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Rheumatology International Oct 2023Idiopathic Granulomatous Mastitis (IGM) is an infrequent, benign breast disease that primarily affects women during their childbearing years and can be mistaken for...
Idiopathic Granulomatous Mastitis (IGM) is an infrequent, benign breast disease that primarily affects women during their childbearing years and can be mistaken for breast cancer. This study aimed to review the clinical, radiological, and histopathological findings of patients with IGM in addition to management and outcome. Retrospective cross-sectional study of biopsy-confirmed IGM at an academic medical center and a private hospital in Amman, Jordan. Fifty-four patients were included, with a mean age of 37.0 ± 9.04 years, mostly presenting with a breast lump (n = 52, 96.3%) and breast pain (n = 45 patients, 84.9%). Approximately half of the patients (51.9%) were parous, and 50% had breastfed for an average duration of 30.37 ± 22.38 months. Most of the patients had either solitary or multiple abscesses on breast ultrasound. Histopathological analysis (n = 35) showed mostly either moderate inflammation (n = 16, 45.7%) or severe inflammation (n = 14, 40%). Two-thirds of the patients underwent surgical interventions at the time of diagnosis, mostly incision and drainage (n = 16, 29%) or surgical excision (n = 7, 13%), and no mastectomies were performed. The most common medical treatment included a combination of antibiotics, corticosteroids, and methotrexate (n = 21, 38.8%). After follow-up, 31 patients remained in remission, 3 experienced relapses, and 3 had a chronic course. The use of corticosteroids was significantly associated with remission (p = 0.035). The presentation and demographics of IGM patients in Jordan were consistent with the existing literature. Prospective research is needed to explore different treatment options and disease outcomes.
Topics: Female; Humans; Adult; Middle Aged; Granulomatous Mastitis; Retrospective Studies; Prospective Studies; Cross-Sectional Studies; Neoplasm Recurrence, Local; Adrenal Cortex Hormones; Inflammation; Immunoglobulin M
PubMed: 37347273
DOI: 10.1007/s00296-023-05375-6 -
JACC. Heart Failure Sep 2023The pathophysiology of peripartum cardiomyopathy (PPCM) and its distinctive biological features remain incompletely understood. High-throughput serum proteomic...
BACKGROUND
The pathophysiology of peripartum cardiomyopathy (PPCM) and its distinctive biological features remain incompletely understood. High-throughput serum proteomic profiling, a powerful tool to gain insights into the pathophysiology of diseases at a systems biology level, has never been used to investigate PPCM relative to nonischemic cardiomyopathy.
OBJECTIVES
The aim of this study was to characterize the pathophysiology of PPCM through serum proteomic analysis.
METHODS
Aptamer-based proteomic analysis (SomaScan 7K) was performed on serum samples from women with PPCM (n = 67), women with nonischemic nonperipartum cardiomyopathy (NPCM) (n = 31), and age-matched healthy peripartum and nonperipartum women (n = 10 each). Serum samples were obtained from the IPAC (Investigation of Pregnancy-Associated Cardiomyopathy) and IMAC2 (Intervention in Myocarditis and Acute Cardiomyopathy) studies.
RESULTS
Principal component analysis revealed unique clustering of each patient group (P for difference <0.001). Biological pathway analyses of differentially measured proteins in PPCM relative to NPCM, before and after normalization to pertinent healthy controls, highlighted specific dysregulation of inflammatory pathways in PPCM, including the upregulation of the cholesterol metabolism-related anti-inflammatory pathway liver-X receptor/retinoid-X receptor (LXR/RXR) (P < 0.01, Z-score 1.9-2.1). Cardiac recovery by 12 months in PPCM was associated with the downregulation of pro-inflammatory pathways and the upregulation of LXR/RXR, and an additional RXR-dependent pathway involved in the regulation of inflammation and metabolism, peroxisome proliferator-activated receptor α/RXRα signaling.
CONCLUSIONS
Serum proteomic profiling of PPCM relative to NPCM and healthy controls indicated that PPCM is a distinct disease entity characterized by the unique dysregulation of inflammation-related pathways and cholesterol metabolism-related anti-inflammatory pathways. These findings provide insight into the pathophysiology of PPCM and point to novel potential therapeutic targets.
