Reported Reasons for Cannabis Use Before and After Pregnancy Recognition.

OBJECTIVES: Cannabis use is cautioned against during pregnancy, yet many pregnant people continue to use. This study aimed to evaluate the patterns and reasons for cannabis use before and after conception in pregnant people who screened positive for cannabis use at initiation of prenatal care. METHODS: Pregnant patients at 1 prenatal practice in Baltimore, MD, who either self-reported cannabis use or tested positive on urine toxicology were approached for enrollment. Those who consented were given an anonymous survey with multiple choice questions regarding frequency and reasons for use before and after pregnancy recognition. Fisher exact, χ 2 test, and analysis of variance were used for analysis. RESULTS: Of 117 pregnant people approached, 105 enrolled in the study. Of the 105 respondents, 40 (38.1%) reported complete abstinence after pregnancy recognition, whereas 65 (61.9%) reported continued use. Of the respondents who continued cannabis use, 35 (53.8%) had decreased frequency of use or quit, 26 (40%) reported no change in frequency of use, and 4 (6.2%) reported increase in frequency of use. Those who considered their use medical or mixed before pregnancy were 4 times as likely to continue use compared with those who considered their use nonmedical (66.7% vs 33.3%; odds ratio, 4.0; 95% confidence interval, 1.3-12.8). Respondents who continued use after pregnancy recognition were significantly more likely to discuss their use with their obstetrician (89.2% vs 50%, P < 0.001). CONCLUSIONS: Reasons for use frequently changed after recognition of pregnancy. Most people who continued use during pregnancy reported that their reasons were for symptom control.

COVID-19 Management Missteps.

In December 2019, the first case of a novel coronavirus infectious disease, coronavirus disease 2019 (COVID-19), was identified in the province of Wuhan, China. Since the initial identification on March 11, 2020, by the World Health Organization (WHO), COVID-19 had rapidly spread all over the world, leading to the declaration of COVID-19 as a pandemic. In response to the exponential trend of reported confirmed cases, national governments worked quickly to devise plans to combat the spread and to soften the consequences which were to follow. Two primary approaches included limiting the spread of the virus and increasing hospital capacity. The implementation of these strategies, however, varied greatly among different governments and their respective populations. Countries developed similar guidelines in response to COVID-19, but with a variation. Many of these guidelines were similar in that they fell under the same general topics such as the use of facial masks, social distancing, and online learning. The effect of COVID-19 on public health was more reliant on the implementation of these recommendations rather than the recommendations themselves.  The medical therapies used to treat the widespread COVID-19 disease are flourishing and evolving rapidly. Ongoing research shows that the spectrum of treatment for COVID-19 varies from pharmacological and non-pharmacological therapeutic interventions. Some of the treatments that are being used in clinical practice include supportive care, antiviral drugs, immunomodulatory agents, convalescent plasma transfusion, and monoclonal antibody treatments. In addition, the most promising approach thus far is the COVID-19 vaccine developed by Pfizer-BioNTech, Moderna, and most recently Johnson & Johnson. Overall, as various treatment approaches are being explored and administered to people globally, it is important to acknowledge that there is currently no definite cure or any evidence-based treatment for COVID-19.  COVID-19 infections caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have brought devastating consequences to the lives of millions of people through their health effects and the failure of global initiatives to contain it. A review of many missteps that potentially could have altered the landscape for this virus to affect the lives of many is discussed with hope for a better approach going forward.

Altered gut microbiome and autism like behavior are associated with parental high salt diet in male mice.

