Are hormonal contraceptives less effective in overweight and obese women?

Loss of efficacy of hormonal contraceptives is of particular concern for women who are overweight or obese. Only recently have clinical trials started to include overweight and obese women in their study populations, limiting the data available on which to make the best prescribing decisions for hormonal contraceptives for these patients. Other methods, such as the copper or levonorgestrel-containing intrauterine device, the etonogestrel implant, and depot medroxyprogesterone acetate, are preferred over combined oral contraceptives, the transdermal patch, and the vaginal ring.

Unlocking Health Literacy: The Ultimate Guide to Hypertension Education From ChatGPT Versus Google Gemini.

Background Google Gemini (Google, Mountain View, CA) represents the latest advances in the realm of artificial intelligence (AI) and has garnered attention due to its capabilities similar to the increasingly popular ChatGPT (OpenAI, San Francisco, CA). Accurate dissemination of information on common conditions such as hypertension is critical for patient comprehension and management. Despite the ubiquity of AI, comparisons between ChatGPT and Gemini remain unexplored. Methods ChatGPT and Gemini were asked 52 questions derived from the American College of Cardiology's (ACC) frequently asked questions on hypertension, following a specified prompt. Prompts included: no prompting (Form 1), patient-friendly prompting (Form 2), physician-level prompting (Form 3), and prompting for statistics/references (Form 4). Responses were scored as incorrect, partially correct, or correct. Flesch-Kincaid (FK) grade level and word count were recorded. Results Across all forms, scoring frequencies were as follows: 23 (5.5%) incorrect, 162 (38.9%) partially correct, and 231 (55.5%) correct. ChatGPT showed higher rates of partially correct answers than Gemini (p = 0.0346). Physician-level prompts resulted in a higher word count across both platforms (p < 0.001). ChatGPT showed a higher FK grade level (p = 0.033) in physician-friendly prompting. Gemini exhibited a significantly higher mean word count (p < 0.001); however, ChatGPT had a higher FK grade level across all forms (p > 0.001). Conclusion To our knowledge, this study is the first to compare cardiology-related responses from ChatGPT and Gemini, two of the most popular AI chatbots. The grade level for most responses was collegiate level, which was above average for the National Institutes of Health (NIH) recommendations, but on par with most online medical information. Both chatbots responded with a high degree of accuracy, with inaccuracies being rare. Therefore, it is reasonable that cardiologists suggest either chatbot as a source of supplementary education.

The Impact of Coronary Artery Disease on Outcomes in Patients With Peripartum Cardiomyopathy.

Introduction The purpose of this study was to determine the prevalence of coronary artery disease (CAD) among patients admitted with peripartum cardiomyopathy (PPCM) as well as to analyze the independent association of CAD with in-hospital outcomes among PPCM patients. Methods Data were obtained from the National Inpatient Sample from January 2016 to December 2019. We assessed the independent association of CAD with outcomes in patients admitted with PPCM. Predictors of mortality in patients admitted with PPCM were also analyzed. Results There was a total of 4,730 patients with PPCM, 146 of whom had CAD (3.1%). Multivariate analysis demonstrated that CAD in patients with PPCM was independently associated with several outcomes, and, among them, ST-segment elevation myocardial infarction (STEMI) (adjusted odds ratio (aOR): 58.457, 95% CI: 5.403-632.504, p= 0.001) was positively associated with CAD. CAD was found to be protective against preeclampsia (aOR: 0.351, 95% CI: 0.126-0.979, p = 0.045). Predictors of in-hospital mortality for patients with PPCM include cardiogenic shock (aOR: 12.818, 95% CI: 7.332-22.411, p = 0.001), non-ST elevation myocardial infarction (NSTEMI) (OR: 3.429, 95% CI: 1.43-8.22, p = 0.006), chronic kidney disease (OR: 2.851, 95% CI: 1.495-5.435, p = 0.001), and atrial fibrillation (OR: 2.326, 95% CI: 1.145-4.723, p = 0.020). Conclusion In a large cohort of patients admitted with PPCM, we found the prevalence of CAD to be 3.1%. CAD was associated with several adverse outcomes, including STEMI, but protective against preeclampsia.

