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Endo M, Konishi T, Yamana H, Jo T, Ishikawa T, Yasunaga H. Association of the Japanese herbal kampo medicine kakkonto with antibiotic use and surgical drainage for noninfectious mastitis: A nationwide database study. J Obstet Gynaecol Res 2024; 50:113-119. [PMID: 37844586 DOI: 10.1111/jog.15810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 10/01/2023] [Indexed: 10/18/2023]
Abstract
AIM Kakkonto, a Japanese herbal kampo medicine, is empirically prescribed to improve milk stasis and ameliorate breast inflammation in patients with noninfectious mastitis. We investigated whether early use of kakkonto is associated with a reduction in antibiotic use and surgical drainage in patients with noninfectious mastitis. METHODS We identified 34 074 patients with an initial diagnosis of noninfectious mastitis within 1 year of childbirth between April 2012 and December 2022 using the nationwide administrative JMDC Claims Database. Patients were divided into the kakkonto (n = 9593) and control (n = 9648) groups if they received and did not receive kakkonto on the day of the initial diagnosis of noninfectious mastitis, respectively. Antibiotic administration and surgical drainage within 30 days after the initial diagnosis of noninfectious mastitis in the two groups were compared using propensity score-stabilized inverse probability of treatment weighting analysis. RESULTS The frequency of antibiotic administration within 30 days after the initial diagnosis of noninfectious mastitis was significantly lower in the kakkonto group than in the control group (10% vs. 12%; odds ratio, 0.88 [95% confidence interval, 0.80-0.96]). The frequency of antibiotic administration during 1-3 and 4-7 days after the initial diagnosis were also significantly lower in the kakkonto group than in the control group. The frequency of surgical drainage did not differ significantly between the two groups. CONCLUSIONS Kakkonto was associated with reduced administration of antibiotics for noninfectious mastitis, making it a potential treatment option for relieving breast inflammation and promoting antimicrobial stewardship.
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Affiliation(s)
- Masayuki Endo
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan
| | - Takaaki Konishi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Hayato Yamana
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan
- Department of Data Science Center, Jichi Medical University, Tochigi, Japan
| | - Taisuke Jo
- Department of Health Services Research, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Tomoki Ishikawa
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan
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2
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Ivanova E, Hue-Beauvais C, Chaulot-Talmon A, Castille J, Laubier J, De Casanove C, Aubert-Frambourg A, Germon P, Jammes H, Le Provost F. DNA methylation and gene expression changes in mouse mammary tissue during successive lactations: part I - the impact of inflammation. Epigenetics 2023; 18:2215633. [PMID: 37302099 PMCID: PMC10732689 DOI: 10.1080/15592294.2023.2215633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 05/10/2023] [Accepted: 05/12/2023] [Indexed: 06/13/2023] Open
Abstract
Mastitis is among the main reasons women cease breastfeeding, which leads to them supplementing breast milk with artificial formula. In farm animals, mastitis results in significant economic losses and the premature culling of some animals. Nevertheless, researchers do not know enough about the effect of inflammation on the mammary gland. This article discusses the changes to DNA methylation in mouse mammary tissue caused by lipopolysaccharide-induced inflammation (4 h post-injection of lipopolysaccharide). We analysed the expression of some genes related to mammary gland function, epigenetic regulation, and the immune response. The analysis focused on three comparisons: inflammation during the first lactation, inflammation during second lactation with no history of inflammation, and inflammation during second lactation with previous inflammation. We identified differentially methylated cytosines (DMCs), differentially methylated regions (DMRs), and some differentially expressed genes (DEGs) for each comparison. The three comparisons shared some DEGs; however, few DMCs and only one DMR were shared. These observations suggest that inflammation is one of several factors affecting epigenetic regulation during successive lactations. Furthermore, the comparison between animals in second lactation with and without inflammation, with no inflammation history during first lactation showed a different pattern compared to the other conditions in this experiment. This indicates that inflammation history plays an important role in determining epigenetic changes. The data presented in this study suggest that lactation rank and previous inflammation history are equally important when explaining mammary tissue gene expression and DNA methylation changes.Abbreviations: RRBS, reduced representation bisulfite sequencing; RT-qPCR, real-time quantitative polymerase chain reaction; MEC, mammary epithelial cells; TSS, transcription start site; TTS, transcription termination site; UTR, untranslated region; SINE, short interspersed nuclear element; LINE, long interspersed nuclear element; CGI, CpG island; DEG, differentially expressed gene; DMC, differentially methylated cytosine; DMR, differentially methylated region; GO term, gene ontology term; MF, molecular function; BP, biological process.
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Affiliation(s)
- E. Ivanova
- Université Paris-Saclay, INRAE, AgroParistech, GABI, France
| | | | - A. Chaulot-Talmon
- Université Paris-Saclay, UVSQ, INRAE, BREED, Jouy-En-Josas, France
- Ecole Nationale Vétérinaire d’Alfort, BREED, Maisons-Alfort, France
| | - J. Castille
- Université Paris-Saclay, INRAE, AgroParistech, GABI, France
| | - J Laubier
- Université Paris-Saclay, INRAE, AgroParistech, GABI, France
| | - C De Casanove
- Université Paris-Saclay, INRAE, AgroParistech, GABI, France
| | - A. Aubert-Frambourg
- Université Paris-Saclay, UVSQ, INRAE, BREED, Jouy-En-Josas, France
- Ecole Nationale Vétérinaire d’Alfort, BREED, Maisons-Alfort, France
| | - P. Germon
- INRAE, Université de Tours, ISP, Nouzilly, France
| | - H. Jammes
- Université Paris-Saclay, UVSQ, INRAE, BREED, Jouy-En-Josas, France
- Ecole Nationale Vétérinaire d’Alfort, BREED, Maisons-Alfort, France
| | - F. Le Provost
- Université Paris-Saclay, INRAE, AgroParistech, GABI, France
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Zhou F, Li Z, Liu L, Wang F, Yu L, Xiang Y, Zheng C, Huang S, Yu Z. The effectiveness of needle aspiration versus traditional incision and drainage in the treatment of breast abscess: a meta-analysis. Ann Med 2023; 55:2224045. [PMID: 37350731 PMCID: PMC10291949 DOI: 10.1080/07853890.2023.2224045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 04/16/2023] [Accepted: 06/06/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Breast abscess is a common and intractable clinical condition and the use of needle aspiration (NA) or incision and drainage (ID) in treatment is controversial. This meta-analysis aimed to systematically compare the clinical effectiveness of NA and ID in treating breast abscesses. METHODS The Web of Science, ScienceDirect, PubMed, Cochrane Library, EMBASE, China National Knowledge Infrastructure, and Wanfang Data were searched for randomized controlled trials (RCTs) published from inception to January 7, 2022. The ROB-2 tool assessed risk of bias; the GRADE methodology rated certainty in outcomes; and Stata 16.0 performed data analyses. RESULTS Nine RCTs were included, including 703 patients. The results showed there was no significant difference in cure rate between the two groups (relative risk [RR] = 0.96, 95% confidence interval [CI] [0.86, 1.07]; p = .469), and after subgroup analysis, we found that it was not related to the use of ultrasound guidance or not. There was no significant difference in the recurrence rate (RR = 0.68, 95% CI [0.35, 1.30]; p = .241). Furthermore, the NA group was associated with shorter healing time (weighted mean differences = -11.02, 95% CI [-15.14, -6.90]; p < .001), lower incidence of breast fistula (RR = 0.21, 95% CI [0.06, 0.72]; p = .013), lower interrupted breastfeeding rate (RR = 0.28, 95% CI [0.20, 0.39]; p < .001), and higher satisfaction rate of appearance (RR = 1.51, 95% CI [1.03-2.21]; p = .035). CONCLUSION NA has better advantages in terms of healing time, avoidance of breast fistula, continuous breastfeeding, and patient satisfaction. Although NA and ID have similar cure and recurrence rates, NA, with or without ultrasound guidance, could be used as a first-line treatment for breast abscesses. Patients with large volumes, multicompartmental abscesses, or those who have been ineffective against multiple NA, should be considered for ID.KEY MESSAGESBreast abscess is a common and intractable clinical condition in general surgery.Compared with ID for breast abscesses, NA has better advantages in terms of healing time, avoidance of breast fistula, continuous breastfeeding, and patient satisfaction and could be used as a first-line treatment for breast abscesses.Patients with large volumes, multicompartmental abscesses, or those who have been ineffective against multiple NA, should be considered for ID.
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Affiliation(s)
- Fei Zhou
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, China
- Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, China
| | - Zhaohui Li
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, China
- Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, China
| | - Liyuan Liu
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, China
- Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, China
| | - Fei Wang
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, China
- Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, China
| | - Lixiang Yu
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, China
- Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, China
| | - Yujuan Xiang
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, China
- Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, China
| | - Chao Zheng
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, China
- Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, China
| | - Shuya Huang
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, China
- Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, China
| | - Zhigang Yu
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, China
- Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, China
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Pal B, Shaikh O, Vijayakumar C, Prakash S, Balasubramanian G, Kumbhar U. A Randomized Controlled Trial Comparing Ultrasonography-Guided Needle Aspiration and Surgical Drainage for the Management of Breast Abscess. Cureus 2023; 15:e50956. [PMID: 38249226 PMCID: PMC10800148 DOI: 10.7759/cureus.50956] [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] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
Background A breast abscess is a localized collection of inflammatory exudate in breast tissue. It is more common in lactating women. Treatment of the breast abscess is usually by incision and drainage, which is accompanied by extensive trauma, lengthy surgical incisions, psychological distress, surgical scar, and discomfort during dressing changes. Recent research has shown that ultrasonography-guided needle aspiration is an alternative to incision and drainage for breast abscess treatment, has superior cosmetic outcomes, and has fewer costs. However, there are no clear guidelines for the same. The primary objective of this study was to assess and contrast the outcomes and efficacy of two approaches in the treatment of breast abscesses: ultrasonography-guided needle aspiration and conventional incision and drainage. Methods This was a single-center, prospective, randomized, controlled, non-inferiority trial. Patients with breast abscesses were randomized either to receive needle aspiration or incision drainage. Patients with lactational breast abscesses were encouraged to breastfeed from either breast. The antibiotic was given for 10 days to all the patients. The study's main focus was on the primary outcome, which was the failure rate. Additionally, several secondary outcomes were examined, including postoperative pain, time required for healing, presence of residual abscess or recurrence, formation of fistulas, and the assessment of scar appearance. Results A total of 44 patients were randomized to 23 and 21 in each arm. There was no statistical difference in treatment failure (p-value=0.862), fistula formation (p-value=1.00), and recurrence (p-value=1.00). There was a significant statistical difference in healing period (p-value <0.001), scar formation (p-value <0.0001), continuation of breastfeeding (p-value=0.005), and clinical resolution (p-value=0.002). There was a significant reduction in post-intervention pain in the needle aspiration group than in the other group (p-value <0.001). Conclusion This study showed a significant difference in postoperative pain, healing time, the continuation of breastfeeding, and scar formation in the needle aspiration group, favouring minimally invasive treatment for breast abscess. However, due to the small sample size, we could not conclude that ultrasonography-guided needle aspiration of the breast abscess is non-inferior to the conventional incision and drainage.
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Affiliation(s)
- Bishal Pal
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Oseen Shaikh
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Chellappa Vijayakumar
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Sagar Prakash
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Gopal Balasubramanian
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Uday Kumbhar
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
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Jin X, Xiao J, Lu C, Ma W, Fan Y, Xue X, Xia Y, Chen N, Liu J, Pei X. Breastmilk microbiome changes associated with lactational mastitis and treatment with dandelion extract. Front Microbiol 2023; 14:1247868. [PMID: 38029215 PMCID: PMC10679338 DOI: 10.3389/fmicb.2023.1247868] [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: 06/26/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Dandelion (Pugongying) is one of the most frequently used Chinese herbs for treating lactational mastitis (LM). Pugongying granules, a patented medication primarily comprised of dandelion extract, have been approved by CFDA for LM treatment in China. The aims of this study were to investigate the etiology of LM and the mechanism by which Pugongying granules decrease LM symptoms, with a particular focus on the microbial communities found in breastmilk. Methods Participants were recruited from a previously performed randomized controlled trial (Identifier: NCT03756324, ClinicalTrials.gov). Between 2019 and 2020, women diagnosed with unilateral LM at the Beijing University of Chinese Medicine Third Affiliated Hospital were enrolled. In total, 42 paired breastmilk samples from the healthy and affected breasts of the participants were collected. Additionally, 37 paired pre- and post-treatment breastmilk samples from the affected breast were collected from women who received a 3-day course of either Pugongying granules (20 women) or cefdinir (17 women). Clinical outcomes [e.g., body temperature, visual analogue scale (VAS) score for breast pain, the percentage of neutrophils (NE%)] were analyzed pre- and post-treatment, and the breastmilk samples were subjected to 16S rRNA gene sequencing to analyze the alpha and beta diversities and identify significant bacteria. Finally, the relationship between microorganisms and clinical outcomes was analyzed. Results There was no significant difference in fever and pain between the Pugongying group and cefdinir group. The most prevalent bacterial genera in breastmilk were Streptococcus and Staphylococcus. Compared to healthy breastmilk, microbial diversity was reduced in affected breastmilk, and there was a higher relative abundance of Streptococcus. After Pugongying treatment, there was an increase in microbial diversity with significantly higher abundance of Corynebacterium. A negative correlation was found between Corynebacterium, VAS score, and NE%. Treatment with cefdinir did not affect microbial diversity. Taken together, our results show a correlation between LM and reduced microbial diversity, as well as an increased abundance of Streptococcus in affected breastmilk. Conclusion Pugongying granules enhanced microbial diversity in breastmilk samples. Given the substantial variation in individual microbiomes, identifying specific species of Streptococcus and Corynebacterium associated with LM may provide additional insight into LM pathogenesis and treatment.
