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Singla DV, Garg DD, Dua DA, Bal DA, Singh DT, Prabhakar DN, Dahiya DD. Imaging enigma in mastitis: A comprehensive study of multifaceted causes, clinical and radiological presentations. Curr Probl Diagn Radiol 2024:S0363-0188(24)00154-3. [PMID: 39179467 DOI: 10.1067/j.cpradiol.2024.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 07/21/2024] [Accepted: 08/08/2024] [Indexed: 08/26/2024]
Abstract
BACKGROUND Mastitis is an inflammatory condition of the breast which represents an array of underlying etiologies encompassing both infectious and non-infectious causes. Exacerbating factors include endemic infections, lack of awareness and suboptimal breastfeeding practices. Neglected cases lead to prolonged morbidity, recurrent episodes, and complications such as abscess or sinus formation, resulting in permanent breast disfigurement. Its overlapping clinical presentation with breast cancer necessitates an integrated multidisciplinary approach for diagnosis and treatment. OBJECTIVES The primary aim was to investigate demographic, radiological, and histopathological characteristics of mastitis. Objectives included correlating radiological and histopathological findings, classifying mastitis by etiology, identifying the clinical and imaging patterns across diverse clinical settings to enhance the understanding of mastitis. MATERIAL AND METHOD This is a retrospective observational study, analysing the clinical, radiological, and histopathological data from 65 patients with mastitis between February 2023 and February 2024. RESULTS The study included 65 patients, aged 18 to 65 years, with breast pain as the most prevalent clinical presentation. Cases were classified as infectious (47.6%) and non-infectious (52%). Acute puerperal mastitis (26.15%) and granulomatous mastitis (30%) were the most common subtypes. The commonest mammographic finding was focal asymmetry. On ultrasound, infectious mastitis showed oedema with other inflammatory changes, including diffuse skin thickening and collections; while non-infectious mastitis typically presented as solitary or multiple breast masses (p < 0.001). Surprisingly, idiopathic granulomatous mastitis constituted the largest percentage amongst various histopathological causes of mastitis in our study. CONCLUSION An integrated multidisciplinary approach with understanding of the pathogenesis is imperative for prompt diagnosis and optimizing treatment strategies, thereby improving patient outcome. Radiological imaging is critical for diagnosis, evaluating disease extent, conducting guided interventions, and monitoring treatment response.
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Affiliation(s)
- Dr Veenu Singla
- Department of Radiodiagnosis, PGIMER, Chandigarh 160012, India.
| | - Dr Dollphy Garg
- Department of Radiodiagnosis, PGIMER, Chandigarh 160012, India
| | - Dr Ashish Dua
- Department of Radiodiagnosis, PGIMER, Chandigarh 160012, India
| | - Dr Amanjit Bal
- Department of Histopathology, PGIMER, Chandigarh 160012, India
| | - Dr Tulika Singh
- Department of Radiodiagnosis, PGIMER, Chandigarh 160012, India
| | | | - Dr Divya Dahiya
- Department of General Surgery, PGIMER, Chandigarh 160012, India
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Paramasivam R, Gopal DR, Dhandapani R, Subbarayalu R, Elangovan MP, Prabhu B, Veerappan V, Nandheeswaran A, Paramasivam S, Muthupandian S. Is AMR in Dairy Products a Threat to Human Health? An Updated Review on the Origin, Prevention, Treatment, and Economic Impacts of Subclinical Mastitis. Infect Drug Resist 2023; 16:155-178. [PMID: 36636377 PMCID: PMC9831082 DOI: 10.2147/idr.s384776] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 12/20/2022] [Indexed: 01/07/2023] Open
Abstract
Background Bovine mastitis is the most frequent and costly illness impacting dairy herds worldwide. The presence of subclinical mastitis in dairy cows has an impact on the decreased output of milk and milk quality, culling of affected cows, mortality rate, as well as mastitis-related treatment expenses, generating significant financial loss to the dairy industry. The pathogenic bacteria invade through the mammary gland, which then multiply in the milk-producing tissues causing infection, and the presence of pathogenic bacteria in milk is concerning, jeopardizes human health, and also has public health consequences. Intervention to promote herd health is essential to protect public health and the economy. Results This review attempts to provide an overview of subclinical mastitis, including mastitis in different species, the effect of mastitis on human health and its pathogenic mechanism, the prevalence and incidence of subclinical mastitis, and current preventive, diagnostic, and treatment methods for subclinical mastitis. It also elaborates on the management practices that should be followed by the farms to improve herd immunity and health. Conclusion This review brings the importance of the threat of antimicrobial resistance organisms to the dairy industry. Furthermore, this review gives a glimpse of the economic consequences faced by the farmers and a futuristic mastitis market analysis in the dairy industry.
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Affiliation(s)
- Ragul Paramasivam
- Research and Development Division, Chimertech Private Limited, Chennai, India
| | - Dhinakar Raj Gopal
- Department of Animal Biotechnology, Madras Veterinary College, Tamilnadu Veterinary and Animal Science University (TANUVAS), Chennai, 600007, India
| | | | | | | | - Bhavadharani Prabhu
- Research and Development Division, Chimertech Private Limited, Chennai, India
| | - Veeramani Veerappan
- Research and Development Division, Chimertech Private Limited, Chennai, India
| | | | | | - Saravanan Muthupandian
- AMR and Nanotherapeutics Lab, Centre for Transdisciplinary Research (CFTR), Department of Pharmacology, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences (SIMATS), Chennai, India,Division of Biomedical Science, College of Health Sciences, School of Medicine, Mekelle University, Mekelle, Ethiopia,Correspondence: Saravanan Muthupandian, Email
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Taban Q, Ahmad SM, Mumtaz PT, Bhat B, Haq E, Magray S, Saleem S, Shabir N, Muhee A, Kashoo ZA, Zargar MH, Malik AA, Ganai NA, Shah RA. Scavenger receptor B1 facilitates the endocytosis of Escherichia coli via TLR4 signaling in mammary gland infection. Cell Commun Signal 2023; 21:3. [PMID: 36604713 PMCID: PMC9813905 DOI: 10.1186/s12964-022-01014-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/11/2022] [Indexed: 01/06/2023] Open
Abstract
SCARB1 belongs to class B of Scavenger receptors (SRs) that are known to be involved in binding and endocytosis of various pathogens. SRs have emerging role in regulating innate immunity and host-pathogen interactions by acting in co-ordination with Toll-like receptors.Query Little is known about the function of SCARB1 in milk-derived mammary epithelial cells (MECs). This study reports the role of SCARB1 in infection and its potential association in TLR4 signaling on bacterial challenge in Goat mammary epithelial cells (GMECs). The novelty in the establishment of MEC culture lies in the method that aims to enhance the viability of the cells with intact characteristics upto a higher passage number. We represent MEC culture to be used as a potential infection model for deeper understanding of animal physiology especially around the mammary gland. On E.coli challenge the expression of SCARB1 was significant in induced GMECs at 6 h. Endoribonuclease-esiRNA based silencing of SCARB1 affects the expression of TLR4 and its pathways i.e. MyD88 and TRIF pathways on infection. Knockdown also affected the endocytosis of E.coli in GMECs demonstrating that E.coli uses SCARB1 function to gain entry in cells. Furthermore, we predict 3 unique protein structures of uncharacterized SCARB1 (Capra hircus) protein. Overall, we highlight SCARB1 as a main participant in host defence and its function in antibacterial advances to check mammary gland infections. Video Abstract.
