Breastfeeding practices and lactation mastitis

Clinical impression suggests that lactation mastitis is associated with inexperienced nursers, improper nursing techniques, stress and fatigue. A pilot study was conducted to describe the frequency of self-reported breastfeeding practices during the first week post partum among 100 breastfeeding women delivering at a freestanding birthing center or participating in an early discharge program. Nine cases of lactation mastitis were identified from the survey population and an additional 8 from the target population for the survey. Seventeen controls matched by delivery date were identified from survey participants. The frequency of self-reported breastfeeding practices, the presence of fatigue and stress during the week prior to the mastitis date in the case was compared among cases and controls. In the first week post partum, most women fed their babies every 2-3 hr for approx. 20 min a feeding. The cradle or Madonna position was the most frequently used nursing position. Nine percent reported supplementing feedings with formula. Women with mastitis were more likely than controls to report a history of mastitis with a previous child. In the week prior to the mastitis date of the case, women with mastitis were more likely than controls to report breast or nipple pain and cracks or breast fissures. They were less likely to report being able to take a daytime nap. Future studies should focus on the relative importance of and interrelationships among these factors.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/31759/1/0000700.pd

Short-Term PTH(1-34) Therapy in Children to Correct Severe Hypocalcemia and Hyperphosphatemia due to Hypoparathyroidism: Two Case Studies

The standard treatment of hypoparathyroidism is to control hypocalcemia using calcitriol and calcium supplementation. However, in severe cases this approach is insufficient, and the risks of intravenous (i.v.) calcium administration and prolonged hospitalization must be considered. While the use of recombinant human parathyroid hormone 1-34 [rhPTH(1-34)] for long-term control of hypocalcemia has been established, the benefits of short-term rhPTH(1-34) treatment in children have not been explored. We report two patients with hypoparathyroidism treated with rhPTH(1-34). Patient 1 is a 10-year-old female with polyglandular autoimmune syndrome type 1. Patient 2 is a 12-year-old female with hypoparathyroidism after total thyroidectomy. Both patients showed poor response to i.v. and oral calcium and calcitriol, and patient 1 did not respond to phosphate binders. Patient 1 had rapid increase in serum calcium with a decrease in serum phosphate after a 3-day course of subcutaneous rhPTH(1-34). Patient 2 had normalization of calcium and phosphate levels after a 7-day course of rhPTH(1-34). These cases support a role for rhPTH(1-34) in the acute management of hypoparathyroidism in hospitalized patients to more rapidly correct hypocalcemia and hyperphosphatemia, shorten hospitalization, and reduce the need for frequent i.v. calcium boluses

Formative Evaluation and Adaptation of a Navajo Cancer Survivor Physical Activity Intervention to Serve a Broader Native American Cancer Survivor Community

Background: Although exercise has been shown to improve cancer survivorship in other communities, cancer exercise studies among Native American communities are rare. We sought to adapt a Navajo-tailored cancer exercise pilot program to serve a broader Native American cancer community. Methods: Tribal experts representing 10 different Tribal Nations were engaged in small focus groups (n=2–4) to assess program materials for cultural appropriateness and adaptation to expand tribal inclusiveness. Facilitated by a trained Native American interviewer, focus groups were provided a primer survey and then reviewed intervention materials (protocols, incentives, logo, flyers, etc.). Consensus was reached by the research team on all program adaptations. Results: The program name, Restoring Balance, layout, graphics, and symbols were considered culturally appropriate overall. Program exercises and biomarker measurements were viewed as valuable to health improvements in the community. Important color, linguistic, and logistic program modifications were recommended to improve cultural alignment. The order of incentive items was revised to highlight restoration and the logo rotated to align with the four corners of the earth, an important cultural element. Linguistic modifications primarily related to prior traumatic research experiences in Native American communities where data had been taken without adequate community benefit or permission. Program emphasis should be on nurturing, added value and giving. Conclusion and Relevance: The methodology used for cultural expert review was successful in eliciting adaptations to expand the tribal inclusiveness of Restoring Balance. Culture, as well as historically traumatic research experiences, among Native American populations must be considered when adapting health promotion programming.Immediate accessThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Randomized, placebo controlled phase I trial of safety, pharmacokinetics, pharmacodynamics and acceptability of tenofovir and tenofovir plus levonorgestrel vaginal rings in women.