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Affiliation(s)
- Xinyan Jin
- Centre for Evidence-based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- Beijing University of Chinese Medicine Affiliated Xiamen Hospital, Xiamen, China
| | - Jinhe Xiao
- Department of Prevention and Treatment of Breast Disease, Haidian District Maternal and Child Health Care Hospital, Beijing, China
| | - Chunli Lu
- Guangdong Provincial Research Center of Integration of Traditional Chinese Medicine and Western Medicine in Metabolic Diseases (Institute of Chinese Medicine), Guangdong Pharmaceutical University, Guangzhou, China
| | - Wenxin Ma
- Centre for Evidence-based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Yingyi Fan
- Department of Breast Surgery, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China
| | - Xue Xue
- The First Clinical Medical School, Hubei University of Chinese Medicine, Wuhan, China
| | - Yaru Xia
- Department of Breast Surgery, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China
| | - Nana Chen
- Department of Breast Surgery, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China
| | - Jianping Liu
- Centre for Evidence-based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Xiaohua Pei
- Beijing University of Chinese Medicine Affiliated Xiamen Hospital, Xiamen, China
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Zhao J, Xu L, Lv L, Wang L, Wang X, Liang C, Wang C, Qiu Y, Pei X. Network pharmacology and in vivo and in vitro experiments to determine the mechanism behind the effects of Jiawei Yanghe decoction via TLR4/Myd88/NF-κB against mastitis. Heliyon 2023; 9:e21219. [PMID: 37964842 PMCID: PMC10641157 DOI: 10.1016/j.heliyon.2023.e21219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/15/2023] [Accepted: 10/18/2023] [Indexed: 11/16/2023] Open
Abstract
Background In the Qing dynasty, Yanghe decoction was as a therapeutic soup for effectively treating chronic inflammatory disorders. It was used as a therapeutic soup for effectively treating chronic inflammatory disorders. In the clinical use of Yanghe decoction, the adjustment of the medication for a variety of inflammatory diseases have therapeutic effect, including mastitis. Therefore, Jiawei Yanghe decoction (JWYHD) may be used to treat inflammatory breast diseases. Methods First, LM- and JWYHD-related components were retrieved from the database and analysis platform. Next, protein-protein interaction networks were constructed to screen the key targets, and gene ontology and Kyoto encyclopedia of gene and genome enrichment analyses were performed to predict the potential biological functions and mechanisms of JWYHD. Simultaneously, the JWYHD samples were collected and analyzed by UPLC-HRMS. Finally, in vivo and in vitro experiments were conducted to construct animal and cellular inflammation models of mastitis with LPS. Pathological changes in the mammary tissues were detected. Enzyme-linked immunosorbent assay, reverse transcription-polymerase chain reaction, and Western blotting was performed to determine the mRNA and protein levels of inflammatory cytokines and toll-like receptor 4/myeloid differentiation primary response 88/nuclear factor kappa B signaling pathway in the breast tissues to elucidate the potential underlying mechanisms of anti-mastitis effects of JWYHD from different aspects. Results In total, 103 compounds were detected in JWYHD by UPLC-HRMS. 691 active ingredients of JWYHD were screened by network pharmacology, and 47 LM-related targets were identified. The PPI network analysis of the targets revealed the 5 core targets. The KEGG enrichment results established the NF-κB signaling pathways as the core. After JWYHD intervention, low inflammatory enrichment and mild inflammatory damage in breast tissues were observed. Furthermore, JWYHD treatment affected mammary gland inflammatory cytokines and the TLR4/Myd88/NF-κB signaling pathway by considerably reducing the respective protein levels and gene expression; thus, JWYHD alleviated LM symptoms. Conclusions We hypothesized and demonstrated the anti-inflammatory effects of JWYHD by cytokine regulation via the TLR4/Myd88/NF-κB signaling pathway. In conclusion, JWYHD showed its potential in LM treatment and in treating other acute and chronic inflammatory diseases.
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Affiliation(s)
- Jing Zhao
- Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, 100029, China
| | - Liuyan Xu
- Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, 100029, China
| | - Lingyan Lv
- Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, 100029, China
| | - Liuyi Wang
- Xiamen University, Xiamen, 361102, China
| | - Xuan Wang
- Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, 100029, China
| | - Chen Liang
- Dongfang Hospital Beijing University of Chinese Medicine, Beijing, 100078, China
| | - Chunhui Wang
- Fangshan Hospital Beijing University of Chinese Medicine, Beijing, 102488, China
| | - Yan Qiu
- Eye Institute of Xiamen University, Xiamen, 361102, China
| | - Xiaohua Pei
- Xiamen Hospital of Beijing University of Traditional Chinese Medicine, Xiamen, 361015, China
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Ye H, Hu D, Zheng H, Yang Y, Lin Y, Liu J, Luo X, Li R, Hu F, Jin L. Clinical efficacy of Gualou Xiaoyong Decoction and painless lactation manipulation in treating lactation acute mastitis and breast abscess: An observational study. Medicine (Baltimore) 2023; 102:e34617. [PMID: 37653765 PMCID: PMC10470690 DOI: 10.1097/md.0000000000034617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/11/2023] [Accepted: 07/14/2023] [Indexed: 09/02/2023] Open
Abstract
Information on the effects of Chinese medicine in the treatment of lactational acute mastitis and breast abscess is limited; thus, we conducted an observational study to analyze the clinical efficacy of Gualou Xiaoyong Decoction combined with painless lactation manipulation in the treatment of lactational acute mastitis and breast abscess. A total of 41 patients with lactational acute mastitis and breast abscess who were treated with Gualou Xiaoyong Decoction and painless lactation manipulation from October 2021 to October 2022 were included in this study. The age, fetal times(primiparous/multiparous), delivery mode (cesarean section/vaginal delivery), onset time, breast lump diameter, skin rash diameter, body temperature, visual analogue score, blood routine, C-reactive protein, procalcitonin, bacterial culture in milk, B ultrasound and other data of these patients were statistically analyzed. After treatment, the breast lump diameter of these patients decreased significantly, the skin rash diameter was reduced or disappeared, the body temperature decreased or returned to a normal range, and the visual analogue score also decreased. Besides, these patients had a decreased total number of white blood cells and a reduced percentage of neutrophils, C-reactive protein, and procalcitonin after treatment. In addition, bacteria in the milk of most patients disappeared, and there was no abnormality in B ultrasonic imaging. Except for 2 patients with breast abscess who stopped breastfeeding on the affected side for 1 day and 3 days respectively, all other patients continued to provide breast milk for their infants, and no adverse reactions were observed in these infants. The combination of Gualou Xiaoyong Decoction and painless lactation manipulation can achieve favorable clinical effects in the treatment of lactational acute mastitis and breast abscess. This combined therapy has good efficacy, short course of treatment, low costs, and great convenience with the avoidance of pain, hospitalization, influence on lactation, breast scar and other adverse outcomes.
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Affiliation(s)
- Huijun Ye
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Xinhua Hospital of Zhejiang Province, Hangzhou, China
| | - Dexin Hu
- Department of Orthopaedics, Hangzhou Red Cross Hospital, Hangzhou, China
| | - Huiling Zheng
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Xinhua Hospital of Zhejiang Province, Hangzhou, China
| | - Yi Yang
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Xinhua Hospital of Zhejiang Province, Hangzhou, China
| | - Yunxia Lin
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Xinhua Hospital of Zhejiang Province, Hangzhou, China
| | - Jiali Liu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Xinhua Hospital of Zhejiang Province, Hangzhou, China
| | - Xi Luo
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Xinhua Hospital of Zhejiang Province, Hangzhou, China
| | - Ruilan Li
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Xinhua Hospital of Zhejiang Province, Hangzhou, China
| | - Fengying Hu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Xinhua Hospital of Zhejiang Province, Hangzhou, China
| | - Lihua Jin
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Xinhua Hospital of Zhejiang Province, Hangzhou, China
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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: 7] [Impact Index Per Article: 7.0] [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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Ong SS, Xu J, Sim CK, Khng AJ, Ho PJ, Kwan PKW, Ravikrishnan A, Tan KTB, Tan QT, Tan EY, Tan SM, Putti TC, Lim SH, Tang ELS, Nagarajan N, Karnani N, Li J, Hartman M. Profiling Microbial Communities in Idiopathic Granulomatous Mastitis. Int J Mol Sci 2023; 24:ijms24021042. [PMID: 36674562 PMCID: PMC9863225 DOI: 10.3390/ijms24021042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/27/2022] [Accepted: 12/30/2022] [Indexed: 01/06/2023] Open
Abstract
Idiopathic granulomatous mastitis (IGM) is a rare and benign inflammatory breast disease with ambiguous aetiology. Contrastingly, lactational mastitis (LM) is commonly diagnosed in breastfeeding women. To investigate IGM aetiology, we profiled the microbial flora of pus and skin in patients with IGM and LM. A total of 26 patients with IGM and 6 patients with LM were included in the study. The 16S rRNA sequencing libraries were constructed from 16S rRNA gene amplified from total DNA extracted from pus and skin swabs in patients with IGM and LM controls. Constructed libraries were multiplexed and paired-end sequenced on HiSeq4000. Metagenomic analysis was conducted using modified microbiome abundance analysis suite customised R-resource for paired pus and skin samples. Microbiome multivariable association analyses were performed using linear models. A total of 21 IGM and 3 LM paired pus and skin samples underwent metagenomic analysis. Bray−Curtis ecological dissimilarity distance showed dissimilarity across four sample types (IGM pus, IGM skin, LM pus, and LM skin; PERMANOVA, p < 0.001). No characteristic dominant genus was observed across the IGM samples. The IGM pus samples were more diverse than corresponding IGM skin samples (Shannon and Simpson index; Wilcoxon paired signed-rank tests, p = 0.022 and p = 0.07). Corynebacterium kroppenstedtii, reportedly associated with IGM in the literature, was higher in IGM pus samples than paired skin samples (Wilcoxon, p = 0.022). Three other species and nineteen genera were statistically significant in paired IGM pus−skin comparison after antibiotic treatment adjustment and multiple comparisons correction. Microbial profiles are unique between patients with IGM and LM. Inter-patient variability and polymicrobial IGM pus samples cannot implicate specific genus or species as an infectious cause for IGM.