An idea to explore: How an interdisciplinary undergraduate course exploring a global health challenge in molecular detail enabled science communication and collaboration in diverse audiences.

Communication and collaboration are key science competencies that support sharing of scientific knowledge with experts and non-experts alike. On the one hand, they facilitate interdisciplinary conversations between students, educators, and researchers, while on the other they improve public awareness, enable informed choices, and impact policy decisions. Herein, we describe an interdisciplinary undergraduate course focused on using data from various bioinformatics data resources to explore the molecular underpinnings of diabetes mellitus (Types 1 and 2) and introducing students to science communication. Building on course materials and original student-generated artifacts, a series of collaborative activities engaged students, educators, researchers, healthcare professionals and community members in exploring, learning about, and discussing the molecular bases of diabetes. These collaborations generated novel educational materials and approaches to learning and presenting complex ideas about major global health challenges in formats accessible to diverse audiences.

An Uncommon Presentation of Hyperthyroidism Can Culminate in Devastating Neurological Consequences: A Case Report.

Wernicke's encephalopathy remains largely an underdiagnosed condition. It has two variants: alcoholic and non-alcoholic. A 56-year-old female patient presented with two weeks of persistent nausea, vomiting, and unintentional weight loss. Initial investigations revealed hypercalcemia associated with pancreatitis of biliary origin for which she underwent cholecystectomy as well as thyroiditis resulting in postoperative initiation of methimazole. Persistent symptoms prompted esophagogastroduodenoscopy (EGD), which was unremarkable. She developed diffuse weakness and impaired memory with poor orientation. Magnetic resonance imaging of the brain showed fluid-attenuated inversion recovery (FLAIR) hyperintensity at the central pons and bilateral thalami. Her mental status continued to worsen rapidly within a few days, and she became minimally responsive, hypothermic, and hypotensive; as such, she was intubated for airway protection. Cerebrospinal fluid analysis was unremarkable. She received a thiamine replacement. Repeat MRI after a few days showed improving thalamic hyperintensities with improvement in mentation. This case serves to remind clinicians of the uncommon link between hyperthyroidism and non-alcoholic Wernicke's encephalopathy (WE).

A Case Report: Ethambutol Causes a Rare Adverse Effect of Peripheral Neuropathy.

Mycobacterium gordonae is a slow-growing acid-fast bacilli mycobacterium with low pathogenic potential. Patients with this infection are treated with antimycobacterial agents such as ethambutol, clarithromycin, and rifampin. We present a rare side effect of ethambutol causing peripheral neuropathy, along with regression of this upon discontinuation of the inciting medication. A 78-year-old male with a past medical history of lumbar degenerative disc disease and lumbosacral radiculopathy presented to the clinic with three weeks of progressively worsening rhinorrhea, nasal congestion, and productive cough with yellow sputum. After a bronchoalveolar lavage (BAL) and a chest computed tomography (CT) scan, he was diagnosed with an M. gordonae infection. He was started on a 12-month triple regimen of rifampin, clarithromycin, and high-dose ethambutol. During the first three months of antibiotic therapy, the patient began to have symptoms of gastrointestinal upset and worsening numbness in bilateral lower extremities, especially at night. Because he was unable to tolerate these adverse effects, the patient stopped taking these medications three months into his 12-month course. Upon stopping the antimycobacterial therapy, the patient's neuropathy began to return to baseline. Based on imaging, electromyography (EMG), nerve conduction studies (NCS), and a literature search of antimycobacterial medicines, we concluded that the high dose of ethambutol is the most likely cause of this patient's peripheral neuropathy. An important takeaway is that while ethambutol is a well-known cause of optic neuritis, it may also lead to peripheral neuropathy, which may regress upon discontinuation of the medication.

Solar radiation and solar energy estimation using ANN and Fuzzy logic concept: A comprehensive and systematic study.