To prevent the global health burdens of human immunodeficiency virus [HIV] and unintended/mistimed pregnancies, we developed an intravaginal ring [IVR] that delivers tenofovir [TFV] at ~10mg/day alone or with levonorgestrel [LNG] at ~20μg/day for 90 days. We present safety, pharmacokinetics, pharmacodynamics, acceptability and drug release data in healthy women. CONRAD A13-128 was a randomized, placebo controlled phase I study. We screened 86 women; 51 were randomized to TFV, TFV/LNG or placebo IVR [2:2:1] and 50 completed all visits, using the IVR for approximately 15 days. We assessed safety by adverse events, colposcopy, vaginal microbiota, epithelial integrity, mucosal histology and immune cell numbers and phenotype, cervicovaginal [CV] cytokines and antimicrobial proteins and changes in systemic laboratory measurements, and LNG and TFV pharmacokinetics in multiple compartments. TFV pharmacodynamic activity was measured by evaluating CV fluid [CVF] and tissue for antiviral activity using in vitro models. LNG pharmacodynamic assessments were timed based on peak urinary luteinizing hormone levels. All IVRs were safe with no significant colposcopic, mucosal, immune and microbiota changes and were acceptable. Among TFV containing IVR users, median and mean CV aspirate TFV concentrations remained above 100,000 ng/mL 4 hours post IVR insertion and mean TFV-diphosphate [DP] concentrations in vaginal tissue remained above 1,000 fmol/mg even 3 days post IVR removal. CVF of women using TFV-containing IVRs completely inhibited [94-100%] HIV infection in vitro. TFV/LNG IVR users had mean serum LNG concentrations exceeding 300 pg/mL within 1 hour, remaining high throughout IVR use. All LNG IVR users had a cervical mucus Insler score <10 and the majority [95%] were anovulatory or had abnormal cervical mucus sperm penetration. Estimated in vivo TFV and LNG release rates were within expected ranges. All IVRs were safe with the active ones delivering sustained high concentrations of TFV locally. LNG caused changes in cervical mucus, sperm penetration, and ovulation compatible with contraceptive efficacy. The TFV and TFV/LNG rings are ready for expanded 90 day clinical testing. Trial registration ClinicalTrials.gov #NCT02235662

Non-invasive detection of severe neutropenia in chemotherapy patients by optical imaging of nailfold microcirculation

White-blood-cell (WBC) assessment is employed for innumerable clinical procedures as one indicator of immune status. Currently, WBC determinations are obtained by clinical laboratory analysis of whole blood samples. Both the extraction of blood and its analysis limit the accessibility and frequency of the measurement. In this study, we demonstrate the feasibility of a non-invasive device to perform point-of-care WBC analysis without the need for blood draws, focusing on a chemotherapy setting where patients’ neutrophils—the most common type of WBC—become very low. In particular, we built a portable optical prototype, and used it to collect 22 microcirculatory-video datasets from 11 chemotherapy patients. Based on these videos, we identified moving optical absorption gaps in the flow of red cells, using them as proxies to WBC movement through nailfold capillaries. We then showed that counting these gaps allows discriminating cases of severe neutropenia (1,500 neutrophils per µL). This result suggests that the integration of optical imaging, consumer electronics, and data analysis can make non-invasive screening for severe neutropenia accessible to patients. More generally, this work provides a first step towards a long-term objective of non-invasive WBC counting

Solution structure of a membrane-anchored ubiquitin-fold (MUB) protein from Homo sapiens

The protein Bc059385, whose solution structure is reported here, is the human representative of a recently identified family of membrane-anchored ubiquitin-fold (MUB) proteins. Analysis of their similarity to ubiquitin indicates that homologous amino acid residues in MUBs form a hydrophobic surface very similar to the recognition patch surrounding Ile-44 in ubiquitin. This suggests that MUBs may interact with proteins containing an α-helical motif similar to those of some ubiquitin binding domains. A disordered loop common to MUBs may also provide a second protein interaction site. From the available data, it is probable that this protein is prenylated and associated with the membrane. With <20% identity to ubiquitin, the MUB family further expands the sequence space that maps to the β-grasp fold, and adds membrane localization to its list of functional roles

Randomized, placebo controlled phase I trial of safety, pharmacokinetics, pharmacodynamics and acceptability of tenofovir and tenofovir plus levonorgestrel vaginal rings in women - Fig 2