Topics: Pregnancy; Humans; Female; Peripartum Period; Proteomics; Heart Failure; Cardiomyopathies; Puerperal Disorders; Pregnancy Complications, Cardiovascular; Inflammation; Cholesterol
PubMed: 37542511
DOI: 10.1016/j.jchf.2023.05.031 -
Revista Da Associacao Medica Brasileira... 2023
Topics: Female; Humans; Psychotic Disorders; Puerperal Disorders
PubMed: 37556644
DOI: 10.1590/1806-9282.2023S125 -
Preventing Chronic Disease Nov 2023Postpartum depression is a serious public health problem that can adversely impact mother-child interactions. Few studies have examined depressive symptoms in the later...
INTRODUCTION
Postpartum depression is a serious public health problem that can adversely impact mother-child interactions. Few studies have examined depressive symptoms in the later (9-10 months) postpartum period.
METHODS
We analyzed data from the 2019 Pregnancy Risk Assessment Monitoring System (PRAMS) linked with data from a telephone follow-up survey administered to PRAMS respondents 9 to 10 months postpartum in 7 states (N = 1,954). We estimated the prevalence of postpartum depressive symptoms (PDS) at 9 to 10 months overall and by sociodemographic characteristics, prior depression (before or during pregnancy), PDS at 2 to 6 months, and other mental health characteristics. We used unadjusted prevalence ratios (PRs) to examine associations between those characteristics and PDS at 9 to 10 months. We also examined prevalence and associations with PDS at both time periods.
RESULTS
Prevalence of PDS at 9 to 10 months was 7.2%. Of those with PDS at 9 to 10 months, 57.4% had not reported depressive symptoms at 2 to 6 months. Prevalence of PDS at 9 to 10 months was associated with having Medicaid insurance postpartum (PR = 2.34; P = .001), prior depression (PR = 4.03; P <.001), and current postpartum anxiety (PR = 3.58; P <.001). Prevalence of PDS at both time periods was 3.1%. Of those with PDS at both time periods, 68.5% had prior depression.
CONCLUSION
Nearly 3 in 5 women with PDS at 9 to 10 months did not report PDS at 2 to 6 months. Screening for depression throughout the first postpartum year can identify women who are not symptomatic early in the postpartum period but later develop symptoms.
Topics: Pregnancy; United States; Female; Humans; Depression; Postpartum Period; Depression, Postpartum; Risk Assessment; Prevalence
PubMed: 37943725
DOI: 10.5888/pcd20.230107 -
Journal of Midwifery & Women's Health 2024Cervical laceration (CL), although infrequent, is an often-unrecognized complication of vaginal birth and can cause significant blood loss in the immediate postpartum... (Review)
Review
Cervical laceration (CL), although infrequent, is an often-unrecognized complication of vaginal birth and can cause significant blood loss in the immediate postpartum period. The rate of clinically significant CL ranges from 0.14% to 0.2% of births. Nulliparity, operative vaginal birth, occiput posterior position of the fetus, induction of labor, and episiotomy have been cited as possible risk factors. Much of the available literature regarding CL, however, is dated or anecdotal, and there are varying and inconsistent risk associations with its occurrence. Given this unpredictability, CL should be considered in all women with immediate postpartum hemorrhage when there is difficulty obtaining hemostasis. Although midwives receive training about CLs, the low incidence may lead to delay in diagnosis and management. This Clinical Rounds case presents a composite case of postpartum hemorrhage caused by a CL. Risk factors, diagnosis and midwifery management are discussed.
Topics: Female; Humans; Pregnancy; Delivery, Obstetric; Episiotomy; Lacerations; Midwifery; Obstetric Labor Complications; Parity; Postpartum Hemorrhage; Risk Factors
PubMed: 38052748
DOI: 10.1111/jmwh.13579 -
Annals of Global Health 2023In resource-poor settings, perinatal infections contribute significantly to maternal and neonatal deaths, and the use of clean delivery kits (CDKs) has been proposed as... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
In resource-poor settings, perinatal infections contribute significantly to maternal and neonatal deaths, and the use of clean delivery kits (CDKs) has been proposed as a tool to reduce the risk of infection-related deaths. This study aims to assess the acceptability and effectiveness of CDKs in preventing infections in deliveries attended by traditional birth attendants (TBAs) in Abeokuta, Nigeria.
METHODS
The study was a cluster-randomized trial with 67 birth centres/clusters, 453 births/mothers, and 457 babies randomized to intervention or control arms; intervention involved supplementation of delivery with JANMA CDKs. Interviews were conducted at the birth homes, and the primary outcomes were neonatal infection and puerperal fever. The association between infection and perinatal risk factors was tested using the Chi-square and Fisher's exact tests.