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Affiliation(s)
- Qamar Taban
- grid.444725.40000 0004 0500 6225Division of Animal Biotechnology, Sher-E-Kashmir University of Agricultural Sciences and Technology of Kashmir, FV.Sc and A.H, Shuhama, Jammu and Kashmir India ,grid.412997.00000 0001 2294 5433Department of Biotechnology, University of Kashmir, Hazratbal Srinagar, Jammu and Kashmir India
| | - Syed Mudasir Ahmad
- grid.444725.40000 0004 0500 6225Division of Animal Biotechnology, Sher-E-Kashmir University of Agricultural Sciences and Technology of Kashmir, FV.Sc and A.H, Shuhama, Jammu and Kashmir India
| | - Peerzada Tajamul Mumtaz
- grid.24434.350000 0004 1937 0060Department of Nutrition and Health Sciences, University of Nebraska-Lincoln, Lincoln, USA
| | - Basharat Bhat
- grid.444725.40000 0004 0500 6225Division of Animal Biotechnology, Sher-E-Kashmir University of Agricultural Sciences and Technology of Kashmir, FV.Sc and A.H, Shuhama, Jammu and Kashmir India
| | - Ehtishamul Haq
- grid.412997.00000 0001 2294 5433Department of Biotechnology, University of Kashmir, Hazratbal Srinagar, Jammu and Kashmir India
| | - Suhail Magray
- grid.444725.40000 0004 0500 6225Division of Animal Biotechnology, Sher-E-Kashmir University of Agricultural Sciences and Technology of Kashmir, FV.Sc and A.H, Shuhama, Jammu and Kashmir India
| | - Sahar Saleem
- grid.444725.40000 0004 0500 6225Division of Animal Biotechnology, Sher-E-Kashmir University of Agricultural Sciences and Technology of Kashmir, FV.Sc and A.H, Shuhama, Jammu and Kashmir India
| | - Nadeem Shabir
- grid.444725.40000 0004 0500 6225Division of Animal Biotechnology, Sher-E-Kashmir University of Agricultural Sciences and Technology of Kashmir, FV.Sc and A.H, Shuhama, Jammu and Kashmir India
| | - Amatul Muhee
- grid.444725.40000 0004 0500 6225Department of Clinical Veterinary Medicine, Sher-E-Kashmir University of Agricultural Sciences and Technology of Kashmir, FV.Sc and A.H, Shuhama, Jammu and Kashmir India
| | - Zahid Amin Kashoo
- grid.444725.40000 0004 0500 6225Department of Veterinary Microbiology & Immunology, Sher-E-Kashmir University of Agricultural Sciences and Technology of Kashmir, FV.Sc and A.H, Shuhama, Jammu and Kashmir India
| | - Mahrukh Hameed Zargar
- grid.414739.c0000 0001 0174 2901Department of Advanced Centre for Human Genetics, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir India
| | - Abrar A. Malik
- grid.444725.40000 0004 0500 6225Division of Animal Biotechnology, Sher-E-Kashmir University of Agricultural Sciences and Technology of Kashmir, FV.Sc and A.H, Shuhama, Jammu and Kashmir India
| | - Nazir A. Ganai
- grid.444725.40000 0004 0500 6225Division of Animal Biotechnology, Sher-E-Kashmir University of Agricultural Sciences and Technology of Kashmir, FV.Sc and A.H, Shuhama, Jammu and Kashmir India
| | - Riaz A. Shah
- grid.444725.40000 0004 0500 6225Division of Animal Biotechnology, Sher-E-Kashmir University of Agricultural Sciences and Technology of Kashmir, FV.Sc and A.H, Shuhama, Jammu and Kashmir India
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Munsittikul N, Tantaobharse S, Siripattanapipong P, Wutthigate P, Ngerncham S, Yangthara B. Integrated breast massage versus traditional breast massage for treatment of plugged milk duct in lactating women: a randomized controlled trial. Int Breastfeed J 2022; 17:43. [PMID: 35655213 PMCID: PMC9162379 DOI: 10.1186/s13006-022-00485-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 05/26/2022] [Indexed: 12/05/2022] Open
Abstract
Background Plugged milk duct during lactation is a common problem in breastfeeding. Traditional breast massage (TBM) has been performed in Thailand with reasonable outcomes, but several follow-up sessions are often required. A new massage technique, the integrated breast massage (IBM), was subsequently developed. This study aimed to compare resolution time, reduction in mass size, and pain score after breast massage between the IBM and TBM techniques. Methods This randomized controlled trial was conducted at the Lactation Clinic of the Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand during February 2019-July 2020. Women presenting with acute plugged milk duct were enrolled and randomly allocated to the IBM or TBM/control groups. Mass size in square centimeters (cm2) was calculated by multiplying the perpendicular axes of the mass. Pain score was self-scored by participants using a numerical rating scale. Median time (95% confidence interval [CI]) to resolution of plugged milk duct was derived using Kaplan–Meier survival analysis. Intention-to-treat analysis was performed. Results Eighty-four women (42 per group) were included. All enrolled study participants completed the study and were included in the final analysis. Twenty-six (61.9%) and 25 (59.5%) participants from IBM and TBM, respectively, had mass diameter > 5 cm. The median (interquartile range [IQR]) mass size was 30 (20–48) and 20 (12–14) cm2 in IBM and TBM (p = 0.05), respectively. The median (95% CI) time to resolution of plugged duct was 0 (not available) and 1 (0.47–1.53) day in IBM and TBM, respectively (p < 0.01). After the first breast massage, the median (IQR) size of mass reduction was 30 (20–48) and 10 (10–26) cm2 in IBM and TBM, respectively (p = 0.01). The median (IQR) reduction in pain score was 8 (7–8) and 6 (4–7) in IBM and TBM, respectively (p = 0.01). No participants developed skin bruising or hematoma after breast massage. Conclusions The IBM technique resolved plugged milk duct significantly faster, with significantly less pain, and with significantly greater reduction in mass size after the first massage compared to TBM. Trial registration Retrospectively registered in the Thai Clinical Trials Registry on 25 September 2019 (TCTR20190925001).