<p><b>(A) TFV in CV aspirate</b>. Blue Bars: TFV IVR, Red Bars: TFV/LNG IVR, Visit 4, pooled across sampling times of 1, 2, 4 and 8 hours post insertion [n = 18 for each IVR group], Visit 5: 24 hours post insertion [n = 20 for TFV and n = 19 for TFVLNG IVRs], Visit 6: LH surge or Menstrual Cycle day 17 [n = 20 for each IVR group], Visit 7: Prior to IVR Removal [n = 19 for each IVR group], Visit 8: 24 hours post removal [n = 15 for TFV and n = 20 for TFVLNG IVRs]. Reference line indicates 1,000 ng/mL, aspirate level associated with 75% reduction in HIV acquisition in CAPRISA 004 study subset [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0199778#pone.0199778.ref041" target="_blank">41</a>, <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0199778#pone.0199778.ref042" target="_blank">42</a>] <b>(B) TFV [ng/mg] in vaginal tissue</b>. Blue Bars: TFV IVR, Red Bars: TFV/LNG IVR, Proximal indicates biopsy was obtained close to the IVR, in the posterior vaginal fornix, Distal indicates biopsy was obtained farther from the IVR, in the lower 1/3 of the vagina closer to the introitus. Visit 5: 24 hours post insertion [for proximal biopsies n = 15 for TFV and n = 16 for TFVLNG IVR. For distal biopsies, n = 19 for TFV and n = 20 for TFVLNG IVR]. Visit 7: Prior to IVR Removal [for proximal biopsies n = 15 for TFV and n = 17 for TFVLNG IVR] and [for distal biopsies, n = 19 for TFV and n = 20 for TFVLNG IVR]. Visit 8: 24 hours post removal [n = 9 for TFV and n = 8 for TFVLNG IVR], Visit 9 72 hours post removal [n = 5 for TFV and n = 9 for TFVLNG IVR]. Dashed line indicates TFV level [10 ng/mg] associated with high TFV-DP concentrations of approximately 1,000 fmol/mg [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0199778#pone.0199778.ref024" target="_blank">24</a>, <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0199778#pone.0199778.ref041" target="_blank">41</a>, <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0199778#pone.0199778.ref042" target="_blank">42</a>]. <b>(C) TFV-DP [fmol/mg] in vaginal tissue</b>. Blue Bars: TFV IVR, Red Bars: TFV/LNG IVR. Proximal indicates biopsy was obtained close to the IVR, in the posterior vaginal fornix. Distal indicates biopsy was obtained farther from the IVR, in the lower 1/3 of the vagina closer to the introitus. Visit 5: 24 hours post insertion [for proximal biopsies, n = 14 for TFV and n = 16 for TFVLNG IVR. For distal biopsies, [n = 19 for TFV and n = 20 for TFVLNG IVR], Visit 7: Prior to IVR Removal [for proximal biopsies, n = 14 for TFV and n = 17 for TFVLNG IVR]. For distal biopsies, n = 19 for both IVRs], Visit 8: 24 hours post removal [n = 8 for TFV and n = 7 for TFVLNG IVR], Visit 9 72 hours post removal [n = 5 for TFV and n = 9 for TFVLNG IVR]. Dashed line indicates levels found to be protective against SHIV transmission in non-human primates [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0199778#pone.0199778.ref043" target="_blank">43</a>, <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0199778#pone.0199778.ref044" target="_blank">44</a>] <b>(D) TFV in CV fluid [ng/mg] obtained from lower genital tract swabs</b>. Blue Bars: TFV IVR, Red Bars: TFV/LNG IVR, Visit 4: 1–8 hours post IVR insertion vaginal swab taken near IVR [n = 20 combined observations for TFV IVR and TFVLNG IVR], Visit 5: 24 hours post insertion taken near IVR [n = 20 for both IVRs], ectocervix [n = 20 for both IVRs] and introitus [n = 20 for both IVRs], Visit 7: Prior to IVR removal, taken near IVR [n = 20 for both IVRs], ectocervix [n = 20 for both IVRs] and introitus [n = 20 for TFV and n = 18 for TFV/LNG IVR], Visit 8: 24 hours post removal [n = 19 for TFV and n = 20 for TFVLNG IVR]. Cx = Ectocervix, Int = Introitus, IVR = vaginal near IVR.</p

Accuracy of Patient-reported Adherence to Glaucoma Medications on a Visual Analog Scale Compared With Electronic Monitors

Glaucoma medications can reduce intraocular pressure and improve clinical outcomes when patients adhere to their medication regimen. Providers often ask glaucoma patients to self-report their adherence, but the accuracy of this self-report method has received little scientific attention. Our purpose was to compare a self-report medication adherence measure with adherence data collected from Medication Event Monitoring Systems (MEMS) electronic monitors. Additionally, we sought to identify which patient characteristics were associated with over-reporting adherence on the self-reported measure