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Affiliation(s)
- Seeu Si Ong
- Women’s Health and Genetics, Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore 138672, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Jia Xu
- Human Development, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore 117609, Singapore
| | - Choon Kiat Sim
- Human Development, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore 117609, Singapore
| | - Alexis Jiaying Khng
- Women’s Health and Genetics, Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore 138672, Singapore
| | - Peh Joo Ho
- Women’s Health and Genetics, Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore 138672, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Saw Swee Hock, School of Public Health, National University of Singapore, Singapore 117549, Singapore
| | - Philip Kam Weng Kwan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Aarthi Ravikrishnan
- Metagenomic Technologies and Microbial Systems, Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore 138672, Singapore
| | - Kiat-Tee Benita Tan
- Division of Surgical Oncology, National Cancer Centre Singapore, Singapore 169610, Singapore
- Department of Breast Surgery, Singapore General Hospital, Singapore 169608, Singapore
- Department of General Surgery, Sengkang General Hospital, Singapore 544886, Singapore
| | - Qing Ting Tan
- KK Breast Department, KK Women’s and Children’s Hospital, Singapore 229899, Singapore
| | - Ern Yu Tan
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
- Institute of Molecular and Cell Biology, Agency for Science, Technology and Research, Singapore 138673, Singapore
| | - Su-Ming Tan
- Division of Breast Surgery, Changi General Hospital, Singapore 529889, Singapore
| | - Thomas Choudary Putti
- Department of Pathology, National University Health System, Singapore 119228, Singapore
| | - Swee Ho Lim
- KK Breast Department, KK Women’s and Children’s Hospital, Singapore 229899, Singapore
| | - Ee Ling Serene Tang
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
- Department of Surgery, Woodlands Health Campus, Singapore 768024, Singapore
| | - Niranjan Nagarajan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Metagenomic Technologies and Microbial Systems, Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore 138672, Singapore
| | - Neerja Karnani
- Human Development, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore 117609, Singapore
- Data Hub Division, Bioinformatics Institute, Agency for Science, Technology and Research, Singapore 138671, Singapore
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Jingmei Li
- Women’s Health and Genetics, Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore 138672, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Correspondence: ; Tel.: +(65)-6808-8312
| | - Mikael Hartman
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Saw Swee Hock, School of Public Health, National University of Singapore, Singapore 117549, Singapore
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore 119228, Singapore
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Sodium and Potassium Concentrations and Somatic Cell Count of Human Milk Produced in the First Six Weeks Postpartum and Their Suitability as Biomarkers of Clinical and Subclinical Mastitis. Nutrients 2022; 14:nu14224708. [PMID: 36432395 PMCID: PMC9694808 DOI: 10.3390/nu14224708] [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] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022] Open
Abstract
The sodium (Na) concentration and the ratio of Na to potassium (K; Na/K) in human milk are used commonly as biomarkers of subclinical mastitis, but limited data exist on their relationship to and ability to predict clinical mastitis. Here, we assessed concentrations of Na, K, Na/K, and somatic cell count (SCC), a mammary health biomarker used in the dairy industry, in milk prospectively collected from both breasts of 41 women over the first 6 weeks postpartum. Although values differed over time postpartum, there were no differences in mean values between breasts. Nearly one-quarter (24%) of participants experienced clinical mastitis. Somatic cell counts >4.76 × 105 cells/mL were most strongly related to development of clinical mastitis in the following week (odds ratio, 7.81; 95% CI, 2.15−28.30; p = 0.002), although relationships were also observed for SCC > 4.00 × 105 cells/mL and Na concentration >12 mmol/L. Estimates of the prevalence of subclinical mastitis in women who never progressed to clinical mastitis differed by biomarker but ranged from 20 to 75%. Despite these findings, positive predictive values (PPV) of the biomarkers for identifying clinical mastitis were low (≤0.34), indicating additional research is needed to identify single biomarkers or composite measures that are highly specific, sensitive, and predictive of clinical mastitis in women.
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11
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Huang Q, Zheng XM, Zhang ML, Ning P, Wu MJ. Lactation mastitis: Promising alternative indicators for early diagnosis. World J Clin Cases 2022; 10:11252-11259. [PMID: 36387788 PMCID: PMC9649554 DOI: 10.12998/wjcc.v10.i31.11252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/31/2022] [Accepted: 09/22/2022] [Indexed: 02/05/2023] Open
Abstract
Although lactation mastitis (LM) has been extensively researched, the incidence rate of LM remains a salient clinical problem. To reduce this incidence rate and achieve a better prognosis, early and specific quantitative indicators are particularly important. It has been found that milk electrolyte concentrations (chloride, potassium, and sodium) and electrical conductivity (EC) significantly change in the early stages of LM in an animal model. Several studies have evaluated EC for the detection of subclinical mastitis in cows. EC, chloride, and sodium content of milk were more accurate for predicting infection status than were other variables. In the early stages of LM, lactic sodium, chloride, and EC increase, but potassium decreases. However, these indicators have not been reported in the diagnosis of LM in humans. This review summarizes the pathogenesis and the mechanism of LM in terms of milk electrolyte concentration and EC, and aim to provide new ideas for the detection of sub-clinical mastitis in humans.
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Affiliation(s)
- Qian Huang
- School of Medicine, University of Electronic Science and Technology of China, Chengdu 610000, Sichuan Province, China
| | - Xue-Mei Zheng
- School of Medicine, University of Electronic Science and Technology of China, Chengdu 610000, Sichuan Province, China
| | - Mao-Lin Zhang
- Department of Anesthesiology, Chongqing Medical University, Chongqing 400016, Sichuan Province, China
| | - Ping Ning
- Department of Breast, Chengdu Women's and Children's Central Hospital, Chengdu 610000, Sichuan Province, China
| | - Meng-Jun Wu
- Department of Anesthesiology, Chengdu Women's and Children's Central Hospital, Chengdu 610000, Sichuan Province, China
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12
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Pommeret-de Villepin B, Barasinski C, Rigourd V. Initiating and Supporting Breastfeeding: Guidelines for Interventions during the Perinatal Period from the French National College of Midwives. J Midwifery Womens Health 2022; 67 Suppl 1:S56-S73. [PMID: 36480673 DOI: 10.1111/jmwh.13420] [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: 04/14/2022] [Accepted: 05/10/2022] [Indexed: 12/13/2022]
Abstract
Exclusive breastfeeding is recommended for children for the first 4 to 6 months of life, with complementary foods added thereafter. It is the most ecological way of protecting the child's and mother's health. Training of health professionals is required to avoid transmitting inconsistent information in 3 areas: 1) implementing these 3 predictors: safe skin-to-skin, first breastfeed, and rooming-in 24/7; 2) teaching and monitoring: i) early signs of waking and feeding rhythms, ii) positioning and latching, and iii) signs of effective transfer; and 3) referring women to specialized support services if difficulties arise (eg, inadequate milk production, pain, cracked nipples, engorgement). Breastfeeding should continue during mastitis or an abscess. Ultrasound-guided needle aspiration is beneficial in treating an abscess. Précis: Information is provided to enable health professionals to better support breastfeeding and help women with the most common difficulties, thus promoting breastfeeding initiation and duration.
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Affiliation(s)
- Brune Pommeret-de Villepin
- Service gynécologie-obstétrique, Centre hospitalier de Tourcoing, 155 rue du Président-René-Coty, Tourcoing, 59200, France
| | - Chloé Barasinski
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, Axe TGI-DecisipH, Clermont-Ferrand, F-63000, France
| | - Virginie Rigourd
- Pédiatre en néonatalogie médecin responsable du lactarium régional d'Ile de France Hopital, Necker Enfants malades, Paris, France
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Baeza C, Paricio-Talayero JM, Pina M, De Alba C. Re: "Academy of Breastfeeding Medicine Clinical Protocol #36: The Mastitis Spectrum, Revised 2022" by Mitchell et al. Breastfeed Med 2022; 17:970-971. [PMID: 36378818 DOI: 10.1089/bfm.2022.0129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | - Monica Pina
- Internal Medicine, Clínica Planalto, Lisbon, Portugal
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AlQurashi M, Alqatari S, Alzaher MZ, AlAwami K, Boumarah DN. Recurrent Non-Lactational Fungal Abscesses in a Systemic Lupus Erythematosus Patient: Causation or Mere Association? A Case Report and Literature Review. Med Arch 2022; 76:391-394. [PMID: 36545451 PMCID: PMC9760232 DOI: 10.5455/medarh.2022.76.391-394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 10/20/2022] [Indexed: 11/16/2022] Open
Abstract
Background Systemic lupus erythematosus is a multisystemic autoimmune disorder that can present in many different ways that can be debilitating for many patients. These patients are at risk for developing infections following the introduction of immunosuppressive therapy. Breast infections, particularly of the fungal type, in nonlactating patients who are not in an immunosuppressive state are extremely rare. Objective We report a case of recurrent right breast fungal infections manifesting in the form of multiple abscesses in a systemic lupus erythematosus patient. Case report A 39 years old female patient presented with recurrent fungal breast abscesses. She was diagnosed with systemic lupus erythematosus nine years ago and was in remission being maintained with an antimalarial agent without the use of immunosuppressive therapy. Fluconazole was started for her prior to her visit to us, and she had no active complaints. She was not breastfeeding nor pregnant currently nor during any of the previous episodes. Examination was unremarkable, however cultures of samples from her previous lesions demonstrated growth of Candida albicans. A decision to manage her conservatively with the continuation of her antifungal therapy was made. Conlusion Lactation and breastfeeding are well-known risk factors for infectious mastitis and there is sparse literature regarding this condition in the absence of these risk factors. Studies evaluating other risk factors, particularly systemic lupus erythematosus, need to be conducted to determine any relationship and how to best manage this condition in such patients.
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Affiliation(s)
- Mariam AlQurashi
- Department of Surgery, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Safi Alqatari
- Department of Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Mohamad Zaki Alzaher
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Karam AlAwami
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Dhuha N. Boumarah
- Department of Surgery, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
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15
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The preventive and therapeutic effects of probiotics on mastitis: A systematic review and meta-analysis. PLoS One 2022; 17:e0274467. [PMID: 36084006 PMCID: PMC9462749 DOI: 10.1371/journal.pone.0274467] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 08/27/2022] [Indexed: 11/19/2022] Open
Abstract
Acute mastitis is one of the main reasons why breastfeeding women stop breastfeeding, and medication should be used with caution. Considering the uncertainty of mastitis infection and the indications of antibiotic use, as well as the problem of drug resistance and the safety of medication during lactation, probiotics have become an alternative treatment choice. However, a meta-analysis of the effects of probiotics in preventing and treating lactational mastitis is still lacking. Therefore, we searched six electronic databases and the sites of clinical trial registration, a total of six randomized controlled trials were included in this meta-analysis, which showed that oral probiotics during pregnancy can reduce the incidence of mastitis (RR: 0.49, 95% CI: 0.35 to 0.69; p<0.0001). After oral administration of probiotics, the counts of bacteria in the milk of healthy people and mastitis patients were both significantly reduced (in healthy people: MD: -0.19, 95% CI: -0.23 to -0.16, p<0.00001; in mastitis patients: MD: -0.89, 95% CI: -1.34 to -0.43, p = 0.0001). These indicate that to a certain extent, probiotics are beneficial in reducing the incidence rate of mastitis during lactation and some related mastitis symptoms. However, high-quality multicenter clinical trials are still needed to support this result.
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16
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Long T, Ning Z, Fu B, Yao Y, Wu L, Luo J, Lin Z, Ma H. Maintaining Breastfeeding During the Treatment of Breast Abscesses Is Not Contraindicated. Breastfeed Med 2022; 17:753-757. [PMID: 36121389 DOI: 10.1089/bfm.2022.0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: World Health Organization guidelines recommend maintaining breastfeeding if a woman develops breast abscess, because of benefits to her recovery and the infant's health. However, clinical staff recommend weaning to promote faster recovery from the abscess. The purpose of this study was to determine whether maintaining breastfeeding after development of a breast abscess has any influence on the resolution of the breast abscess. Methods: The records of 212 patients who were breastfeeding and developed breast abscess treated at Guangzhou Women and Children's Medical Center from January 2018 to December 2019 were retrospectively reviewed. Patients were divided into two groups: those who maintained breastfeeding (study group) and those who stopped breastfeeding (control group). Results: There were 139 patients in study group and 73 patients in the control group. Baseline characteristics were similar between the two groups. The time to cure in the study group and in the control group was 7.20 ± 2.21 days and 7.01 ± 2.39 days, respectively (t = 0.579, p = 0.563). Common complications were milk fistula and galactocele, and the frequency of both was similar between the two groups (milk fistula: 7.9% versus 8.2%, respectively; χ2 = 0.006, p = 0.938; galactocele: 8.6% versus 9.6%, respectively; χ2 = 0.054, p = 0.817). There was no significant difference in the recurrence rates between the two groups (5.0% versus 2.7%; χ2 = 0.184, p = 0.668). Conclusion: Maintaining breastfeeding during treatment of breast abscess does not affect the outcome of treatment provided, on condition that the abscess is treated appropriately.
