Author Interviews, Blood Pressure - Hypertension, NEJM, OBGYNE / 28.01.2021
Emergency Contraception: Hormonal vs Copper IUDs Compared
MedicalResearch.com Interview with:
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Dr. Turok[/caption]
DAVID K. TUROK, MD, MPH, FACOG
ASSOCIATE PROFESSOR OF OBSTETRICS AND GYNECOLOGY
CHIEF OF THE DIVISION OF FAMILY PLANNING
UNIVERSITY OF UTAH
MedicalResearch.com: What is the background for this study?
Response: Researchers and clinicians have long known that copper intrauterine devices (IUDs) work extremely well for emergency contraception, using contraception after sex to prevent pregnancy. However, the hormonal IUD (levonorgestrel 52 mg IUD) has distinct characteristics that many people prefer. Namely, it reliably reduces or eliminates menstrual bleeding and cramping. Until now we did not know if the levonorgestrel IUD worked for emergency contraception. Now we know. In a first-of-its-kind study, our team at the University of Utah Health and Planned Parenthood Association of Utah found that hormonal IUDs were comparable to copper IUDs for use as emergency contraceptives.
Dr. Turok[/caption]
DAVID K. TUROK, MD, MPH, FACOG
ASSOCIATE PROFESSOR OF OBSTETRICS AND GYNECOLOGY
CHIEF OF THE DIVISION OF FAMILY PLANNING
UNIVERSITY OF UTAH
MedicalResearch.com: What is the background for this study?
Response: Researchers and clinicians have long known that copper intrauterine devices (IUDs) work extremely well for emergency contraception, using contraception after sex to prevent pregnancy. However, the hormonal IUD (levonorgestrel 52 mg IUD) has distinct characteristics that many people prefer. Namely, it reliably reduces or eliminates menstrual bleeding and cramping. Until now we did not know if the levonorgestrel IUD worked for emergency contraception. Now we know. In a first-of-its-kind study, our team at the University of Utah Health and Planned Parenthood Association of Utah found that hormonal IUDs were comparable to copper IUDs for use as emergency contraceptives.
Dr. Cano[/caption]
Marlene Cano MD. PhD.
Post-Doctoral Research Fellow in Pulmonary Transplant Immunology
Division of Pulmonary and Critical Care
Department of Medicine
Washington University/Barnes-Jewish Hospital
Saint Louis, MO
MedicalResearch.com: What is the background for this study? How does this test differ from other tests for COVID-19?
Response: We know COVID-19 causes a wide spectrum of disease, and that while many develop only mild uncomplicated illness, others develop severe respiratory failure, multi-organ failure and death. These patients often require prolonged hospitalization, ICU level care and even mechanical intubation for respiratory support. However, we still do not have a great way to identify which patients are likely to develop severe disease. We felt it was important to have a test that could act as sort of a ‘biomarker’ that we could measure early in COVID-19 patients and would help predict which patients would develop severe disease. From prior work, we knew that mitochondrial DNA, which are proinflammatory molecules that are released into the circulation from damaged organs could be this such ‘biomarker’. So, we measured the levels of mitochondrial DNA circulating in the plasma of patients with COVID-19 at the time they first presented to the hospital. Then we investigated if higher levels of mitochondrial DNA indeed predict the development of more severe disease.
Currently there are no ‘biomarker’ tests specific for COVID-19. We do currently measure levels of other markers in the hospital that we feel might help us assess overall how sick patients may be, but these are very non-specific and assess only level of inflammation. This test instead can measure level of tissue injury.
Dr. Wei Shan Hoong[/caption]
Dr Caroline Wei Shan Hoong, MBBS, MRCP
Associate Consultant Endocrinologist
Department of General Medicine
Woodlands Health Campus
National Healthcare Group, Singapore
MedicalResearch.com: What is the background for this study?
Response: In the course of our clinical work, we have noticed a predominance of musculoskeletal complaints among some of COVID-19 patients who are otherwise clinically well, and a small subset of them who develop a viral arthralgia (joint pains) sometimes occurring separately from the onset of acute respiratory symptoms. Besides a few isolated case reports, there was not much described about COVID-19 associated viral arthralgia in the literature.