RESULTS
CDKs were well accepted by TBAs. The incidence of puerperal fever and neonatal infection was 1.1% and 11.2%, respectively. Concurrent infection was found in 1 (0.22%) of the mother-neonate pair. There was no significant association between any of the sociodemographic factors and infection for both mothers and neonates. PROM and prolonged labour were significantly associated with puerperal infection. All mothers with puerperal fever were from the control group. Compared to the control group, the relative risk of puerperal infection and neonatal infection in the intervention group was 0.08 (0.004 -1.35, p = 0.079) and 0.64 (0.37 to 1.1, p = 0.10), respectively.
CONCLUSION
CDKs hold promising results in attenuating maternal infections in resource-poor settings. Larger studies with greater statistical power are required to establish statistically reliable information.
Topics: Female; Humans; Infant; Infant, Newborn; Pregnancy; Home Childbirth; Midwifery; Nigeria; Parturition; Puerperal Infection
PubMed: 38077261
DOI: 10.5334/aogh.4015 -
Journal of the American Academy of... Dec 2023Peek-A-Boo is a beloved game played around the world, crossing language and cultural barriers alike. In addition to reinforcing the magical principle of object...
Peek-A-Boo is a beloved game played around the world, crossing language and cultural barriers alike. In addition to reinforcing the magical principle of object permanence, Peek-A-Boo generates laughter and shared joy that is contagious. While engaging with a patient diagnosed with postpartum depression, I was delighted to witness the power of this game on full display. When her 10-month-old son grew fussy as she discussed her matrescence, the patient gave me a playful look before abruptly covering her eyes with both hands. She waited a moment, then quickly uncovered her eyes while squealing "Peek-A-Boo, I see you!" I can still hear his gasp of surprise followed by a hearty, deeply committed belly laugh that echoed in the room. Why is this game so universally loved? Is it because it promotes connection, can be used as a powerful learning tool, or perhaps because it reinforces the idea that things stick around even when you can't see them? Maybe it is all of these things swirling together at once, built on a deeper principle that feeling seen and accepted without condition feels pretty darn good. Either way, I walked away from that encounter reminded of the simple truth that laughter-especially from a spirited baby-can be the best medicine.
Topics: Female; Humans; Infant; Depression, Postpartum; Awareness; Irritable Mood; Learning
PubMed: 37652183
DOI: 10.1016/j.jaac.2023.08.002 -
Journal of Affective Disorders Dec 2023Postpartum depression (PPD), the depressive episodes following delivery, is a serious and frequent psychiatric disorder. While numerous screening tools existed for...
BACKGROUND
Postpartum depression (PPD), the depressive episodes following delivery, is a serious and frequent psychiatric disorder. While numerous screening tools existed for depressive episodes, e.g., the Edinburgh Postnatal Depression Scale (EPDS), there are no objective biological measures for predicting PPD. Despite several studies done to identify biomarkers in PPD, there has been limited exploration into cerebrospinal fluid (CSF) which directly interfaces with the brain. Consequently, novel potential biomarkers of CSF are required to predict PPD, so as to target specific preventive interventions.
METHODS
Seventy-five parturients undergoing caesarean delivery were enrolled for CSF collection at delivery. Of the twenty-eight subjects who didn't meet any exclusion criteria, the number of the healthy parturients whose score of EPDS 6-weeks postpartum (6-wpp) < 5 and PPD patients whose EPDS 6-wpp ≥ 13 was ten respectively. Gas chromatography-mass spectrometry (GC-MS) analysis of CSF was used for metabolomic assessments.
RESULTS
We found that capric acid, dodecanoic acid, arachidic acid and behenic acid in CSF were significantly negatively correlated with PPD symptoms, meanwhile L-tryptophan had an obvious positive correlation. Moreover, these five biomarkers can be used as effective predictive biomarkers for PPD.
LIMITATIONS
The main limitations are the inclusion of only parturients who underwent caesarean sections and a small sample size.
CONCLUSIONS
This study innovatively investigated potential predictive biomarkers of PPD before the onset through intrapartum maternal CSF metabolomics, which offered a more objective approach to predict and diagnose PPD, leading to help identify high-risk parturients for early initiation of secondary prevention to reduce global PPD burden.