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Affiliation(s)
- Tianzhu Long
- Department of Breast Surgery, and Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Ziyu Ning
- Department of Breast Surgery, and Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Benjie Fu
- Department of Breast Surgery, and Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Yuzhi Yao
- Department of Surgical Clinic, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Ling Wu
- Department of Breast Surgery, and Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Jiayue Luo
- Department of Breast Surgery, and Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Zeyu Lin
- Department of Hepatobiliary Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hongmin Ma
- Department of Breast Surgery, and Guangzhou Women and Children's Medical Center, Guangzhou, China
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Elder E, Pianosi K, Lawlor CM, Graham ME. Supporting Lactation in Otolaryngology Patients Through Medication Optimization, Radiology Considerations, and More: A Literature Review. JAMA Otolaryngol Head Neck Surg 2022; 148:973-980. [PMID: 35951313 DOI: 10.1001/jamaoto.2022.2286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The benefits of breastfeeding are well established, with the American Academy of Pediatrics and Canadian guidelines recommending exclusive breastfeeding for the first 6 months of life. However, maternal hospitalization, illness, medication use, and poor support can result in early termination of breastfeeding. Caring for breastfeeding patients in otolaryngology is a challenge because of the lack of literature regarding otolaryngology-specific medication safety, patient concerns, and inadequate education among otolaryngologists. This review highlights recent literature regarding lactation in otolaryngology patients, including medication, radiologic imaging, perioperative considerations, and subspecialty-specific considerations for lactating patients. Observations The majority of common medications used in general otolaryngology are safe for breastfeeding patients, including antihistamines, mucolytics, antitussives, antifungals, and decongestants. Certain analgesics and anti-inflammatories, such as tramadol, are not preferred in breastfeeding individuals. Some subspeciality-specific medications such as biologics (dupilumab) and methotrexate should be avoided. Lactating patients require special perioperative attention to ensure that optimal patient care is provided, such as managing supply, considering length of surgery, managing postoperative pain, and determining the safe amount of time until an infant can be fed. Conclusions and Relevance Most medications can be safely used with lactating patients. If physicians are unsure about a medication's safety, they should consult appropriate resources prior to recommending breastfeeding cessation or to discard pumped milk.
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Affiliation(s)
- Emily Elder
- Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Kiersten Pianosi
- Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Claire M Lawlor
- George Washington School of Medicine and Health Science & Children's National Hospital, Washington, DC
| | - M Elise Graham
- Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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18
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Ameli G, Maier JT, Abu Daher G, Mihajlov V, Hellmeyer L. Acute Quadriplegia in a Lactating Woman With Mastitis and Breast Abscess. J Hum Lact 2022; 38:531-536. [PMID: 35236167 DOI: 10.1177/08903344221079645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Puerperal mastitis, as well as breast abscess, are common complications that can arise during the breastfeeding period. Acute-onset quadriplegia has been described as a complication of bacterial or viral infections. Here we report a case of puerperal breast abscess with transient acute-onset staphylococcal mediated quadriplegia. MAIN ISSUE A 28-year-old lactating Caucasian woman presented at our tertiary perinatal center 31 days postpartum with weakness of all four limbs, the signs and symptoms of mastitis in her left breast and a possible breast abscess with redness, a painful breast lump, and fever. A few hours after admission, the participant developed a proximal quadriplegia. MANAGEMENT The participant was admitted to the intensive care unit for monitoring. The neurologists treated her as a possible case of Guillain-Barré syndrome and administered intravenous immunoglobulin therapy for 5 days. The breast abscess was diagnosed via ultrasound and treated by regular aspiration of pus and intravenous antibiotic therapy with ampicillin and sulbactam as Staphylococcus aureus was isolated from breast abscess fluid. Fifteen days after the first symptoms the participant recovered completely and could breastfeed her son exclusively, even though she developed a galactocele on the affected side. CONCLUSION We report a possible association between mastitis and abscess formation, common breastfeeding issues, and transient acute onset staphylococcal mediated quadriplegia. To the best of our knowledge this is the only case in the medical literature. Independent of the systemic complications, antibiotic treatment and regular abscess aspirations have proven to be a key strategy to the resolution of puerperal mastitis and breast abscess.
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Affiliation(s)
- Giada Ameli
- Department of Obstetrics and Gynecology, Vivantes Klinikum im Friedrichshain, affiliate of Charité University, Berlin, Germany
| | - Josefine Theresia Maier
- Department of Obstetrics and Gynecology, Vivantes Klinikum im Friedrichshain, affiliate of Charité University, Berlin, Germany
| | - Gada Abu Daher
- Department of Obstetrics and Gynecology, Vivantes Klinikum im Friedrichshain, affiliate of Charité University, Berlin, Germany
| | - Valentin Mihajlov
- Department of Obstetrics and Gynecology, Vivantes Klinikum im Friedrichshain, affiliate of Charité University, Berlin, Germany
| | - Lars Hellmeyer
- Department of Obstetrics and Gynecology, Vivantes Klinikum im Friedrichshain, affiliate of Charité University, Berlin, Germany
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Heron E, McArdle A, Cooper M, Geddes D, McKenna L. Adaptation of a clinical reasoning model for use in inflammatory conditions of the lactating breast: a retrospective mixed-methods study. PeerJ 2022; 10:e13627. [PMID: 35910773 PMCID: PMC9332403 DOI: 10.7717/peerj.13627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 06/02/2022] [Indexed: 01/17/2023] Open
Abstract
Background Many potential factors associated with Inflammatory Conditions of the Lactating Breast (ICLB) have been reported in the literature, by lactating mothers and clinicians. Clinicians, including general practitioners, lactation consultants and physiotherapists, require a clinical reasoning model that summarises associated or linked factors, to aid in the assessment, treatment, and prevention of ICLB. Thus, we aimed to adapt the existing Breastfeeding Pain Reasoning Model (BPRM), for use in the management of ICLB, using prior research and clinical audit data to guide adaptation. The existing BPRM categorises contributing factors for breastfeeding nipple pain, rather than ICLB. Methods Factors linked with ICLB were identified from prior research and considered for inclusion into the existing model. Clinical data from a retrospective audit of ICLB patient notes at a private physiotherapy practice were also examined. Any factors identified from prior research that could not be identified in the clinical notes were not considered for inclusion into the existing model. Additional factors from the clinical notes that appeared repeatedly were considered for inclusion into the adaptation of the BPRM. A draft adapted model was created comprising all eligible factors, considering their counts and percentages as calculated from the clinical data. The research team iteratively examined all factors for appropriate categorisation and modification within the adapted model. Results Prior research and data from 160 clinical notes were used to identify factors for inclusion in the adapted model. A total of 57 factors, 13 pre-existing in the BPRM and 44 extra identified from the prior research or clinical audit, comprised the draft adapted model. Factor consolidation and terminology modification resulted in a total of 34 factors in the final proposed adapted ICLB model. The three main categories, CNS modulation, External influences and Local stimulation, from the existing model were maintained, with one minor terminology change to the former Local stimulation category, resulting in 'Local influences' category. Terminology for five subcategories were modified to better reflect the types of factors for ICLB. The most common factors in the adapted model, calculated from the clinical audit population of mothers with ICLB, were employment (85%), high socioeconomic status (81%), antibiotic use during breastfeeding (61%), history of an ICLB (56%), any breast pump use (45%), multiparity (43%), birth interventions (35%), decreased milk transfer (33%), breastfeeding behaviour and practices (33%), nipple pain (30%) and fit and hold (attachment and positioning) difficulty (28%). Conclusion An ICLB-specific linked factors model is proposed in this paper. Clinicians treating mothers with ICLB can use this model to identify influencing and determining factors of ICLB clinical presentations and provide targeted education and effective treatment plans.
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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
| | | | - 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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Zhang Y, Gao Y, He X, Ding S, Gao H. Oral Lactobacillus fermentum CECT5716 in the patients with lactational abscess treated by needle aspiration: The late follow-up of a randomized controlled trial. Medicine (Baltimore) 2022; 101:e29761. [PMID: 35777008 PMCID: PMC9239655 DOI: 10.1097/md.0000000000029761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Lactational mastitis and breast abscess cause trouble for women. It has been shown that oral probiotics can improve breast microecology, thus alleviating inflammatory responses. Our study aims to understand the long-term effect of Lactobacillus fermentum CECT5716 on patients with lactational breast abscess after needle aspiration. METHODS Data continued in a randomized controlled study of 101 subjects with lactational abscess from 12 hospitals were included. They were randomly divided into an experimental group and a control group. After needle aspiration treatment, the experimental group was orally administrated with L fermentum CECT5716 for 4 consecutive weeks, while the control group was treated with maltodextrin in the same way). In the third month after randomized controlled trial, the subjects were followed up by an online questionnaire investigation. The observation indexes included the relief of breast pain, recurrence of mastitis from the end of oral administration to the follow-up, and the effect on continuing breastfeeding. RESULTS A total of 101 patients were enrolled and 83 valid questionnaires were received during follow-up, including 40 in the experimental group and 43 in the control group. The rate of stop breastfeeding due to recurrence of mastitis was 2.5% (1/40) in the experimental group and 18.6% (8/43) in the control group, with a statistically significant difference (odds ratio = 0.112, 95% confidence interval: 0.013-0.942, P < .05). The rate of stop breastfeeding was 10% (4/40) in the experimental group and 25.6% (11/43) in the control group, without significant difference. The pain relief rate in the experimental group was 80% (32/40), which showed no significant difference from that in the control group, that is, 72.1% (31/43). The recurrence rate of mastitis in the experimental group was 20% (8/40), which was not significantly different from that in the control group, that is, 16.3% (7/43). CONCLUSIONS In lactating women with a history of breast abscess, oral L fermentum CECT5716 may reduce the risk of stop breastfeeding due to recurrence of mastitis.
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Affiliation(s)
- Yi Zhang
- Department of Breast Surgery, Maternal and Child, Center for Prevention and Cure of Breast Diseases, Haidian Maternal and Child Health Hospital, Haidian District, Beijing, China
| | - Yajun Gao
- Department of Breast Surgery, Maternal and Child, Center for Prevention and Cure of Breast Diseases, Haidian Maternal and Child Health Hospital, Haidian District, Beijing, China
- *Correspondence: Yajun Gao, MBBS, Department of Breast Surgery, Maternal and Child, Center for Prevention and Cure of Breast Diseases, Haidian Maternal and Child Health Hospital, Haidian District, Beijing 100080, China (e-mail: )
| | - Xiangping He
- Department of Breast Surgery, Maternal and Child, Center for Prevention and Cure of Breast Diseases, Haidian Maternal and Child Health Hospital, Haidian District, Beijing, China
| | - Songtao Ding
- Department of Breast Surgery, Maternal and Child, Center for Prevention and Cure of Breast Diseases, Haidian Maternal and Child Health Hospital, Haidian District, Beijing, China
| | - Haifeng Gao
- Department of Breast Surgery, Maternal and Child, Center for Prevention and Cure of Breast Diseases, Haidian Maternal and Child Health Hospital, Haidian District, Beijing, China
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Abstract
Lactation and breastfeeding are core components of reproductive health care and obstetrical providers should be familiar with common complications that may arise in lactating individuals. While many breastfeeding challenges are best addressed by a lactation consultant, there are conditions that fall out of their scope and require care from a clinician. The objective of this chapter is to review common complications of breastfeeding and lactation including inflammatory conditions, disorders of lactogenesis, dermatologic conditions, and persistent pain with lactation.
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22
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Anderson LA, Kildea S, Lee N, Kynoch K, Gao Y. A Comparison of the Timing of Hand Expressing of Human Milk With Breast Massage to Standard Care for Mothers of Preterm Infants: An Exploratory Pilot Using a Randomized Controlled Design. J Hum Lact 2022; 39:226-235. [PMID: 35543459 DOI: 10.1177/08903344221088789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Globally, 10% of all births are preterm. Access to human milk via manual breast expression is required to reduce the incidence of adverse outcomes related to prematurity. However, there is little evidence to recommend optimum timing to commence breast expression in mothers of preterm infants or the most effective method. RESEARCH AIMS (1) To test feasibility of recruitment and compliance to the protocol and (2) to determine influence of using hand expressing and breast massage on milk production, engorgement, mastitis, and breastfeeding status at 3 months. METHODS This study was an exploratory parallel two-group, pilot randomized controlled trial. Mothers of preterm infants at a metropolitan maternity hospital in Queensland Australia (N = 31) were randomized to receive either hand expressing and breast massage within the 1st hr of birth or standard care, hand expressing within 6 hr of birth, to determine the influence on milk production, engorgement, mastitis, and breastfeeding status at 3 months. RESULTS Feasibility targets were not met; however, valuable learning from this trial uncovered barriers facing midwives in the birth suite to commencing expressing in the 1st hr of birth. There was no difference in occurrence of secondary outcomes, although trends support future study. CONCLUSIONS Overall, unpredictability of preterm birth influenced our ability to recruit participants. Important directions for future study design would benefit from incorporating expressing times up to 6 hr with a replicable breast massage.