Clinicians are well aware of the need to test for COVID-19 when patients present with cough or shortness of breath. However, when they present as joint pains without any respiratory symptoms, a diagnosis of COVID-19 could easily be missed. Due to overlapping clinical features like low platelet count and elevated liver enzymes, they could easily be misdiagnosed as having other vector-borne infections such as dengue fever, if clinicians do not have a high clinical suspicion of COVID-19. Hence we decided to describe the epidemiology and various presentations of musculoskeletal manifestations of COVID-19 in our cohort of patients.
Dr. Kim[/caption]
Brian Kim, MD
Associate Professor of Dermatology
Co-Director, Center for the Study of Itch & Sensory Disorders
John T. Milliken Department of Internal Medicine
Washington University in St. Louis
MedicalResearch.com: What is the background for this study?
Response: Patients with eczema suffer from chronic itch due to the rashes they have on their body. However, as a physician, I have always noticed that patients with eczema will have sudden flares of their itching all over there body that is often triggered by what appear to be allergens – being around a cat, pollen, mold in a house, etc. Eczema is in the family of allergic diseases such as food allergy, asthma, and hay fever. All of these conditions are noted for patients being reactive to allergens by way of an antibody called IgE that coats a cell called the mast cell. Upon IgE binding an allergen, mast cells produce tons of histamine which can cause symptoms like itching. So we speculated that perhaps because patients with eczema have such misbehaving IgE, that exposure to allergen is what triggers this kind of severe itch flare that we see in patients.
Dr. Conway Morris[/caption]
Dr Andrew Conway Morris
Wellcome Trust Clinical Research Career Development Fellow
University of Cambridge
Hon Consultant in Intensive Care Medicine
Addenbrookes Hospital, Cambridge
MedicalResearch.com: What is the background for this study?
Response: Patients with COVID-19 frequently need to come to the intensive care unit (ICU), where we use mechanical ventilation to support their lungs as they get over the intense inflammation caused by the virus. During the first wave of the virus we noted that a lot of our patients appeared to be developing secondary infections (infections they didn’t have when they came into the ICU).
We therefore rolled out a rapid diagnostic test for these secondary bacterial infections that we had developed previously, and this study reports the use of this diagnostic and also describes the types of bacteria seen. To see if the increase in secondary infections was due to COVID specifically, we compared them to patients who were managed in the same ICU but who did not have COVID.
Dr. Pedersen[/caption]
Eric R. Pedersen, Ph.D.
Adjunct Behavioral Scientist, RAND
Associate Professor of Psychiatry and Behavioral Sciences
Keck School of Medicine
University of Southern California
MedicalResearch.com: What is the background for this study?
Response: In November of 2016, CA voted to legalize cannabis for sale and possession to adults 21 and older for recreational use. It wasn’t until January of 2018 that stores in most parts of LA County (we call these “outlets”) were legally able to begin selling recreational cannabis. We were collecting data from about 2,500 young adults in LA County as part of a longitudinal study (Principal Investigator Elizabeth D’Amico at RAND) and were able to look at cannabis use and intentions assessed at a period prior to the opening of the recreational cannabis outlets (pre-January 2018) to a period when those outlets were open (after January 2018). It has been suggested that once cannabis was more available for recreational purchase (and not just for medical purposes among those enrolled in CA’s medical marijuana program), use of cannabis among young adults would increase.
Dr. Butler[/caption]
Jay C. Butler, MD, FAAP, MACP, FIDSA
Deputy Director for Infectious Diseases
Centers for Disease Control and Prevention
Atlanta, GA 30333
MedicalResearch.com: What is the background for this study?
Response: There are still disagreements about the significance of transmission of SARS-CoV-2 from asymptomatic persons. It has been known since at least March 2020 that, unlike the closely related coronavirus that causes SARS, transmission of COVID-19 from asymptomatic and presymptomatic persons occurs and that at least 30% of infected persons do not develop symptoms. Estimating the proportion of transmissions from persons without symptoms informs the decision analysis for prioritization of community mitigations opportunities: wearing of masks, social distancing, and hand hygiene. If only a low proportion of transmission occurs from people without symptoms, these interventions would be less likely to control transmission when broadly applied in the community. On the other hand, if a significant proportion of spread is from infected persons without symptoms, the value of these measures is enhanced.
Additionally, obtaining strategic and systematic screening tests for SARS-CoV-2 to identify and isolate persons without symptoms in selected settings, such as congregational housing settings, will have greater potential impact if spread from persons without symptoms is common.
Dr. Joshi[/caption]
Nitin Joshi, Ph.D.
Engineering in Medicine/Department of Medicine
Brigham and Women's Hospital
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