Breast Cancer Surgery Experiences and Outcomes in Sex and Gender Minority Individuals: A Systematic Review

Purpose of the study: The purpose of this study was to summarize and critique contemporary research describing the experiences and outcomes of sex and gender minority (SGM) individuals with breast cancer surgery through systematic literature review. Methods: We performed a comprehensive search using keywords and subject headings to elicit studies that addressed experiences and outcomes of SGM breast cancer survivors in PubMed, Embase, CINAHL, PsycINFO, and LGBT Life. Studies were included if (1) participants were breast cancer survivors who identified as sexual and gender minority (SGM) women or transgender men; (2) one or more of the following were reported: experiences, preferences, or needs related to breast cancer care or surgical treatment decision-making, as well as interactions with healthcare providers and support persons; (3) they were published in English; and (4) they were published in the last 20 years. Covidence® was used to document the inclusion/exclusion process. Included studies were assessed using The Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research. The authors performed thematic content analysis to identify emergent themes. Results: The search yielded 115 records, and seven studies were included in the final critical appraisal. All studies were qualitative with sample sizes ranging n=10–81, and quality scores ranged 6–8 out of 10. Studies were performed in the U.S. and Canada, and included sexual and gender diverse individuals. Major themes were identified: 1) surgical decision-making, 2) experiences of the post-surgical body, 3) information and support seeking, and 4) interactions with healthcare providers. Subthemes are explored, including body image vs. function, gender policing and politicizing of the body, and intersectionality. Conclusions: SGM breast cancer survivors have unique experiences of healthcare access, decision-making, and quality of life in survivorship. Researchers and clinicians must consider SGM breast cancer survivors' personal values and preferences for treatment, as well as their support network. Culturally sensitive healthcare provider interactions are critical for reducing health disparities in cancer care access and quality of life outcomes.

Propionibacterium acnes endocarditis in a native valve complicated by intraventricular abscess: a case report and review

Propionibacterium acnes is a constituent of the normal skin flora. It has been described as causing infection on prosthetic valves but very rarely on native valves. We describe a case of aggressive P. acnes endocarditis in a healthy 36-y-old man which infected a native aortic valve and was complicated by an aortic root abscess and review the literature.

Delirium from nicotine withdrawal in neuro-ICU patients

Five cases of presumed nicotine withdrawal delirium among brain-injured patients treated in a neurologic intensive care unit are presented. Each patient had a history of heavy tobacco use and experienced dramatic and sustained clinical improvement within hours of transdermal nicotine replacement. These preliminary observations suggest that nicotine withdrawal may be an under-recognized cause of delirium in patients with acute brain injury.

Serum octadeca-9,11 dienoic acid--an assay of free radical activity or a result of bacterial production?

The diene conjugated linoleic acid isomer is currently used as an assay of free radical activity, but recent studies have cast doubt on the specificity of the assay. Therefore, 180 strains of common bacterial lung pathogens were studied to determine whether they could produce the diene conjugated isomer of linoleic acid in vitro. The various strains were grown in tissue culture fluid spiked with linoleic acid. Concentrations of the diene conjugated 18:2 [9,11] linoleic acid isomer and the parent compound, 18:2 [9,12] linoleic acid were then determined using a high performance liquid chromatography method. The percentage molar ratio of these two isomers was found to be significantly elevated in 12.8% of all bacterial strains examined. In contrast the thiobarbituric acid reactivity, a non-specific measure of lipid peroxidation, was not elevated in any of the strains incubated in an identical fashion. These results suggest that the diene conjugated linoleic assay may not be a reliable marker of the free radical processes in the lung in the presence of certain bacterial infections.

The relationship between social support and stress in adolescent mothers

This study addressed the questions of whether younger and older adolescent mothers differ in type and amount of stress and social support and whether social support can reduce stress in this population. Research achieves were examined to identify mothers 18 years old and younger who attended a special well-baby clinic during a 1-year period when the Barth questionnaire, a measure of perceived stress, was being collected. There were 62 who had completed at least two or more questionnaires that included a measure of attitude toward the pregnancy, attitudes toward childrearing, attitudes toward the infant, and assessment of social support completed in early infancy. Of these, 47 also completed the Barth questionnaire and 48 had a measure of life event stress in the first year. Compared with senior (age 17 and 18) adolescent mothers, junior mothers (younger than age 17) had significantly more negative attitudes toward the pregnancy (p < .007), less current perceived stress after the baby was born (p < .02), and more social support (p < .002). Path analysis indicated that those who were more anxious during pregnancy got more support even after partialing out the effects of maternal age; but after birth, social support was associated with less stress. Hostile childrearing attitudes contributed to increased stress with a pattern suggesting that those with more hostile attitudes engaged in behavior that contributed directly to making their lives more stressful as well as less effective in obtaining the support they needed.

Prosthetic hip-joint infection associated with a penicillin-tolerant group B streptococcus

We report a case of prosthetic hip-joint infection with Streptococcus agalactiae (Lancefield group B streptococcus). The infection recurred after 3 months' treatment with amoxycillin. On further investigation, the isolate was found to be amoxycillin-tolerant. Addition of gentamicin abolished tolerance in vitro and the patient has remained asymptomatic since receiving a 10-day course of amoxycillin and gentamicin followed by amoxycillin alone.

The pharmacokinetics of cefuroxime axetil in the sick elderly patient

The pharmacokinetics of cefuroxime axetil (RS3 formulation) were studied in 20 elderly patients following admission for lower respiratory or urinary tract infection. The mean age was 83.9 years. A 12-hourly dose of 250 mg was given for five days. The mean time to attain maximum serum concentration was 3.2 h with a mean peak concentration of 8.5 mg/l. The mean serum elimination half-life was 3.5 h and the AUC0-infinity 60.4 mg/h.l. There was no accumulation of the drug in the patients studied after five days treatment. The data suggest that the standard dosage regimen is adequate in the sick elderly patient.

Octadeca-9,11-dienoic acid in cervical intraepithelial neoplasia: a colposcopic study

488 women were studied to evaluate the use of the molar ratio (%MR) of octadeca-9,11-dienoic acid (18:2(9, 11] to linoleic acid (18:2(9, 12] as a new screening method for cervical cancer and pre-cancer. A combination of Papanicolaou cytology, colposcopy and %MR 18:2(9, 11)/18:2(9, 12) were employed. 86 women (17.6%) were found to have histologically proven cervical intraepithelial neoplasia (CIN). The %MR was obtained in 452 cases (92%). There was no significant difference in %MR in cervical cell scrapes from women with or without CIN. The %MR of cervical scrapes in some women with anaerobic vaginosis was significantly elevated suggesting bacterial generation of 18:2(9, 11). The %MR of 18:2(9, 11)/18:2(9, 12) is unsuitable for the diagnosis of cervical intraepithelial neoplasia.