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Affiliation(s)
- Loretta A Anderson
- School of Nursing Midwifery and Social Work, University of Queensland, St Lucia, QLD, Australia
| | - Sue Kildea
- Molly Wardaguga Research Centre, College of Nursing and Midwifery, Charles Darwin University, Casuarina, NT, Australia.,Mater Research, School of Nursing Midwifery and Social Work, University of Queensland, South Brisbane, QLD, Australia
| | - Nigel Lee
- School of Nursing Midwifery and Social Work, University of Queensland, St Lucia, QLD, Australia
| | - Kathryn Kynoch
- Mater Health and QLD Centre for Evidence Based Nursing and Midwifery: A JBI Centre of Excellence, South Brisbane, QLD, Australia.,Australian Centre for Health Services Innovation (AusHSI) and School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Yu Gao
- Molly Wardaguga Research Centre, College of Nursing and Midwifery, Charles Darwin University, Casuarina, NT, Australia.,Mater Research, School of Nursing Midwifery and Social Work, University of Queensland, South Brisbane, QLD, Australia
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23
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Pileri P, Sartani A, Mazzocco MI, Giani S, Rimoldi S, Pietropaolo G, Pertusati A, Vella A, Bazzi L, Cetin I. Management of Breast Abscess during Breastfeeding. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5762. [PMID: 35565158 PMCID: PMC9099791 DOI: 10.3390/ijerph19095762] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/05/2022] [Accepted: 05/07/2022] [Indexed: 02/01/2023]
Abstract
(1) Background: Breast abscess (BA) is a condition leading in the majority of cases to breastfeeding interruption. Abscesses are commonly treated with antibiotics, needle aspiration or incision and drainage (I&D), but there is still no consensus on the optimal treatment. Since there are no well-defined clinical guidelines for abscess management, we conducted a retrospective, observational study with the aim of assessing ultrasound (US)-guided management of BA without surgery, regardless of the BA size. The secondary objective was the microbiologic characterization and, in particular, the S. aureus methicillin resistance identification. (2) Methods: our population included 64 breastfeeding mothers with diagnosis of BA. For every patient, data about maternal, perinatal and breastfeeding features were collected. All patients underwent office US scans and 40 out of 64 required a more detailed breast diagnostic ultrasound performed by a radiologist. In all cases, samples of milk or abscess material were microbiologically tested. All patients received oral antibiotic treatment. We performed needle aspiration, when feasible, even on abscesses greater than 5 cm. (3) Results: most of the women developed BA during the first 100 days (68.8% during the first 60 days) after delivery and 13 needed hospitalization. Four abscesses were bilateral and 16 had a US major diameter greater than 5 cm. All patients were treated with antibiotic therapy according to our clinical protocol and 71.9% (46/64) underwent fine needle aspiration. None of them required I&D. The average duration of breastfeeding was 5 months (IR 2; 9.5) and 40.6% of women with BA continued to breastfeed for more than 6 months. Only 21 mothers interrupted breastfeeding before 3 months. (4) Conclusions: our observational data suggest, regardless of the size and the clinical features of the BA, a conservative approach with antibiotic therapy targeted at the Methicillin-Resistant Staphilococcus aureus (MRSA) identified and needle aspiration, if feasible. In our experience, treatment with needle aspiration is a cost- effective method. Unlike drainage, it is an outpatient procedure, easily repeatable, with no cosmetic damage. In addition, it has lower risk of recurrences since, differently from surgical incision, it does not cause interruption of the ducts. Moreover, needle aspiration is less painful, does not require the separation of the mother-child dyad and allows for a quicker, if not immediate, return to breastfeeding.
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Affiliation(s)
- Paola Pileri
- Department of Woman, Child and Neonate, Buzzi Children Hospital, ASST Fatebenefratelli Sacco, Via L. Castelvetro 32, 20154 Milan, Italy; (M.I.M.); (I.C.)
- Departmental Breast Unit, ASST Fatebenefratelli Sacco, University of Milan, Via G.B. Grassi 74, 20157 Milan, Italy;
| | - Alessandra Sartani
- Department of Biomedical and Clinical Sciences, University of Milan, Via G.B. Grassi 74, 20157 Milan, Italy; (A.S.); (G.P.); (A.P.)
| | - Martina Ilaria Mazzocco
- Department of Woman, Child and Neonate, Buzzi Children Hospital, ASST Fatebenefratelli Sacco, Via L. Castelvetro 32, 20154 Milan, Italy; (M.I.M.); (I.C.)
| | - Sofia Giani
- Departmental Breast Unit, ASST Fatebenefratelli Sacco, University of Milan, Via G.B. Grassi 74, 20157 Milan, Italy;
| | - Sara Rimoldi
- Laboratory of Clinical Microbiology, Virology and Diagnostics of Bioemergencies, ASST Fatebenefratelli Sacco, University of Milan, Via G.B. Grassi 74, 20157 Milan, Italy;
| | - Gaia Pietropaolo
- Department of Biomedical and Clinical Sciences, University of Milan, Via G.B. Grassi 74, 20157 Milan, Italy; (A.S.); (G.P.); (A.P.)
| | - Anna Pertusati
- Department of Biomedical and Clinical Sciences, University of Milan, Via G.B. Grassi 74, 20157 Milan, Italy; (A.S.); (G.P.); (A.P.)
| | - Adriana Vella
- Department of Radiology, “Luigi Sacco” University Hospital, Via G.B. Grassi 74, 20157 Milan, Italy; (A.V.); (L.B.)
| | - Luca Bazzi
- Department of Radiology, “Luigi Sacco” University Hospital, Via G.B. Grassi 74, 20157 Milan, Italy; (A.V.); (L.B.)
| | - Irene Cetin
- Department of Woman, Child and Neonate, Buzzi Children Hospital, ASST Fatebenefratelli Sacco, Via L. Castelvetro 32, 20154 Milan, Italy; (M.I.M.); (I.C.)
- Departmental Breast Unit, ASST Fatebenefratelli Sacco, University of Milan, Via G.B. Grassi 74, 20157 Milan, Italy;
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24
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General Use of Chinese Herbal Products among Female Patients with Mastitis in Taiwan. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:3876240. [PMID: 35368771 PMCID: PMC8975662 DOI: 10.1155/2022/3876240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 02/22/2022] [Indexed: 11/30/2022]
Abstract
Objectives Little information is available regarding the use of Chinese herbal medicine to treat mastitis. This study evaluated the prescription patterns of Chinese herbal medicine products in women with mastitis in Taiwan. Design This is a population-based cross-sectional study. Setting. 8,531 women aged 20–49 years, who received a diagnosis of mastitis between 2004 and 2013, were identified from the Longitudinal Health Insurance Database in Taiwan. We collected data on demographic characteristics, including age, monthly insurance premium, and urbanization level. The ten most Chinese herbal medicines prescribed for mastitis were assessed, including frequency, percentage, average daily dose, and average duration of prescription. Main outcome measures. We analysed the ten most single Chinese herbs and Chinese herbal formulae prescribed for mastitis. Results Overall, 437 (5.1%) women received Chinese herbal medicine to treat mastitis. Mai Men Dong (Ophiopogon japonicus (Thunb.) Ker Gawl.; 22.3%), Pu Gong Yin (Taraxacum mongolicum Hand.-Mazz.; 7.8%), and Wang Bu Liu Xing (Vaccaria hispanica (Mill.) Rauschert; 3.5%) were three of the most commonly prescribed single Chinese herbs for mastitis. Xian-Fang-Huo-Ming-Yin (18.2%), Jia-Wei-Xiao-Yao-San (9.1%), and Chai-Hu-Shu-Gan-San (8.4%) were three of the most commonly prescribed Chinese herbal formulae. Conclusion Xian-Fang-Huo-Ming-Yin can clear heat, detoxify body, alleviate swelling, activate blood, and relieve pain. It was the most frequently prescribed Chinese herbal formula in patients with mastitis.
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25
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Grzeskowiak LE, Saha MR, Ingman WV, Nordeng H, Ystrom E, Amir LH. Incidence, antibiotic treatment and outcomes of lactational mastitis: Findings from The Norwegian Mother, Father and Child Cohort Study (MoBa). Paediatr Perinat Epidemiol 2022; 36:254-263. [PMID: 34841537 DOI: 10.1111/ppe.12824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Mastitis is a common and distressing maternal postpartum condition, but the relationship between mastitis timing and antibiotic treatment and breastfeeding outcomes and postnatal mental health is unclear. OBJECTIVES To describe the incidence of mastitis and treatment with antibiotics in first 6 months postpartum, and to investigate the impact of mastitis timing and antibiotic treatment on breastfeeding practices and postnatal mental health. METHODS This study is based on 79,985 mother-infant dyads in the Norwegian Mother, Father and Child Cohort Study (MoBa). Women were classified according to self-reported mastitis within first month ('early') or 1-6 months ('later') postpartum and antibiotic treatment. Breastfeeding outcomes included predominant or any breastfeeding and abrupt breastfeeding cessation until 6 months postpartum. Maternal mental health was assessed by self-report at 6 months postpartum. RESULTS The incidence of mastitis was 18.8%, with 36.8% reporting treatment with antibiotics. Women reporting early mastitis were less likely to report predominant breastfeeding (adjustedd relative risk [aRR] 0.92, 95% confidence interval [CI] 0.86, 0.99) and any breastfeeding for 6 months (aRR 0.97, 95% CI 0.96, 0.98) than women who did not report mastitis, and more likely to report abrupt breastfeeding cessation (aRR 1.37, 95% CI 1.23, 1.53). Late-onset mastitis was not associated with poorer breastfeeding outcomes. Among women reporting mastitis, the risk of abrupt breastfeeding cessation was higher in those also reporting antibiotic use. Mastitis was associated with an increased risk of mental health problems postpartum which was highest among those reporting no antibiotic use (aRR 1.29, 95% CI 1.18, 1.41), in contrast to those also reporting antibiotic use (aRR 1.08, 95% CI 0.96, 1.22). CONCLUSIONS Lactational mastitis and its associated treatment with antibiotics are common. Early (<1 month postpartum) mastitis appears to be a modest risk factor for suboptimal breastfeeding outcomes. In addition, mastitis is associated with poorer mental health.
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Affiliation(s)
- Luke E Grzeskowiak
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.,South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - Moni R Saha
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Wendy V Ingman
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia.,Discipline of Surgery, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Hedvig Nordeng
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, and PharmaTox Strategic Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway.,Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
| | - Eivind Ystrom
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, and PharmaTox Strategic Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway.,Department Mental Disorders, the Norwegian Institute of Public Health, Oslo, Norway.,PROMENTA Research Center, Department of Psychology, University of Oslo, Oslo, Norway
| | - Lisa H Amir
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia.,Breastfeeding Service, Royal Women's Hospital, Parkville, Victoria, Australia
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26
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Sugawara C, Yamana H, Sasagawa E, Yonezawa K, Hikita N, Morita K, Matsui H, Yasunaga H, Haruna M. Factors Associated with Surgical Treatment in Postpartum Women with Mastitis or Breast Abscess: A Retrospective Cohort Study. Breastfeed Med 2022; 17:233-238. [PMID: 34936486 DOI: 10.1089/bfm.2021.0244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective: The aim of this study was to identify factors associated with requiring surgical treatment for mastitis or breast abscess in postpartum mothers. Materials and Methods: This was a retrospective cohort study using the Japan Medical Data Center Claims Database. Information on pairs of infants born between April 2012 and December 2016 and their mothers were extracted. Data regarding the baseline characteristics, medical history, medical practice, and prescription drugs of mothers and their infants were collected. Multivariable logistic regression analysis was used to examine factors associated with undergoing surgical treatment. Results: The data of 69,363 eligible mothers were analyzed. The proportion of mothers who were diagnosed with mastitis or breast abscess within 1 year after childbirth was 10.8% (7,516/69,363). There were 114 mothers who underwent surgical treatment within 1 year after childbirth. This was 0.2% of all mothers and 1.5% of those diagnosed with mastitis or breast abscess. Surgical treatment was significantly associated with mothers having their first child (adjusted odds ratio [AOR], 2.58; 95% confidence interval [CI], 1.63-4.07) compared to those with a second or later child; it was also significantly associated with the diagnosis of breast abscess (AOR, 10.38; 95% CI, 5.28-20.40). Conclusions: This was the first report of the prevalence of mastitis or breast abscess and the requirement for surgical treatment among postpartum mothers in Japan. A first diagnosis of breast abscess and having a first child were associated with requiring surgical treatment. Health care professionals providing postpartum care should be aware of these factors.