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Affiliation(s)
| | | | - Pitiporn Siripattanapipong
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Punnanee Wutthigate
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Sopapan Ngerncham
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Buranee Yangthara
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
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Heron E, McArdle A, Karim MN, Cooper M, Geddes D, McKenna L. Construct validity and internal consistency of the Breast Inflammatory Symptom Severity Index in lactating mothers with inflammatory breast conditions. PeerJ 2021; 9:e12439. [PMID: 34820185 PMCID: PMC8603819 DOI: 10.7717/peerj.12439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/15/2021] [Indexed: 12/31/2022] Open
Abstract
Background Inflammatory Conditions of the Lactating Breast (ICLB) affect more than one in five lactating mothers, yet no fully validated outcome measures exist to aid clinicians in their patient-centred care of women with ICLB. The Breast Inflammatory Symptom Severity Index (BISSI) is an ICLB-specific clinician administered patient-reported outcome measure, currently used by Australian clinicians, who treat mothers with ICLB. To date the BISSI has undergone partial psychometric development. This study, therefore, aimed to undertake the next stage of psychometric development by determining the construct validity and internal consistency of the BISSI. Methods A retrospective audit was conducted on patient records of 160 mothers who were treated for ICLB, at a private physiotherapy practice in Melbourne, Australia. An electronic data capture tool was used to collate BISSI scores and associated ICLB assessment variables. Construct validity was determined through factor analysis and discriminant performance. Reliability was determined by assessing measures of internal consistency. Results Factor analysis established that BISSI items (n = 10) loaded on to four factors, Wellness, Pain, Physical Characteristics of Affected Area (PCAA), and Inflammation, which together, explained 71.2% of variance. The remaining item (‘Wellness/sickness unspecified’) did not load. Wellness, Pain, PCAA and Inflammation factors individually and collectively displayed the ability to discriminate symptom severity, as scores were significantly higher in mothers with high symptom severity (assessed via AUC close to or >0.7 and P value <0.005 for each factor). The BISSI demonstrated internal consistency with an overall Cronbach alpha of 0.742. Conclusions The BISSI has adequate construct validity, demonstrating behaviour consistent with theoretical constructs of inflammation severity, via its dimensionality and ability to discriminate symptom severity. The BISSI also has adequate internal consistency demonstrating reliability. Therefore, clinicians can have confidence that the BISSI is valid, the individual item scores are correlated, and the concepts are consistently measured.
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Affiliation(s)
- Emma Heron
- School of Allied Health, Curtin University, Bentley, Western Australia, Australia
| | - Adelle McArdle
- Monash Rural Health, Monash University, Churchill, Victoria, Australia
| | - Md Nazmul Karim
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | | | - Donna Geddes
- School of Molecular Sciences, University of Western Australia, Crawley, Western Australia, Australia
| | - Leanda McKenna
- School of Allied Health, Curtin University, Bentley, Western Australia, Australia
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Schrey-Petersen S, Tauscher A, Dathan-Stumpf A, Stepan H. Diseases and complications of the puerperium. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:arztebl.m2021.0168. [PMID: 33972015 PMCID: PMC8381608 DOI: 10.3238/arztebl.m2021.0168] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 02/28/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND In terms of maternal morbidity and mortality, the puerperium is just as significant as pregnancy and childbirth. Nearly half of all maternal deaths occur in the time after delivery. METHODS This review is based on pertinent articles in English and German from the years 2000- 2020 that were retrieved by a selective search in MEDLINE and EMBASE, as well as on the available guidelines in English and German and on German-language textbooks of obstetrics. RESULTS The most common and severe complications are, in the post-placental phase, bleeding and disturbances of uterine involution; in the first seven days after delivery, infection (e.g., endomyometritis, which occurs after 1.6% [0.9; 2.5] of all births) and hypertension-related conditions. Thromboembolism, incontinence and disorders of the pelvic floor, mental disease, and endocrine disturbances can arise at any time during the puerperium. In an Australian study, the incidence of embolism was 0.45 per 1000 births, with 61.3% arising exclusively after delivery. CONCLUSION Basic familiarity with the most common and severe diseases in the puerperium is important for non-gynecologists as well, among other things because highly acute, lifethreatening complications can arise that demand urgent intervention.
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Affiliation(s)
| | - Anne Tauscher
- Division of Obstretics, University of Leipzig Medical Center
| | | | - Holger Stepan
- Division of Obstretics, University of Leipzig Medical Center
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Stachs A, Stubert J, Reimer T, Hartmann S. Benign Breast Disease in Women. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 116:565-574. [PMID: 31554551 DOI: 10.3238/arztebl.2019.0565] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/02/2019] [Accepted: 07/02/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Most clinical breast changes in women are benign; in only 3% to 6% of cases are they due to breast cancer. How- ever, there is a lack of up-to-date, evidence-based treatment recommendations for the various benign differential diagnoses. METHODS Selective literature search of PubMed from 1985 to May 2019, including current national (AWMF, Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften [Association of Scientific Medical Societies in Germany]) and inter- national guidelines. RESULTS Mastalgia and fibrocystic changes are common (around 50% of all women over the age of 30). Fibroadenomas occur in 25% of women; they are the most common benign tumors of the breast and do not require treatment. With most benign breast changes the risk of dedifferentiation is very low. However, it is important in the differential diagnosis to distinguish between such benign changes and breast cancer or changes that carry a risk of malignancy. Complex cysts, for example, carry a risk of malig- nancy of 23% to 31%, papillary lesions 16% , and radial scars 7%. Where there is doubt, histological confirmation should be sought by means of percutaneous biopsy. CONCLUSION Benign breast changes can be definitively distinguished from malignant lesions through the selective use of avail- able diagnostic investigations and interdisciplinary collaboration. When lesions of uncertain malignant potential are found (B3 in the biopsy classification), complete excision is indicated. Prospective studies on the early diagnosis of breast cancer in lesions carrying a risk of malignancy are desirable.
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Affiliation(s)
- Angrit Stachs
- Department of Obstetrics and Gynecology, University of Rostock
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Development of a novel patient focussed symptom severity index for use in assessing and treating inflammatory conditions of the lactating breast: a Delphi study. INT J EVID-BASED HEA 2020; 18:231-240. [PMID: 32487966 DOI: 10.1097/xeb.0000000000000225] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AIM To investigate the content and face validity of a patient-reported outcome measure used by Australian physiotherapists in the assessment of inflammatory conditions of the lactating breast. METHODS Sixty one experts representing 'women who previously had inflammatory conditions of the lactating breast' (48%), 'clinicians' (38%) and 'academics' (8%) interested in women's health and 7% unidentified participants were invited to complete a three round Delphi study. RESULTS Ninety five percent of participants agreed that overall, the patient-reported outcome measure was appropriate for use in assessing and treating inflammatory conditions of the lactating breast. The item 'impact' was added to ensure the appropriate assessment of functional aspects of daily life. The item terminology used in the patient-reported outcome measure was simplified to 'pain', 'redness', 'hardness/tightness', 'temperature of affected area', 'sickness/wellness' and 'affected area. A clinician script was developed to ensure the patient-reported outcome measure has utility and consistency regardless of the experience of the women presenting with inflammatory conditions of the lactating breast or the clinician. CONCLUSION The resultant Breast Inflammatory Symptom Severity Index (BISSI) is a patient-reported outcome measure for use in the diagnosis and monitoring of clinical changes of symptoms associated with inflammatory conditions of the lactating breast including engorgement, blocked ducts and mastitis. It utilizes person-centred language and assesses symptoms considered important to both patient and clinician. The development of the clinician script facilitates utility regardless of the experience of either the woman with the inflammatory condition or the treating clinician.