Neurodevelopmental disorders are conditions caused by the abnormal development of the central nervous system. Autism spectrum disorder (ASD) is currently the most common form of such disorders, affecting 1% of the population worldwide. Despite its prevalence, the mechanisms underlying ASD are not fully known. Recent studies have suggested that the maternal gut microbiome can have profound effects on neurodevelopment. Considering that the gut microbial composition is modulated by diet, we tested the hypothesis that ASD-like behavior could be linked to maternal diet and its associated gut dysbiosis. Therefore, we used a mouse model of parental high salt diet (HSD), and specifically evaluated social and exploratory behaviors in their control-fed offspring. Using 16S genome sequencing of fecal samples, we first show that (1) as expected, HSD changed the maternal gut microbiome, and (2) this altered gut microbiome was shared with the offspring. More importantly, behavioral analysis of the offspring showed hyperactivity, increased repetitive behaviors, and impaired sociability in adult male mice from HSD-fed parents. Taken together, our data suggests that parental HSD consumption is strongly associated with offspring ASD-like behavioral abnormalities via changes in gut microbiome.

Adapting and Extending a Typology to Identify Vaccine Misinformation on Twitter.

Objectives. To adapt and extend an existing typology of vaccine misinformation to classify the major topics of discussion across the total vaccine discourse on Twitter.Methods. Using 1.8 million vaccine-relevant tweets compiled from 2014 to 2017, we adapted an existing typology to Twitter data, first in a manual content analysis and then using latent Dirichlet allocation (LDA) topic modeling to extract 100 topics from the data set.Results. Manual annotation identified 22% of the data set as antivaccine, of which safety concerns and conspiracies were the most common themes. Seventeen percent of content was identified as provaccine, with roughly equal proportions of vaccine promotion, criticizing antivaccine beliefs, and vaccine safety and effectiveness. Of the 100 LDA topics, 48 contained provaccine sentiment and 28 contained antivaccine sentiment, with 9 containing both.Conclusions. Our updated typology successfully combines manual annotation with machine-learning methods to estimate the distribution of vaccine arguments, with greater detail on the most distinctive topics of discussion. With this information, communication efforts can be developed to better promote vaccines and avoid amplifying antivaccine rhetoric on Twitter.

Novel Anastomotic Technique for Uterine Transplant Using Utero-ovarian Veins for Venous Drainage and Internal Iliac Arteries for Perfusion in Two Laparoscopically Harvested Uteri.

STUDY OBJECTIVE: To evaluate 2 cases of uterine transplant surgery that used utero-ovarian veins as outflow channels, internal iliac arteries for perfusion, and the organ harvest surgery performed laparoscopically. DESIGN: Case study (Canadian Task Force Classification III). SETTING: An urban, private, tertiary care hospital. PATIENTS: Two patients, ages 30 and 24years, diagnosed with absolute uterine factor infertility secondary to Mayer-Rokitansky-Küster-Hauser syndrome underwent related living donor uterine transplants; donors were their mothers with normal menses. INTERVENTIONS: Retrieval of organs through minilaparotomy and laparoscopic harvest of donor internal iliac arteries and ovarian veins. MEASUREMENTS AND MAIN RESULTS: Anastomosis was completed with bilateral donor internal iliac arteries to recipient internal iliac arteries in an end-to-end manner and with bilateral donor ovarian veins to recipient external iliac veins in an end-to-side manner. The lengths of utero-ovarian veins of both donors were 11 and 11cm on both sides; the lengths of the internal iliac arteries of both donors were 10 and 7.5cm on the left side and 10 and 6cm on the right side. The operative times for harvest surgery, bench surgery and transplant surgery were 2:40 and 3:20 hours, 34:32 and 33:30 min and 4:00 and 4:30 hours respectively for recipients 1 and 2. Daily postoperative uterine Doppler was completed through day 8 and then every other day and showed good intrauterine blood flow (i.e., low resistance arcuate vessel flow; resistance index < .5). Cervical biopsies on postoperative days 7 and 14 showed no evidence of rejection in either recipient. Both recipients started menstruating within 2 months of surgery. CONCLUSION: By using ovarian veins as outflow channels, the challenges involved in dissection along the internal iliac vein are avoided, and harvesting the donor internal iliac artery reduces the tension on vascular anastomosis. The selection of vessels to be harvested could make the technique reproducible, although larger studies are warranted to confirm results.

Laparoscopic-Assisted Uterus Retrieval From Live Organ Donors for Uterine Transplant: Our Experience of Two Patients.