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Affiliation(s)
- Chihiro Sugawara
- Division of Health Sciences and Nursing, Department of Midwifery and Women's Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hayato Yamana
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Emi Sasagawa
- Division of Health Sciences and Nursing, Department of Midwifery and Women's Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kaori Yonezawa
- Division of Health Sciences and Nursing, Department of Midwifery and Women's Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Naoko Hikita
- Division of Health Sciences and Nursing, Department of Midwifery and Women's Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kojiro Morita
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Megumi Haruna
- Division of Health Sciences and Nursing, Department of Midwifery and Women's Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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27
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Challenges in the Management of Breast Conditions During Lactation. Obstet Gynecol Clin North Am 2022; 49:35-55. [DOI: 10.1016/j.ogc.2021.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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28
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Cullinane M, Scofield L, Murray GL, Payne MS, Bennett CM, Garland SM, Amir LH. Random amplified polymorphic DNA analysis reveals no clear link between Staphylococcus epidermidis and acute mastitis. Aust N Z J Obstet Gynaecol 2022; 62:605-609. [PMID: 35229883 PMCID: PMC9543939 DOI: 10.1111/ajo.13503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Mastitis is commonly experienced by breastfeeding women. While Staphylococcus aureus is usually implicated in infectious mastitis, coagulase‐negative staphylococci (CoNS) are a possible alternative pathogen. This case‐control study examined the role of CoNS in mastitis using isolates cultured from breast milk of 20 women with mastitis and 16 women without mastitis. Gene sequencing determined bacterial species, and random amplified polymorphic DNA (RAPD) analysis investigated strain‐level variation. The majority of CoNS isolates were Staphylococcus epidermidis (182/199; 91%). RAPD analysis identified 33 unique S. epidermidis profiles, with no specific profile associated with mastitis cases.
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Affiliation(s)
- Meabh Cullinane
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, 3086, Australia
| | - Lauren Scofield
- Royal Women's Hospital, Melbourne, Victoria, 3052, Australia
| | - Gerald L Murray
- Royal Women's Hospital, Melbourne, Victoria, 3052, Australia.,University of Melbourne Department of Obstetrics and Gynaecology, The Royal Women's Hospital, Melbourne, Victoria, 3052, Australia.,Molecular Microbiology Group, Murdoch Children's Research Institute, Melbourne, Victoria, 3052, Australia
| | - Matthew S Payne
- Division of Obstetrics and Gynaecology, University of Western Australia, Perth, Western Australia, 6009, Australia
| | - Catherine M Bennett
- Institute of Health Transformation, Deakin University, Melbourne, Victoria, 3125, Australia
| | - Suzanne M Garland
- Royal Women's Hospital, Melbourne, Victoria, 3052, Australia.,University of Melbourne Department of Obstetrics and Gynaecology, The Royal Women's Hospital, Melbourne, Victoria, 3052, Australia
| | - Lisa H Amir
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, 3086, Australia.,Royal Women's Hospital, Melbourne, Victoria, 3052, Australia.,University of Melbourne Department of Obstetrics and Gynaecology, The Royal Women's Hospital, Melbourne, Victoria, 3052, Australia
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29
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Muresan M, Chiorean A. Unconventional Treatment of Breast Abscess: Case Report. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2022; 3:194-197. [PMID: 35262056 PMCID: PMC8896217 DOI: 10.1089/whr.2021.0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/14/2022] [Indexed: 06/14/2023]
Abstract
We describe the case of two lactating mothers with breast abscesses who refused invasive interventions. In the first case, a mother developed a 10 mm abscess and refused needle aspiration. Under ultrasonography (US) follow-up she was treated with antibiotics until the abscess disappeared on the US scan, while fully breastfeeding. In the second case, a woman with a large abscess refused invasive interventions. We followed the recommendations in case of breast Adenitis, first to nurse the baby from the affected breast and then squeezing regularly the lump to drain the pus. In this study, we demonstrate that this procedure is also beneficial in the case of breast abscesses. Under antibiotic treatment, the abscess was completely resolved on the US scan after 23 days. In conclusion, when invasive intervention is refused in the case of breast abscess, successful treatment can be applied by using effective breast drainage, US follow-up, and aggressive antibiotic therapy.
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Affiliation(s)
- Marta Muresan
- Promama Center Association, Lactation Institute, and Breastfeeding Center, Cluj-Napoca, Romania
| | - Angelica Chiorean
- University of Medicine and Pharmacy “Iuliu Hateganu,” Cluj-Napoca, Romania
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30
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Haifeng G, Yi Z, Ying C, Xin L, Yan L, Songtao D, Yajun G, Xiangping H, Si C, Xingxing L. Exploring the Efficacy of Comprehensive Management of Breast Abscesses in Restoring Milk Volume. J Hum Lact 2022; 38:171-176. [PMID: 33818190 DOI: 10.1177/08903344211005400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Approximately 54.8% of patients with breast abscesses discontinue breastfeeding due to the lack of adequate breastfeeding support. RESEARCH AIMS We aimed to (1) examine the difference in milk volume produced by healthy breasts and breasts with abscesses; and (2) to explore the changes in milk volume before and after comprehensive management. METHOD A prospective, consecutive series study was designed. Lactating patients (N = 50) with breast abscesses were selected from March 2017 to November 2018. The volume and frequency of milk expression of the affected and the unaffected breast were recorded every 24 hr before and after comprehensive management. The difference in the milk volume produced by healthy breasts (control) and breasts with abscesses, as well as the milk volume produced by each breast before and after comprehensive management, was determined. RESULTS There was a significant difference in the milk volume produced by healthy breasts and breasts with abscess before (t = 3.016; p = .004) and after (t = 4.336; p < .001) comprehensive management. The frequency of milk expression was significantly higher after comprehensive management than before it (z = -6.145; p < .001); the milk volume produced by each side significantly increased after comprehensive management (healthy breasts: t = -4.789; p < .001; breasts with abscess: t = 2.555; p = .014). CONCLUSION The total milk volume produced by breasts with abscesses can be less than that produced by healthy breasts. The management of abscesses by increasing the frequency of milk expression and degree of emptying can help mothers increase their milk volume.
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Affiliation(s)
- Gao Haifeng
- 71531 Center for Prevention and Treatment of Breast Diseases, Haidian District Maternal and Child Health Hospital, Beijing, China
| | - Zhang Yi
- 71531 Center for Prevention and Treatment of Breast Diseases, Haidian District Maternal and Child Health Hospital, Beijing, China
| | - Chen Ying
- 71531 Center for Prevention and Treatment of Breast Diseases, Haidian District Maternal and Child Health Hospital, Beijing, China
| | - Li Xin
- 71531 Center for Prevention and Treatment of Breast Diseases, Haidian District Maternal and Child Health Hospital, Beijing, China
| | - Li Yan
- 71531 Center for Prevention and Treatment of Breast Diseases, Haidian District Maternal and Child Health Hospital, Beijing, China
| | - Ding Songtao
- 71531 Center for Prevention and Treatment of Breast Diseases, Haidian District Maternal and Child Health Hospital, Beijing, China
| | - Gao Yajun
- 71531 Center for Prevention and Treatment of Breast Diseases, Haidian District Maternal and Child Health Hospital, Beijing, China
| | - He Xiangping
- 71531 Center for Prevention and Treatment of Breast Diseases, Haidian District Maternal and Child Health Hospital, Beijing, China
| | - Chen Si
- 71531 Center for Prevention and Treatment of Breast Diseases, Haidian District Maternal and Child Health Hospital, Beijing, China
| | - Liu Xingxing
- 71531 Center for Prevention and Treatment of Breast Diseases, Haidian District Maternal and Child Health Hospital, Beijing, China
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31
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Mitoulas LR, Davanzo R. Breast Pumps and Mastitis in Breastfeeding Women: Clarifying the Relationship. Front Pediatr 2022; 10:856353. [PMID: 35757121 PMCID: PMC9226559 DOI: 10.3389/fped.2022.856353] [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: 01/17/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
Mastitis is a debilitating condition that can impact around 20% of mothers and is characterized by fever, flu-like symptoms and tender, swollen areas of the breasts. Despite the emerging evidence that breast milk dysbiosis is an underlying cause of mastitis, breast pumps have been implicated as a predisposing risk factor in the pathophysiology of mastitis in breastfeeding mothers. Previous studies have suggested that the use of a breast pump increases a mother's risk for developing mastitis, however, incidence rates of mastitis over the stages of lactation do not match breast pump usage rates. Furthermore, breast pumps, even when used at low vacuum, still promote some breast drainage, thus avoiding milk stasis, which is considered a key factor in the development of mastitis. As a consequence, these data suggest that the literature association of breast pumps with mastitis is more a case of reverse causation and not direct association. Moreover, it is important to note that breast pumps are actually a part of the conservative management of mastitis. In combination, these data show that the breast pump should not be considered a driver in the pathophysiology of mastitis in women.
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Affiliation(s)
- Leon R Mitoulas
- School of Molecular Sciences, The University of Western Australia, Perth, WA, Australia.,Medela AG, Baar, Switzerland
| | - Riccardo Davanzo
- Institute for Maternal and Child Health Institute, IRCCS "Burlo Garofolo", Trieste, Italy
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Douglas P. Re-thinking benign inflammation of the lactating breast: Classification, prevention, and management. WOMEN'S HEALTH 2022; 18:17455057221091349. [PMID: 35441543 PMCID: PMC9024158 DOI: 10.1177/17455057221091349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Despite the known benefits of breastfeeding for both infant and mother, clinical support for problems such as benign inflammation of the lactating breast remain a research frontier. Breast pain associated with inflammation is a common reason for premature weaning. Multiple diagnoses are used for benign inflammatory conditions of the lactating breast which lack agreed or evidence-based aetiology, definitions, and treatment. This article is the second in a three-part series. This second review analyses the heterogeneous research literature concerning benign lactation-related breast inflammation from the perspectives of the mechanobiological model and complexity science, to re-think classification, prevention, and management of lactation-related breast inflammation. Benign lactation-related breast inflammation is a spectrum condition, either localized or generalized. Acute benign lactation-related breast inflammation includes engorgement and the commonly used but poorly defined diagnoses of blocked ducts, phlegmon, mammary candidiasis, subacute mastitis, and mastitis. End-stage (non-malignant) lactation-related breast inflammation presents as the active inflammations of abscess, fistula, and septicaemia, and the inactive condition of a galactocoele. The first preventive or management principle of breast inflammation is avoidance of excessively high intra-alveolar and intra-ductal pressures, which prevents strain and rupture of a critical mass of lactocyte tight junctions. This is achieved by frequent and flexible milk removal. The second preventive or management principle is elimination of the mechanical forces which result in high intra-alveolar pressures. This requires elimination of conflicting vectors of force upon the nipple and breast tissue during milk removal; avoidance of focussed external pressure applied to the breast, including avoidance of lump massage or vibration; and avoidance of other prolonged external pressures upon the breast. Three other key preventive or management principles are discussed. Conservative management is expected to be effective for most, once recommendations to massage or vibrate out lumps, which worsen micro-vascular trauma and inflammation, are ceased.
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Affiliation(s)
- Pamela Douglas
- School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia
- General Practice Clinical Unit, The University of Queensland, Brisbane, QLD, Australia
- The Possums Clinic, Brisbane, QLD, Australia
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Douglas P. Re-thinking benign inflammation of the lactating breast: A mechanobiological model. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455065221075907. [PMID: 35156466 PMCID: PMC8848036 DOI: 10.1177/17455065221075907] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Despite the known benefits of breastfeeding for both infant and mother, clinical support for problems such as inflammation of the lactating breast remains a research frontier. Breast pain associated with inflammation is a common reason for premature weaning. Multiple diagnoses are used for inflammatory conditions of the lactating breast, such as engorgement, blocked ducts, phlegmon, mammary candidiasis, subacute mastitis, mastitis and white spots, which lack agreed or evidence-based aetiology, definitions and treatment. This is the first in a series of three articles which review the research literature concerning benign lactation-related breast inflammation. This article investigates aetiological models. A complex systems perspective is applied to analyse heterogeneous and interdisciplinary evidence elucidating the functional anatomy and physiology of the lactating breast; the mammary immune system, including the human milk microbiome and cellular composition; the effects of mechanical forces during lactation; and the interactions between these. This analysis gives rise to a mechanobiological model of breast inflammation, in which very high intra-alveolar and intra-ductal pressures are hypothesized to strain or rupture the tight junctions between lactocytes and ductal epithelial cells, triggering inflammatory cascades and capillary dilation. Resultant elevation of stromal tension exerts pressure on lactiferous ducts, worsening intraluminal backpressure. Rising leucocyte and epithelial cell counts in the milk and alterations in the milk microbiome are signs that the mammary immune system is recruiting mechanisms to downregulate inflammatory feedback loops. From a complex systems perspective, the key mechanism for the prevention or treatment of breast inflammation is avoidance of excessively high intra-alveolar and intra-ductal pressures, which prevents a critical mass of mechanical strain and rupture of the tight junctions between lactocytes and ductal epithelial cells.