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Puerperal mastitis in the past decade: results of a single institution analysis. Arch Gynecol Obstet 2019; 300:1637-1644. [DOI: 10.1007/s00404-019-05333-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 10/10/2019] [Indexed: 10/25/2022]
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Lu P, Ye ZQ, Qiu J, Wang XY, Zheng JJ. Acupoint-tuina therapy promotes lactation in postpartum women with insufficient milk production who underwent caesarean sections. Medicine (Baltimore) 2019; 98:e16456. [PMID: 31464890 PMCID: PMC6736488 DOI: 10.1097/md.0000000000016456] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Breast milk is recognized and strongly recommended by the World Health Organization (WHO) as the optimal feeding for all babies. Breastfeeding is associated with better nutritional and non-nutritional outcomes when compared to formula feeding, and has proven health benefits to both infants and their mothers. This clinical research is to examine the feasibility and efficacy of Acupoint-Tuina therapy in treating postpartum women who underwent C-sections and suffered from insufficient milk production.The patients in the control group received standard medical care, while the patients in the Tuina group received Tuina therapy during the next 48 hours in addition to standard care, given once daily for 2 days. To evaluate the efficacy of Tuina therapy, patients of both groups were assessed for surface temperature of breasts, volume of breasts, volume of breast milk production, serum PRL level, and uterus recovery at various time points.Tuina therapy significantly increased the milk production when compared to the control group, for as much as 13-fold and 10-fold of that in the control group on the third and fourth postpartum days. In addition, Tuina therapy also significantly increased the full breast enlargement and the serum PRL level change, and decreased the breast surface temperature rise. Last but not the least, Tuina therapy also accelerated the post-surgery recovery of uterus.During the early postpartum days, Tuina therapy increases the milk production and promotes other physiological changes supporting lactation for postpartum women with C-section delivery and insufficient breast milk production. The novel intervention is warranted for further investigation and validation.
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Affiliation(s)
- Ping Lu
- Teaching and Research Office of Basic Tuina Science, Shanghai University of Traditional Chinese Medicine School of Acupuncture-Moxibustion and Tuina, Shanghai
| | - Zhi-qi Ye
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine
| | - Jin Qiu
- Shanghai Tenth People's Hospital, Tenth People's Hospital of TongJi University
| | | | - Juan-juan Zheng
- Teaching and Research Office of Basic Tuina Science, Shanghai University of Traditional Chinese Medicine School of Acupuncture-Moxibustion and Tuina, Shanghai
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Breast abscesses in lactating women: evidences for ultrasound-guided percutaneous drainage to avoid surgery. Emerg Radiol 2019; 26:507-514. [PMID: 31154537 DOI: 10.1007/s10140-019-01694-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 05/02/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Surgical incision with drainage remains the first-line therapy recommendation for breast abscesses greater than 5 cm. PURPOSE To determine recovery with ultrasound guided (US-guided) procedures for treatment of lactational breast abscesses without surgical incision for drainage. MATERIAL AND METHODS Institutional review board approval and written informed patient consent were obtained for this retrospective study. From May 1, 2009, to June 1, 2018, 92 consecutive women (mean age 30 years, range 18-45) with 105 abscesses were treated with oral antibiotics and US-guided percutaneous drainage under local anesthesia. A total number of 202 US-guided procedures were performed. Three techniques were used: needle aspiration (diameter 18 to 14G), pigtail catheter insertion (diameter 5 to 7F), and/or vacuum-assisted biopsy/aspiration (diameter 10G). When using needle aspiration or pigtail catheter, a saline irrigation of the cavity was performed according to pus viscosity. RESULTS The median diameter of abscesses was 4.5 cm (range 1-15), 82/105 (78%) were larger than 3 cm and 40/105 (38%) larger than 5 cm. US-guided management was successful for 101/105 (96%; 95% CI, (91-99%)) abscesses regardless the size. After the first round of procedures, 49/105 (47%) abscesses were recovered, 56/105 (53%) needed more than one drainage with a median number drainages of 2.6 (2-6). In 4/105 cases (4%), women underwent additional surgery under general anesthesia. By excluding abscesses which occurred in the weaning phase (n = 17), breastfeeding carried on for 68/75 (91%) women. CONCLUSION Unlike previous studies, US percutaneous guided management of lactational abscesses is effective even for abscesses greater than 5 cm and allows continued breastfeeding.
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Russell SP, Neary C, Abd Elwahab S, Powell J, O'Connell N, Power L, Tormey S, Merrigan BA, Lowery AJ. Breast infections - Microbiology and treatment in an era of antibiotic resistance. Surgeon 2019; 18:1-7. [PMID: 31076276 DOI: 10.1016/j.surge.2019.03.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 03/16/2019] [Accepted: 03/20/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Primary breast abscesses occur in <1% of non-lactating women, rising to 11% in women with lactational mastitis. In patients undergoing breast cancer surgery, the inflammatory response to post-operative surgical site infection (SSI) has been implicated in recurrence. Anti-microbial resistance increasingly hampers treatment in each group. AIMS Describe the demographic and predisposing characteristics of patients with primary breast abscesses and secondary infections, identify the microbial and antimicrobial patterns and formulate an evidence-based protocol for treating breast infections. METHODS Retrospective cohort study of all breast infections (primary and post-operative) treated at UHL from 2014 to 2017. Data collected from microbiology databases and patient records was analysed using Minitab V18. RESULTS 537 cultures from 108 patients were analysed. 47 (43.5%) had primary abscesses, 12 (11.1%) were lactational and 49 (45.4%) were post-operative SSI. For primary infections, the mean age was 41.9 (±12.2) and reinfection rate 33%. For SSIs the mean age was 51.8 (±14.52) and reinfection rate 11.8%. Overall, 29.3% were smokers, 6.4% diabetic and 2.9% pregnant. 60 (43%) patients required radiological drainage and 2 (1%) surgical drainage. 57.5% had mixed growth. The most common isolate was Staphylococcus aureus; cultured in 16.7% of primary abscesses and 24% of SSIs. 13 empiric antibiotic regimes were prescribed before 26.4% of patients changed to 12 different targeted regimes. CONCLUSION Breast infections are frequently polymicrobial with a wide variety of organisms isolated, suggesting the need for broad spectrum coverage until culture results become available. Based on our local culture results, the addition of clindamycin to flucloxacillin would provide excellent empiric coverage for all categories of breast infection. An evidence-based treatment guideline is required and should be formulated in close collaboration with microbiology specialists.
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Affiliation(s)
- S P Russell
- Mid-Western Breast Unit, University of Limerick Hospitals, Limerick, Ireland.
| | - C Neary
- Department of Surgery, Lambe Institute, National University of Ireland Galway, Ireland
| | - S Abd Elwahab
- Mid-Western Breast Unit, University of Limerick Hospitals, Limerick, Ireland
| | - J Powell
- Department of Microbiology, University of Limerick Hospitals, Limerick, Ireland
| | - N O'Connell
- Department of Microbiology, University of Limerick Hospitals, Limerick, Ireland
| | - L Power
- Department of Microbiology, University of Limerick Hospitals, Limerick, Ireland
| | - S Tormey
- Mid-Western Breast Unit, University of Limerick Hospitals, Limerick, Ireland
| | - B A Merrigan
- Mid-Western Breast Unit, University of Limerick Hospitals, Limerick, Ireland
| | - A J Lowery
- Mid-Western Breast Unit, University of Limerick Hospitals, Limerick, Ireland; Department of Surgery, Lambe Institute, National University of Ireland Galway, Ireland
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Boakes E, Woods A, Johnson N, Kadoglou N. Breast Infection: A Review of Diagnosis and Management Practices. Eur J Breast Health 2018; 14:136-143. [PMID: 30123878 DOI: 10.5152/ejbh.2018.3871] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 03/08/2018] [Indexed: 11/22/2022]
Abstract
Mastitis is a common condition that predominates during the puerperium. Breast abscesses are less common, however when they do develop, delays in specialist referral may occur due to lack of clear protocols. In secondary care abscesses can be diagnosed by ultrasound scan and in the past the management has been dependent on the receiving surgeon. Management options include aspiration under local anesthetic or more invasive incision and drainage (I&D). Over recent years the availability of bedside/clinic based ultrasound scan has made diagnosis easier and minimally invasive procedures have become the cornerstone of breast abscess management. We review the diagnosis and management of breast infection in the primary and secondary care setting, highlighting the importance of early referral for severe infection/breast abscesses. As a clear guideline on the management of breast infection is lacking, this review provides useful guidance for those who rarely see breast infection to help avoid long-term morbidity.