To overcome the need of the world for energy consumption, we have to find some better and stable alternate ways of renewable energy with advanced technology. The most readily available source of energy is solar energy but solar energy has nonlinear nature due to the random nature of climate conditions. So, one way to solve is solar radiation prediction and solar energy prediction using more accurate techniques. Also, energy business and power system control units require more accuracy along with very short to large duration prediction in advance. So, to complete the requirement many prediction techniques are used and among them, Artificial Neural Network (ANN) and Fuzzy are more accurate and reliable techniques. In this paper basically, a literature study for solar radiation and energy prediction using ANN and Fuzzy logic techniques has been carried out. Many studies are reviewed and then selected some most accurate, reliable, and relevant studies for further study. ANN models with different algorithms such as feed-forward back-propagation-based ANN, Multi-layer feed-forward-based ANN model, Linear regression with ANN model, GNN-based model are reviewed in the study. ANN models with different input parameters combinations and the different number of neurons were also reviewed. Fuzzy logic-based and Adaptive Neuro-Fuzzy interface (ANFIS)-based different models have been reviewed and observed that the ANFIS technique performs better. From the study, it has been noted that ANN and Fuzzy logic employed models are most effective for estimation than any other empirical models. It is found that solar radiation and energy prediction models are dependent on input parameters more. At last, highlighted some possible research opportunities and areas for better efficiency of the results.

Seronegative Immune-Mediated Necrotizing Myopathy: A Case Report.

Idiopathic inflammatory myopathies (IIMs) are a group of chronic autoimmune disorders characterized by proximal skeletal muscle weakness. One subtype of the IIMs is immune-mediated necrotizing myopathy (IMNM). IMNM can be further classified according to its autoantibody presence, including anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR), anti-signal recognition particle (SRP), and seronegative.  Here, we describe the case of a 61-year-old Caucasian female with a prior history of distant lung cancer and current statin use presenting with a subacute onset of bilateral proximal lower extremity muscle weakness and markedly elevated creatinine kinase (CK) and amino transaminases. In the acute inpatient setting, she underwent successful treatment with corticosteroids that were eventually discontinued and replaced with azathioprine three months after hospital admission. At that point, she had attained a 60% increase in muscle strength.

Controlling drug release with additive manufacturing-based solutions.

3D printing is an innovative manufacturing technology with great potential to revolutionise solid dosage forms. Novel features of 3D printing technology confer advantage over conventional solid dosage form manufacturing technologies, including rapid prototyping and an unparalleled capability to fabricate complex geometries with spatially separated conformations. Such a novel technology could transform the pharmaceutical industry, enabling the production of highly personalised dosage forms with well-defined release profiles. In this work, we review the current state of the art of using additive manufacturing for predicting and understanding drug release from 3D printed novel structures. Furthermore, we describe a wide spectrum of 3D printing technologies, materials, procedure, and processing parameters used to fabricate fundamentally different matrices with different drug releases. The different methods to manipulate drug release patterns including the surface area-to-mass ratio, infill pattern, geometry, and composition, are critically evaluated. Moreover, the drug release mechanisms and models that could aid exploiting the release profile are also covered. Finally, this review also covers the design opportunities alongside the technical and regulatory challenges that these rapidly evolving technologies present.

Emerging SARS-CoV-2 Variants: A Review of Its Mutations, Its Implications and Vaccine Efficacy.

The widespread increase in multiple severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) variants is causing a significant health concern in the United States and worldwide. These variants exhibit increased transmissibility, cause more severe disease, exhibit evasive immune properties, impair neutralization by antibodies from vaccinated individuals or convalescence sera, and reinfection. The Centers for Disease Control and Prevention (CDC) has classified SARS-CoV-2 variants into variants of interest, variants of concern, and variants of high consequence. Currently, four variants of concern (B.1.1.7, B.1.351, P.1, and B.1.617.2) and several variants of interests (B.1.526, B.1.525, and P.2) are characterized and are essential for close monitoring. In this review, we discuss the different SARS-CoV-2 variants, emphasizing variants of concern circulating the world and highlight the various mutations and how these mutations affect the characteristics of the virus. In addition, we discuss the most common vaccines and the various studies concerning the efficacy of these vaccines against different variants of concern.