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Affiliation(s)
- Pamela Douglas
- School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia.,General Practice Clinical Unit, The University of Queensland, Brisbane, QLD, Australia.,Possums & Co., Brisbane, QLD, Australia
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Nurdin M, Yulianty R, Latief S, Prihantono, Abu J, Usman AN. Effects of Centella asiatica (L.) Urban extract in TNF-α levels. GACETA SANITARIA 2021; 35 Suppl 2:S281-S283. [PMID: 34929832 DOI: 10.1016/j.gaceta.2021.10.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 07/30/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study aimed to determine the effectiveness of Centella asiatica leaf extract to TNF-α levels. METHODS There were four treatment groups (each group consisted of five rats). Group I was given 0.5% Na CMC, group II was given Cefadroxil 45mg/kg WB, Group III C. asiatica leaf extract 100mg/kg BW, and group IV combination Cefadroxil and Centella leaf extract. Each group was given treatment twice for 12h a day for five days. RESULTS TNF-α levels between groups did not significantly affect day three and differed significantly after day 6. On day 3, the control group had a higher TNF-α level of 25.13pg/ml than the group given antibiotics and C. asiatica. While when compared to the group given only C. asiatica leaf extract, the control group was more height of 17.1pg/ml. On the 6th day, this condition was changed. The most significant difference was found in the group given C. asiatica, in which the control group had higher levels of TNF-α 72.34pg/ml than the group receiving C. asiatica. Then, the control group is higher than 66.46pg/ml than those given antibiotics and C. asiatica. CONCLUSION C. asiatica leaf extract effectively reduces TNF both given alone and given along with antibiotics. It is potential to be explored into alternative and complementary treatments in mastitis cases with human trials.
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Affiliation(s)
- Melliyana Nurdin
- Midwifery Study Program, Graduated School, Hasanuddin University, Indonesia
| | - Risfah Yulianty
- Department of Pharmaceutical Chemistry, Pharmacy Faculty, Hasanuddin University, Indonesia.
| | - Syamsa Latief
- Midwifery Study Program, Graduated School, Hasanuddin University, Indonesia
| | - Prihantono
- Department of Oncology, Medicine Faculty, Hasanuddin University, Indonesia
| | - Jasmin Abu
- Midwifery Study Program, Graduated School, Hasanuddin University, Indonesia
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35
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Scott DM. Inflammatory diseases of the breast. Best Pract Res Clin Obstet Gynaecol 2021; 83:72-87. [PMID: 34991976 DOI: 10.1016/j.bpobgyn.2021.11.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/29/2021] [Accepted: 11/30/2021] [Indexed: 11/30/2022]
Abstract
Inflammatory disorders of the breast are common benign breast conditions. Lactational mastitis occurs in breastfeeding women and may be associated with breast abscess in severe cases. Non-lactational inflammatory disorders are less common and include idiopathic granulomatous mastitis, periductal mastitis, and tuberculous mastitis. While these disorders have some similarities in their presentation, each disorder requires a specific treatment regimen for resolution, and correct diagnosis is crucial for appropriate treatment. In this chapter, we will review the presentation, diagnosis, and management of each of these distinct clinical entities.
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Affiliation(s)
- Dana Marie Scott
- Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, CT, USA.
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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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Obermeyer S, Shiehzadegan S. Case Report of the Management of Milk Blebs. J Obstet Gynecol Neonatal Nurs 2021; 51:83-88. [PMID: 34762834 DOI: 10.1016/j.jogn.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2021] [Indexed: 10/19/2022] Open
Abstract
The formation of a milk bleb during breastfeeding is frequently associated with nipple pain that may affect the breastfeeding success of the mother-infant dyad. Early cessation of breastfeeding may occur when pain is ongoing. Timely evaluation and diagnosis and effective management are imperative to prevent tissue damage and lingering symptoms. In this case report, we evaluate the unique challenges of the diagnosis and management of milk blebs, including nonpharmacologic and pharmacologic treatment.
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Li Y, Ma XJ. Risk Factors for Failure of Ultrasound-Guided Fine-Needle Aspiration Therapy for Lactational Breast Abscess. Breastfeed Med 2021; 16:894-898. [PMID: 34165329 DOI: 10.1089/bfm.2021.0060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: Ultrasound-guided fine-needle aspiration in the treatment of breast abscess has become the preferred treatment. Although fine-needle aspiration has a good therapeutic effect, there are still some patients failed who finally underwent drainage. Objective: To analyze the risk factors of ultrasound-guided fine-needle aspiration treatment failure for patients with lactational breast abscess. Materials and Methods: The clinical data of 1,472 patients with lactational breast abscess who underwent ultrasound-guided fine-needle aspiration treatment from January 2014 to March 2017 were analyzed in this retrospective study. According to the treatment results, these patients were divided into two groups: fine-needle aspiration failure group (n = 111) and fine-needle aspiration recovery group (n = 1,361). Chi-square test was used to compare the differences between the two groups in terms of postpartum time, age, location of abscess cavity, number of abscess cavities, volume of pus, frequency of aspiration, infected bacteria, treatment time, weaning, and recurrence. Multivariate logistic regression was used to analyze the risk factors of patients with failed fine-needle aspiration treatment. Results: Univariate analysis showed statistically significant differences in the location of abscess, volume of pus, treatment time, frequency of aspiration, and weaning between the two groups (p < 0.05). Multivariate analysis showed that the location of abscess, volume of pus, frequency of aspiration, and treatment time were risk factors for the failure of ultrasound-guided fine-needle aspiration treatment (p < 0.05). Conclusions: For patients with breast abscess during lactation, abscess in center area, volume of pus >50 mL, frequency of aspiration >3 times and treatment time >14 days, the failure probability of ultrasound-guided fine-needle aspiration treatment was high. Therefore, whether fine-needle aspiration is the preferred treatment for these patients needs to be considered.
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Affiliation(s)
- Yan Li
- Center for Prevention and Treatment of Breast Diseases, Haidian Maternal and Child Health Hospital, Beijing, China
| | - Xiang-Jun Ma
- Center for Prevention and Treatment of Breast Diseases, Haidian Maternal and Child Health Hospital, Beijing, China
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39
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Marshall J, Ross S, Buchanan P, Gavine A. Providing effective evidence based support for breastfeeding women in primary care. BMJ 2021; 375:e065927. [PMID: 34725097 DOI: 10.1136/bmj-2021-065927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Joyce Marshall
- Division of Maternal Health, University of Huddersfield, UK
| | - Sam Ross
- School of Medicine, Dentistry and Nursing, University of Glasgow and NHS Greater Glasgow and Clyde, UK
| | | | - Anna Gavine
- School of Health Sciences, University of Dundee, UK
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40
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Radiology–Pathology Correlation: Inflammatory Conditions of the Breast. CURRENT BREAST CANCER REPORTS 2021. [DOI: 10.1007/s12609-021-00432-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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41
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Li Y, Ma XJ, He XP. Clinical characteristics of lactational breast abscess caused by methicillin-resistant Staphylococcus aureus: hospital-based study in China. Int Breastfeed J 2021; 16:80. [PMID: 34641942 PMCID: PMC8513335 DOI: 10.1186/s13006-021-00429-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 09/29/2021] [Indexed: 11/10/2022] Open
Abstract
Background This study aimed to identify the differences in clinical characteristics, puncture efficacy, antibiotic use, treatment duration, breastfeeding post-illness, and recurrence of patients with breast abscesses caused by methicillin-resistant Staphylococcus aureus (MRSA) or methicillin-susceptible Staphylococcus aureus (MSSA) infection during lactation. Methods The clinical data of patients with breast abscesses during lactation who were treated from January 2014 to February 2017 at Haidian Maternal and Child Health Hospital, Beijing, were reviewed. According to bacterial culture results, they were divided into MRSA (n = 260) and MSSA (n = 962) groups. Hospitalization (whether or not the patients were hospitalized), postpartum period, maternal age, location of abscess cavities, number of abscess cavities, amount of pus, frequency of needle aspiration, failure of needle aspiration, antibiotic use, treatment duration, cessation of breastfeeding and recurrence were compared between the two groups using a t-test and a chi-squared test. Results We noted that only the cessation of breastfeeding was statistically significantly different between the two groups (P = 0.018). Hospitalization, postpartum period, maternal age, location of abscess cavities, number of abscess cavities, amount of pus, number of needle aspiration, failure of needle aspiration, antibiotic use, treatment duration and recurrence showed no statistically significant differences (P = 0.488, P = 0.328, P = 0.494, P = 0.218, P = 0.088, P = 0.102, P = 0.712, P = 0.336, P = 0.512, P = 0.386 and P = 0.359, respectively). Conclusions There was no difference in clinical characteristics between breast abscesses infected by MRSA and those infected by MSSA. Ultrasound-guided needle aspiration could be the first choice for MRSA-infected breast abscess treatment. There is no need to increase antibiotic use because of MRSA infection, unless it is necessary. The reason why more patients with MRSA infected breast abscesses terminated breastfeeding is unclear from this study.
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Affiliation(s)
- Yan Li
- Center for Prevention and Treatment of Breast Diseases, Haidian Maternal and Child Health Hospital, Beijing, China.
| | - Xiang-Jun Ma
- Center for Prevention and Treatment of Breast Diseases, Haidian Maternal and Child Health Hospital, Beijing, China
| | - Xiang-Ping He
- Center for Prevention and Treatment of Breast Diseases, Haidian Maternal and Child Health Hospital, Beijing, China
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Costa Morais Oliveira V, Cubas-Vega N, López Del-Tejo P, Baía-da-Silva DC, Araújo Tavares M, Picinin Safe I, Cordeiro-Santos M, Lacerda MVG, Val F. Non-lactational Infectious Mastitis in the Americas: A Systematic Review. Front Med (Lausanne) 2021; 8:672513. [PMID: 34422853 PMCID: PMC8378399 DOI: 10.3389/fmed.2021.672513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/05/2021] [Indexed: 10/29/2022] Open
Abstract
Background: Non-lactational infectious mastitis (NLIM) is an inflammatory breast disease with broad clinical presentation. Inadequate treatment can lead to chronic infections that cause breast deformities. NLIM information is limited, especially in the Americas. A systematic review and meta-analysis have been conducted here. Methods: Literature search was conducted in three databases (Lilacs, PubMed, and Scielo) on NLIM cases in the Americas. Demographic, epidemiological, clinical, radiological, and laboratory data were extracted. The main characteristics and results were also compared according to the country's gross national income. Results: A total of 47 articles were included, resulting in 93 cases. The etiological agent was described in 86 (92.5%) patients. Bacteria were the most prevalent etiology (73; 84.8%). Amongst bacterial diagnoses, more frequent cases were Mycobacterium tuberculosis (28; 38.4%); Corynebacterium spp. (15; 20.5%); non-tuberculous mycobacteria (13; 17.8%). The cases were reported in eight different countries, with the USA being the country with the highest number of cases (35; 37.6%). Patients from high-income countries group presented a shorter diagnostic time when compared to low, low-middle, and upper-middle-income countries. A greater number of radiographic studies with pathological findings were described in high-income countries. Conclusion: Non-lactational infectious mastitis is a complex public health problem with diagnostic and treatment challenges. Hence, multi-professional approach-based additional studies are recommended on its epidemiology, diagnosis, treatment, and control.
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Affiliation(s)
- Victor Costa Morais Oliveira
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Fundação Hospital Adriano Jorge, Manaus, Brazil.,Programa de Pós-graduação em Medicina Tropical, Universidade Do Estado Do Amazonas, Manaus, Brazil
| | - Nadia Cubas-Vega
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Programa de Pós-graduação em Medicina Tropical, Universidade Do Estado Do Amazonas, Manaus, Brazil
| | - Paola López Del-Tejo
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Programa de Pós-graduação em Medicina Tropical, Universidade Do Estado Do Amazonas, Manaus, Brazil
| | - Djane C Baía-da-Silva
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Programa de Pós-graduação em Medicina Tropical, Universidade Do Estado Do Amazonas, Manaus, Brazil
| | | | | | - Marcelo Cordeiro-Santos
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Programa de Pós-graduação em Medicina Tropical, Universidade Do Estado Do Amazonas, Manaus, Brazil.,Departamento de Ensino e Pesquisa, Universidade Nilton Lins, Manaus, Brazil
| | - Marcus Vinícius Guimarães Lacerda
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Programa de Pós-graduação em Medicina Tropical, Universidade Do Estado Do Amazonas, Manaus, Brazil.,Rede de Pesquisa em Malária, Instituto Leônidas and Maria Deane, Fiocruz-Amazonas, Manaus, Brazil
| | - Fernando Val
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Programa de Pós-graduação em Medicina Tropical, Universidade Do Estado Do Amazonas, Manaus, Brazil
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Case Report of Recurrent Bilateral Mastitis in a Woman Who Is Exclusively Pumping Breast Milk for an Infant in the NICU. J Obstet Gynecol Neonatal Nurs 2021; 50:765-773. [PMID: 34384768 DOI: 10.1016/j.jogn.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2021] [Indexed: 11/20/2022] Open
Abstract
In this report, we describe a case of bilateral lactational mastitis in a primigravid, Spanish-speaking woman who exclusively pumped breast milk for a hospitalized, critically ill infant in the NICU within a free-standing children's hospital. The case follows her clinical presentation, assessments, diagnostics, and therapeutic interventions during the 45-day postpartum period. This case report highlights the situational and environmental context of the woman's experiences and emphasizes potential disconnections of care. Regarding her mastitis, the maternity care providers relied on the woman to provide all relevant information without knowledge of her hospitalized infant's health status. Traditionally during the postpartum period, infants hospitalized in the NICU and their mothers are cared for by separate provider teams. Clinicians must acknowledge that when women transition from recent patients to parent visitors after birth, they will likely have ongoing medical, obstetric, and psychosocial care needs.