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Affiliation(s)
- Eve Boakes
- Department of General Surgery, London North West Healthcare NHS Trust, Northwick Park Hospital, Middlesex, London
| | - Amy Woods
- Department of Medicine, Croydon University Hospital, Croydon, London
| | - Natalie Johnson
- Department of General Surgery, London North West Healthcare NHS Trust, Northwick Park Hospital, Middlesex, London
| | - Naim Kadoglou
- Department of General Surgery, London North West Healthcare NHS Trust, Northwick Park Hospital, Middlesex, London
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14
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The microbiology and treatment of human mastitis. Med Microbiol Immunol 2018; 207:83-94. [PMID: 29350290 DOI: 10.1007/s00430-017-0532-z] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 12/15/2017] [Indexed: 12/29/2022]
Abstract
Mastitis, which is generally described as an inflammation of breast tissue, is a common and debilitating disease which frequently results in the cessation of exclusive breastfeeding and affects up to 33% of lactating women. The condition is a primary cause of decreased milk production and results in organoleptic and nutritional alterations in milk quality. Recent studies employing culture-independent techniques, including metagenomic sequencing, have revealed a loss of bacterial diversity in the microbiome of mastitic milk samples compared to healthy milk samples. In those infected, the pathogens Staphylococcus aureus, Staphylococcus epidermidis and members of corynebacteria have been identified as the predominant etiological agents in acute, subacute and granulomatous mastitis, respectively. The increased incidence of antibiotic resistance in the causative species is also a key cause of concern for treatment of the disease, thus leading to the need to develop novel therapies. In this respect, probiotics and bacteriocins have revealed potential as alternative treatments.
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15
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Harrelson P, Hallford D, Ross T. Short communication: Effects of fluoxetine on lactation at weaning in sheep. J Dairy Sci 2018; 101:801-805. [DOI: 10.3168/jds.2017-12991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 08/31/2017] [Indexed: 11/19/2022]
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16
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Mutic AD, Jordan S, Edwards SM, Ferranti EP, Thul TA, Yang I. The Postpartum Maternal and Newborn Microbiomes. MCN Am J Matern Child Nurs 2017; 42:326-331. [PMID: 29049057 PMCID: PMC5649366 DOI: 10.1097/nmc.0000000000000374] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Biological and environmental changes to maternal and newborn microbiomes in the postnatal period can affect health outcomes for the mother-baby dyad. Postpartum sleep deprivation and unmet dietary needs can alter commensal bacteria within the body and disrupt gut-brain communication. Perineal injury and breast infections also change microbial community composition, potentiating an environment favoring pathogen growth. The gut microbiome refers to the collection of microorganisms working in harmony. Disruptions within the gut microbiome and gut-brain communication may lead to postpartum depression, a potentially devastating sequela. Postnatal newborn changes to the gut and skin microbiome materialize quickly after birth and are profoundly influenced by mode of birth, feeding method, and bathing and skin care practices. During the newborn period, infant microbiomes are highly vulnerable and susceptible to multiple influences. Maternal-newborn nurses have a valuable role in helping mothers and newborns promote healthy microbiomes. Factors that influence the rapidly changing postnatal microbiome of the mother and her newborn, and the role nurses have to positively influence immediate and long-term health outcomes are presented.
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Affiliation(s)
- Abby D Mutic
- Abby D. Mutic is a Certified Nurse-Midwife, Doctoral Candidate, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA. She can be reached via e-mail at Sheila Jordan is Pre-Doctoral Fellow, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA. Sara M. Edwards is PhD Candidate, Instructor, Laney Graduate School and Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA. Erin P. Ferranti is an Assistant Professor, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA. Taylor A. Thul is Doctoral Student, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA. Irene Yang is an Assistant Professor, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
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17
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Tchaou M, Darre T, Amavi AK, Kanassoua KK, N'Timon B, Sonhaye L, Agoda-Koussema LK, Adjenou K. Breast Abscessed Cancer in Nonlactating Women in Tropical Environment: Radiological, Bacteriological, and Anatomopathological Features about 3 Cases. Case Rep Radiol 2017; 2017:1639847. [PMID: 28932615 PMCID: PMC5591997 DOI: 10.1155/2017/1639847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 07/25/2017] [Indexed: 11/21/2022] Open
Abstract
The association of breast cancer and abscess is rare in daily practice. The authors report a short series of 3 cases of cancer of the breast in nonlactating women presented as breast abscess, reviewing aspects in radiology (ultrasound and mammography), correlating them with the histopathology findings and the bacteriological profile of the isolated germs.
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Affiliation(s)
- Mazamaesso Tchaou
- University Teaching Hospital of Lomé, Department of Radiology, Lomé, Togo
| | - Tchin Darre
- University Teaching Hospital of Lomé, Department of Pathology, Lomé, Togo
| | - Ayi Kossi Amavi
- University Teaching Hospital of Lomé, Department of General Surgery, Lomé, Togo
| | | | - Bidamin N'Timon
- University Teaching Hospital of Lomé, Department of Radiology, Lomé, Togo
| | - Lantam Sonhaye
- University Teaching Hospital of Lomé, Department of Radiology, Lomé, Togo
| | | | - Komlavi Adjenou
- University Teaching Hospital of Lomé, Department of Radiology, Lomé, Togo
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Tena D, López-Garrido B, Losa C. Clinical mastitis in breastfeeding women: study of 56 cases. Infect Dis (Lond) 2016; 48:867-8. [PMID: 27387225 DOI: 10.1080/23744235.2016.1204662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Daniel Tena
- a Section of Microbiology , University Hospital of Guadalajara , Guadalajara , Spain
| | | | - Cristina Losa
- a Section of Microbiology , University Hospital of Guadalajara , Guadalajara , Spain
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Tena D, Fernández C, López-Garrido B, Pérez-Balsalobre M, Losa C, Medina-Pascual MJ, Sáez-Nieto JA. Lactational mastitis caused by Streptococcus lactarius. Diagn Microbiol Infect Dis 2016; 85:490-2. [PMID: 27220606 DOI: 10.1016/j.diagmicrobio.2016.04.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 04/27/2016] [Accepted: 04/30/2016] [Indexed: 11/25/2022]
Abstract
Human infections caused by Streptococcus lactarius have not been previously reported. In the present report, we describe a lactational mastitis caused by this organism. The infection occurred in a 28-year-old breast-feeding female, with a 10-days history of moderate pain on the right breast. The patient was cured after antibiotic treatment with levofloxacin for 21 days. Our case shows that S. lactarius should be considered as a cause of lactational mastitis. The introduction of molecular microbiology techniques can be extremely useful for knowing the implication of streptococci in lactational mastitis.
