying the American College of Obstetricians and Gynecologists' practice bulletins.

OBJECTIVE: Clinical guidelines are an important source of guidance for clinicians. Few studies have examined the quality of scientific data underlying evidence-based guidelines. We examined the quality of evidence that underlies the recommendations made by the American College of Obstetricians and Gynecologists (the College). METHODS: The current practice bulletins of the College were examined. Each bulletin makes multiple recommendations. Each recommendation is categorized based on the quality and quantity of evidence that underlies the recommendation into one of three levels of evidence: A (good and consistent evidence), B (limited or inconsistent evidence), or C (consensus and opinion). We analyzed the distribution of levels of evidence for obstetrics and gynecology recommendations. RESULTS: A total of 84 practice bulletins that offered 717 individual recommendations were identified. Forty-eight (57.1%) of the guidelines were obstetric and 36 (42.9%) were gynecologic. When all recommendations were considered, 215 (30.0%) provided level A evidence, 270 (37.7%) level B, and 232 (32.3%) level C. Among obstetric recommendations, 93 (25.5%) were level A, 145 (39.7%) level B, and 117 (34.8%) level C. For the gynecologic recommendations, 122 (34.7%) were level A, 125 (35.5%) level B, and 105 (29.8%) level C. The gynecology recommendations were more likely to be of level A evidence than the obstetrics recommendations (P=.049). CONCLUSION: One third of the recommendations put forth by the College in its practice bulletins are based on good and consistent scientific evidence.

Viridans streptococcal (Streptococcus intermedius) mitral valve subacute bacterial endocarditis (SBE) in a patient with mitral valve prolapse after a dental procedure: the importance of antibiotic prophylaxis.

BACKGROUND: Subacute bacterial endocarditis (SBE) is an infection of the heart involving damaged valves or endothelium. The most common organisms causing SBE are the viridans streptococci. Viridans streptococci differ in their propensity to cause SBE, which is related to the ability to adhere to damaged heart valves and endothelium, which is a function of extracellular matrix production. Streptococcus intermedius is a member of the S. anginosus group. S. intermedius is one of the many strains of viridans streptococci and a rare cause of SBE. SBE may result following a high-grade, sustained veridans streptococcal bacteremia in patients with predisposing cardiac lesions. Because viridans streptococci are relatively avirulent pathogens in normal hosts, they usually present as SBE. Some strains of viridans streptococci are inherently more virulent (eg, S. intermedius) and clinically resemble S. lugdunensis or S. aureus. METHODS: We report a case of S. intermedius SBE in a patient with mitral valve prolapse (MVP). Throughout the patient's life, she received antibiotic prophylaxis for dental procedures and never developed SBE. Because of changes in endocarditis prophylaxis guidelines in 2007, recommending no prophylaxis for dental procedures in patients with MVP, she did not receive prophylaxis for a dental procedure 3 months before admission. The change in prophylaxis recommendations was based on the relatively low incidence of endocarditis with certain cardiac lesions. The recommendations were also based on concern for antibiotic resistance from widespread antibiotic use for antibiotic prophylaxis. There has been no appreciable increase in penicillin resistance, and antimicrobial resistance is not an important consideration among the viridans streptococci. The incidence of SBE is not high after dental procedures in patients with MVP, but if SBE occurs, it may result in serious consequence for the patient. RESULTS: In this case, the patient developed S. intermedius, mitral valve SBE complicated by a cerebral vascular accident, and embolic occlusion of her leg. She was given optimal antibiotic treatment with ceftriaxone 2 g (intravenously) every 24 hours plus gentamicin 120 mg (intravenously) every 24 hours (synergy dose) but failed to respond to antimicrobial therapy. Although her S. intermedius bacteremia was rapidly cleared with antimicrobial therapy, sterilization of her vegetation was not accomplished, and during therapy, the size of her cardiac vegetation actually increased in size. Because of therapeutic failure despite optimal antibiotic therapy, the increasing size of her vegetation necessitated mitral valve replacement, which the patient underwent. Reasons for apparent/real antibiotic failure include inappropriate antimicrobial therapy, inadequately dosed antimicrobial therapy, antibiotic "tolerance," or increased pathogen virulence. Her strain of S. intermedius was sensitive to all antibiotics and not due to a "tolerant strain", i.e., her minimal inhibitory concentration (MIC) and minimal bactericidal concentration (MBC) were the same (<0.25 microg/mL). CONCLUSION: In this case, despite optimal antimicrobial therapy, and in the absence of resistance/tolerance, therapeutic failure was best explained on the basis of S. intermedius virulence. The take-home lesson for clinicians is that it is better to err on the side of antibiotic prophylaxis even in patients with low-risk cardiac lesions. Failure to administer antibiotic prophylaxis for dental procedures may result in SBE and have disastrous consequences for the patient, which, in this case, resulted in a cerebral vascular accident, embolic occlusion of the leg, and mitral valve replacement. In terms of virulence in patients with endocarditis, S. intermedius may resemble S. lugdenesis.