STUDY OBJECTIVE: To report the first ever laparoscopic-assisted live donor uterus retrieval in 2 patients for uterus transplant. DESIGN: Case study (Canadian Task Force classification III). SETTING: Galaxy CARE Laparoscopy Institute, Pune, India. PATIENTS: Two patients with absolute uterine factor infertility with their mothers as donors. INTERVENTIONS: In vitro fertilization and uterine transplant. MEASUREMENTS AND MAIN RESULTS: A 12-member team was formed, and approval for transplant was obtained from the institutional review board. Pretransplant, in vitro fertilization for both patients was done. Two consecutive uterine transplants were done on 2 successive days. Vessels were harvested laparoscopically in both donors. Uterus and harvested vessels were retrieved by a small abdominal incision to prevent injury and infection. The uterus was transplanted in the recipients by end to side anastomosis of the harvested vessels to external iliac vessels, followed by anchoring of supports of the donor uterus to those of the recipients. Surgical intra- and postoperative parameters, postoperative investigations, and follow-up data of 6 months were measured. Operative time for laparoscopic donor surgery was 4 hours. Bench surgery took 45 minutes. Recipient surgery time was 4 hours. There were no intraoperative or immediate postoperative complications. Both the recipients started menstruating after 34 days and 48 days, respectively, and have had 6 cycles of menses at regular intervals. Uterine artery Doppler showed good flow in both patients. Hysteroscopy-guided cervical biopsies were used as a method of surveillance of graft rejection after uterine transplant. Office hysteroscopy was done after 2 months in both patients, and hysteroscopy-guided endometrial and cervical biopsies were taken. Minimal slough was seen on the endometrium in the patient with Mayer-Rokitansky-Küster-Hauser syndrome, which was removed. Repeat hysteroscopy after 10 days showed a healthy endometrium. CONCLUSIONS: Laparoscopic-assisted uterus donor retrieval is feasible and affords all the advantages of a minimally invasive technique, thereby reducing the morbidity of the procedure. It helps in better dissection of the vessels, shortens the operative time, and helps to minimize tissue handling of the harvested uterus and vessels.

Laparoscopic-Assisted Uterus Retrieval From Live Organ Donors for Uterine Transplant.

STUDY OBJECTIVE: The authors present the first ever laparoscopic-assisted uterus retrieval in a live donor for uterus transplant. DESIGN: A step-by-step surgical demonstration. SETTING: Galaxy CARE Laparoscopy Institute, Pune, India. PATIENTS: Two patients, ages 21 and 26 years, with Mayer-Rokitansky-Küster-Hauser syndrome and Asherman syndrome, respectively, with their mothers as donors. INTERVENTIONS: A 12-member team was formed. After a review of the available literature on uterine transplant, a protocol was formulated and submitted to the Institutional Review Board (IRB). Approval from the Institutional Review Board was obtained. Thorough screening of the candidates was done. Two consecutive uterine transplants were done on 2 successive days. Vessels were harvested laparoscopically in both donors. Uterus was retrieved through a small abdominal incision, to prevent any injury to the uterus and harvested vessels. Uterus was transplanted in the recipients by end-to-side anastomosis of the harvested vessels to the external iliac vessels, followed by anchoring of supports of the donor uterus to those of the recipients. MEASUREMENTS AND MAIN RESULTS: Surgical intra- and postoperative parameters, postoperative investigations, and follow-up data of 4 months. The operative time for laparoscopic donor surgery was 4 hours. Bench surgery took 45 minutes. The recipient surgery was completed in 4 hours. There were no intraoperative or immediate postoperative complications. Both recipients started menstruating after 34 days and 48 days, respectively, and have had 3 cycles of menses at regular intervals to date. After discharge, follow-up cervical biopsies at 3 weekly intervals showed no signs of rejection. Uterine artery Doppler ultrasound showed good flow in both patients. CONCLUSION: Laparoscopic-assisted donor retrieval is feasible and affords all advantages of a minimally invasive technique. It helps in better dissection of vessels, shortens the operative time, and helps minimize tissue handling, thereby reducing the morbidity of the procedure.