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Affiliation(s)
- Daniel Tena
- Section of Microbiology, University Hospital of Guadalajara, Guadalajara, Spain.
| | - Cristina Fernández
- Section of Microbiology, University Hospital of Guadalajara, Guadalajara, Spain
| | | | | | - Cristina Losa
- Section of Microbiology, University Hospital of Guadalajara, Guadalajara, Spain
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20
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Baeza C. Chronic Mastitis, Mastalgia, and Breast Pain. CLINICAL LACTATION 2016. [DOI: 10.1891/2158-0782.7.1.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Whereas the management of acute mastitis seems clear, there is little scientific evidence to support management of chronic mastitis/breast pain. This article reviews bacteriological findings, their possible meanings, and their use in clinical settings. Clinical experience, newer and more accurate microbiological techniques, and the growing knowledge about our metagenome have many insights to offer.
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21
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Viduedo ADFS, Leite JRDC, Monteiro JCDS, dos Reis MCG, Gomes-Sponholz FA. Severe lactational mastitis: particularities from admission. Rev Bras Enferm 2015; 68:1116-21. [PMID: 26676435 DOI: 10.1590/0034-7167.2015680617i] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 08/14/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to identify characteristics of women who have suffered severe lactational mastitis. METHOD a descriptive, retrospective, documentary, quantitative study was performed. Data were collected from patient records of 114 hospitalized women from January of 2009 to December of 2013. Data were analyzed by using descriptive statistics. RESULTS a higher percentage of severe lactational mastitis was found in young, primiparous women who had completed high school, who had no partner, and did not have a job; 96.5% of women had breast complications before admission and remained hospitalized an average of 4.4 days; at discharge, 23.7% of women had weaned their infants. CONCLUSION this study showed that severe lactational mastitis can cause great harm to the woman and the baby.
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Affiliation(s)
- Alecssandra de Fátima Silva Viduedo
- Programa de Pós-Graduação Enfermagem em Saúde Pública, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Juliana Rocha de Carvalho Leite
- Curso de Bacharelado e Licenciatura em Enfermagem, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Juliana Cristina dos Santos Monteiro
- Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | | | - Flávia Azevedo Gomes-Sponholz
- Curso de Bacharelado e Licenciatura em Enfermagem, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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22
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Zobel G, Weary DM, Leslie KE, von Keyserlingk MAG. Invited review: Cessation of lactation: Effects on animal welfare. J Dairy Sci 2015; 98:8263-77. [PMID: 26409963 DOI: 10.3168/jds.2015-9617] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 08/08/2015] [Indexed: 01/09/2023]
Abstract
The forced cessation of milk production, or dry-off, is a routine management practice in dairy cattle, sheep, and goats. This practice initiates a dry period, during which the animal is not milked. Milking begins again after parturition. Most of the literature on the dry period has focused on how various drying-off strategies affect milk production and disease; little work to date has addressed how dry-off affects the overall welfare of the dairy animal. The first aim of this review was to present an overview of the importance of dry-off and how it is commonly achieved. Our review shows that much scientific progress has been made in improving health status between lactations. The second aim was to identify important gaps in the literature, of which 2 key research disparities have been identified. We find that much of the work to date has focused on cattle and very little research has examined dry-off in dairy sheep and goats. We also find a lack of research addressing how common dry-off methodologies affect animal welfare on more than just a biological level, regardless of species.
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Affiliation(s)
- G Zobel
- Animal Welfare Program, Faculty of Land and Food Systems, University of British Columbia, 2357 Main Mall, Vancouver, British Columbia, V6T 1Z4, Canada
| | - D M Weary
- Animal Welfare Program, Faculty of Land and Food Systems, University of British Columbia, 2357 Main Mall, Vancouver, British Columbia, V6T 1Z4, Canada
| | - K E Leslie
- Department of Population Medicine, University of Guelph, Stewart Building, Guelph, ON, N1G 2W1, Canada
| | - M A G von Keyserlingk
- Animal Welfare Program, Faculty of Land and Food Systems, University of British Columbia, 2357 Main Mall, Vancouver, British Columbia, V6T 1Z4, Canada.
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Zhao C, Tang R, Wang J, Guan X, Zheng J, Hu J, Hu G, Song C. Six-Step Recanalization Manual Therapy: A Novel Method for Treating Plugged Ducts in Lactating Women. J Hum Lact 2014; 30:324-330. [PMID: 24804998 DOI: 10.1177/0890334414532314] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Plugged ducts are a common, painful condition in lactating women, but no standard treatment is currently available. OBJECTIVE This study aimed to evaluate the clinical efficacy of a newly established 6-step recanalization manual therapy (SSRMT) for treating plugged ducts. METHODS This observational study included 3497 lactating women with plugged ducts. The SSRMT comprised the following well-defined steps: (1) preparation, (2) clearing the plugged duct outlets, (3) nipple manipulation, (4) pushing and pressing the areola, (5) pushing and kneading the breast, and (6) checking for residual milk stasis. The response to the treatment was graded as I (complete resolution), II (marked improvement), III (improvement), or IV (no response). RESULTS Of the 3497 patients, the mean age was 26.7 years and 3284 (93.9%) patients were primiparas. Fever was present in 1231 (35.2%) patients. After a single SSRMT treatment, 3189 (91.2%), 173 (4.9%), and 83 (2.4%) patients achieved grade I, II, and III responses, respectively, with only 52 (1.5%) showing unresponsiveness. For the 308 (8.8% of total) non-grade I patients, a second SSRMT given 3 days later resulted in grade I, II, and III responses in 267 (7.6% of total), 28 (0.8% of total), and 13 (0.4% of total) patients, respectively, and none were absolutely unresponsive. No complications with clinical significance were observed. CONCLUSION Based on this large-scale clinical observation, SSRMT appears to be a useful, safe, low-cost treatment for postpartum plugged milk ducts.
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Affiliation(s)
- Chunying Zhao
- Department of Breast Surgery, Shuguang Hospital Affiliated with Shanghai University of Traditional Chinese Medicine, Shanghai, PR China
| | - Rui Tang
- Department of Breast Surgery, Shuguang Hospital Affiliated with Shanghai University of Traditional Chinese Medicine, Shanghai, PR China
| | - Jiandong Wang
- Department of Breast Surgery, Shuguang Hospital Affiliated with Shanghai University of Traditional Chinese Medicine, Shanghai, PR China
| | - Xiao Guan
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Jie Zheng
- Department of Breast Surgery, Shuguang Hospital Affiliated with Shanghai University of Traditional Chinese Medicine, Shanghai, PR China
| | - Junyan Hu
- Department of Breast Surgery, Shuguang Hospital Affiliated with Shanghai University of Traditional Chinese Medicine, Shanghai, PR China
| | - Gaowu Hu
- Department of Breast Surgery, Shuguang Hospital Affiliated with Shanghai University of Traditional Chinese Medicine, Shanghai, PR China
| | - Cong Song
- Department of Breast Surgery, Shuguang Hospital Affiliated with Shanghai University of Traditional Chinese Medicine, Shanghai, PR China
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Bikker FJ, Koop G, Leusink NB, Nazmi K, Kaman WE, Brand HS, Veerman ECI. Tailor made plasmin substrates as potential diagnostic tool to test for mastitis. Vet Res Commun 2014; 38:271-7. [DOI: 10.1007/s11259-014-9611-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2014] [Indexed: 10/25/2022]
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Mediano P, Fernández L, Rodríguez JM, Marín M. Case-control study of risk factors for infectious mastitis in Spanish breastfeeding women. BMC Pregnancy Childbirth 2014; 14:195. [PMID: 24902596 PMCID: PMC4063223 DOI: 10.1186/1471-2393-14-195] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 05/29/2014] [Indexed: 01/30/2023] Open
Abstract
Background The purpose of this study was to identify potential predisposing factors associated with human infectious mastitis. Methods We conducted a case–control study among breastfeeding women, with 368 cases (women with mastitis) and 148 controls. Data were collected by a questionnaire designed to obtain retrospective information about several factors related to medical history of mother and infant, different aspects of pregnancy, delivery and postpartum, and breastfeeding practices that could be involved in mastitis. Bivariate analyses and multivariate logistic regression model were used to examine the relationship between mastitis and these factors. Results The variables significantly- and independently-associated with mastitis were cracked nipples (P < 0.0001), oral antibiotics during breastfeeding (P < 0.0001), breast pumps (P < 0.0001), topical antifungal medication during breastfeeding (P = 0.0009), mastitis in previous lactations (P = 0.0014), breast milk coming in later than 24 h postpartum (P = 0.0016), history of mastitis in the family (P = 0.0028), mother-infant separation longer than 24 h (P = 0.0027), cream on nipples (P = 0.0228) and throat infection (P = 0.0224). Conclusions Valuable factors related to an increased risk of infectious mastitis have been identified. This knowledge will allow practitioners to provide appropriate management advice about modifiable risk factors, such as the use of pumps or inappropriate medication. They also could identify before delivery those women at an increased risk of developing mastitis, such as those having a familial history of mastitis, and thus develop strategies to prevent this condition.