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44
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Affiliation(s)
- Lisa H Amir
- Breastfeeding Service, Royal Women's Hospital, Parkville, Australia
- Judith Lumley Centre, La Trobe University, Victoria, Australia
| | | | - Jayne R Charlamb
- Division of Breast Health & Breastfeeding Medicine, Department of Obstetrics & Gynecology, SUNY Upstate Medical University, Syracuse, NY, USA
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45
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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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Yao Y, Long T, Pan Y, Li Y, Wu L, Fu B, Ma H. A Five-step Systematic Therapy for Treating Plugged Ducts and Mastitis in Breastfeeding Women: A Case-Control Study. Asian Nurs Res (Korean Soc Nurs Sci) 2021; 15:197-202. [PMID: 34048977 DOI: 10.1016/j.anr.2021.04.001] [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: 10/23/2020] [Revised: 02/27/2021] [Accepted: 04/27/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE This study aimed to describe the clinical response to five-step systematic therapy (FSST) in the management of plugged ducts and mastitis. FSST was a comprehensive milk stasis dredging treatment, which contained five steps to make the milk out of the plugged duct. METHODS This retrospective study included 922 breastfeeding women, 714 with plugged ducts, and 208 with mastitis who received FSST from June to September 2017. The breast pain score, swelling degree, and range of breast induration were recorded pre-FSST and post-FSST. RESULTS After a single FSST, pain score and swelling degree were significantly improved (both p < .001) in all cases. After FSST, the mean breast pain relief score was 1.69 ± 0.70, whereas the mean swelling fade away degree was 1.61 ± 0.62. In the subgroup analysis, pain score and swelling degree were significantly improved (both p < .001) in the plugged ducts group and the mastitis group. The score of pain relief in the plugged ducts group was less than that in the mastitis group (1.63 ± 0.68 vs. 1.91 ± 0.70, t = 5.30; p < .001), whereas improvement of swelling fade away was greater in the plugged ducts group than the mastitis group (1.65 ± 0.64 vs. 1.48 ± 0.56, t = 3.49; p = .001). The composition ratio of changes in induration range between the two groups was statistically different (Pearson χ2 = 137.87, p < .001), of which more obvious improvement in the plugged ducts group than the mastitis group (χ2 = 25.65, p < .001). CONCLUSION FSST can relieve pain, reduce breast swelling and range of induration, and for plugged ducts or mastitis varied degree differently.
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Affiliation(s)
- Yuzhi Yao
- Department of Breast Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Tianzhu Long
- Department of Breast Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Yuhong Pan
- Department of Breast Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Yin Li
- Department of Breast Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Ling Wu
- Department of Breast Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Benjie Fu
- Department of Breast Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Hongmin Ma
- Department of Breast Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, China.
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Barker M, Peters MDJ, Adelson P, Steen M. Probiotics and human lactational mastitis: a scoping review protocol. JBI Evid Synth 2021; 18:1341-1348. [PMID: 32813384 DOI: 10.11124/jbisrir-d-19-00190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this scoping review is to identify and examine the evidence on probiotic consumption and its effect on human lactational mastitis. INTRODUCTION Lactational mastitis is a painful, inflammatory condition of the breast tissue commonly occurring among breastfeeding women. It can lead to decreased breastfeeding rates, which then may lead to poorer maternal and newborn outcomes. There is growing interest and research on the use of probiotics to prevent or treat this condition following promising, but equivocal, evidence from studies of probiotics in relation to animals and other human conditions. INCLUSION CRITERIA Eligible studies will include women of any age who are planning a pregnancy, pregnant, breastfeeding, or expressing post-childbirth. There will be no exclusion based on comorbidity, previous history, or current diagnosis or treatment of lactational mastitis. All probiotic species and strains and all dosages, preparations, and timing/scheduling of probiotic administration will be eligible for inclusion. All concepts regarding the use of probiotics and their effect on lactational mastitis will be included, and all types of research will be considered. METHODS This scoping review will follow JBI methodology for scoping reviews. Sources of evidence published in English from 2000 to present will be included. The search will include the Cochrane Library, Scopus, Embase, and Emcare, in addition to gray literature. A critical appraisal will be performed, and the results will be presented in the final review. A tabular and accompanying narrative summary of the information will be provided.
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Affiliation(s)
- Melissa Barker
- Rosemary Bryant AO Research Centre, School of Nursing and Midwifery, University of South Australia, Adelaide, Australia.,The Women's and Children's Hospital, Adelaide, Australia
| | - Micah D J Peters
- Rosemary Bryant AO Research Centre, School of Nursing and Midwifery, University of South Australia, Adelaide, Australia.,Adelaide Nursing School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia.,The Centre for Evidence-based Practice South Australia (CEPSA): A JBI Centre of Excellence
| | - Pam Adelson
- Rosemary Bryant AO Research Centre, School of Nursing and Midwifery, University of South Australia, Adelaide, Australia
| | - Mary Steen
- Rosemary Bryant AO Research Centre, School of Nursing and Midwifery, University of South Australia, Adelaide, Australia.,The Women's and Children's Hospital, Adelaide, Australia
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Lai BY, Yu BW, Chu AJ, Liang SB, Jia LY, Liu JP, Fan YY, Pei XH. Risk factors for lactation mastitis in China: A systematic review and meta-analysis. PLoS One 2021; 16:e0251182. [PMID: 33983987 PMCID: PMC8118550 DOI: 10.1371/journal.pone.0251182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 04/22/2021] [Indexed: 12/30/2022] Open
Abstract
Background Lactation mastitis (LM) affects approximately 3% to 33% of postpartum women and the risk factors of LM have been extensively studied. However, some results in the literature reports are still not conclusive due to the complexity of LM etiology and variation in the populations. To provide nationally representative evidence of the well-accepted risk factors for LM in China, this study was aimed to systematically summary the risk factors for LM among Chinese women and to determine the effect size of individual risk factor. Material and methods Six major Chinses and English electronic literature databases (PubMed, Web of Science, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Wan fang Database and China Science Technology Journal Database) were searched from their inception to December 5st, 2020. Two authors extracted data and assessed the quality of included trials, independently. The strength of the association was summarized using the odds ratio (OR) with 95% confidence intervals (CI). The population attributable risk (PAR) percent was calculated for significant risk factors. Results Fourteen studies involving 8032 participants were included. A total of 18 potential risk factors were eventually evaluated. Significant risk factors for LM included improper milking method (OR 6.79, 95%CI 3.45–13.34; PAR 59.14%), repeated milk stasis (OR 6.23, 95%CI 4.17–9.30; PAR 49.75%), the first six months postpartum (OR 5.11, 95%CI 2.66–9.82; PAR 65.93%), postpartum rest time less than 3 months (OR 4.71, 95%CI 3.92–5.65; PAR 56.95%), abnormal nipple or crater nipple (OR 3.94, 95%CI 2.34–6.63; PAR 42.05%), breast trauma (OR 3.07, 95%CI 2.17–4.33; PAR 15.98%), improper breastfeeding posture (OR 2.47, 95%CI 2.09–2.92; PAR 26.52%), postpartum prone sleeping position (OR 2.46, 95%CI 1.58–3.84; PAR 17.42%), little or no nipple cleaning (OR 2.05, 95%CI 1.58–2.65; PAR 24.73%), primipara (OR 1.73, 95%CI 1.25–2.41; PAR 32.62%), low education level (OR 1.63, 95%CI 1.09–2.43; PAR 23.29%), cesarean section (OR 1.51, 95%CI 1.26–1.81; PAR 18.61%), breast massage experience of non-medical staff (OR 1.51, 95%CI 1.25–1.82; PAR 15.31%) and postpartum mood disorders (OR 1.47, 95%CI 1.06–2.02; PAR 21.27%). Conclusions This review specified several important risk factors for LM in China. In particular, the incidence of LM can be reduced by controlling some of the modifiable risk factors such as improper breastfeeding posture, improper milking method, repeated milk stasis, nipple cleaning, breast massage experience of non-medical staff and postpartum sleeping posture.
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Affiliation(s)
- Bao-Yong Lai
- Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Bo-Wen Yu
- Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Ai-Jing Chu
- Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Shi-Bing Liang
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Li-Yan Jia
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Jian-Ping Liu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Ying-Yi Fan
- Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
- * E-mail: (XHP); (YYF)
| | - Xiao-Hua Pei
- Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
- The Xiamen Hospital of Beijing Universality of Chinese Medicine, Xiamen, China
- * E-mail: (XHP); (YYF)
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Comprehensive evaluation of the risk of lactational mastitis in Chinese women: combined logistic regression analysis with receiver operating characteristic curve. Biosci Rep 2021; 40:222210. [PMID: 32100818 PMCID: PMC7087359 DOI: 10.1042/bsr20190919] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 02/18/2020] [Accepted: 02/20/2020] [Indexed: 01/07/2023] Open
Abstract
Objective: To identify the potential risk factors for acute mastitis during lactation comprehensively. Subsequently, to evaluate logistic regression model in predicting the risk of lactational mastitis in Chinese women by applying receiver operating characteristic (ROC) curve. Methods: A case–control study among Chinese women enrolled 652 patients with mastitis and 581 healthy women with breastfeeding experience as control. The retrospective information was obtained by questionnaires that included medical history of pregnancy, delivery, puerperium and breastfeeding behaviors. Univariate analysis and multivariate logistic regression model were performed to investigate the relationship between these factors and the occurrence of lactational mastitis. Using ROC curve to evaluate the prognostic value of these selected indicators in the risk of acute mastitis. Results: The multivariate logistic regression analysis showed that the primiparity (P < 0.001), mastitis in previous breastfeeding (P < 0.001), nipple’s heteroplasia (P < 0.001), cracked nipple (P < 0.001), breast trauma by external force (P = 0.002), lateral position (P = 0.007), breast pump (P = 0.039), nipple sucking (P = 0.007), sleep with sucking (P = 0.007), and tongue-tie (P = 0.013) were risk variables independently and significantly related with mastitis. While vaginal delivery (P = 0.015), clean nipple before breastfeeding (P = 0.015), first contact with child within 1 h (P = 0.027) were protective factors. The ROC analysis demonstrated that the area under the curve of model 2 was 0.8122 (95%CI = 0.7885–0.8360), which stated that the model presented a high sensitivity and specificity. Conclusion: By means of collecting and summarizing the risk factors associated with the occurrence of breast mastitis in Chinese women, we established risk discriminant model to identify and warn the individuals susceptible to acute mastitis early, which will allow practitioners to provide appropriate management advice and effective individual care.
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Franco J, Morris L, Lee J, Williams JC. The Health Care Provider's Role in Securing Work Accommodations for Pregnant and Postpartum Patients. J Midwifery Womens Health 2021; 65:474-486. [PMID: 32841486 DOI: 10.1111/jmwh.13131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 03/23/2020] [Accepted: 04/08/2020] [Indexed: 11/30/2022]
Abstract
Most women today are the primary, sole, or cobreadwinners for their families; their continued ability to work during and after pregnancy is crucial for their families' well-being. Midwives and other health care providers are regularly asked to provide work notes for patients who need adjustments to how, when, or where their job is done to continue working while maintaining a healthy pregnancy or breastfeeding. Whereas an improperly written work note can result in the patient being forced out on leave or losing their job, an effectively written work note from a health care provider can ensure the patient will receive the adjustments they need to stay safe and healthy on the job. Health care providers can also play an important role by incorporating discussions about workplace issues into care conversations. This article provides an overview of pregnancy-related employment rights, guidelines for writing effective work notes, and a discussion of common workplace issues patients face and how health care providers can respond.
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Affiliation(s)
- Juliana Franco
- Center for WorkLife Law, University of California, Hastings College of the Law, San Francisco, California
| | - Liz Morris
- Center for WorkLife Law, University of California, Hastings College of the Law, San Francisco, California
| | - Jessica Lee
- Center for WorkLife Law, University of California, Hastings College of the Law, San Francisco, California
| | - Joan C Williams
- Center for WorkLife Law, University of California, Hastings College of the Law, San Francisco, California
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