Topics: Female; Pregnancy; Humans; Depression, Postpartum; Risk Factors; Cesarean Section; Postpartum Period; Biomarkers
PubMed: 37730149
DOI: 10.1016/j.jad.2023.09.021 -
Trials Dec 2023Postpartum haemorrhage (PPH) causes about 70,000 maternal deaths every year. Tranexamic acid (TXA) is a life-saving treatment for women with PPH. Intravenous (IV) TXA... (Randomized Controlled Trial)
Randomized Controlled Trial
Tranexamic acid by the intramuscular or intravenous route for the prevention of postpartum haemorrhage in women at increased risk: a randomised placebo-controlled trial (I'M WOMAN).
BACKGROUND
Postpartum haemorrhage (PPH) causes about 70,000 maternal deaths every year. Tranexamic acid (TXA) is a life-saving treatment for women with PPH. Intravenous (IV) TXA reduces deaths due to PPH by one-third when given within 3 h of childbirth. Because TXA is more effective when given early and PPH usually occurs soon after childbirth, giving TXA just before childbirth might prevent PPH. Although several randomised trials have examined TXA for PPH prevention, the results are inconclusive. Because PPH only affects a small proportion of births, we need good evidence on the balance of benefits and harms before using TXA to prevent PPH. TXA is usually given by slow IV injection. However, recent research shows that TXA is well tolerated and rapidly absorbed after intramuscular (IM) injection, achieving therapeutic blood levels within minutes of injection.
METHODS
The I'M WOMAN trial is an international, multicentre, three-arm, randomised, double-blind, placebo-controlled trial to assess the effects of IM and IV TXA for the prevention of PPH in women with one or more risk factors for PPH giving birth vaginally or by caesarean section.
DISCUSSION
The trial will provide evidence of the benefits and harms of TXA for PPH prevention and the effects of the IM and IV routes of administration. The IM route should be as effective as the IV route for preventing bleeding. There may be fewer side effects with IM TXA because peak blood concentrations are lower than with the IV route. IM TXA also has practical advantages as it is quicker and simpler to administer. By avoiding the need for IV line insertion and a slow IV injection, IM administration would free up overstretched midwives and doctors to focus on looking after the mother and baby and expand access to timely TXA treatment.
TRIAL REGISTRATION
ClinicalTrials.gov NCT05562609. Registered on 3 October 2022. ISRCTN Registry ISRCTN12590098. Registered on 20 January 2023. Pan African Clinical Trial Registry PACTR202305473136570. Registered on 18 May 2023.
Topics: Pregnancy; Female; Humans; Postpartum Hemorrhage; Tranexamic Acid; Cesarean Section; Delivery, Obstetric; Administration, Intravenous; Antifibrinolytic Agents
PubMed: 38044460
DOI: 10.1186/s13063-023-07687-1 -
Journal of Affective Disorders Jul 2023Clinical prediction models have been widely used to screen and diagnose postpartum depression (PPD). This study systematically reviews and evaluates the risk of bias and... (Review)
Review
OBJECTIVES
Clinical prediction models have been widely used to screen and diagnose postpartum depression (PPD). This study systematically reviews and evaluates the risk of bias and the applicability of PPD prediction models.
METHODS
A systematic search was performed in eight databases from inception to June 1, 2022. The literature was independently screened, and data were extracted by two investigators using the checklist for critical appraisal and data extraction for systematic reviews of prediction modeling studies (CHARMS). The risk of bias and applicability was assessed using the Prediction Model Risk of Bias Assessment Tool (PROBAST).
RESULTS
After the screening, 12 studies of PPD risk prediction models were included, with the area under the ROC curve of the models ranging from 0.611 to 0.937. The most-reported predictors of PPD included several aspects, including prenatal mood disorders, endocrine and hormonal influences, psychosocial aspects, the influence of family factors, and somatic illness factors. The applicability of all studies was good. However, there was some bias, mainly due to inadequate outcome events, missing data not appropriately handled, lack of model performance assessment, and overfitting of the models.
CONCLUSIONS
This systematic review and evaluation indicate that most present PPD prediction models have a high risk of bias during development and validation. Despite some models' predictive solid performance, the models' clinical practice rate is low. Therefore, future research should develop predictive models with excellent performance in all aspects and clinical applicability to better inform maternal medical decisions.
Topics: Female; Humans; Pregnancy; Depression, Postpartum; Forecasting; Prognosis; Risk Factors
PubMed: 37084958
DOI: 10.1016/j.jad.2023.04.026