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Affiliation(s)
| | | | | | - María Marín
- Departamento de Nutrición, Bromatología y Tecnología de los Alimentos, Universidad Complutense de Madrid, 28040 Madrid, Spain.
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Histological analysis of mammary gland remodeling caused by lipopolysaccharide in lactating mice. Cell Tissue Res 2013; 354:495-506. [DOI: 10.1007/s00441-013-1688-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 06/25/2013] [Indexed: 12/20/2022]
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Zobel G, Leslie K, Weary DM, von Keyserlingk MAG. Gradual cessation of milking reduces milk leakage and motivation to be milked in dairy cows at dry-off. J Dairy Sci 2013; 96:5064-71. [PMID: 23769368 DOI: 10.3168/jds.2012-6501] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 05/05/2013] [Indexed: 11/19/2022]
Abstract
The effects of gradual versus abrupt cessation of milking at dry-off in dairy cows are not well understood, but gradually reducing milk production in human mothers is known to reduce discomfort and milk leakage. This study compared the effects of abrupt versus gradual cessation of milking on milk leakage and dairy cow behavior. Holstein dairy cows were housed in groups of 6 and randomly assigned to either abrupt milk cessation (i.e., dry-off on d 0) or gradual milk cessation (i.e., skipped milkings beginning on d 0; dry-off on d 5). Four replicates were performed over time, for a total of 24 cows (mean ± SD; parity=2.3±1.2; milk production the day before d 0=24±5 kg/d). Intramammary antibiotic, internal teat sealer, and external teat sealant were administered at dry-off. Measurements were taken from d -3 to 8 relative to dry-off. Three periods were identified for behavior data: baseline (d -3 to 1), period 1 (abrupt cows dry, gradual cows milking; d 0-4), and period 2 (all cows dry; d 5-8). Lying time was recorded with data loggers. Video scan samples (5-min intervals) were used to measure feeding time and motivation to be milked (i.e., standing at the pen's exit gate). Milk leakage was monitored every 20 min during the 2-h period following the milking times of 0500 and 1500 h after complete cessation of milking (period 1 for abrupt vs. period 2 for gradual). Composite milk samples were taken before dry-off (d -1, 0, and 5) and at the start of the next lactation (colostrum, 24h and 7-10 d postcalving) to determine somatic cell score (SCS) and conduct bacteriological examinations in clinical mastitis cases. Regardless of treatment, dry-off resulted in reduced lying time [14.1 vs. 13.2h/d; standard error of the difference (SED)=0.2], reduced lying bouts (10.7 vs. 8.3 bouts/d; SED=0.2), increased lying bout duration (1.4 vs. 1.7h/bout; SED=0.03) and increased feeding time (5.0 vs. 5.9h/d; SED=0.2). Compared with baseline, the odds of standing at the gate increased for abrupt cows (period 1: odds ratio=6.2; 95% CI: 2.7-14.4; and period 2: odds ratio=5.2; 95% CI: 1.8-14.6). No increase in time spent standing at the gate was noted in gradual cows. Frequency of leakage was greater in abrupt versus gradual cows (75 vs. 27%). Although the gradual treatment showed an increase in SCS over the 5 d of reduced milking frequency, both treatments showed an increase in SCS at calving and both returned to pre-experiment levels within 7 to 10 d after calving. This work demonstrates that gradually reducing milking frequency in high-producing cows results in reduced time spent anticipating milking and reduced milk leakage after dry-off.
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Affiliation(s)
- G Zobel
- Animal Welfare Program, Faculty of Land and Food Systems, University of British Columbia, Vancouver, BC, Canada
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Lavigne V, Gleberzon BJ. Ultrasound as a treatment of mammary blocked duct among 25 postpartum lactating women: a retrospective case series. J Chiropr Med 2012; 11:170-8. [PMID: 23449233 PMCID: PMC3437340 DOI: 10.1016/j.jcm.2012.05.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Revised: 05/18/2012] [Accepted: 05/23/2012] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The purpose of this case series is to report the outcomes of 25 postpartum women who were experiencing difficulties with breastfeeding and were treated using therapeutic ultrasound. METHODS Case files of postpartum women who presented to a chiropractic clinic between 2005 and 2011 with difficulties with breastfeeding due to blocked ducts were identified. RESULTS Twenty-five cases were retrospectively identified of women who presented with a breast lump that was consistent with a blocked duct. Eight women experienced recurrent blocked ducts (5 had multiple episodes while nursing the same child; 3 women experienced episodes with more than 1 child). Patients had been treated with therapeutic ultrasound, receiving between 1 and 7 treatments (average, 3.3) to experience improvement in their presenting symptoms. A majority of the patients reported improvements in breastfeeding and symptoms after treatment. No adverse reactions were identified in the patient records. CONCLUSION For women reported in this case series, chiropractic management including ultrasound therapy was a beneficial treatment for women presenting with blocked ducts and difficulties breastfeeding.
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Affiliation(s)
| | - Brian J. Gleberzon
- Professor, Canadian Memorial Chiropractic Clinic, Toronto, Ontario, Canada
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Betzold CM. Results of microbial testing exploring the etiology of deep breast pain during lactation: a systematic review and meta-analysis of nonrandomized trials. J Midwifery Womens Health 2012; 57:353-64. [PMID: 22758357 DOI: 10.1111/j.1542-2011.2011.00136.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Controversy over the etiology of deep or burning breast pain during lactation continues to persist, despite a long history of published studies and case reports. This article reviews the literature exploring the etiology of deep breast pain, summarizes the results, and identifies possible explanations for the controversies surrounding this disorder. METHODS A clinical query and a librarian-assisted search of MEDLINE were used to find articles published between 1896 and 2010. Inclusion criteria consisted of comparing microbial testing results from symptomatic and asymptomatic lactating women. Cases were restricted to those experiencing deep or burning breast pain when possible. RESULTS Prospective studies consisting of 1 unmatched case-control and 6 cohorts were found. Trials typically detected higher microbial levels in the milk or nipple(s) or both of symptomatic women, irrespective of the detection method or type and range of microbes (bacterial, yeast, or fungal) studied. Case milk samples were positively associated with finding Staphylococcus aureus (relative risk ratio [RR] 7.29; 95% confidence interval [CI], 3.25-16.36) or Candida (RR 8.45; 95% CI, 3.96-18.06). Moreover, recent reports about small-colony variants and biofilm-producing organisms may explain the atypical symptoms unique to this disorder. DISCUSSION In lactating women reporting deep breast pain, evidence consistent with infection is persistently found, and explanations exist for the disorder's atypical characteristics. Although lactating women with deep breast pain are more likely to test positive for Candida, the risk of testing positive for S aureus is also present. Thus, these women should have cultures done. Management options include treating immediately while awaiting results or waiting until results are available to guide treatment. With either approach, providers must consider the risk of falsely negative tests.
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Abstract
Red, hot, and painful breast inflammation can have a large number of causes. The history of the condition and clinical observations usually give a pointer to the aetiological diagnosis, which is based on the classic triad of clinical, radiological and histopathological examinations, and guide the choice of additional investigations for rapid therapeutic management of this breast emergency. In breastfeeding women, the cause is often mastitis or, more rarely, an abscess; in non-breastfeeding women, the problem may be mastitis or a periareolar abscess, inflammatory lesions sometimes with secondary infection, or more rarely a real abscess, regardless of a catalogue of various causes. In all cases, the possibility must be considered of inflammatory breast cancer.
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Affiliation(s)
- G Boutet
- Gynaecological Surgery and Reproductive Medicine Department, Pellegrin Hospital Group, Bordeaux University Hospitals, place Amélie-Raba-Léon, 33075 Bordeaux, France.
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Semrau K, Kuhn L, Brooks DR, Cabral H, Sinkala M, Kankasa C, Thea DM, Aldrovandi GM. Exclusive breastfeeding, maternal HIV disease, and the risk of clinical breast pathology in HIV-infected, breastfeeding women. Am J Obstet Gynecol 2011; 205:344.e1-8. [PMID: 21784403 DOI: 10.1016/j.ajog.2011.06.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2011] [Revised: 03/07/2011] [Accepted: 06/06/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The objective of the study was to examine the relationship between breastfeeding patterns, markers of maternal human immunodeficiency virus (HIV) disease, and woman's breast pathology. STUDY DESIGN Secondary data analysis from a randomized breastfeeding trial including 947 HIV-infected women (n = 5982 visits) from breastfeeding initiation until 6 months postpartum; 1 month after breastfeeding cessation; or loss to follow-up or death. Generalized estimating equations assessed the effects of breastfeeding pattern and maternal HIV status on breast pathology. RESULTS One hundred ninety women (20.1%) had a breast problem; 86 (9.1%) had mastitis; and 31 (3.3%) had abscess. After confounder adjustment, nonexclusively breastfeeding women had an increased risk of breast problems (odds ratio, 1.98; 95% confidence interval, 1.33-2.95) and mastitis (odds ratio, 2.87, 95% confidence interval, 1.69-4.88) compared with exclusive breastfeeders. Women with a CD4 count less than 200 cells/μL tended to have an increased risk of abscess. CONCLUSION Nonexclusive breastfeeding significantly increased the risk of breast pathology. Exclusive breastfeeding is not only optimal for infant health but it also benefits mothers by reducing breast problems.
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Breast Abscess in Lactation. J Midwifery Womens Health 2010; 54:150-1. [DOI: 10.1016/j.jmwh.2008.07.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2008] [Accepted: 07/24/2008] [Indexed: 11/20/2022]
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Marshall AM, Nommsen-Rivers LA, Hernandez LL, Dewey KG, Chantry CJ, Gregerson KA, Horseman ND. Serotonin transport and metabolism in the mammary gland modulates secretory activation and involution. J Clin Endocrinol Metab 2010; 95:837-46. [PMID: 19965920 PMCID: PMC2840848 DOI: 10.1210/jc.2009-1575] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
CONTEXT Serotonin [5-hydroxytryptamine (5-HT)] is an important local regulator of lactation homeostasis; however, the roles for the serotonin reuptake transporter and monoamine oxidase have not been known. OBJECTIVE The aim of the study was to determine whether drugs that impact 5-HT affect human lactation physiology. DESIGN AND SETTING We conducted laboratory studies of human and animal models and an observational study of the onset of copious milk secretion in postpartum women at a university medical center. PARTICIPANTS We studied women expecting their first live-born infant; exclusion criteria were: referred to the medical center for another medical condition, known contraindication to breastfeed, and less than 19 yr of age and unable to obtain parental consent. INTERVENTION(S) The mothers were interviewed. The cell and animal studies consisted of a variety of biochemical, pharmacological, and genetic interventions. MAIN OUTCOME MEASURE(S) The human subjects outcome was prevalence of delayed onset of copious milk secretion. The cell and animal outcomes were physiological and morphological. RESULTS Inhibiting serotonin reuptake in mammary epithelial cells altered barrier function, and the effects were amplified by coadministering a monoamine oxidase inhibitor. Direct delivery of fluoxetine by slow-release pellets caused localized involution. TPH1 knockout mice displayed precocious secretory activation. Among a cohort of 431 women, those taking SSRI were more likely (P = 0.02) to experience delayed secretory activation. CONCLUSIONS Medications that perturb serotonin balance dysregulate lactation, and the effects are consistent with those predicted by the physiological effects of intramammary 5-HT bioactivity. Mothers taking serotonergic drugs may need additional support to achieve their breastfeeding goals.
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Affiliation(s)
- Aaron M Marshall
- 231 Albert Sabin Way, Molecular and Cellular Physiology, Cincinnati, Ohio 45267-0576, USA
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Kvist LJ. Toward a clarification of the concept of mastitis as used in empirical studies of breast inflammation during lactation. J Hum Lact 2010; 26:53-9. [PMID: 19910519 DOI: 10.1177/0890334409349806] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective of this study is to clarify use of the term mastitis in empirical studies of lactational mastitis. Eighteen articles published between 1998 and 2008 were critically analyzed, and a concept clarification of the term mastitis was carried out. Four articles suggested that mastitis was an infection, 4 made no mention of the etiology of symptoms, and 10 articles described mastitis as an inflammation or an infection. Eight studies made no use of distinctions between milk stasis, noninfectious mastitis, and infectious mastitis. Bacterial cultivation was used in 5 articles, and 1 article measured leukocytes and C-reactive protein. Several different causes were cited. Antibiotics were suggested as appropriate treatment in 4 articles. Use of the concept of mastitis in empirical studies remains inconsistent and may do so until the etiology of symptoms is understood. Understanding is also needed as to why some women who present with symptoms suggesting septic reaction recover without antibiotic therapy.
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Nilsen H, Olsen HG, Hayes B, Nome T, Sehested E, Svendsen M, Meuwissen THE, Lien S. Characterization of a QTL region affecting clinical mastitis and protein yield on BTA6. Anim Genet 2009; 40:701-12. [DOI: 10.1111/j.1365-2052.2009.01908.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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